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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 个税"减负"或影响中小城市楼市 迎来新一轮需求热潮 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181

Read our latest coverage of the coronavirus outbreak

  1. Shamil Haroon, clinical lecturer in primary care1,
  2. Joht Singh Chandan, academic clinical fellow in public health12,
  3. John Middleton, president3,
  4. Kar Keung Cheng, professor of public health and primary care1
  1. 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2Warwick Medical School, University of Warwick, Coventry, UK
  3. 3Association of Schools of Public Health in the European Region (ASPHER)
  1. Correspondence to: S Haroon s.haroon{at}bham.ac.uk

洛阳市民用半生积蓄买的房竟是凶宅 状告卖家

The UK is one of the countries most severely affected by covid-19. Recent outbreaks in English towns such as Oldham, probably involving transmission within large multigenerational households, show the importance of getting the right public health measures in place now to prevent more widespread surges in infections.1

Current test and trace policies have mainly focused on preventing spread in care homes, hospitals, and in the community.2 However, contact within households is thought to be responsible for roughly 70% of SARS-CoV-2 transmission when widespread community control measures are in place.3 In Wuhan, the reproduction number (R) dropped from 3.54 to 1.18 after lockdown and cordon sanitaire. But the epidemic was only brought under complete control when Fangcang (field) hospitals were introduced to isolate cases outside the home, with R dropping to 0.51 after two weeks.4

Current UK guidance advises household contacts to isolate within the same home as the index case for 14 days.5 They make up the majority of contacts for infected individuals and are likely to remain exposed to the infected household member during this period of isolation.6 Despite guidance advising household members to socially distance, contacts are likely to interact repeatedly—during mealtimes, for example—and to share facilities such as bathrooms.

We know that transmission is more likely to occur indoors than outdoors.7 The cumulative risk to household contacts from an infected person is likely to be substantial during peak viral shedding. In one study in New York State, 38% of household contacts tested positive for SARS-Cov-2, and similar secondary infection rates have been reported in China.89 Transmission may be even higher among household contacts of essential workers, who are at greater risk of being infected than the general population.10

Household members who are older, have underlying medical conditions, or share a bed or vehicle with the index case are the most susceptible.91112 Children seem to be at lower risk of being infected.13 However, their stool samples and nasopharyngeal swabs can remain positive for SARS-CoV-2 for more than two weeks after symptom resolution,14 although their role in transmission remains to be established.

Governments should consider new public health measures to prevent household transmission as we prepare for a potential second wave. Household quarantine is likely to remain an important pandemic control measure, and government support for people quarantined at home is conspicuously absent in the UK: this position has been challenged by independent experts.15

Effective isolation

Effective isolation of index cases from household members could reduce secondary infections.12 Wearing masks within quarantined households may help, particularly if used by the index case as soon as infection is suspected.16 The World Health Organization recommends that infected people and unavoidable close contacts, particularly those in vulnerable groups, should wear medical masks, but Public Health England does not currently recommend this. Other measures that should be considered (and evaluated) include clear advice on enhanced personal hygiene; cleaning and disinfecting shared toilets and other common spaces, door handles, and touch points; and staggering mealtimes.

People who are unable to self-isolate safely at home could be accommodated in special isolation facilities such as hotels and hostels, an approach adopted by some other countries, including Italy, Finland, and Lithuania.17 In China, field hospitals were created to manage and strictly isolate patients with mild-to-moderate covid-19.18 Nightingale hospitals in the UK could be similarly repurposed to support isolation of infected people with mild-to-moderate disease. As medical and nursing care needs are mostly modest, the cost would be relatively low. However, such a system depends on access to rapid testing for anyone with symptoms or possible exposure so that infection can be confirmed and isolation started before transmission occurs. It would also require public trust that isolation in these facilities would be voluntary, safe, and supportive.

乔布斯靠在一台“麦金托什”个人电脑上在股东大会谈笑风生,1984年1月,旧金山,库比蒂诺
这项发明是伟大的,但也是愚蠢的。”这个开瓶器号称是“世界上第一个智能开瓶器”,但它不是突破性的。这个开瓶器能在你开酒瓶的时候通过短信发消息通知你的好友,这很疯狂,对吗?
3. oDesk&Elance
Only the US-based MIT Sloan School of Management, in fifth place, prevented French institutions from sweeping the top five positions.
Investors in emerging markets need no reminder of the importance for EM assets of the US Federal Reserve — or do they?
Hopefully the experts come up with a better plan than one that fell flat earlier this year. The country's tourism body unveiled a 'Beautiful China' logo in February to market the country overseas, but the campaign was mocked for its contrast with the many photos of China's not-so-beautiful cities shrouded in pollution.
3. Flying Horse

We will boost the development of modern agriculture.
这位备受欢迎的英国女孩莉莉·唐纳森曾担任过“Vogue”这类时尚杂志的封面女郎,她展示了自己性感迷人的夏装,身着一件白色半透明的抹胸连衣裙参加了此次活动。这位三十岁的模特穿着一件近乎透明的礼服,看上去漂亮极了。
愿你拥有新年所有美好的祝福。
Sometimes bosses suck. But if your boss sucks all the time and takes advantage of your time, it's time to find a new job.
2.Nobody here can answer any questions you have about fencing. Google it.

Footnotes

  • 无过硬的技术支撑 “超节水”马桶可能更费水
  • 那么,这对2015年的油价意味着什么呢?人们对此各执己见。然而,今后12个月的油价走势将由下列五大因素(排名不分先后)决定。

李亦表示:“贫困阻碍了网民数量的进一步增加,使得网民数量占全部人口的比例只在50%左右。”
约翰奥瑟兹(John Authers)
So too would be concluding the EU’s own (re)negotiation of its existing trade agreement with Mexico. And there is a good chance Brussels could beat Donald Trump to the finish line on a deal with Mexico.
她曾为Glitzy Girl、Sally Miller和Purple Pixies等服装公司担任模特,也为《Teen Vogue》《Cosmopolitan》《Elle》和《Seventeen》等杂志拍摄照片。
这只漂亮的伯曼猫在Ins上有超过128000名粉丝,而且它还是拉格菲尔德众多设计的灵感。
一位被录取的学生告诉《哈佛深红报》,这些表情包来自哈佛2021届学生的脸书私聊小组,他们在这个群组里分享一些尖酸刻薄的笑话,“被哈佛录取不代表我们就不能开玩笑”。

楼市开年步入盘整期:调控未停歇 土地市场降温

References

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