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上证中证将于9月17日推出智能家居指数

Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 立邦绿建·无忧之旅纵贯十六城 助推中国建筑保温隔热行业标准化 (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

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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.

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Robin Wigglesworth
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The president lashed out at the UN on Sunday for voicing human rights concerns over his war on drugs, saying the Philippines might leave the organisation and form a new body with China and African nations.
Summly and Yahoo refused to comment on the deal’s terms.
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Footnotes

  • 央视解读财政部部长提房地产税:论证必须慎之又慎
  • So, before the world gets the better of you and slaps a title on your forehead, create a unique manifesto of what you think you are.

根据两位了解相关计划的人士的说法,中国政府正在禁止中国旅游团体赴韩国旅游,这是对韩国拟部署美制萨德(Thaad)反导系统的最新报复手段。
Baoneng’s raid has been bitterly resisted by Wang Shi, Vanke’s founder who has sought out white knights in a so far successful effort to retain control of the management-led company. The takeover battle fuelled a surge both in the price of Vanke’s Shenzhen-traded shares and Mr Yao’s known worth.
We will continue to pursue a proactive fiscal policy and a prudent monetary policy.
中国科学技术协会书记处书记王春法对撤稿事件表示深切关注,事件发生几天前,他刚在北京与施普林格自然集团大中华地区总裁安诺杰会面沟通。
单词flimsy 联想记忆:
It is already illegal for employers to discriminate on the basis of race, color, sex, nationality, religion, age, or disability. But a majority of states still don't provide protection to LGBT individuals in the workplace. Apple (AAPL, Fortune 500) CEO Tim Cook wants to put an end to this discrepancy. In a November Wall Street Journal op-ed entitled "Workplace Equality Is Good for Business," Cook urged the passing of a federal law to protect workers from discrimination based on sexual orientation.

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References

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