Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 浙民投与佳兆业“生化”危机再起 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181
- Shamil Haroon, clinical lecturer in primary care1,
- Joht Singh Chandan, academic clinical fellow in public health12,
- John Middleton, president3,
- Kar Keung Cheng, professor of public health and primary care1
- 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- 2Warwick Medical School, University of Warwick, Coventry, UK
- 3Association of Schools of Public Health in the European Region (ASPHER)
- Correspondence to: S Haroon
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 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.
His footballing rival Lionel Messi - who the 31-year-old beat to be crowned the World Player of the Year in January - was second on the list, taking home pound 56 million in 2015/16.
当发生问题时，库克会迅速而无情地采取行动。2012年底，苹果过早推出了有缺陷的苹果地图(Apple Maps)应用之后，库克解雇了乔布斯的亲密盟友、领导开发iOS的斯科特?福斯托(Scott Forstall)，以及前Dixons首席执行官、掌管苹果零售部门不到一年的约翰?布劳伊特(John Browett)。此举传递出一条信息：库克不会容忍业绩不佳或内部政治。
Children and hobbies do not belong on a résumé. And never, ever say, "Now that my kids are in college, I'm ready to get back in the workforce."
Investigators have arrested one youth and one 18-year-old in connection to the July 9th shooting.
- 爱屋吉屋放弃低佣金模式 前景仍然不被看好
If a child on the street who has nothing, is willing to share, why are we who have everyting still so greedy? 如果一个孩子在自己一无所有的时候都能愿意分享，为什么拥有一切的大人却如此贪婪？
The truth is, to shut our door to the outside world would not help China do its own things well, so China will continue to open to the outside world, with this opening-up being a gradual process.
Social media finds you as you browse
Exports from China to Brazil of everything from cars to textiles shipped in containers fell 60 per cent in January from a year earlier while the total volume of imports via containers into Latin America’s biggest economy halved, according to Maersk Line, the world’s largest shipping company.
“Selling out!” “Pandering to the Americans!” The cries went up immediately when the official selection was announced. The list of directors crossing over to make films in English was a long one including the Italians Matteo Garrone and Paolo Sorrentino, Yorgos Lanthimos of Greece, Norway's Joachim Trier and even Guillaume Nicloux of France, a country whose cultural establishment is highly sensitive to the creeping Anglophone menace. The argument goes that Cannes is supposed to be a haven for world cinema; for English, there is Hollywood. But does it really matter? Films at Cannes in languages other than French or English play with subtitles in both languages – and that's a lot of text to deal with.