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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 楼市新政落地首付提高 买房人诉解约获得支持 (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

“十三五”新发展理念来袭:瓷砖行业还在玩“墨守成规”吗?

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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David said: ‘It was wonderful, you couldn’t fault it. It was perfection.’
She said: 'Bobbi's like a little Beyonce, a little madam really.'
美联储上个月公布了今年放缓购债步伐的时间表。美联储计划在每一次政策会议上将购债规模减少100亿美元,直到今年年底不再进行购债。自从2012年末以来,美联储每个月都买入850亿美元美国国债和住房抵押贷款支持证券。
Maria Rios
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《固定电话》

Andy Murray's US Open victory and Olympic gold medal helped him to become the most searched-for British Olympian.
n. 代理人,代用品,替身,继母
经理们在公司会管理等级制度上低于他们的人,但是优秀的经理也有方法管理他们的上级和代表团队的同事。很多时候这意味着有效的交流,管理期望和及时寻求帮助。
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A Datafolha polling group survey published in the Folha de S. Paulo newspaper showed that at Saturday's Brazil versus Chile match, 67 percent of attendees classified themselves as white and 90 percent came from Brazil's top two economic classes, which represent about 15 percent of the country's population.

Footnotes

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  • Of the other teams, Germany have a fantastic team, with some great options all over the pitch. The Italians can never be discounted at tournaments, whilst Portugal, with Ronaldo in the team will be dangerous, and Belgium, with such an array of talent will be amongst everyone's list of dark horses.

Professor Kaufmann and a colleague, Gareth Harris, found that white Britons who lived in areas that are rapidly diversifying became more likely to vote for the right-wing British National Party. Daniel Hopkins, a professor of political science at the University of Pennsylvania, found a similar pattern of ethnic change leading to anti-immigrant politics in the United States.
John Williams's classic score still raises goosebumps over 40 years after this summer blockbuster hit theaters. Jaws preys on our primal fear of the unknown in deep waters, showing a small beach town ravaged by a series of attacks from a single killer shark. In recent years, environmentalists have stressed the generally nonthreatening nature of sharks, which kill an average of just eight swimmers each year.
17. Most Complex Hurdle As of Dec. 7, seven out of 20 domestic top-grossing movies released this year had female-driven stories, according to the website Box Office Mojo. By contrast, five out of 20 female-driven stories topped the international market, which accounts for some 70 percent of the industry’s revenue. This may look bad, but the numbers appear marginally better than they have in recent years.
Shapley made early theoretical inroads into the subject, using game theory to analyze different matching methods in the 1950s and 1960s. Together with US economist David Gale, he developed a mathematical formula for how 10 men and 10 women could be coupled in a way so that no one would benefit from trading partners. While that may have had little impact on marriages and divorces, the algorithm they developed has been used to better understand many different markets.
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从周日起,各地的观众都在叹息该剧剧终,至少从Twitter名人的帖子来看是这样的。

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References

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