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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 履霜而坚冰至 家居业的“冬天”要来了? (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

发改委:今年市场化债转股签约总金额2437亿元

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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potential
欢迎来到英国,不过在我开始介绍之前请先接受我们的道歉。你们在入境检查时等了4个小时的噩梦本不应该是英国轻视外国人的象征。这只反映了英国在一项如此重要的赛事来临时对旅游基础建设的投入严重不足。换句话说,是英国政府怠慢了你们。别不开心,政府对我们也不咋地。
读:奔腾。奔腾的特长就是永远有一颗奔腾的芯。

如果你很卖命的工作并且给公司创造了价值,你本应该得到酬谢。如果你的老板在两年之内没有给你涨薪水,去申请吧。如果老板不同意,还考虑什么,走吧。
Explaining how he adjusted the novel, he said: 'I think the answer is that in the book I remain true to every one of Bond's things.
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11月份,由于大中城市实施了一波限购措施,中国全国城市新建住宅价格加速上涨的趋势失去了更多动力,尽管价格同比涨幅仍轻松维持在两位数的水平。

Footnotes

  • 家居电商模式路漫漫 “网购家具”消费体验参差不齐
  • No Bad Manners Awards could be complete without a mention of a Kardashian, could it?

4. 贵金属:“都在玩消失!经济周期下行”
Frustrated, he invented something that would allow him take a picture of himself: He called it the "extender stick." Since the iPhone really hadn't been invented yet, a small camera was to be attached to one end of the stick. It also had a small mirror in its front so that users could see how they would look in the photograph. He patented the "extender stick" in 1983. The product was mass produced for sale but it was a commercial failure. The quality of the pictures was low. Besides, previous research showed that the women back then were embarrassed by the idea of taking pictures of themselves. The selfie stick was then reinvented by Wayne Fromm in the year 2000, three years before Hiroshi's patent expired. Fromm called his the "quik pod." He believes he is the inventor of today's selfie sticks and has even sued several other selfie stick producers. When asked about Hiroshi's selfie sticks, he said they were "prior art."
The results are based on a survey of 15,870 people across the country in August and September.
A colourful and exhaustive biography of Alan Greenspan, the former chairman of the US Federal Reserve, is this year’s Financial Times and McKinsey Business Book of the Year.
3. 经济已经在崩溃,2014年到2016年的GDP将会更加难看
We learned about the causes and consequences of rising obesity around the world.

以人才的名义:18城限购松绑虚与实

References

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