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前八月全国300城土地收入2.2万亿

Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 中央深改委:赋予雄安新区更大改革自主权 (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.

democratic
国家卫生健康委员会补充称,其中81.8%的新病例是同性恋行为造成的,这是由于学生“尽管对疾病有很高的认识,但对保护的意识不强”。
2013年排名:2
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Due to the rapid growth of the online gaming sector, NetEase founder Ding Lei doubled his wealth to 96 billion yuan, surpassing Baidu Inc Chairman Robin Li and ranking third in the IT rich list.
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John Hummel, chief investment officer for AIS Group, a fund manager with $400 million under management, said all the new sources of global oil are expensive to extract, and he sees U.S. shale output falling by 2015.
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Footnotes

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  • 3. Will Guo Jingjing, China's diving queen, get married in 2010?

"If reform implemented 30 years ago solved the problem of ideology, then, at present, reform is to solve the problem of interests. Reform at present is actually like cutting our own with a knife, and we all need to be determined and must strengthen our confidence." WANG YANG, NPC deputy and member of the Political Bureau of the Communist Party of China Central Committee
安娜来自一个黑帮家庭,她的发型有时搭配大墨镜或阿玛尼大翻领军装式风衣,既能点明她的社会阶层,又有严肃的威慑力。
Callabro,喜欢唱歌剧的男孩组合在经过不懈努力之后成功成为了本年度的英国达人秀冠军,最具天赋的歌唱组合。
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1.Provide strong leadership and a clear vision
This is the second year running that Peking University has reached the height of No. 2 university.

地板厚度与环保性

References

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