Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 浙江省消保委对家装建材进行抽检 不合格率达68.9% (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.
11. Am I dwelling on the past? It is very tempting and almost involuntary to look back on the past and obsess over something we regret or something we miss. Learn to let go and only focus on what’s happening right now, and on the choices you will make today.
On issue after issue, from Iranian sanctions to withdrawal from Afghanistan, there was little difference between his position and that of the administration, but Romney insisted he would have projected American strength more effectively.
尼古拉斯·凯奇（Nicolas Cage）向来不随大流，他曾向媒体透露，因为居住权问题，他因影片《离开拉斯维加斯》（Leaving Las Vegas）所获得的小金人“正在某辆卡车上穿越路易斯安那州”。显然，如果政府要对你查户口，问问你的小金人在何处就可以了。
"The articles were submitted with reviewer suggestions, which had real researcher names but fabricated email addresses," Peter Butler, editorial director for cell biology and biochemistry at Springer Nature, told Shanghai-based news website The Paper.
I only want you for New year!我只要你作为我的新年礼物！
Notably, the domain name for the top fake news story of the year is “abcnews.com.co.” In a November interview with The Verge, Professor Nicole A. Cooke of the University of Illinois’ School of Information Sciences cited the slight modification of familiar domains as a particularly dangerous and common tactic for fake news sites. They make the source look reputable at first glance. The man who operates abcnews.com.co told The Washington Post that he believes his websites were a key factor in the election of Donald Trump.
- 上市家居企业重心下移 行业进入中低速发展时期
World illiteracy has reduced by 50% between 1970 to today.
Madison Marriage is accounting and tax correspondent
o Tesla is a car for rich people. With an average price of $85,000, it is safe to say that few Tesla owners are buying one to save money on fuel, and the car’s range limitations mean that a Tesla is never the only car in an owner’s garage. At some point, these same people will stop viewing Tesla as the flavor of the month, its order backlog will shrink, and Tesla will have to scrap for sales like other manufacturers.
节目30 相声，郭德纲 于谦