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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 2016家居行业必须关注的四件大事 (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.

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In an interview with Yicai magazine last week, the chairman of China Construction Bank pointed to the rising tide of non-performing loans as the biggest problem confronting China’s banks.
标有*符号的奖项已于9月10日到11日举行的艾美奖创新艺术典礼上公布。
Consumer prices continued to rebound from an August dip, accelerating 0.2 percentage points to 2.1 per cent year on year, bang-on analysts’ median forecast.
On January the U.S. government levied a $70 million fine on Honda for failing to disclose, as required, more than 1,700 deaths and injuries in its vehicles to the National Highway Traffic Administration (NHTSA).
"In addition, universities have paid a lot of attention to cultivating innovation instead of starting up companies. This is another reason for the low desire on campus to found startups."
科学家周日表示,2013年,全球温室气体排放量增加了2.3%,达到历史新高。这个最新迹象表明,在控制全球变暖方面,国际社会的努力仍远远不够。

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v. 置于城堡中,(棋)移动王车易
n. 远景,看法,透视
John Authers
据Birinyi收集的数据,下面是今年迄今已经获得授权的5大回购。

Footnotes

  • 电商发展实体+虚拟 卫浴企业能打开新局面
  • 4.Virtual Assistant: 17.6 percent increase

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Awards: Despite early wins for VW’s Golf GTI, the Detroit-centric jurors of the North American Car and Truck award 2015 prizes to Ford’s Mustang as well as Ford’s F-150 pickup truck.
"Although it may seem counterintuitive, the best way to maximize profits over the long-term is not to make them the primary goal of the business," Mackey said in an interview earlier this year.
201001/94005.shtml
体操、蹦床、竞技体操、艺术体操、
One of the biggest trends I’m noticing in entrepreneurship right now focuses on access. Innovators are taking what was once costly, time-intensive, or otherwise beyond reach and efficiently offering it to consumers. Whether it’s learning new skills, inspiring a new interest, or tapping into formerly cost-prohibitive markets, entrepreneurs are finding new ways to bring the unique and specialized to a more mainstream market. We started to see this with collaborative consumption business models and I predict we’ll continue to see an influx of ‘access-based’ business models in the year ahead.

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References

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