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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 雄安新区规划编制体系的创新实践 (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.

宝能的“突袭”遭到了万科创始人王石的强烈抵制,后者寻找“白衣骑士”出手相助,迄今为止成功地保住了对这家由管理层主导的企业的控制权。这场收购大战既推动万科在深圳股市的股价大涨,又大幅推升了姚振华的已知财富。
The world’s 100 biggest brands still command a significant premium over others and that value increased by 3 per cent to $3.4tn this year, according to the latest BrandZ rankings compiled by Millward Brown, the research agency.
艾米卡兹明(Amy Kazmin)
美国仍是最具价值品牌大国,2016年该国10强品牌的品牌价值增长10%,至1.3万亿美元。以沃达丰(Vodafone)为首的英国10强品牌的品牌价值缩水8%。以德国软件集团SAP为首的欧洲大陆10强品牌的品牌价值增长5%。最后,以腾讯(Tencent)、中国移动和阿里巴巴(Alibaba)为首的亚洲10强品牌的品牌价值达3600亿美元,仅比欧洲大陆和英国10强品牌的品牌价值总和低10%。
Lori Steele
我们一定要让企业和群众更多感受到“放管服”改革成效,着力打通“最后一公里”,坚决除烦苛之弊、施公平之策、开便利之门。
单词demographic 联想记忆:

现在达洛伊西奥还不负责管理他的收入。他坚称说,我太年轻了,还不懂如何发挥其价值。我没有房贷,我才17。对我来说100英镑就是个大数目了,这就是我对钱的大致概念。尽管他无法对Summly的售价置评,但当我逼问他未来打算如何支配的时候,他说他在考虑以后也许可以用所发之财来做一名天使投资人。在他身边,似乎没人觉得这份钱会毁掉他或者他会挥霍钱财浪费人生。戴安娜说,孩子很踏实,很有冲劲儿,他不会停止奋斗的。
图表一显示的是上世纪70年代以来新兴市场银行、汇率及债务违约危机的发生次数——对照名义联邦基金利率。克普克以此为据,试图证明高位且不断上升的利率通常在新兴市场危机爆发周期之前出现。
“有1400人出境去参加圣战,加入叙利亚和伊拉克境内的恐怖主义组织。” Valls告诉BFMTV。
toxic
“双创”是有着很强的生命力的。

Footnotes

  • “设计师+卖场”或成进口家具市场主流
  • Forbes found 1,810 billionaires this year, down from last year's record of 1,826. The aggregate net worth of the billionaires was 6.48trillion dollars, 570billion dollars less than last year.

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《余秀华:从普通农妇到著名诗人》(A Chinese Poet’s Unusual Path From Isolated Farm Life to Celebrity)
Morgan Stanley CEO James Gorman will do an about-face on the bank's 'lower risk' corporate strategy.
While the president emerged as the narrow winner on the night, the encounter, which was cordial and largely uneventful compared with the previous two debates, is unlikely to have much impact on the outcome of the election.
Shanghai is the most popular destination for new job seekers, followed by Shenzhen, Guangzhou and Beijing. Provincial capitals cities in central and western regions are also among the top choices for the new graduates.

上半年北京购房需求得到部分释放 房价总体基本平稳

References

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