Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 戴德梁行调低下半年香港楼价走势至平稳 (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.
The quickest growth in executive pay on average came from the hotel and catering sectors, at 47.58%.
TOGETHERNESS (HBO, Jan. 11) HBO’s Sunday night comedy block already covers early-20-something New York women (“Girls,” beginning its fourth season the same night) and late-20-something San Francisco gay men (“Looking,” beginning its second). Now it adds 30-something Los Angeles straight people in this sometimes bleakly comic half-hour from Jay and Mark Duplass, the brothers behind quirky films like “The Puffy Chair” and “Baghead.” Mark Duplass and Melanie Lynskey play a married couple sharing a house with his best friend (Steve Zissis) and her sister (Amanda Peet).
2. 大卫·维勒莱斯(David Virelles)，《姆波克》(Mbókò)，ECM。才华横溢的年轻钢琴手大卫·维勒莱斯继续着对非洲-古巴文化与仪式的深入研究，带着有条不紊的酷意与精神上的开放性。罗曼·迪亚兹(Román Díaz)担任打击乐手，这张迷人的组曲有着既古典又现代的深刻内涵。
‘Jeopardy!’ This game show celebrated the 50th anniversary of its debut (broadcast on March 30, 1964), and proved it can still not only stump viewers but also surprise them. That’s not just because the host, Alex Trebek, briefly regrew a mustache after 13 clean-shaven years, but also because some contestants showed they could still rile an audience. This year, it was Arthur Chu, who introduced a blitzkrieg style of gamesmanship that provoked a cyber hate-fest. His strategy was thrilling and certainly effective: he came in second in the Tournament of Champions. (Ben Ingram, the nice guy, finished first.)
The TV version premiered on Jan 30 and starred two popular actresses, Yang Mi and Dilraba. It is about a fairy’s romance with a god in their three different lives.
Similar trends have been seen at other Cup matches, though no polls were carried out previously.
Jack Ma, founder and executive chairman of e-commerce giant Alibaba Group topped the ranking of China's richest IT people for the third consecutive year.
Some 150,000 rural residents in southwest China's Tibet Autonomous Region escaped poverty last year, according to the Tibet Poverty Alleviation Office.
The report shows that social media, and especially WeChat, has become more and more popular in the past year among people over the age of 40.
Last year he told an interviewer that 'among others' he would be giving his riches to Choupette.
Sweden, one of the most generous countries in terms of contributing funds to humanitarian aid, ranks No. 6 overall. The country is No. 2 in Citizenship and No. 1 in Best Countries for Green Living.