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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 增强城市核心功能 聚焦关键重点领域——十一届市委四次全会侧记 (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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在本届达沃斯世界经济论坛(World Economic Forum)盛大闭幕会议上,与会者承认风险的存在,认为缺乏有效管理的新兴市场很容易受到危机冲击,但他们最终得出的结论是,前景是多年来最为光明的。
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“同为南方的儿子和疯狂的体育迷,我向你脱帽致敬,”前美国总统比尔?克林顿(Bill Clinton)发了一条推特(tweet)回应库克的文章。
当瑞秋布鲁姆听闻自己赢得喜剧类电视最佳女主角奖项时,喜极而泣。亚马逊节目《丛林中的莫扎特》也意外斩获最佳剧集奖项。
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美国有540位富豪入选,是世界上最多的国家。中国和德国则分别有251人和120人入选,分列二、三位。

[?m'fibi?s]
Whiteness means being part of the group whose appearance, traditions, religion and even food are the default norm. It’s being a person who, by unspoken rules, was long entitled as part of “us” instead of “them.”
据牛津经济研究院(Oxford Economics)估算,若剔除价格影响,中国10月进口量同比降幅为2.6%。
金发女郎乐队《花粉传播者》
位于武汉的这些楼房有12层楼高,这些建筑(被夷平是)为一个新的商业区让路,这个商业区包括一栋高707米的摩天大楼。

Footnotes

  • 南康家具产业基地跻身成为国家级工业化产业示范基地
  • n. 泄漏

总部位于广东的房地产开发企业碧桂园集团现年35岁的女继承人杨惠妍以485亿元的身家紧随其后。
自动驾驶汽车,自拍杆,无人驾驶飞机,触屏设备,电子香烟,喷射背包和许多其他看起来像现代的发明的东西,其实都是老发明。大部分的"发明者"把它们当做新发明,甚至去申请专利。但事实是,这些"发明"已经存在一段时间了。它们都有早期类似的原型,这些早期产品最终没有投入生产,或因为特定原因而限量生产。而有些"发明"得以大批量生产,却因为销售不佳而流产。
Ever since the 1994 World Cup, the average scoring has been on a steady downward slope. In 2010 it bottomed out at 2.27, the second lowest average in World Cup history (1990 averaged just 2.20).
Average years of work experience: 12 years
Mr Draghi hit back the day after the December vote, saying that there was no “limit” to what eurozone policymakers could do to return inflation to its target.
As a result, his position on the Forbes' ranking dropped 220 spots, leaving him tied with 19 others as the 544th richest person in the world.

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References

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