Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 预计2020年 国内建陶需求量不超过90亿平方米 (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.
Directing for a Mini-Series or Movie: Susanne Bier, “The Night Manager”
Those concerns are casting a heavy shadow over a two-day meeting of G20 central bank governors and finance ministers due to start tomorrow. The International Monetary Fund this week already warned that it was poised to downgrade its forecast for global growth this year, saying the leading economies needed to do more to boost growth.
Global gold production rose to 3,268.7 tonnes in 2017 from 3,263 tonnes a year earlier, according to the WGC. That was the smallest increase since 2008, when gold mined fell more than 2 per cent during the financial crisis.
Last year, only 930,000 of the 1.39 million qualified finally entered the exam halls.
"Well, I am going to have a Cabinet that looks like America," the former secretary of state replied. "And 50 percent of America is women, right?"
The implosion of a giant subprime mortgage lender in 2007?The collapse of Lehman Brothers in 2008?
"We felt very helpless that people thought that the fog and haze were caused by poor-quality oil produced by us." FU CHENGYU, member of the CPPCC National Committee and chairman of Sinopec
Dachis says: Fiat suffered through a slow global sales year in 2012. Sluggish sales were reflected in sluggish social activity as the company went in reverse on positive discussion around the web.
Historical and fictional films each have their own strengths when it comes to storytelling. Every now and then, though, movies pop up that don't quite fit into either category. The stories are wildly unrealistic, but they carry an inkling of truth between their pages. While these are some of the most interesting films out there, viewers often don't even know that what they're watching really happened. Well, wonder no more! Keep reading to learn about some of Hollywood's zanier scripts that took their inspiration from good old-fashioned real-life drama.