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Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 涂料行业下一个商机:中高端产品市场 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181

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  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}

山东日照关停2家建材企业 污染治理集中攻坚效果显著

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.

Collins grew up in rural, apartheid-era South Africa in the 1970s. Her childhood inspired her to focus on empowering women living below the poverty line through grassroots efforts. The Wonderbag, which was inspired by watching her grandmother cook with cushions, uses heat retention technology to cook food for 8-12 hours without the need for additional fuel. Collins witnessed the benefits African women received from using Wonderbags, reducing the amount of time they spent collecting firewood. For every bag sold, another is donated to a household in Africa, and in the past four years, the Wonderbags have found themselves in 600,000 African homes. Collins has launched the Wonderbag in the U.S. on Amazon, and hopes to sell the products via other retailers by 2014.
Not only does its small cohort of about 50 allow the school to select highly experienced participants, it also creates a strong bond between them.
纽约前市长迈克尔·R·布隆伯格(Michael R. Bloomberg)正在为抗击气候变化花费自己私人财产的数千万美元,他在一份声明中说,“全球气温稳步上升、如今破纪录地上升的问题,不是一个未来的问题。这是一个迫在眉睫的明显危险,对经济、健康、环境和地缘政治有重大的危害。”
Some Brexiters and Republicans believe in the ideal of absolutely free markets.
We learned that animals may make choices based on aesthetics.

“Right now the fitness tracker isn’t on that list,” he says, “but the next generation of wearables has the potential to pass that critical milestone.”
n. 港口,避难所,安息所 v. 安置 ... 于港中,


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Shapley made early theoretical inroads into the subject, using game theory to analyze different matching methods in the 1950s and 1960s. Together with US economist David Gale, he developed a mathematical formula for how 10 men and 10 women could be coupled in a way so that no one would benefit from trading partners. While that may have had little impact on marriages and divorces, the algorithm they developed has been used to better understand many different markets.
7. 阿里尔·福克斯曼《型时代》
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I experienced this pessimism personally in Davos in January 2014. Several leading western intellectuals asked me whether war would break out between China and Japan. I was so confident that there would be no war in east Asia that I offered to take bets with ten-to-one odds against myself with eminent western journalists. Two took up my bets. And I will be collecting on these bets when I return to Davos in January.

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