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Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 人民日报评楼市:房子是壳,什么是核? (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}

巴曙松:房地产业有望明年触底 一线城市别担心

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.

Suspecting that the water had been mixed with something harmful, Tang reported the incident to the class monitor and teachers.
4. Rihanna
The Olympic games are a time when the countries of the world should put aside their differences to engage in sport. Whether that actually happens, however, is debatable. While the athletes are surely capable of focusing on the competition, it can be hard for long-standing disagreements to be forgotten -- even temporarily -- by their home countries.
China has fully complied with UN resolutions on the denuclearization of the Korean Peninsula, and is a staunch supporter of upholding the international nuclear non-proliferation regime.
进入前五强的还有桑德拉·布洛克(Sandra Bullock),是我们榜单中仅有的两位女演员之一(另一位是排名第十的詹妮弗·劳伦斯)。布洛克出演了两部电影题材迥异的热门影片:《地心引力》(Gravity)是一部紧张刺激的惊险片,有望使她再次获得奥斯卡提名;而《辣手警花》(The Heat)则是一部票房成绩不俗的喜剧片,全球票房收入达2.3亿美元。
Having longer does not seem to make it easier, however. Proper time management is essential in order to maintain the momentum. “A couple of obligatory projects would help keep the pace and avoid a very intense last quarter,” commented one graduate from Warwick Business School. Overall, the graduates from the class of 2012 took slightly longer than 2.5 years to graduate.

May the joy of New Year be with you throughout the year.
All told, Ujiri parted with Terrence Ross, Jared Sullinger, and a total of three picks to acquire the two veterans.


  • 厨电成精装修房屋软肋
  • 周边环境:斯托宁顿位于康涅狄格州东南部的小纳拉甘西特湾(Little Narragansett Bay),从哈特福特(Hartford)和罗德岛的普罗维登斯(Providence, R.I.)开车约1小时可达,从纽约市开车约3小时。这里曾是一个具有悠久历史的繁忙港口,至今仍然保留着一支商业捕鱼船队,有几个分布着殖民式和联邦式建筑的历史区,以及一个繁荣的航海社区。在该镇的一端有个小型的公共海滩,而在另一端罗德岛的沃奇·希尔(Watch Hill)则有个大得多的海滩,开车大约20分钟可到。这栋希腊复兴式房屋带有此类建筑必不可少的爱奥尼亚柱和山形墙上的扇骨半圆窗,房屋就坐落在市镇中心。

Will businesses finally shed their caution?
9. Investors brains are so distracted, in denial, they won't get out in time.
朱克斯提醒,我们目前正处于第四次超级大泡沫之中,它是美联储在保守经济学兴起以来的30年时间里吹起来的。他将这个泡沫称为“暂时没有名字的泡沫”(Bubble With No Name Yet)。好,大家来给这个新泡沫命名吧。但不管你叫它什么,都要快点起名,因为它马上就要爆了,就像过去30年相继破灭的亚洲泡沫、互联网泡沫和信贷泡沫一样。

房价上涨等致二手房纠纷增多 从三方面规避纠纷


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