Halting virus spread in households could be key to controlling new COVID-19 outbreaks

More effective measures to prevent infection spreading within households are a vital part of preventing a second wave of COVID-19, say researchers.

In an article published in The BMJ, experts at the University of Birmingham’s Institute of Applied Health Research and Warwick Medical School argue that robust strategies are needed to prevent in-household transmission, particularly within large, multi-generational households. This should now be a core part of government strategy for controlling the spread of the virus.

Dr Shamil Haroon, of the University of Birmingham’s Institute for Applied Health Research, says: “Recent outbreaks of the virus in English towns such as Oldham predominantly involve communities with large, multigenerational households. Within household infection is thought to be responsible for around 70 per cent of SARS-CoV-2 transmission. Until an effective vaccine is available, strategies to prevent household transmission need to be prioritised.”

Measures recommended by the team include:

•            Effective isolation of the family member first showing symptoms of the virus

•            Wearing of facemasks within quarantined households, ideally as soon as infection is suspected or confirmed

•            A renewed emphasis on personal hygiene, including cleaning and disinfecting shared toilets, door handles and other common spaces

•            Staggering meal times in households where infection is suspected or confirmed.

The team also recommends the use of special isolation facilities for those who are unable to successfully self-isolate. This could be in field hospitals, or in hotels and hostels – an approach already adopted by several European countries. Effectiveness would depend on reliable and rapid testing measures being implemented. This would enable speedy identification of cases where isolation would be an appropriate intervention.

Co-author, Professor K K Cheng said: “The epidemic in Wuhan was only brought under complete control when “Fangcang” field hospitals were introduced to centrally isolate cases. In the UK, it should be possible, for example, to repurpose the Nightingale Hospitals to support isolation of infected individuals with mild-to-moderate symptoms.

“Public trust and confidence that isolation in these facilities is voluntary, safe and supportive is critical. We believe this approach should be evaluated as a matter of urgency. It is high time that the UK government amend its mantra of ‘test and trace’ to ‘test, trace, isolate and support’.”

Co-author Dr Joht Singh Chandan, from Warwick Medical School at the University of Warwick and the University of Birmingham added: “Household quarantine is likely to remain an important pandemic control measure and we already know that transmission is more likely to occur indoors than outdoors. Encouraging interventions like the wearing of face coverings within quarantined households would be a simple step that could help to protect the most vulnerable individuals within multi-generational households.”