Dr Miriam Stoppard: It's vital to control spread of Covid-19 within the family

With so much emphasis on contact tracing, quarantine and isolation, it’s easy to forget that contact ­between family members is thought to cause approximately 70% of Covid infections.

Surprising isn’t it? Then again, not so surprising when you remember lots of families are multigenerational, including old relatives who have ­underlying medical conditions and they all live together.

The recent Oldham outbreak was probably seeded by the younger ­generation and transmitted within large multigenerational households. If we don’t get the right public health measures in place there could be more surges within households introduced by young family members.

Current test-and-trace policies, imperfect though they are, have focused on preventing spread in care homes, hospitals and in the community. Households have been neglected.

Experts think contact within ­households is high even when there’s widespread community control of Covid infections. The Chinese know this. In Wuhan, the epidemic was only brought under complete control when field hospitals were introduced to isolate patients outside the home. The R value dropped to 0.51 in two weeks.

Dr Shamil Haroon and colleagues from Birmingham University point out in The BMJ the weaknesses in the current UK guidance that advises household contacts to isolate within the same home for 14 days. But that won’t stop family members from being in contact with the infected person during isolation.

Even a household recognising social distancing but sharing a bathroom and eating meals together means contacts are likely to be exposed repeatedly. Studies in New York and China confirm this. Wearing masks might help. The WHO advises that infected people and unavoidable close contacts, particularly those in vulnerable groups, should wear medical masks.

Providing accommodation for people who can’t self-isolate is surely the answer through repurposed ­Nightingale hospitals. It’s only what other countries are doing.

Italy, Finland and Lithuania are using special isolation facilities such as hotels and hostels. In China, field hospitals were created to strictly isolate patients with mild to moderate Covid-19.

It would be a low-cost strategy as medical and nursing needs are pretty standard. Even if we had a rapid test- and-trace system so that infection could be confirmed and isolation started before the infection passes on, it wouldn’t be enough.

We need to test, trace, isolate and support. Until an effective vaccine is available, plans to prevent household transmission will be vital. Government just isn’t thinking this through.

And, importantly, the public would need to trust that these isolation facilities would be voluntary, safe and supportive.