ABSTRACT
Objective@#To investigate a cluster of coronavirus disease 2019(COVID-19)caused by latent infection in Haikou,so as to provide reference for the prevention and control of COVID-19 clusters. @*Methods@#An epidemiological investigation was conducted according to the COVID-19 Prevention and Control Program(Fourth Edition). The course of diagnosis and treatment,clinical characteristics and field investigation data were collected to analyze the transmission chain and the intergeneration between cases. @*Results @#Among 39 people involved,five confirmed cases and two asymptomatic infections were found,with an attack rate of 17.95%. The cases aged from 40 to 65 years and lived in the dormitories near the farm of Dongshan. The first case(named Case 1)closely contacted with a confirmed case of COVID-19 in Chengmai from January 28 to February 10,was isolated on February 13 and developed symptoms on February 16. The other six cases(Case 2 to Case 7)shared the water source with Case 1 from January 28 to February 13(within the incubation period of Case 1). They needed to open the power switch outside Case 1's room and the water valve in Case 1's washroom before the use of water. They might be infected by contacting the doorknob and the water valve contacted by Case 1,or by the aerosol formed after Case 1 used the washroom,then infected each other when living together. The onset of Case 2 to Case 7 was earlier than Case 1,and they had no travelling history in Hubei Province 14 days before and contacted no confirmed cases except Case 1. Therefore,Case 1 was the source of the cluster during his incubation period of COVID-19. @*Conclusion@#This was a cluster of COVID-19 due to latent transmission by living in the same area and touching the same objects indirectly,which indicated that COVID-19 was infectious in the incubation period.
ABSTRACT
The “patient-centred medical home” is a model of healthcare delivery first conceived in the United States. It seeks to bring the values and principles of family medicine back into focus in this age of subspecialisation and fragmentation of care. This model is based on the following principles: a personal physician, physician-directed medical practice, whole person orientation, coordinated and integrated care, quality and safety, enhanced access to care and appropriate payment. Locally, should this model of care be implemented, a corresponding change in care delivery and funding model is needed. However, the patient-centred medical home has been associated with positive health outcomes at the primary care level in the United States. It will be interesting to see the potential impact on our healthcare system if such a model were to be implemented in Singapore.
ABSTRACT
We report a case of streptococcal pneumonia associated haemolytic uraemic syndrome (SP-HUS) in a 4-year old child. It is a rare complication of invasive streptococcus pneumonia infection. This article touches on the how the patient's mother was unusually calm after hearing the bad news. Factors that could account for her reaction are explored. Other issues triggered by this case were questions on the pathophysiology, clinical features, treatment and prognosis of this complication. We also discussed "catch-up" vaccination for children immunised with the old 7-valent pneumococcal vaccine, early diagnosis of community acquired pneumonia, recognising antibiotic failure and SP-HUS.