Diagnosis and Treatment of COVID-19

Time: 2020-03-31 15:23:40 This Article is Composed by www.lightfromchina.org

Clinical classification of COVID-19

Our lungs
Our lungs

Light

The clinical symptoms are mild, and no pneumonia is manifested on imaging.

Ordinary

With fever, respiratory tract and other symptoms, imaging shows pneumonia.

Heavy

Adults meet any of the following:

  1. Shortness of breath , RR≥30 times / minute;
  2. In the resting state, the oxygen saturation ≤93%;
  3. Arterial blood oxygen partial pressure (PaO2) / oxygen concentration (FiO2) ≤300mmHg (1mmHg = 0.133kPa).
  4. Lung imaging shows that the lesions progressed significantly over 50 percent within 24 to 48 hours.
Children meet any of the following:
  1. Shortness of breath (<2 months old, RR≥60 times / minute; 2 to 12 months old, RR≥50 times / minute; 1 to 5 years old, RR≥40 times / minute;> 5 years old, RR≥30 Times / minute), except for the effects of fever and crying;
  2. In the resting state, the oxygen saturation ≤92%;
  3. Assisted breathing (groaning, wing flaps, three depression sign), cyanosis, intermittent apnea;
  4. Lethargy and convulsions;
  5. Refusal of food or difficult feeding, and dehydration.

Dangerous.

One of the following:

  1. Respiratory failure and need mechanical ventilation;
  2. Shock;
  3. Be accompanied by other organ failures, and need ICU monitoring and treatment.

Heavy and critical clinical warning indicators

Adult

  1. Progressive decline in peripheral blood lymphocytes;
  2. Progressive increase in peripheral blood inflammatory factors such as IL-6 and C-reactive protein;
  3. Progressive elevation of lactic acid; intrapulmonary lesions progress rapidly in the short term.

Children

  1. Increased breathing rate;
  2. Poor mental response and drowsiness;
  3. Progressive elevation of lactic acid;
  4. Imaging shows rapid bilateral or multilobe infiltration, pleural effusion, or rapid disease progression in the short term;
  5. Infants under three months may have underlying diseases (congenital heart disease, bronchopulmonary dysplasia, respiratory malformations, abnormal hemoglobin, severe malnutrition, etc.), and have immunodeficiency or low immune system.

Proofreader: Wang Qianqian Zhang Nana
Translator:Ding JiahuaWu Chanyu
Compiler of Chinese materials:Li Sirui

References source:
https://mp.weixin.qq.com/s/hlgjws6aJPa64bduuN-J4w
http://med.china.com.cn/content/pid/163336/tid/1026

Identification of COVID-19

  1. The mild symptoms of novel coronavirus infection should be differentiated from the upper respiratory tract infection caused by other viruses.
  2. The COVID-19 is mainly distinguished from other known viral pneumonia and mycoplasma pneumoniae, such as influenza virus, adenovirus, respiratory syncytial virus. In particular, methods including rapid antigen detection and multiple PCR nucleic acid testing should be adopted for suspected cases to check common respiratory pathogens.
  3. The COVID-19 should also be differentiated from non-infectious diseases, such as vasculitis, dermatomyositis and organic pneumonia.

Treatment of COVID-19

The ward should be determined according to the conditions.

  1. The suspected and confirmed cases should be isolated and treated in the designated hospitals equipped with effective isolation and prevention status. Each suspected case shall be isolated in a single room, and the confirmed cases could be in the same ward with more than one person.
  2. Critical cases should be treated in ICU as soon as possible.

General Treatment

  1. Strengthen supportive treatment, and guarantee bed rest and sufficient heat; pay attention to water and electrolyte balance to maintain internal environment stability; closely monitor vital life signs, oxygen saturation, etc.
  2. Monitor patients’ blood count, urinalysis, CPR, biochemical indicator (liver enzyme, myocardial enzyme, renal function) coagulation function, arterial blood gas analysis, chest imaging depending on their conditions, and conduct cytokine testing if possible.
  3. Take effective oxygen therapy measures in a timely manner, including nasal catheter oxygen inhalation, mask oxygen inhalation, high-flow nasal cannula oxygen therapy(HFNC) and, if possible, hydrogen and oxygen mixture (H2/O2: 66.6%/33.3%) therapy.
  4. For antiviral therapy, try to take interferon-α, lopinavir/ritonavir, ribavirin, chloroquine phosphate, arbidol.
  5. For antibacterial drug therapy, avoid blindly or inappropriately taking antibacterial drugs, especially in combination with broad-spectrum antibiotics.

Proofreader: Wang Qianqian Zhang Nana
Translator: Chang Gengyuan He Yipu
Compiler of Chinese materials: Li Sirui

References:
https://mp.weixin.qq.com/s/hlgjws6aJPa64bduuN-J4w
http://med.china.com.cn/content/pid/163336/tid/1026

Management Advice for Delivery of COVID-19 Pregnant Women

The clinical management of COVID-19 pregnant women is not exactly the same with that of the common patients for their special pathophysiological features. They need to be treated more carefully, especially in the delivery period when there is the possibility of respiratory virus exposure as hyperventilation occurs, and the risk of viral transmission could be increased by amniotic fluid, vaginal discharge and bloody fluid spatter.Therefore, it is not prone to conducting prevention and control of COVID-19 infections caused by viral transmission during the delivery. Recommendations on the management during the delivery period for pregnant women with suspected or confirmed COVID-19 are described as follows:

1. Hospital selection for pregnant women with suspected or confirmed COVID-19

Pregnant women with suspected or confirmed COVID-19 are recommended to be treated in designated hospitals designated by the local government. Ahead of that, the designated hospital must also function as a midwifery medical institution capable of completing the treatment of suspected or confirmed pregnant women under the joint management of the medical departments of obstetrics, intensive medicine, respiration, infection, anesthesiology and pediatrics. Local health departments should divide designated hospitals at different levels according to regional features to ensure the safety of maternity delivery.

2. The time determination of pregnancy termination

The timing of pregnancy termination depends on the COVID-19 severity, gestational weeks and intrauterine conditions of the fetus, and is decided by joint discussion among medical departments and comprehensive judgment based on the principle of giving priority to the safety of pregnant women. Pregnant women with mild or common COVID-19, within 34 weeks of gestation and with no other medical indications of termination, could continue their pregnancy under close monitoring; pregnant women with severe or critical COVID-19 should actively terminate their pregnancy.

3. The mode determination of delivery

It is recommended to use cesarean section as a mode to terminate pregnancy if possible. On one hand, this mode can reduce the decline in resistance caused by physical exertion during the delivery and avoid further aggravation of the disease. On the other hand, as hyperventilation occurs, the infection prevention and control is complicated by amniotic fluid, vaginal bleeding and secretions during the labor. In addition, if an emergency occurs during the labor and patients need to be turned to cesarean section, the risk of viral spread and infection with medical staff will be increased for possibly not being in place quickly of infection prevention and control measures. Pregnant women with severe or critical COVID-19 should choose cesarean section under the joint multi-department discussion and management.

Proofreader: Wang Qianqian  Zhang Nana
Translator:    Zhang Xiaomin  Lu Qianqian  
Compiler of Chinese materials:Li Sirui

References:  https://mp.weixin.qq.com/s/tqVw4P9afALOBEMZOuyhvQ

4. Management of the delivery period

Vaginal delivery plan for suspected or confirmed COVID-19 pregnant women
Make delivery plan: including pre-delivery preparation, protection during the delivery, supervision and management during the labor, neonatal rescue preparation, emergency cesarean operation plan, etc. Under the premise of ensuring the safety of pregnant women and newborns, emphasis is placed on strengthening the prevention and control of infection with medical staff throughout the delivery process.

1. Preparation before the delivery:

  1. If possible, delivery of suspected or confirmed COVID-19 pregnant women should be conducted in a negative pressure isolation delivery room or a negative pressure operating room. If no such conditions exist in the hospital, delivery should be conducted in the isolation delivery room or ward. Once the COVID-19 pregnant women is treated in the hospital, it is necessary to turn off the central air conditioning and keep them warm. The isolation area should be divided into the contaminated, buffer and clean areas and separate from the normal treatment area.
  2. Remove all the unnecessary items and equipment in the wards of the contaminated area. The senior doctors and midwives should be arranged for childbirth preparations, and the job rotation should be carried out every 6 to 8 hours to avoid excessive fatigue or weak physical strength. At the same time, neonatologists need to prepare for neonatal resuscitation.
  3. It is necessary to formulate a detailed preparation list of related items and emergency transfer and handover process, such as the transfer and handover passage and process for pregnant women who need to be transferred into the operating room for emergency cesarean section, and for  pediatric medical staff to take over newborns.

2. Antenatal protection:

  1. The standard for antenatal protection is in level III, which means medical staff should be equipped with N95 masks, goggles or face shields, disposable hats, protective suits, isolation suits, shoe covers, boots, etc. The possibility of amniotic fluid and blood spraying occurs during childbirth, midwifery or cesarean section, so goggles and face shields should be worn simultaneously, as well as waterproof long leggings or boots. The level III protection should run through the entire process of childbirth or operation, and the strict aseptic operation should be guaranteed.
  2. Note: the pregnant women need to wear surgical or N95 masks throughout the delivery.

3. Easing restrictions on indications of cesarean section during labor:

It is necessary to closely monitor the changes of vital signs of pregnant women and the labor progress. If the labor progress is not smoothly progressed, the excessive intervention is not recommended, and the indications of cesarean section could not be taken too hard. Considering the fact that the childbirth process should not be too long and in order to reduce the exposure of medical staff, unnecessary operations during childbirth process should be reduced as much as possible in principle, including analgesia of drugs in the spinal canal.

4.  Emergency Delivery:

When suspected or confirmed COVID-19 pregnant women are in labor and could deliver within a short period, and especially there is no transfer chance, it is necessary to take quarantine measures on the spot, call medical staff to assist immediately and prepare protective items quickly and facilitate delivery on the spot. During delivery, medical staff should assist in the clean area and try to avoid cross contact with staff in the contaminated area. It is recommended that during the epidemic, the level III protective items are provided in the areas where COVID-19 pregnant women could be treated in the midwifery department, so that they can be applied in time in emergency to avoid infections by medical staff to the greatest extent. For those staff involved in on-the-spot treatment and suspected exposure, they should be isolated and observed as required.

5. Routine Drills:

Every midwifery department led by the Medical Department should:

  • organize multi-department joint drills;
  • act according to varying circumstances;
  • check every detail of specified processes and procedures;
  • cope with each emergency situation in a safe and orderly manner in compliance with infection prevention and control requirements.

Proofreader: Wang Qianqian  Zhang Nana
Translator:    Zhang Xiaomin  Wu Chanjue  Ding Jiahua
Compiler of Chinese materials:Li Sirui

References: https://mp.weixin.qq.com/s/tqVw4P9afALOBEMZOuyhvQ

Our lungs  
A woman gave birth to a baby during the epidemic

5. Preoperative preparation

1. The work division in each part

Before surgery, various medical departments, including obstetrics, anesthesiology, respiratory, pediatric and surgical nurses, need make joint efforts to develop surgery and protection plans. In addition, special needs should be explained in advance. For instance, medical staff need to prepare a legs splitting bed, heating blanket, and heating blood transfusion apparatus in the operation that pregnant women need placenta implantation. Furthermore, medical staff need identify the special transfer passage for pregnant women and newborns, the protection requirements for transfer staff and the disinfection measures for the transfer passage. And the neonatal transfer incubator and equipment need to be prepared in advance. The medical staff entering the contaminated area shall be in level III protection; the medical staff transferring newborns shall be in the transition area, take protective measures in above level II, and use a special transfer incubator or vehicle to transfer the newborns to the neonatal isolation and observation area.

2. The transfer of suspected or confirmed COVID-19 pregnant women

The suspected or confirmed COVID-19 pregnant women should wear medical surgical masks throughout the route, take the predetermined route from the receiving area to the operating room, and take a dedicated transfer elevator. The elevator are supposed to be evacuated with doors, windows and air conditions closed, and disinfected in a timely manner after transfer, so as to avoid hospital-acquired infections (which include patient-to-patient infection, patient-to-medical staff infection, etc). After surgery, the delivery women should be transferred as quickly as possible to isolation wards or negative pressure wards by the appointed elevator and passage which need disinfection again.

6. Preparation during operation

1. Operating room

The operation of suspected or confirmed COVID-19 pregnant women should be performed in negative pressure operating room if possible. In addition, remove unused equipment from the operating room as much as possible before surgery, and wrap the air-conditioning return vent with 1000mg/L chlorine disinfectant gauze. During operation, the door of the operating room must be closed and marked clearly to remind other medical staff not to enter into the operating room by chance.

2. The protection of medical staff

All medical staff partaking the operation should adopt protective measures in level III. Considering the high risk of amniotic fluid or blood splashing during cesarean section, it is recommended that medical staff need to wear goggles and face shields simultaneously.

3. The work division for surgery staff

The number of surgical staff should be reduced as much as possible, and the operation should be performed by senior doctors, and neonatal physicians should arrive at the operating room in advance to prepare. The medical staff in the transition area outside the operating room shall coordinate and cooperate with each other, and if necessary, be responsible for passing emergency items temporarily needed during the operation. And the medical staff in the transition area shall take protective measures in above level II.

4. The preparation of medical items

Use disposable surgical bag and articles as much as possible. According to the requirements of infections control, the articles and equipment related to the disease shall be clearly marked, placed in an independent area and given priority to disinfection.

5. Newborns

After the baby is born, his or her umbilical cord should be clamped and cut off as soon as possible, and the surface amniotic fluid and maternal blood should be wiped off as much as possible, and the contact between the mother and infant shall be avoided too early. The obstetricians or pediatricians shall hand over the newborns in the transition area, and then transfer to the pediatric isolation area for observation. The mother and infant shall not share the same ward.

7. Anesthesia method

It is suggested to carry out epidural or spinal anesthetic to reduce the possibility of viral transmission during intubation and extubation. The suspected or confirmed COVID-19 pregnant women who have been intubated can have cesarean section under general anesthesia. The anesthesiologists must take protective measures in level III and pay special attention to the exposure infections during tracheal intubation.

Proofreader: Wang Qianqian  Zhang Nana
Translator:Lu QianqianChang Gengyuan  He Yipu
Compiler of Chinese materials:Li Sirui

References:  https://mp.weixin.qq.com/s/tqVw4P9afALOBEMZOuyhvQ

 

Diagnosis and Treatment Method of COVID-19

Background:

The First Affiliated Hospital of Zhejiang University School of Medicine has treated 104 confirmed patients in the past fifty days, creating a miracle of "0 mortality ,0 misdiagnosis, and 0 Medical Staff Infection"; Front-line medical workers while fighting against the virus, they wrote the prevention and clinical treatment experience day and night, and quickly published this manual. Hoping to give some practical advice and reference to the global medical staff. This manual compares and analyzes the work experience of other teams in China. It provides detailed and comprehensive answers to the principles of patient classification and the various problems that may occur during the diagnosis and treatment. It is a comprehensive guide that has condensed the top medical experts in China to cope with the novel coronavirus.

Quote:

From:Prof. Tingbo LIANG
Editor-in-Chief of the Handbook of COVID-19 Prevention and Treatment
Chairman of The First Affiliated Hospital, Zhejiang University School of Medicine

Faced with an unknown virus, sharing and collaboration are the best remedy. The publication of this Handbook is one of the best ways to mark the courage and wisdom our health care workers have demonstrated over the past two months. Thanks to all those who have contributed to this Handbook, sharing the invaluable experience with health care colleagues around the world while saving the lives of patients. Thanks to the support from health care colleagues in China who have provided experience that inspires and motivates us. Thanks to Jack Ma Foundation for initiating this program, and to Ali Health for the technical support, making this Handbook possible to support the fight against the epidemic. The Handbook is available to everyone for free. However, due to the limited time, there might be some errors and defects. Your feedback and advice are highly welcomed!  

English edition:

Spanish edtion:

French editon:

Arabic editon:

More language versions are available at : https://covid-19.alibabacloud.com/zh

For the diagnosis and treatment part, we have made a mind map to help everyone to find the diagnosis and treatment method that you need quickly.


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Proofreader:Wang Jiajia  Zhang Nana  Wang  Qianqian
Translator& mind map:Li Sirui
Complier of Chinese materials:Li Sirui

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