Diagnosis and treatment protocol for COVID‐19 patients (Tentative 10th Version)

Abstract To further improve the diagnosis and treatment of COVID‐19, the National Health Commission of People's Republic of China and the National Administration of Traditional Chinese Medicine convened a group of experts to revise the relevant content of the Diagnosis and Treatment Protocol for COVID‐19 Patients (Trial Version 9) and developed the Diagnosis and Treatment Protocol for COVID‐19 Patients (Trial Version 10), summarizing the etiological characteristics, epidemiological characteristics, prevention, clinical features, diagnosis, clinical classification, population with high risk of severe/critical illnesses, early warning predictors for severe/critical illnesses, differential diagnosis, case identification and reporting, treatment, nursing, control of nosocomial infection in medical institutions, and discharge criteria for inpatients.

2019-nCoV has a single-stranded, positive-sense RNA (+RNA) genome of 29.9 kb.The genome of 2019-nCoV is typically organized in the order of 5′-leader-UTR-replicase (ORF1a/ORF1b)-S-ORF3a-ORF3b-E-M-ORF6-ORF7a-OR F7b-ORF8-N-ORF9a-ORF9b-ORF10-3′.The N protein wraps the RNA genome to form a nucleocapsid, which is the core of the virus particle and is surrounded by a lipid bilayer that contains the S, the M, and the N proteins.In the respiratory tract, the S protein of the 2019-nCoV enters the host cell by recognizing and binding to angiotensin converting enzyme 2 (ACE-2) through its receptor-binding domain (RBD).The 2019-nCoV undergoes frequent genetic mutations during its spread among the population.When multiple subtypes or subvariants of the 2019-nCoV infect the human body at the same time, genetic recombination will also occur to produce recombinant strains; Certain genetic mutations or recombinations may affect the biological characteristics of the 2019-nCoV.For example, mutations of amino acids in the spike protein will strengthen the binding affinity of the 2019-nCoV and ACE-2 and enhance the virus's ability of cell replication and transmission.Some amino acid mutations in the spike protein also increase the 2019-nCoV's ability to evade vaccinations and reduce cross-protection among variants, leading to breakthrough infection and reinfection.
As of the end of 2022, there are five "variants of concern" (VOC) defined by the World Health Organization (WHO), namely Alpha (B.As the global spread of the 2019-nCoV continues, new subvariants of Omicron will continue to emerge.BA.5.2 was a predominant Omicron variant that circulated globally for several months.Since October 2022, BF.7, BQ.1, and BQ.1.1,as well as the sublineage recombinant XBB, which are more immune evasive and transmissible, have spread rapidly and replaced BA.5.2 as the predominant strains in some countries and regions.
Available evidence at home and abroad shows that the Omicron variant demonstrates weakened lung pathogenicity, and the clinical presentation has changed from mainly pneumonia to mainly upper respiratory tract infections.The Omicron variant does not impact the he 2019-nCoV detection capability of RT-PCR assays diagnostic, but it may reduce the neutralizing effect of some monoclonal antibody drugs.
Coronavirus is sensitive to ultraviolet rays, organic solvents (ether, 75% ethanol, peracetic acid, chloroform, etc.) and chlorine-containing disinfectants.Seventy-five percentage ethanol and chlorinecontaining disinfectants are commonly used to inactivate the virus in clinics and laboratories, while chlorhexidine cannot.

| Source of infection
The source of infection is mainly patients infected with the 2019-nCoV as well as asymptomatic carriers.Patients are infectious during the incubation period and are highly infectious within 3 days after the onset of the disease.

| Route of transmission
a.The main route of transmission of 2019-nCov is respiratory droplet transmission and close contact transmission.b.The virus may spread through aerosols in a relatively closed environment.c.Contact with items contaminated by the virus can also cause infection.

| Susceptible population
Everyone is susceptible to 2019-nCoV.Infection or vaccination can acquire certain immunity.The elderly and patients with severe underlying diseases have a higher rate of severe illness and fatality after infection than the general population, and such rates can be reduced after vaccination.

| Vaccination
Vaccination is an effective means of reducing the incidence of critical illness and death, resulting in a reduction in the 2019-nCoV infection and morbidity.People who meet the requirements for vaccination and booster vaccination should be vaccinated in a timely manner.

| General precautions
People should maintain good personal hygiene and a clean environment surrounding them, with balanced nutrition, proper exercise, adequate rest, and no excessive fatigue.They should wash hands frequently, wear masks, keep the "one meter line" and use public chopsticks.Covering mouths and noses when sneezing or coughing and keeping the room ventilated well are encouraged for personal protection.

| Clinical manifestations
The incubation period is mostly 2 to 4 days.The main symptoms are dry throat, sore throat, cough, and fever.Most patients have low to moderate fever, but in some cases patients can have high fever, which does not exceed 3 days.Some patients may present with muscle aches, decreased or lost sense of smell and/or taste, nasal congestion, runny nose, diarrhea, and conjunctivitis.In a small number of patients, the disease continues to progress with ongoing fever and pneumonia-related manifestations.Severe patients often develop dyspnea and/or hypoxemia within 5 to 7 days after the onset.Critically ill cases can quickly progress to acute respiratory distress syndrome, septic shock, irreversible metabolic acidosis, coagulation dysfunction, and multiple organ failure.A very small number of patients may also have central nervous system involvement.
The clinical manifestations of infection in children are similar to those in adults, with high fever being relatively common; some cases may have atypical symptoms, such as vomiting, diarrhea, and other gastrointestinal symptoms or only poor response and shortness of breath; a few children may develop acute laryngitis or laryngotracheitis, such as hoarseness, wheezing, and pulmonary rales, but rarely severe respiratory distress; a few children may develop febrile convulsions, and a very small number of children may develop encephalitis, meningitis, encephalopathy, and even acute necrotizing encephalopathy, acute disseminated encephalomyelitis, Guillain-Barré syndrome, and other life-threatening neurological complications.Multiple system inflammatory syndromes (MIS-C) may also occur, mainly manifesting as fever with rash, nonpurulent conjunctivitis, mucosal inflammation, hypotension or shock, coagulopathy, acute gastrointestinal symptoms, and encephalopathic manifestations such as convulsions and cerebral.Once this occurs, the condition can deteriorate sharply in a short period of time.
Most patients have a good prognosis, with a few patients being critically ill.Most of the critically ill patients are more common in the elderly, those with chronic underlying diseases, women in late pregnancy and perinatal period, or obese people.

| Chest imaging
In the early stage of patients complicated with pneumonia, multiple small patchy shadows and interstitial changes are seen, especially in the periphery of the lung.
Then it develops into multiple ground glass shadows and infiltration shadows in both lungs.Severe cases can show lung consolidation, but pleural effusion is rare.

| Diagnostic principles
Diagnosis should be made on the basis of a comprehensive analysis of epidemiological history, clinical manifestations, and laboratory tests.A positive nucleic acid test for the new coronavirus is the primary criterion for diagnosis.6 | CLINICAL CLASSIFICATION

| Mild
Upper respiratory tract infection as the main manifestation, such as dry throat, sore throat, cough, fever, and so forth.

| Moderate
Persistent high fever >3 days or (and) cough and shortness of breath, but respiratory rate (RR) <30 breaths/min and oxygen saturation >93% on air inhalation at rest.Characteristic pneumonic manifestations of 2019-nCoV infection can be seen on imaging.

| Severe
Adults meeting any one of the following, which cannot be explained by other reasons other than the 2019-nCoV infection: a. Shortness of breath, RR ≥ 30 times/min; b.In the resting state, the pulse oxygen saturation (SpO 2 ) is ≤93% while breathing ambient air; c.Arterial partial pressure of oxygen (PaO 2 )/the fraction of inspired oxygen (FiO 2 ) ≤300 mmHg (1 mmHg = 0.133 kPa); In areas with high altitude (more than 1000 m above sea level), PaO 2 /FiO 2 should be adjusted according to the following formula: PaO 2 /FiO 2 ×[760/atmospheric pressure (mmHg)].
d.The clinical symptoms are progressively worse, and lung imaging shows that the lesion has progressed significantly >50% within 24 to 48 h.
Children meeting any of the following: a. High fever lasting more than 3 days; Shortness of breath (<2-month-old, RR ≥ 60 beats/min; 2-12 months old, RR ≥ 50 beats/min; 1 to 5-year-old, RR≥40 beats/min; >5-year-old, RR ≥ 30 times/min), the influence of fever and crying excluded; b.In the resting state, the pulse oxygen saturation is ≤93% while breathing ambient air; c.Respiratory distress (nostril flapping, three concave signs, wheezing or stridor); d.Impaired consciousness and convulsions; e. Refusal to feed or feeding difficulties with signs of dehydration.

| Critical
Meet any one of the following conditions:

| Molnupiravir capsule
Indicators are mild-to-moderate adult COVID-19 patients within 5 days of disease onset and high-risk factors of severe disease.Usage: 800 mg should be taken orally every 12 h for 5 days.It is not recommended for use during pregnancy and lactation.

| Monoclonal antibodies
Ambavirumab/Romisevirumab Injection.Used in combination for adults and adolescents (12-17 years old, weight ≥40 kg) with mild to moderate COVID-19 and high-risk factors of severe disease.Usage: two drugs are administered at a dose of 1000 mg respectively.After being diluted with 100 mL of normal saline, the two drugs are administered by intravenous sequential infusion at a rate of not higher than 4 mL/min, and 100 mL of normal saline is used to flush the tube in between.Clinically monitor patients during infusion and at least 1 h after infusion.

| Intravenous immunoglobulin
Intravenous immunoglobulin therapy for COVID-19 can be used among high-risk rapidly deteriorating patients with high viral load in the early stage of the disease.The recommended dosage for mild cases is 100 mg/kg, 200 mg/kg for the moderate case, and 400 mg/kg for the severe illness.The second infusion can be administered the next day, depending on the improvement of the patient's condition, with the total number not exceeding five.For patients with progressive deterioration of oxygenation, rapid imaging progression, and excessive inflammatory responses, glucocorticoids can be used for a short duration (3 to 5 days, and no more than 10 days).The recommended dosage is 5 mg/day for dexamethasone and is 40 mg/day for methylprednisolone.Larger doses and long-term use of glucocorticoids should be avoided to reduce side effects.

| Interleukin-6 (IL-6) inhibitor: Tocilizumab
Eligible for patients with severe and critical patients with elevated IL-6 levels.Specific usage: The first dose is 4-8 mg/kg, with the recommended dose of 400 mg, 0.9% saline to dilute to 100 mL, and the infusion time of more than 1 h.If the first dose is not effective, the same dose can be applied 12 h after the first dose.The maximum number of administrations is two and the maximum single dose does not exceed 800 mg.Allergic reactions must be monitored.Contraindicated in active infections, such as tuberculosis.

| Anticoagulation
For the moderate patient with high-risk factors and rapid disease progression, severe and critically ill patients, therapeutic doses of low molecular weight heparin or unfractionated heparin should be used when there is no contraindication.Treatment should be provided in case of thromboembolism according to the guidelines.

| Prone position
The moderate patients with high risk and rapid disease progression, severe and critically ill patients should be given standardized prone position therapy for longer than 12 h per day.

| Psychological intervention
Patients often have tension and anxiety.Psychological counseling should be strengthened and supplemented with drug treatment if necessary.Some patients have a high risk of HFNC or NIV treatment failure.Any patients receiving HFNO and NIV should be monitored closely.If there is no improvement in hypoxemia or the frequency of breathing or patients have excessive tidal volume or excessive inspiratory effort, especially after the prone position treatment within 1-2 h, invasive mechanical ventilation should be performed immediately.

| Invasive mechanical ventilation
If the PaO 2 /FiO 2 is less than 150 mmHg, especially in patients with significantly enhanced inspiratory effort, endotracheal intubation and invasive mechanical ventilation should be considered.However, given the atypical clinical manifestations of hypoxemia in severe and critically ill patients, PaO 2 /FiO 2 should be evaluated in real-time in combination with clinical manifestations and organ functions other than itself for endotracheal intubation and invasive mechanical ventilation.It is worth noting that the delay of endotracheal intubation may cause greater harm.
Early and appropriate invasive mechanical ventilation is important for critically ill patients.Lung protective mechanical ventilation strategies must be implemented.Lung recruitment manipulation can be performed in patients with moderate to severe acute respiratory distress syndrome with a FiO 2 higher than 50%.Repeatedly implement pulmonary recruitment manipulation should consider lung recrutability.It should be noted that some patients with COVID-19 have poor recrutiablity lung and high PEEP should be avoided.

| Airway management
We recommend using an active heating humidifier and loop heating guide wire if possible for airway humidification.Closed suction and tracheostomy suction if necessary are recommended.Airway clearance therapy such as vibration expectoration, high-frequency thoracic oscillation, and postural drainage is recommended.Passive and active activities should be performed as soon as possible to promote sputum drainage and pulmonary rehabilitation in the case of stable oxygenation and hemodynamics.Critically ill patients who meet the ECMO indications should receive ECMO treatment as soon as possible if there is no contraindication.
ECMO mode selection: Venous-venous ECMO (VV-ECMO) is the most commonly used for respiratory support; Venous-arterial ECMO (VA-ECMO) is used for patients who need both respiratory and circulatory support.veno-arterialvenous EMCO (VAV-ECMO) should be considered when the differential hypoxia is developing in patients receiving VA-ECMO.Lung protective ventilation strategies must be performed after ECMO treatment.Recommended initial settings: tidal volume <4-6 mL/kg ideal body weight, plateau pressure ≤25 cmH 2 O, driving pressure <15 cmH 2 O, PEEP 5-15 cmH 2 O, breathing rate 4-10 times/min, FiO 2 <50%.We recommend prone position ventilation for patients whose oxygenation is difficult to maintain, or with a strong inspiratory effort, obvious consolidation of the gravitydependent areas of the lungs, or active drainage of airway secretions

| Circulation support
Critically ill patients can be complicated with shock.On the basis of adequate fluid resuscitation, vasoactive drugs should be used reasonably.Blood pressure, heart rate, and urine output changes, as well as lactic acid and base excess should be closely monitored.Invasive hemodynamic monitoring should be used if necessary.

| Acute kidney injury and renal replacement therapy
Critically ill patients can be complicated with acute kidney injury.Some factors that induced AKI such as drugs and low perfusion should be considered.Maintain water, electrolyte, and acid-base balance while treating the cause of AKI.Indications for continuous renal replacement therapy (CRRT) include: (1) hyperkalemia; (2) severe acidosis; (3) pulmonary edema or excessive fluid overload with ineffective diuretics.11.7.5 | Treatment of special conditions in children 11.7.5.1 | Acute laryngitis or laryngotracheitis First, the degree of upper airway obstruction and hypoxia should be assessed, and oxygen should be administered if there is hypoxia.At the same time, the air should be kept moist to avoid children's irritability and crying.Glucocorticoids is the first choice for mild cases, who can also take orally single-dose dexamethasone (0.15−0.6 mg/kg, maximum dose 16 mg) or prednisolone (1 mg/kg).Dexamethasone (0.6 mg/kg, maximum dose 16 mg) is the first choice for moderate and severe cases to take orally, and intravenous or intramuscular injection can be administered if the patient is unable to take orally; 2 mg of budesonide can also be given via a nebulizer.For severe airway obstruction, tracheal intubation or tracheotomy and mechanical ventilation should be performed to maintain airway patency.In case of emergency, Inhalation of L-epinephrine via a nebulizer can quickly relieve the symptoms of upper airway obstruction, and the recommended dose is 0.5 mL/kg (maximum 5 mL) for 15 min each time.If the symptoms are not relieved, the inhalation can be repeated after 15-20 min.11.7.5.2 | Lung wheezes bronchodilators and glucocorticoids for aerosol inhalation can be used for patients based on comprehensive treatment; Salbutamol, Ipratropium bromide, and budesonide are also commonly used; for those with thick sputum, N-acetylcysteine can be administered via a nebulizer.

| Neurological complications such as encephalitis and encephalopathy
Body temperature should be controlled, and mannitol should be given to reduce intracranial pressure along with anticonvulsant therapy; tracheal intubation and mechanical ventilation are required for those with rapid disease progression; for patients with severe encephalopathy, especially acute necrotizing encephalopathy, methylprednisolone (20 to 30 mg/kg) should be given every 24 h for 3 days as early as possible, followed by gradual dose reduction depending on the disease; Intravenous immunoglobulin (IVIG) was administered intravenously at a total of 2 g/kg in 1 or 2 days.Plasma exchange, tocilizumab, or cocktail therapy that improves mitochondrial metabolism (vitamin B1, vitamin B6, levocarnitine, etc.) may also be used as appropriate.Treatment principles for encephalitis, meningitis, Guillain Barré syndrome are the same as for related disorders caused by other etiologies.11.7.5.4 | Children's multisystem inflammatory syndrome The treatment principle is anti-inflammatory treatment, correcting shock and coagulation dysfunction, and organ function support.Intravenous immunoglobulin (IVIG, 2 g/kg) and methylprednisolone (1-2 mg/kg/day) are the first choice for patients.When the condition does not improve or worsens, methylprednisolone (10−30 mg/kg/ day) can be given intravenously, or the patient can use Infliximab (5−10 mg/kg) or tocilizumab.

| Severe or critical cases with pregnancy
Multiple-discipline consultation should be sought for risk assessment.The pregnancy should be terminated if necessary.Cesarean section is the first choice.

| Mild cases a. Syndrome of superficies tightened by toxin
Clinical manifestations: fever and headache with no sweat, sore body, itchy throat, cough or dry and sore throat, few phlegm, stuffy nose and muddy mucus.The tongue is red, the coating is thin white or yellow, and the pulse is floating.
Patients with abdominal distension, constipation or poor stool (gastrointestinal dysfunction) can take Da Cheng Qi Tang, which consists of Sheng Da Huang (Rhei Radix et Rhizoma) 30 g, Mang Xiao (Natrii Sulfas) 30 g, Hou Po (Magnoliae officinalis Cortex) 15 g, and Zhi Shi (Aurantii Fructus Immaturus) 20 g, via enema.They can also take 5 to 30 g Sheng Da Huang (Rhei Radix et Rhizoma, decoction pieces or powder) by decocting or mixing it with water 2 to 4 times each day, until bowel movement is 1 to 3 times per day.
Patients with diarrhea or even watery stools can use Huoxiang Zhengqi capsules (softgels, pills, water, liquid).
For patients with coma, drowsiness and other disturbance of consciousness, Suhe Xiang Pill can be used orally or dissolved in water for nasal feeding (take 1 pill at a time, 1-2 times a day).
For patients with fatigue, shortness of breath, weakness, spontaneous sweating and poor appetite, 15 to 30 g of Xi Yang Shen (Panacis Quinquefolii Radix), Sun-cured Ginseng, or Hong Shen (Radix Ginseng Rubra) can be decocted for oral feeding (200 mL of thick decoction, orally or nasal feeding in 3 to 4 times).
Patients with pale face, cold climbs, and aversion to wind can take a decoction of 10 g of Fu Pian (Aconiti Radix lateralis praeparata), 15 g of Gan Jiang (Zingiberis Rhizoma), and 15-30 g of Hong Shen (Radix Ginseng Rubra) (200 mL of thick decoction, orally or nasal feeding in 3 to 4 times).
Patients with dry months and lips, red tounge with pale coating can take a decoction of 20-30 g of Xi Yang Shen (Panacis Quinquefolii Radix), 15 g of Mai Dong (Ophiopogonis Radix), and 15 g of Xuan Shen (Radix Scrophulariae).(200 mL of thick decoction, orally or nasal feeding in 3 to 4 times).
Patients with profuse sweating and cold limbs (shock) can take a decoction of over 30 g of Fu Pian (Aconiti Radix lateralis praeparata) (decocted in advance for 2 h), 20g of Gan Jiang (Zingiberis Rhizoma), 30 g of Hong Shen (Radix Ginseng Rubra) and 30 g of Huang Qi (Astragali Radix) after using the prescription for the internal blockage and external desertion syndrome.(200 mL of thick decoction, orally or nasal feeding in 3 to 4 times).
dampness, clear Feijing 100 times, push Sanguan 40 times and rub Liufu 120 times on the basis of the previous step; if the symptoms are wind-cold and dampness, push Sanguan 90 times and rub Liufu 30 times on the basis of the previous step.
Guasha (Scraping) Therapy: Apply oil on the front neck, chest and back, scrape for 5−10 min until red marks are seen.
Acupuncture: For patients with sore throat, disinfect and puncture Shaoshang acupoint with a three-edged needle to bleed; for patients with high fever that does not subside, disinfect and puncture the Erjian or Shuxuan acupuncture point gently with a three-edged needle to bleed.

| Severe and critically ill cases
Treatment for children with severe or critical illness can refer to the above-mentioned treatment for adults with severe or critical illness.On the basis of syndrome differentiation, therapies that can facilitate catharsis, expel heat, resolve toxin, suppress convulsions and develop Qi should be highlighted.Angong Niuhuang Pills, Dushen Decoction can be used as appropriate for the treatment.

| Early rehabilitation therapy
Attention should be given to early rehabilitation of patients with COVID-19, and early rehabilitation training and intervention for respiratory and physical function, and psychological disorders should be actively implemented to restore physical fitness and immunity as much as possible.

| NURSING
According to the patient's condition, nurses must clarify the key points of care and maintain proper basic care.In critically ill patients, close observation of patient's vital signs, state of consciousness and monitoring of blood oxygen saturation must be implemented.Critically ill patients must have 24h continuous ECG monitoring, measurements of the patient's heart rate, respiratory rate, blood pressure, and SpO 2 every hour, as well as measuring and recording body temperature every 4 h.Venous access must be done correctly, and all conduits must be unobstructed and properly fixed.Bedridden patients must change their positions regularly to prevent pressure sores.Implementation of noninvasive mechanical ventilation, invasive mechanical ventilation, artificial airway, prone position ventilation, sedation and analgesia, and ECMO is done in accordance with nursing regulations.Special attention is needed for patients' oral care and fluid inflow and outflow management, as well as aspiration prevention in patients with invasive mechanical ventilation.Psychological assessment should be done for conscious patients and proper care provided.
a. Have clinical manifestations associated with 2019-nCoV infection; b.Have one or more of the following pathogenic and serological findings; c.Positive nucleic acid test for 2019-nCoV; d.Positive antigen test for 2019-nCoV; e. Positive for antigen isolated by cell culture; f.IgG antibodies are increased by four times or more in the convalescent phase compared to the acute phase.
11.7.2.5 | Extracorporeal membrane oxygenation (ECMO) ECMO indications: patients who receive the optimal mechanical ventilation conditions (FiO 2 ≥80%, tidal volume of 6 mL/kg ideal body weight, PEEP≥5 cmH 2 O, and no contraindications) and prone ventilation meet any one of the following criteria should be considered to implement ECMO as soon as possible: a. PaO 2 /FiO 2 <50 mmHg over 3 h; b.PaO 2 /FiO 2 <80 mmHg over 6 h; c.Arterial blood pH<7.25 and PaCO 2 >60 mmHg for more than 6 h, and respiratory rate (RR)>35 times/min; d.RR >35 times/min, arterial blood pH <7.2 and the plateau pressure >30 cmH 2 O; This disease belongs to plague in TCM, caused by epidemic pathogenic factors.According to the different local climate characteristics and individual states of illness and physical conditions, the following treatment Protocol may vary.The use of over-pharmacopoeia doses should be directed by a physician.For nonkey populations with early-stage COVID-19 infection, home treatment can be carried out by using traditional Chinese medicine and Traditional Chinese medicine prescriptions stated in Guidelines for Home-Based Traditional Chinese Medicine Intervention for Patients with COVID-19 Infection and Notice on the Full Application of Traditional Chinese Medicine Decoction in the Treatment of COVID-19 Infection at the Primary Level in Urban and Rural Areas.11.8.1 | Treatment 11.8.1.1 | Qingfei Paidu decoction Scope of application: It is suitable for mild, moderate, severe, and critically ill patients, and can be used as per patients' conditions and medication requirements.

b.
Recommended acupuncture points for acupuncture treatment: Taixi, Shanzhong, Guanyuan, Baihui, Zusanli, Suliao.c. Recommended Chinese patent medicine for severe and critically ill cases: Qingfei Paidu granules, Huashi Baidu granules, Xiyanping injection, Xuebijing injection, Reduning injection, Tanreqing injection, Xingnaojing injection, Shenfu injection, Shengmai injection, Shenmai injection.Drugs with similar efficacy can be selected according to individual conditions, or can be used in combination according to clinical symptoms.Traditional Chinese medicine injection can be used in combination with TCM decoction.d.Medication for severe and critically ill cases according to the patient's symptoms.
. Differentiation from noninfectious diseases such as vasculitis, dermatomyositis, and organizing pneumonia.d.Children with rashes and mucosal damage should be differentiated from Kawasaki disease.
a. Respiratory failure and mechanical ventilation; b.Shock; c. ICU admission due to other organ failures.7 | POPULATION WITH HIGH RISK OF SEVERE/CRITICAL ILLNESSES a. Older than 65 years, especially those who have not received the full course of 2019-nCoVvaccines; b.Have the comorbidities such as cardio-cerebrovascular diseases (including hypertension), chronic lung diseases, diabetes, chronic liver or kidney disease, and tumors, and patients on maintenance dialysis; c.Immune function deficiency (AIDS patients, longterm use of corticosteroids or other immunosuppressive drugs that lead to immune suppression); d.Obesity (body mass index ≥30); e.Late pregnancy and perinatal women; f.Heavy smokers.a. Manifestations of 2019-nCoV infection must be differentiated from upper respiratory tract infections caused by other viruses.b.Manifestations of 2019-nCoV infection needs to be distinguished from other known viral types of pneumonia including influenza virus, adenovirus, respiratory syncytial virus, and mycoplasma pneumoniae infection.ca.Isolated and treated according to the requirements of respiratory infectious diseases.Ensure adequate energy and nutrition intake, pay attention to the balance of water and electrolyte to maintain homeostasis.For those with high fever, physical cooling and antipyretic drugs should be applied.Give cough and expectorant drugs to those with severe cough and sputum.Indicators are mild-to-moderate adult COVID-19 patients within 5 days of disease onset and high-risk factors of severe disease.Usage: 300 mg of nirmatrelvir with 100 mg of ritonavir, given twice daily for 5 days.The drug instructions should be read carefully before use, and it should not be used in combination with drugs such as meperidine and ranolazine, which are highly dependent on CYP3A for clearance and whose plasma concentration increases can lead to serious and/or life-threatening adverse reactions.They should be used during pregnancy only if the potential benefit to the mother outweighs the potential risk to the fetus.Use during lactation is not recommended.Nematavir should be reduced by half in people with moderate renal impairment and should not be used in people with severe hepatic or It can be used for the treatment of adult patients with moderate SARS-CoV-2 infection.Usage: the tablet should be swallowed whole and taken without food.Five milligrams should be taken every 24 h for a maximum of 14 days.Read the instructions carefully before use and be aware of interactions with other drugs and adverse reactions.It is not recommended for use during pregnancy and lactation, and should be used with caution in patients with moderate to severe hepatic or renal impairment.
13 | CONTROL OF NOSOCOMIAL INFECTION IN MEDICAL INSTITUTIONS a. Implement the pre-screening triage system for emergency and outpatient care to ensure patient triage.Provide guidance on hand hygiene, respiratory hygiene and good cough habits.Patients with respiratory symptoms and accompanying personnel should wear medical surgical masks or medical protective masks.b.Strengthen ward ventilation, and clean and disinfect object surfaces in consultation rooms, wards, offices, duty rooms and other areas.c.Medical personnel should carry out appropriate personal protection according to the risk of exposure in accordance with the principle of standard precautions.They should wear medical surgical masks or medical protective masks during work, and strictly implement hand hygiene.d.Dispose of medical waste according to requirements, and carry out final disinfection after patient transfer or discharge.14 | DISCHARGE CRITERIA FOR INPATIENTS If the patient's condition has improved significantly with stable vital signs, the body temperature is normal for more than 24 h, the lung imaging shows significant improvement of acute exudative lesions, the patient can switch to oral therapy, and there are no complications that require further treatment, the patient can be considered for discharge.The official notice of the release and the official Diagnosis and Treatment Protocol for COVID-19 Patients (Trial Version 10) can be found at: Official Notice, Letter No. 4 [2023] of the National Health Commission, http://www.nhc.gov.cn/xcs/zhengcwj/202301/32de5b2ff9bf4eaa88e75bdf7223a65a.shtmlThe Official Protocol (Trial Version 10), http://www.nhc.gov.cn/xcs/zhengcwj/202301/32de5b2ff9bf4eaa88e75bdf7223a65a/files/02ec13aadff048ffae227593a6363ee8.pdf