Big changes! The ninth edition of the COVID-19 Diagnosis and Treatment Plan is here

The diagnosis and treatment plan for new coronavirus pneumonia has been revised again and ushered in the ninth edition.

The source | the official website of the National Health Commission

The diagnosis and treatment plan for new coronavirus pneumonia has been revised again and ushered in the ninth edition. It is understood that in order to further do a good job in the medical treatment of new crown pneumonia and effectively improve the level of standardized and homogeneous diagnosis and treatment, recently, the National Health Commission and the State Administration of Traditional Chinese Medicine organized experts to revise the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Eighth Revised Edition)", forming the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Ninth Edition)", and issued it for reference and implementation in various places. The new version of the diagnosis and treatment plan is formed on the basis of careful study of the transmission characteristics and case characteristics of mutant strains such as Delta and Omikerong, and in-depth analysis of relevant research results.

According to reports, the key revisions are as follows:

The first is to optimize the case detection and reporting procedures. On the basis of nucleic acid detection, antigen detection is added as a supplement to further improve the early detection capacity of cases. At the same time, the efficiency of diagnosis or exclusion of suspected cases is improved, requiring those whose suspected cases or antigen test results are positive to immediately undergo nucleic acid testing or closed-loop transfer to higher-level medical institutions with conditions for nucleic acid testing. Those who have a positive nucleic acid test result shall be subject to centralized isolation management or sent to a designated hospital for treatment, and directly reported online in accordance with regulations.

The second is to classify and treat cases. According to the opinions reflected in various places, "the patients of the Aomi Kerong mutant strain are mainly asymptomatic infected and mild cases, most of them do not need too much treatment, and all of them will occupy a lot of medical resources in designated hospitals", and further improved the classification and treatment measures for cases:

1. Mild cases are subject to centralized isolation management, and relevant centralized isolation sites cannot isolate people entering the country, close contacts and other groups at the same time. During the isolation and management period, symptomatic treatment and disease monitoring should be done, and if the condition worsens, it should be transferred to a designated hospital for treatment.

2. Ordinary, severe, critical cases and cases with severe risk factors should be treated intensively in designated hospitals, of which severe and critical cases should be included in the ICU as soon as possible, and patients with high risk factors and severe disease tendencies should also be admitted to the ICU for treatment.

The third is to further standardize antiviral treatment. Two specific anti-coronavirus drugs approved by the State Food and Drug Administration were written into the diagnosis and treatment plan, namely: PF-07321332/ritonavir tablets (Paxlovid) and domestic monoclonal antibodies (amphavir monoclonal antibody/romizumab injection).

The fourth is to revise and improve the content of traditional Chinese medicine treatment. Combined with the experience of clinical treatment in various places, the application of non-drug therapies of traditional Chinese medicine has been strengthened, and the content of acupuncture treatment has been increased; combined with the characteristics of children's patients, the relevant content of children's traditional Chinese medicine treatment has been increased.

The fifth is to adjust the management of release from isolation, the criteria for discharge, and the precautions for lifting isolation management and post-discharge. Relevant domestic studies have shown that when the nucleic acid Ct value of the recovering person is ≥ 35, the virus cannot be isolated from the sample, and the close contacts have not been found to be infected. Accordingly, the new version of the diagnosis and treatment plan modifies the "negative nucleic acid test of two consecutive respiratory specimens (sampling time interval is at least 24 hours apart)" in the criteria for dissociation management and discharge to "two consecutive nucleic acid detection N gene and ORF gene Ct values are ≥35 (fluorescence quantitative PCR method, the limit value is 40, the sampling time interval is at least 24 hours), or two consecutive negative nucleic acid tests for the new coronavirus (fluorescence quantitative PCR method, the boundary value is less than 35, Sampling time is at least 24 h apart)". Revise "Continue 14 days of isolation management and health monitoring after discharge" to "release from isolation management or continue home health monitoring after discharge".

Attached: Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Ninth Edition)

Swipe up to read

Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Version 9)

In order to further improve the diagnosis and treatment of novel coronavirus pneumonia (COVID-19), we organized experts to revise the relevant contents of the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Eighth Revised Edition)" to form the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Version 9)".

First, the characteristics of etiology

The novel coronavirus (SARS-CoV-2) belongs to the β genus of coronaviruses, with a coating, round or oval particles, and a diameter of 60 to 140 nm. It has 5 essential genes, targeting nucleoprotein (N), viral envelope (E), matrix protein (M) and spike protein (S) 4 structural proteins and RNA-dependent RNA polymerase (RdRp). The nuclear protein (N) envelops the RNA genome to form the nucleocapsid, which surrounds the viral envelope (E), which is embedded with proteins such as matrix proteins (M) and spike proteins (S). Spike proteins enter cells by binding to angiotensin-converting enzyme 2 (ACE-2). In vitro isolation and culture, the novel coronavirus can be found in human respiratory epithelial cells in about 96 hours, while isolation and culture in Vero E6 and Huh-7 cell lines takes about 4 to 6 days.

Like other viruses, the genome of the new coronavirus will also mutate, and some mutations will affect the biological characteristics of the virus, such as changes in the affinity of S protein and ACE-2 will affect the ability of the virus to invade cells, replicate, and spread, the recovery period of the recovered person and the production of antibodies after vaccination, and the neutralization ability of antibody drugs, which will attract widespread attention. There are five "variant of concern" (VOC) proposed by the World Health Organization (WHO), namely Alpha, Beta, Gamma, Delta and Omicron. Currently, cases of Infection of the Omicron strain have replaced the Delta strain as the main epidemic strain. The available evidence shows that the Omicron strain is more transmissible than the Delta strain, the pathogenicity is weakened, and the diagnostic accuracy of pcrR tests routinely used in mainland China has not been affected, but may have reduced the effect of some monoclonal antibody drugs on it. Coronavirus is sensitive to ultraviolet light and heat, 56 °C for 30 minutes, ether, 75% ethanol, chlorine-containing disinfectants, peracetic acid and chloroform and other lipid solvents can effectively inactivate the virus, chlorhexidine can not effectively inactivate the virus.

2. Epidemiological characteristics

(1) Source of infection.

The source of infection is mainly those infected with the new coronavirus, which is contagious during the incubation period and is more contagious within 5 days after the onset of illness.

(2) Transmission routes.

1. Transmission through respiratory droplets and close contact is the main route of transmission.

2. Aerosol propagation in a relatively closed environment.

3. Infection can also be caused after contact with items contaminated with the virus.

(3) Susceptible groups.

People are generally susceptible. Some immunity can be obtained after infection or after vaccination against the new coronavirus.

3. Pathological changes

The following are the pathological changes of the main organs in the early cases of the novel coronavirus pneumonia epidemic and the test results of the new coronavirus (excluding underlying disease lesions).

(1) Lungs.

Early and mild lesions include intraveolar serous fluid, fibrin exudation, and hyaluronic membrane formation, with inflammation cells dominated by monocytes and lymphocytes; alveolar septal capillary hyperemia. With the progression and aggravation of the lesion, a large number of monocytes/macrophages and fibrin fill the alveolar cavity; type II alveolar epithelial cells proliferate, some cells are exfoliated, multinucleated giant cells can be seen, and occasionally red-stained inclusions. Pulmonary vasculitis, thrombosis (mixed thrombosis, clear thrombosis), thromboembolism may be seen. Partial epithelium detachment of the bronchial mucosa at all levels of the lungs, exudates and mucus may be visible in the lumen. Small bronchi and bronchioles are susceptible to mucus thrombosis. Focal bleeding is predisposed to lung tissue, with hemorrhagic infarction, bacterial and/or fungal infections. Partial alveoli are over-inflated, the alveolar septum ruptures, or cysts form. In cases with a longer course of disease, see alveolar cavity exudate mycoplasmic degeneration and pulmonary interstitial fibrosis.

Coronavirus particles are seen in the cytoplasm of bronchial mucosal epithelium and type II alveolar epithelium cells under electron microscopy. Immunohistochemical staining showed positive immunostaining and nucleic acid testing for some bronchial mucosal epithelium, alveolar epithelial cells, and macrophages.

(2) The spleen, hilar lymph nodes and bone marrow.

The spleen is reduced. Atrophy of the white marrow, decreased lymphocyte number, partial cell necrosis, hyperemia of the red marrow, focal bleeding, hyperplasia of macrophages in the spleen and phagocytosis can be seen; anemia of the spleen is likely to be seen. The number of lymphocytes in the lymph nodes is reduced, necrosis is visible. Immunohistochemical staining showed a decrease in both CD4+ T and CD8+ T cells in the spleen and lymph nodes. Nucleic acid test for novel coronavirus in lymph node tissue may be positive, and macrophages may be positive for antigen immunostaining for novel coronavirus. Bone marrow hematopoietic cells or proliferation or decrease in number, the proportion of granular red increased; occasionally bloodphagia phenomenon.

(3) Heart and blood vessels.

Degeneration, necrosis, interstitial hyperemia, edema, and a small number of mononuclear cells, lymphocytes, and/or neutrophil infiltration may be seen in some cardiomyocytes. Nucleic acid tests for novel coronavirus are occasionally positive. Endothelial cell exfoliation, intimal or full-thickness inflammation may be seen in small blood vessels in major parts of the body, and mixed thrombosis, thromboembolism, and infarction of corresponding sites can be seen in the main parts of the body. The microvascular of the main organ is prone to transparent thrombosis.

(iv) Liver and gallbladder.

Hepatocyte degeneration, focal necrosis with neutrophil infiltration, hepatic sinus hyperemia, lymphocyte and monocyte infiltration and microthrombosis in the conciliator area. The gallbladder is highly plump, and the epithelium of the mucosa of the gallbladder is detached. Nucleic acid test for liver and gallbladder novel coronavirus is positive.

(5) Kidneys.

Glomerular capillary hyperemia, occasionally segmental celloid necrosis, protein exudates in the balloon cavity. The proximal tubule epithelial degeneration, partial necrosis, detachment, distal tubule is easy to see the tubular type. The renal interstitial is hyperemia, and microthrombosis may be seen. Occasionally positive nucleic acid test for novel coronavirus in kidney tissue.

(6) Other organs.

Cerebral tissue hyperemia, edema, degeneration of some neurons, ischemic changes and loss, visible phagocytic phenomenon and satellite phenomenon. Perivascular space mononuclear cell and lymphocyte infiltration may be seen. Focal necrosis of the adrenal glands is seen. The epithelium of the esophagus, stomach and intestinal mucosa degenerates, necroticizes, and sheds to varying degrees, and mononuclear cells and lymphocytes infiltrate the lamina and submucosal layer. Cortical cell degeneration, focal hemorrhage and necrosis may be seen in the adrenal glands. The testicles see varying degrees of decreased spermidal cell numbers, denaturation of Sertoli cells and Leydig cells. The nasopharynx and gastrointestinal mucosa, as well as organs such as the testicles and salivary glands, can detect the novel coronavirus.

Fourth, clinical features

(1) Clinical manifestations.

The incubation period is 1 to 14 days, mostly 3 to 7 days. Fever, dry cough, and fatigue are the main manifestations. Some patients may present with nasal congestion, runny nose, sore throat, loss or loss of sense of smell and taste, conjunctivitis, myalgia, and diarrhea. Severe patients often have dyspnea and/or hypoxemia within a week of onset, and in severe cases, they can rapidly progress to acute respiratory distress syndrome, sepsis shock, difficult-to-correct metabolic acidosis and coagulation dysfunction, and multi-organ failure. Very few patients may also have central nervous system involvement and acrometic necrosis. It is worth noting that severe and critically ill patients may have moderate to low fever during the course of their illness, or even no obvious fever.

Mild patients may present with low-grade fever, mild fatigue, olfactory and taste disturbances, and no pneumonia. There may also be no obvious clinical symptoms after infection with the novel coronavirus. Those who have been vaccinated and infected with the Omicron strain are predominantly asymptomatic and mild. Patients with clinical symptoms mainly present with symptoms of upper respiratory tract infections such as moderate and low fever, dry throat, sore throat, nasal congestion, and runny nose.

Most patients have a good prognosis, and a few patients are critically ill, mostly in the elderly, those with chronic underlying disease, women in the third trimester and perinatal period, and obese people. The symptoms of children's cases are relatively mild, and some children and newborns may have atypical symptoms, manifested by gastrointestinal symptoms such as vomiting and diarrhea, or only by poor response and shortness of breath. A very small number of children may have multisystem inflammatory syndrome (MIS-C), similar to Kawasaki disease or atypical Kawasaki disease, toxic shock syndrome or macrophage activation syndrome, which occur most often in the convalescent period. The main manifestations are fever with rash, non-purulent conjunctivitis, mucosal inflammation, hypotension or shock, coagulation disorders, and acute gastrointestinal symptoms. Once this occurs, the condition can deteriorate sharply in the short term.

(2) Laboratory examination.

1． General examination.

The total number of peripheral leukocytes is normal or decreased in the early stages of the disease, the lymphocyte count is decreased, and some patients may have elevated liver enzymes, lactate dehydrogenase, muscle enzymes, myoglobin, troponin, and ferritin. Most patients have elevated C-reactive protein (CRP) and erythrocyte sediment rate (ESR), and procalcitonin (PCT) is normal. Elevated D-dimer, progressive decrease in peripheral blood lymphocytes, and elevated inflammatory factors may be seen in severe and critically ill patients.

2． Etiology and serology.

(1) Pathogenic examination: nucleic acid amplification detection method is used to detect the nucleic acid of the new coronavirus in nasal, oropharyngeal swabs, sputum and other lower respiratory tract secretions, feces and other specimens. Nucleic acid detection will be affected by the course of the disease, specimen collection, detection process, detection reagents and other factors, in order to improve the accuracy of detection, should standardize the collection of specimens, specimens collected as soon as possible sent for testing.

(2) Serological examination: the novel coronavirus specific IgM antibody and IgG antibody are positive, and the positive rate is low within 1 week of onset. Due to the positive judgment value of the reagent itself, or the presence of interfering substances in the body (rheumatoid factor, heterophilic antibodies, complement, lysozyme, etc.), or the cause of the specimen (hemolysis of the specimen, the specimen is contaminated with bacteria, the specimen is stored for too long, the specimen coagulation is incomplete, etc.), the antibody test may appear false positive. Serological testing is generally not used as a basis for diagnosis alone, and comprehensive judgment is required based on epidemiological history, clinical manifestations and underlying diseases.

(3) Chest imaging.

In the early stages, there are multiple small patches and interstitial changes, which are evident in the outer bands of the lungs. It then develops multiple ground glass shadows and infiltrating shadows in both lungs, and in severe cases, lung consolidation may occur, and pleural effusion is rare. In MIS-C, patients with cardiac insufficiency may see enlarged heart shadow and pulmonary edema.

5. Diagnosis

(1) Diagnostic principles.

Diagnosis is made based on comprehensive analysis of epidemiological history, clinical manifestations, laboratory tests, etc. A positive nucleic acid test for the novel coronavirus is the primary criterion for confirming the diagnosis. If the novel coronavirus vaccine has not been vaccinated, the novel coronavirus-specific antibody test can be used as a reference for diagnosis. In principle, those who have been vaccinated against the new coronavirus and those who have been previously infected with the new coronavirus are not used as the basis for diagnosis.

(2) Diagnostic criteria.

1. Suspected cases.

There is any one of the following epidemiological histories, and any two of the clinical manifestations are met.

If there is no clear epidemiological history, it meets 3 of the clinical manifestations, or any 2 of the clinical manifestations, and the novel coronavirus-specific IgM antibody is positive (those who have recently been vaccinated against the novel coronavirus are not used as reference indicators).

(1) Epidemiological history

Travel history or residence history in the community where the case was reported within 14 days prior to onset of illness;

A history of contact with a person infected with the novel coronavirus in the 14 days prior to the onset of illness;

Patients with fever or respiratory symptoms from the community with their own case reports within 14 days prior to onset;

Cluster onset (2 or more cases of fever and/or respiratory symptoms in a small area such as home, office, school class, etc., within 14 days).

(2) Clinical manifestations

Clinical manifestations related to novel coronavirus pneumonia such as fever and/or respiratory symptoms;

Have the above imaging characteristics of novel coronavirus pneumonia;

The total number of white blood cells is normal or decreased in the early stages of the disease, and the lymphocyte count is normal or decreased.

2. Confirmed cases.

Suspected cases have one of the following etiological or serological evidence:

(1) Positive nucleic acid test for novel coronavirus;

(2) Those who have not been vaccinated against the new coronavirus are positive for the novel coronavirus-specific IgM antibody and IgG antibody.

Sixth, clinical classification

(1) Light.

Clinical symptoms are mild, and no pneumonia is seen in radiography.

(2) Ordinary type.

With these clinical manifestations, imaging manifestations of pneumonia are visible.

(3) Heavy.

Adults meet any of the following criteria:

1. Shortness of breath, RR ≥ 30 times / min;

2. In the resting state, the oxygen saturation ≤ 93% when inhaling air;

3. Arterial partial pressure (PaO2) / oxygen concentration (FiO2) ≤300mmHg (1mmHg = 0.133 kPa); high altitude (altitude more than 1000 meters) should be corrected for PaO2/FiO2 according to the following formula: PaO2/FiO2× [760/atmospheric pressure (mmHg)].

4． Clinical symptoms are progressively worsened, and lung imaging shows significant progression of lesions within 24 to 48 hours>50% of patients.

Children meet any of the following criteria:

1. Persistent high fever for more than 3 days;

2. Shortness of breath (60 beats/min ≥ RR at 2 months of age <; 50 beats/min at RR ≥ 2 to 12 months of age; 40 beats/min in RR ≥ at 1 to 5 years old; 30 beats/min≥ in >5 years old), excluding the effects of fever and crying;

3. In the resting state, the oxygen saturation ≤ 93% when inhaling air;

4. Assisted breathing (nasal flapping, three concave signs);

5. Drowsiness, convulsions;

6. Refusal of food or feeding difficulties, dehydration signs.

(4) Critically ill.

One of the following:

1. Respiratory failure and the need for mechanical ventilation;

2. Shock;

3. Combined with other organ failure requires ICU monitoring and treatment.

7. Heavy/critical and high-risk groups

(1) Elderly persons older than 60 years of age;

(2) Those with cardiovascular and cerebrovascular diseases (including hypertension), chronic lung diseases, diabetes, chronic liver, kidney disease, tumors and other underlying diseases;

(iii) Immune deficiencies (e.g., aids patients, long-term use of corticosteroids or other immunosuppressive drugs leading to a state of hypogetism);

(4) Obesity (body mass index≥30);

(5) Women in the third trimester of pregnancy and perinatal period;

(6) Heavy smokers.

VIII. Early warning indicators for heavy/critical

(1) Adults.

Worsening should be vigilant for changes in the following indicators:

1. Progressive exacerbation of hypoxemia or respiratory distress;

2. Deterioration of tissue oxygenation indexes (such as oxygen saturation, oxygenation index) or progressive increase in lactate;

3. Progressive decrease in peripheral blood lymphocyte count or progressive increase in inflammatory factors such as interleukin 6 (IL-6), CRP, ferritin, etc.;

4. D-dimer and other coagulation function related indicators were significantly increased;

5. Chest imaging shows significant progression of lung lesions.

(2) Children.

1. Increased respiratory rate;

2. Poor mental response, drowsiness;

3. Progressive increase in lactic acid;

4. CrP, PCT, ferritin and other inflammatory factors are significantly increased;

5. Imaging shows bilateral or multiple lobe infiltration, pleural effusion or rapid progression of lesions in the short term;

6. There are underlying diseases (congenital heart disease, bronchopulmonary dysplasia, respiratory malformations, abnormal hemoglobin, severe malnutrition, etc.), immunodeficiency or low (long-term use of immunosuppressants) and newborns.

9. Differential diagnosis

(1) Mild manifestations of novel coronavirus pneumonia need to be distinguished from upper respiratory tract infections caused by other viruses.

(2) The new coronavirus pneumonia is mainly distinguished from other known viral pneumonias such as influenza virus, adenovirus, respiratory syncytial virus and mycoplasma pneumoniae infection, especially for suspected cases, rapid antigen detection, multiple PCR nucleic acid detection and other methods should be adopted as much as possible to detect common respiratory pathogens.

(3) It should also be distinguished from non-infectious diseases, such as vasculitis, dermatomyositis and mechanized pneumonia.

(4) When a child patient has a rash or mucosal lesion, it is necessary to distinguish it from Kawasaki disease.

(5) Those who have close contact with persons infected with the new coronavirus, even if the common respiratory pathogen test is positive, should also be tested for the pathogen of the new coronavirus in a timely manner.

10. Detection and reporting of cases

If all types of medical institutions at all levels find suspected cases that meet the definition of cases or have positive test results for novel coronavirus antigens, they should immediately collect specimens for nucleic acid testing or close-loop transfer to higher-level medical institutions with conditions for nucleic acid testing, during which a single person is isolated in a single room. Those who have a positive nucleic acid test result shall be subject to centralized isolation management or sent to a designated hospital for treatment, and directly reported online in accordance with regulations. Two consecutive negative nucleic acid tests for novel coronavirus (sampling intervals of at least 24 hours) exclude the diagnosis of suspected cases.

11. Treatment

(1) Determine isolation management and treatment sites based on the condition.

(2) General treatment.

1. Bed rest, strengthen supportive treatment, ensure adequate energy and nutrient intake; pay attention to the balance of water and electrolytes, and maintain the stability of the internal environment.

2. Closely monitor vital signs, especially at rest and after activity, finger oxygen saturation, etc.

3. Monitor blood routine, urine routine, CRP, biochemical indicators (liver enzymes, myocardial enzymes, kidney function, etc.), coagulation function, arterial blood gas analysis, chest imaging, etc. according to the condition. Inflammatory factor testing may be done in patients with conditions.

4. Give standardized and effective oxygen therapy measures according to the condition, including nasal cannula, mask oxygen and nasal high-flow oxygen therapy.

5. Antibacterial drug treatment: avoid blind or inappropriate use of antibacterial drugs, especially the combination of broad-spectrum antibacterial drugs.

(3) Antiviral therapy.

1.PF-07321332/Ritonavir tablets (Paxlovid). Suitable for adults and adolescents (12 to 17 years, weight ≥ 40 kg) who are less than 5 days old and have a high risk factor for progression to severe. Usage: 300 mg

PF-07321332 is taken simultaneously with 100 mg of ritonavir every 12 hours for 5 consecutive days. The instructions should be read carefully before use, and should not be combined with drugs such as piperidine and ranozine that are highly dependent on CYP3A for removal and whose plasma concentration increases can lead to serious and / or life-threatening adverse reactions.

2. Monoclonal antibody: amphavir monoclonal / romizumab injection. It is used in combination for the treatment of mild and normal adults and adolescents (12 to 17 years, weight ≥ 40 kg) with progression to a major risk factor. Usage: the dose of the two drugs is 1000 mg respectively. After diluting the two drugs with 100 ml of normal saline before administration, the drug is administered by intravenous sequential infusion, intravenous infusion at a rate of not more than 4 ml / min, and 100 ml of normal saline is used between the tubes. The patient is clinically monitored during the infusion and the patient is observed for at least 1 hour after the infusion is completed.

3. Intravenous injection of immunoglobulins in people with COVID-19. It can be used early in the course of disease in patients with high risk factors, a high viral load, and rapid disease progression. The dose is mild 100 mg/kg, ordinary type 200 mg/kg, severe 400 mg/kg intravenously, depending on the patient's improvement, the next day can be re-infused, the total number of times does not exceed 5 times.

4. Convalescent plasma of convalescent patients. It can be used early in the course of disease in patients with high risk factors, a high viral load, and rapid disease progression. The infusion dose is 200 to 500 ml (4 to 5 ml/kg), and whether to re-infuse can be made according to the individual situation of the patient and the viral load.

(4) Immunotherapy.

1. Glucocorticoids. For severe and critically ill patients with progressive deterioration of oxygenation indicators, rapid progression in imaging, and overactivation of the body's inflammatory response, the use of glucocorticoids in the short term (not more than 10 days) as appropriate, it is recommended that dexamethasone 5 mg / day or methylprednisolone 40 mg / day, avoid long-term, large-dose use of glucocorticoids to reduce side effects.

2. Interleukin 6 (IL-6) inhibitor: tocilizumab. May be tried in severe, critically ill patients with elevated laboratory-tested IL-6 levels. Usage: the first dose of 4 ~ 8mg / kg, the recommended dose of 400mg, normal saline dilution to 100ml, infusion time is greater than 1 hour; the first dose is not effective, can be applied once more than 12 hours after the first dose (the dose is the same as before), the cumulative number of administrations is up to 2 times, and the maximum dose of a single dose is not more than 800mg. Be aware of allergic reactions, people with tuberculosis and other active infections are contraindicated.

(5) Anticoagulation.

It is used in ordinary, severe and critically ill patients with high risk factors for severe disease, with rapid disease progression, and low molecular weight heparin or unfractionated heparin, which can be given therapeutic doses without contraindications. In the event of a thromboembolic event, treatment is carried out according to the appropriate guidelines.

(6) Prone position treatment.

Ordinary, severe and critically ill patients with high risk factors for severe disease and rapid progression should be given standardized prone position therapy, and it is recommended that not less than 12 hours a day.

(7) Psychological intervention.

Patients often have tension and anxiety, and psychological counseling should be strengthened, supplemented by drug therapy if necessary.

(8) Supportive treatment for severe and critically ill.

1. Treatment principle: on the basis of the above treatment, actively prevent complications, treat basic diseases, prevent secondary infections, and timely support organ function.

2. Respiratory support:

(1) Nasal cannula or mask to inhale oxygen

Severe patients with PaO2/FiO2 below 300 mmHg should be given oxygen therapy immediately. After receiving nasal cannula or mask oxygen, close observation for a short period of time (1 to 2 hours), and if respiratory distress and/or hypoxemia do not improve, nasal high-flow oxygen therapy (HFNC) or noninvasive ventilation (NIV) should be used.

(2) Nasal high-flow oxygen therapy or non-invasive ventilation

PaO2/FiO2 below 200 mmHg should be given nasal high-flow oxygen therapy (HFNC) or noninvasive ventilation (NIV). In patients receiving HFNC or NIV, in the absence of contraindications, it is recommended to perform simultaneous prone ventilation, i.e., awake prone ventilation, and the time of prone treatment should be greater than 12 hours per day. Some patients have a high risk of failure with HFNC or NIV and require close observation of the patient's signs and symptoms. If there is no improvement in the condition after a short period of treatment (1 to 2 hours), especially after receiving prone position therapy, hypoxemia still does not improve, or the frequency of breathing, excessive tidal volume or inspiratory effort is too strong, etc., often indicates that HFNC or NIV therapy is not effective, and invasive mechanical ventilation should be carried out in time.

(3) Invasive mechanical ventilation

In general, PaO2/FiO2 is less than 150 mmHg, especially in patients with significantly increased inspiratory efforts, endotracheal intubation should be considered for invasive mechanical ventilation. However, in view of the atypical clinical manifestations of hypoxemia in severe and critically ill patients, the standard of PaO2/FiO2 should not be taken solely as an indication of endotracheal intubation and invasive mechanical ventilation, but should be evaluated in real time in combination with the patient's clinical manifestations and organ function. It is worth noting that delaying endotracheal intubation may cause more harm. Early and appropriate invasive mechanical ventilation is an important treatment for critically ill patients. Implement lung-protective mechanical ventilation strategies. Patients with moderate to severe acute respiratory distress syndrome, or with invasive mechanical ventilation FiO2 above 50%, can be treated with pulmonary brancasia, and depending on the responsiveness of pulmonary branysia, the decision is made whether to repeat the technique. It should be noted that some patients with novel coronavirus pneumonia have poor lung relapse, and excessive PEEP should be avoided to cause barotrauma.

(4) Airway management

To strengthen airway humidification, it is recommended to use active heating humidifier, conditionally use loop heating guide wire to ensure the humidification effect; it is recommended to use closed suction, if necessary, tracheoscopic suction; active airway clearance treatment, such as vibration and excretion, high-frequency thoracic oscillation, postural drainage, etc.; in the case of oxygenation and hemodynamic stability, carry out passive and active activities as soon as possible to promote sputum drainage and pulmonary rehabilitation.

(5) Extracorporeal membrane oxygenation (ECMO)

Timing of ECMO launch. Evaluation of ECMO should be considered as early as possible under optimal mechanical ventilation conditions (FiO2≥80%, tidal volume of 6 ml/kg ideal body weight, PEEP ≥5 cmH2O, and no contraindications), and poor protective ventilation and prone ventilation, and in one of the following:

PaO2/FiO2< 50mmHg for more than 3 hours;

PaO2/FiO2 < 80mmHg for more than 6 hours;

Arterial blood pH <7.25 and PaCO2>60 mmHg for more than 6 hours, and respiratory rate > 35 beats/min;

Respiratory rate > 35 bpm, arterial blood pH < 7.2 and platform pressure > 30 cmH2O. Critically ill patients who meet the ECMO indications and do not have contraindications should initiate ECMO therapy as early as possible to avoid delays and poor prognosis. ECMO mode selection. Venous-vein ECMO (VV-ECMO) is the most commonly used when respiratory support is required, venous-arterial ECMO (VA-ECMO) is used when respiratory and circulatory support is required, and venous-arterial-venous ECMO (VAV-ECMO) is used when va-ECMO has anemia in the cephalic and arm.

After the implementation of ECMO, the lung protective lung ventilation strategy is strictly implemented. Recommended initial settings: tidal volume < 4~6ml/kg ideal body weight, platform pressure ≤ 25cmH2O, drive pressure < 15cmH2O, PEEP5~15cmH2O, respiratory rate 4~10 beats/min, FiO2<50%. Patients with difficulty maintaining oxygenation or strong inspiratory efforts, significant consolidation in gravity-dependent areas of both lungs, or those requiring airway discharge should be aggressively ventilated in prone positions.

Children with weaker cardiopulmonary compensatory capacity than adults, more sensitive to hypoxia, require more aggressive oxygen therapy and ventilation support strategies than adults, and the indications should be relaxed as appropriate; routine use of pulmonary atelectasis is not recommended.

3. Circulatory support: critically ill patients can be combined with shock, on the basis of adequate fluid resuscitation, the rational use of vasoactive drugs, close monitoring of changes in blood pressure, heart rate and urine output, as well as lactate and alkali remaining. Hemodynamic monitoring if necessary.

4. Acute kidney injury and renal replacement therapy: critically ill patients can have acute kidney injury and should actively look for causes, such as hypoperfusion and drug factors. While actively correcting the cause, pay attention to maintaining the balance of water, electrolytes, and acid-base. Indications for continuous renal replacement therapy (CRRT) include hyperkalemia; severe acidosis; pulmonary edema or excessive water load in which diuretics are ineffective.

5. Children's multisystem inflammatory syndrome (MIS-C): the principle of treatment is multidisciplinary cooperation, early anti-inflammatory, correction of shock and coagulation dysfunction, organ function support, and if necessary anti-infection therapy. Intravenous gamma globulin (IVIG) of 2 g/kg is preferred in patients without shock, and intensive therapy such as methylprednisolone 1 to 2 mg/kg/day or tocilizumab is added when the condition does not improve; intravenous gamma globulin (IVIG) combined with methylprednisolone 1 to 2 mg/kg/day is preferred in patients with shock; and children with refractory severe disease are given a large dose of methylprednisolone shock (10 to 30 mg/kg/day) or immunotherapy such as tocilizumab.

6. Patients with severe or critical pregnancies: the risk of continuing pregnancy should be assessed multidisciplinaryly, and if necessary, pregnancy should be terminated, and caesarean section is preferred.

7. Nutritional support: Nutritional risk assessment should be strengthened, enteral nutrition should be preferred, and the calories should be 25 to 30 kcal/kg/day, and the protein > 1.2g/kg/day, and extraintestinal nutrition should be added if necessary. Intestinal microbiome modulators can be used to maintain the balance of the intestinal microecology and prevent secondary bacterial infections.

(9) Traditional Chinese medicine treatment.

This disease belongs to the category of "epidemic" diseases in traditional Chinese medicine, and the cause of the disease is to feel the atmosphere of "epidemic", and all localities can refer to the following schemes for dialectical treatment according to the condition, symptoms and climate. Hyperproteopoeia doses are involved and should be used under the guidance of a physician.

1. Period of medical observation

Clinical manifestations 1: fatigue with gastrointestinal discomfort Recommended proprietary Chinese medicine: Huoxiang Zhengqi capsules (pills, water, oral liquid) Clinical manifestations 2: Fatigue with fever Recommended Chinese proprietary medicines: Jinhua Qinggan granules, Lianhua Qingpeng capsules (granules), Wind And detoxification capsules (granules)

2. Clinical treatment period (confirmed case)

2.1 Lung detoxification soup, lung detoxification granules

Scope of application: Combined with the clinical observation of doctors in many places, it is suitable for mild, ordinary and severe patients, and can be used rationally in combination with the actual situation of patients in the treatment of critically ill patients.

Basic Formula: Ephedra 9g, Licorice Root 6g, Almond 9g, Raw Gypsum 15 30g (first fried), Guizhi 9g, Ze diarrhea 9g, Pig Lily 9g, Bai Shu 9g, Poria 15g,

Chai Hu 16g, Skullcap 6g, Ginger Banxia 9g, Ginger 9g, Aster 9g, Winter Flower 9g, Dried Shot 9g, Fine Spices 6g, Yam 12g, Citrus Aurantium 6g, Tangerine Peel 6g, Herbs 9g.

Directions: Traditional Chinese medicine tablets, decoction. Pay once a day, once in the morning and once in the evening (forty minutes after meals), take warmly, pay three for a course of treatment. If possible, half a bowl of rice soup can be added to each medication, and those who are deficient in dry tongue can take more than one bowl. (Note: If the patient does not have fever, the amount of raw plaster should be small, and the amount of raw gypsum can be increased for fever or strong heat). If the symptoms improve but do not heal, the second course of treatment is taken, if the patient has special circumstances or other underlying diseases, the second course of treatment can be modified according to the actual situation, and the symptoms disappear and the drug is discontinued.

Lung detoxification granules: boiled water, 2 bags at a time, 2 times a day. Course of treatment 3 to 6 days.

2.2 Lightweight

(1) Cold and wet depression lung evidence

Clinical manifestations: fever, fatigue, body aches, cough, sputum, chest tightness, sluggishness, nausea, vomiting, diarrhea or sticky stools. The tongue is pale and fat tooth marks or reddish, the moss is thick or rotten, and the veins are wet or slippery.

Recommended prescription: Cold and wet epidemic prescription

Basic Formula: Raw Ephedra 6g, Raw Gypsum 15g, Almond 9g, Qiang Huo 15g, Leaf Leaf 15g, Guanzhong 9g, Dilong 15g, Xu Changqing 15g, Huoxiang 15g, Peilan 9g, Cangshu 15g, Yunling 45g, Raw White Technique 30g, Jiao Sanxian 9g, Magnolia 15g, Jiao Betel Nut 9g, Simmered Grass Fruit 9g, Ginger 15g.

Directions: 1 dose per day, decoction 600ml, divided into 3 divided doses, 1 time in the morning, 1 time in the evening, before meals.

Cold and wet disease is also suitable for ordinary patients.

(2) Damp heat contains lung evidence

Clinical manifestations: low-grade fever or no fever, slight chills, fatigue, heavy head and body difficulties, muscle soreness, dry cough and less phlegm, sore throat, dry mouth and no desire to drink more, or accompanied by chest tightness, no sweating or poor sweating, or nausea, stool or stool stickiness. The tongue is reddish, the moss is thick or thin yellow, and the veins are slippery or wet.

Recommended prescription: Betel nut 10g, grass fruit 10g, Magnolia 10g, Zhimu 10g, skullcap 10g, Chai Hu 10g, red peony 10g, forsythia 15g, Artemisia annua 10g (posterior lower), Cangshu 10g, large green leaf 10g, raw licorice 5g.

Directions: 1 dose per day, decoction 400ml, take in 2 divided doses, 1 time in the morning and 1 time in the morning.

Recommended Proprietary Chinese Medicine: Jinhua Qinggan Granules, Lianhua Qingpeng Capsules (Granules) Jinhua Qinggan Granules Serving Method: Boiled water, 12 bags at a time, 3 times a day. The course of treatment is 5 to 7 days.

Lianhua Qing plague granules administration: oral. 1 bag at a time, 3 times a day. Course of treatment 7 to 10 days.

Lianhua Qing plague capsule administration: oral. Take 4 capsules at a time, 3 times a day.

Acupuncture treatment recommended acupuncture points: Hegu, Houxi, Yinling Spring, Taixi, Lung Yu, Spleen Yu. Acupuncture method: 3 acupuncture points are selected each time, and the acupuncture method is used to flatten the laxative method, and the qi is the degree, and the needle is left for 30 minutes, once a day.

2.3 Normal type

(1) Wet poison depressed lung evidence

Clinical manifestations: fever, cough with less sputum, or yellow sputum, shortness of breath, bloating, constipation. The tongue is dark red, the tongue is fat, the moss is yellow or yellow, and the pulse slip or string slip.

Recommended prescription: Xuan Lung Septic Poison Prescription

Basic Formula: Ephedra 6g, Fried Bitter Almond 15g, Raw Gypsum 30g, Coix Seed 30g, Bran Stir-fried Cangshu 10g, Patchouli 15g, Artemisia Annua 12g, Knotweed 20g, Verbena 30g, Reed Root 30g, Amaranth Root 15g, Tangerine Red 15g, Licorice Root 10g.

Recommended proprietary Chinese medicine: Xuan Lung Septic Granules

Directions: Take with boiling water, 1 sachet at a time, 2 times a day. Treatment course 7 14 days, or as directed by a physician.

(2) Cold and wet resistance lung evidence

Clinical manifestations: low-grade fever, body heat, or no heat, dry cough, less sputum, fatigue and fatigue, chest tightness, diarrhea, or vomiting, loose stools. The tongue is pale or reddish, mossy or white, and the veins are thick.

Recommended prescription: Cangshu 15g, Tangerine Peel 10g, Magnolia 10g, Herbs 10g, Grass Fruit 6g, Raw Ephedra 6g, Qiang Huo 10g, Ginger 10g, Betel Nut 10g.

(3) Evidence of epidemic poison clamping

Clinical manifestations: chills, fever, muscle aches, runny nose, dry cough, sore throat,

Itchy throat, dry mouth, dry throat, constipation, light tongue, less jin, thin white or dry moss, tight pulses.

Recommended prescription: Xuan Lung Moisturizing Detoxification Formula Basic Formula: Ephedra 6g, Almond 10g, Chai Hu 12g, Sand Ginseng 15g, Mai Dong 15g, Xuan Ginseng 15g, Bai Zhi 10g, Qiang Huo 15g, Cohosh 8g, Mulberry Leaf 15g, Skullcap 10g, Mulberry White Peel 15g, Raw Gypsum 20g.

Acupuncture treatment recommended acupuncture points: Neiguan, Kongzhi, Quchi, Qihai, Yinling Spring, Zhongyi. Acupuncture method: 3 acupuncture points are selected each time, and the acupuncture method is used to flatten the laxative method, and the qi is the degree, and the needle is left for 30 minutes, once a day.

2.4 Heavy duty

(1) Evidence of disease poison closure of the lungs

Clinical manifestations: fever and redness, cough, yellow and sticky sputum, or blood in sputum, wheezing and shortness of breath, fatigue and fatigue, dry and sticky mouth, nausea and inedible, poor stool, short urine. Red tongue, yellowish moss, pulse slip number.

Recommended prescription: Wet and septic poison prescription

Basic formula: raw ephedra 6g, almond 9g, raw gypsum 15g, licorice 3g, lettuce 10g (posterior bottom), Magnolia 10g, Cangshu 15g, grass fruit 10g, Fa banxia 9g, Poria 15g, raw rhubarb 5g (posterior lower), raw astragalus 10g, Amaranth 10g, red peony 10g.

Directions: 12 doses per day, decoction, 100 ml 200 ml each time, 2 times a day 4 times a day, oral or nasal feeding.

Recommended proprietary Chinese medicine: wet septic granules

Directions: Take with boiling water, 2 bags at a time, 2 times a day, or as directed by a doctor.

(2) Gas camp two burnt certificate

Clinical manifestations: fever and thirst, shortness of breath, dizziness, visual staggering, or macules, or vomiting blood, blood, or twitching of limbs. The tongue is less or less mossy, and the veins are finely counted, or floating and large.

Recommended prescription: raw plaster 30 60g (first fried), Zhimu 30g, raw land 30 60g, buffalo horn 30g (first fried), red peony 30g, Xuan Ginseng 30g, forsythia 15g, Danpi 15g, Huanglian 6g, bamboo leaf 12g, Amaranth seed 15g, raw licorice 6g.

Directions: 1 dose per day, decoction, first frying gypsum, buffalo horn and then under the medicine, 100ml 200ml each time, 2 4 times a day, oral or nasal feeding.

Recommended proprietary Chinese medicines: Xiyanping injection, Hebijing injection, hot poison ning injection, sputum hot qing injection, awakening brain jing injection. Drugs with similar efficacy can be selected depending on the individual situation, or they can be used in combination according to clinical symptoms. Chinese medicine injections can be used in combination with Herbal Decoctions.

Acupuncture treatment recommended acupuncture points: large vertebrae, lung Yu, spleen Yu, Taixi, Lieqi, Taichong. Acupuncture method: select 35 acupuncture points at a time, combine the dorsal Yu acupuncture points with the limb acupuncture points, acupuncture flattens the diarrhea, leave the needle for 30 minutes, once a day.

2.5 Critically ill

Internal closure and external deconstruction

Clinical manifestations: dyspnea, frequent wheezing or the need for mechanical ventilation, accompanied by dizziness, irritability, cold sweating limbs, purple and dark tongue, thick or dry moss, large and rootless pulses.

Recommended prescription: 15g of ginseng, 10g of black smooth tablets (fried first), 15g of dogwood, take Suhe xiang pill or Angong beef yellow pill. Mechanical ventilation with bloating and constipation or poor stools can be used to produce rhubarb 5 10 g. In the case of human-machine out-of-sync, in the case of sedation and muscle relaxant use, raw rhubarb 5 10 g and g of glauber can be used.

Recommended proprietary Chinese medicines: Hebijing injection, hot poisoning injection, sputum hot clear injection, awakening brain jing injection, Ginseng injection, Shengmai injection, Ginseng injection. Drugs with similar efficacy can be selected depending on the individual situation, or they can be used in combination according to clinical symptoms. Chinese medicine injections can be used in combination with Herbal Decoctions.

Note: Recommended use of severe and critically ill Chinese medicine injections

The use of traditional Chinese medicine injections follows the principle of starting from small doses and gradually dialectical adjustment in the drug instructions, and the recommended use is as follows: viral infection or combined mild bacterial infection: 0.9% sodium chloride injection 250 ml plus Xiyanping injection lOOmg, 2 times a day, or 0.9% sodium chloride injection 250 ml heated poisoning injection 20 ml, or 0.9% sodium chloride injection 250 ml plus sputum heat clear injection 40 ml, 2 times a day.

Hyperthermia with impaired consciousness: 0.9% sodium chloride injection 250 ml plus awake brain static injection 20 ml, 2 times a day. Systemic inflammatory response syndrome or / and multi-organ failure: 0.9% sodium chloride injection 250 ml plus hemopitin injection 100 ml, 2 times a day.

Immunomodulation: glucose injection 250 ml plus ginseng mai injection 100 ml or shengmai injection 20 60 ml, 2 times a day.

Acupuncture treatment recommended acupuncture points: Taixi, Zhongzhong, Guan yuan, Baihui, Zusanli, Suji. Acupuncture method: select the above acupuncture points, acupuncture flat to make up for diarrhea, leave the needle for 30 minutes, once a day.

2.6 Recovery period

(1) Lung temper deficiency evidence

Clinical manifestations: shortness of breath, fatigue and fatigue, nausea, fullness, weakness of stool, and loose stools. The tongue is light and fat, and the moss is white and greasy.

Recommended prescription: Fa Ban Xia 9g, Tangerine Peel 10g, Dang Ginseng 15g, Astragalus 30g, Stir-fried White Technique 10g, Poria 15g, Herbs 10g, Sand Kernel 6g (posterior bottom), Licorice 6g.

(2) Qi and yin are both false evidence

Clinical manifestations: fatigue, shortness of breath, dry mouth, thirst, palpitations, sweating, poor tolerance, low or no fever, dry cough and less sputum. Dry tongue, thin veins or nihilistic.

Recommended prescription: 10g of northern and southern sand ginseng, 15g of wheat dong, 6g of American ginseng, 6g of schisandra, 15g of raw gypsum, 10g of light bamboo leaves, 10g of mulberry leaves, 15g of reed root, 15g of salvia, 6g of raw licorice.

Acupuncture treatment recommended acupuncture points: Zusanli (moxibustion), Baihui, Taixi. Acupuncture method: select the above acupuncture points, acupuncture flat to make up for diarrhea, leave the needle for 30 minutes, once a day. Septum moxibustion acupuncture points: large vertebrae, lung Yu, spleen Yu, holes, each patch for 40 minutes, once a day.

3. Traditional Chinese medicine treatment for children

The characteristics and core pathogenesis of TCM symptoms of pediatric patients are basically the same as those of adults, and the treatment refers to the treatment plan of adult TCM, combined with the clinical symptoms of pediatric patients and the physiological characteristics of children, and use them dialectically and appropriately. Children can choose to use proprietary Chinese medicine for dialectical use.

(10) Early rehabilitation.

Attach importance to early rehabilitation intervention of patients, actively carry out rehabilitation training and intervention for respiratory function, somatic function and psychological disorders of patients with new coronavirus pneumonia, and restore physical fitness, physique and immune ability as much as possible.

12. Nursing

According to the patient's condition, clarify the focus of nursing and do a good job of basic nursing. Patients with severe illness closely observe the patient's vital signs and state of consciousness, with a focus on monitoring blood oxygen saturation. Critically ill patients have 24-hour continuous ECG monitoring, measuring the patient's heart rate, respiratory rate, blood pressure, and blood oxygen saturation (SpO2) every hour, and measuring and recording body temperature every 4 hours. Rational and correct use of intravenous access, and keep all kinds of pipelines unobstructed and properly fixed. Bedridden patients change position regularly to prevent stressful injuries. According to the nursing norms, do a good job of non-invasive mechanical ventilation, invasive mechanical ventilation, artificial airway, prone ventilation, sedative analgesia, ECMO treatment. Special attention is paid to patient oral care and fluid intake management, and invasive mechanical ventilation prevents aspiration in patients. Sober patients timely assess psychological conditions and do a good job of psychological care.

13. Management of release from isolation, discharge criteria and management of release from isolation, precautions after discharge

(1) Management standards for lifting isolation.

In mild cases, the nucleic acid detection N gene and ORF gene Ct values of the novel coronavirus nucleic acid were ≥35 (fluorescence quantitative PCR method, the limit value is 40, the sampling time interval is at least 24 hours), or two consecutive negative nucleic acid tests for the new coronavirus (fluorescence quantitative PCR method, the limit value is less than 35, the sampling time interval is at least 24 hours), and the isolation management can be lifted.

(2) Discharge criteria.

1. The body temperature returns to normal for more than 3 days;

2. Respiratory symptoms improved significantly;

3. Lung imaging shows significant improvement in acute exudative lesions;

4. Two consecutive nucleic acid detection N gene and ORF gene Ct values of the novel coronavirus are ≥35 (fluorescence quantitative PCR method, the limit value is 40, the sampling time interval is at least 24 hours), or two consecutive negative nucleic acid tests for the new coronavirus (fluorescence quantitative PCR method, the limit value is less than 35, and the sampling time is at least 24 hours apart). Those who meet the above conditions can be discharged from the hospital.

(3) Matters needing attention after lifting isolation management and discharging from hospital.

Continue home health monitoring for 7 days after lifting isolation management or discharge from the hospital, wear a mask, conditionally live in a well-ventilated single room, reduce close contact with family members, eat and drink separately, do a good job of hand hygiene, and avoid outing activities.

14. The principle of transshipment

It is implemented in accordance with the "Work Plan for the Transport of Persons Infected with novel Coronavirus (Second Edition)" issued by the Medical Treatment Group of the Joint Prevention and Control Mechanism of the State Council in Response to the Novel Coronavirus Pneumonia Epidemic.

15. Infection prevention and control in medical institutions

Strictly in accordance with the requirements of the "Technical Guidelines for the Prevention and Control of Novel Coronavirus Infection in Medical Institutions (Third Edition)" issued by the National Health Commission.

16. Prevention

(1) Vaccination against novel coronavirus.

Vaccination against the novel coronavirus can reduce the infection and incidence of the new coronavirus, is an effective means to reduce the incidence of severe illness and death, and those who meet the conditions for vaccination should be vaccinated. Vaccinators who meet the conditions for enhanced immunization should be immunized in a timely manner.

(2) General preventive measures.

Maintain good personal and environmental hygiene, balanced nutrition, moderate exercise, adequate rest, and avoid excessive fatigue. Improve health literacy, develop "one meter line", wash hands frequently, wear masks, public chopsticks and other hygiene habits and lifestyles, and cover your mouth and nose when sneezing or coughing. Keep the indoor ventilation good, do a good job of personal protection scientifically, and go to the fever clinic in time when respiratory symptoms occur. Those who have recently been to high-risk areas or have a history of contact with people infected with the new coronavirus should take the initiative to conduct nucleic acid testing for the new coronavirus.

END

The 2022 National Hospital Operation Conference is coming!

From "large-scale construction" to "fine operation", how to establish a modern hospital management system? How to achieve refined, high-quality and leapfrog development of medical institutions through benign operation? How to build a market-recognized brand ?.... On May 28-29, the 2022 National Hospital Operation Conference sponsored by the 2022 Shanghai Medical Fair Expert Committee, the Institute of Social Medical Institutions of Shanghai Jiaotong University, and the medical media will be held in Shanghai.