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Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version)

Authors
  • Jin, Ying-Hui1
  • Zhan, Qing-Yuan2, 3
  • Peng, Zhi-Yong4, 1
  • Ren, Xue-Qun5
  • Yin, Xun-Tao6
  • Cai, Lin4, 1
  • Yuan, Yu-Feng4, 1
  • Yue, Ji-Rong7, 7
  • Zhang, Xiao-Chun4, 1
  • Yang, Qi-Wen8
  • Ji, Jianguang9
  • Xia, Jian4, 10
  • Li, Yi-Rong4, 1
  • Zhou, Fu-Xiang11
  • Gao, Ya-Dong1
  • Yu, Zhui12
  • Xu, Feng13
  • Tu, Ming-Li14
  • Tan, Li-Ming15
  • Yang, Min16
  • And 41 more
  • 1 Zhongnan Hospital of Wuhan University, Wuhan, 430071, China , Wuhan (China)
  • 2 China-Japan Friendship Hospital, Beijing, 100029, China , Beijing (China)
  • 3 China-Japan Friendship Hospital, Beijing, 10029, China , Beijing (China)
  • 4 Leishenshan Hospital in Wuhan, Wuhan, 430200, China , Wuhan (China)
  • 5 Henan University, Kaifeng, Henan, 475000, China , Kaifeng (China)
  • 6 Guizhou Provincial People’s Hospital, Guiyang, 550002, China , Guiyang (China)
  • 7 West China Hospital of Sichuan University, Chengdu, 610041, China , Chengdu (China)
  • 8 Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, 100730, China , Beijing (China)
  • 9 Lund University and Region Skåne, Malmö, 25002, Sweden , Malmö (Sweden)
  • 10 Zhongnan Hospital of Wuhan University, Wuhan, 403371, China , Wuhan (China)
  • 11 Zhongnan Hospital of Wuhan University, Wuhan, 43071, China , Wuhan (China)
  • 12 Renmin Hospital of Wuhan University, Wuhan, 430060, China , Wuhan (China)
  • 13 Qilu Hospital of Shandong University, Jinan, 250002, China , Jinan (China)
  • 14 Suizhou Central Hospital, Hubei University of Medicine, Suizhou, Hubei, 441300, China , Suizhou (China)
  • 15 Second People’s Hospital of Huaihua City, Huaihua, Hunan, 418000, China , Huaihua (China)
  • 16 The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China , Hefei (China)
  • 17 Zhengzhou University Hospital, Zhengzhou, 450001, China , Zhengzhou (China)
  • 18 Henan Provincial People’s Hospital, Zhengzhou, 450003, China , Zhengzhou (China)
  • 19 Children’s Hospital of Fudan University, Shanghai, 201102, China , Shanghai (China)
  • 20 West China Second Hospital, Sichuan University, Chengdu, 610041, China , Chengdu (China)
  • 21 The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China , Zhengzhou (China)
  • 22 Yichang NO.1 Hospital, Renmin Hospital of China Three Gorges University, Yichang, Hubei, 443000, China , Yichang (China)
  • 23 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China , Wuhan (China)
  • 24 Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, China , Jinan (China)
  • 25 Nanjing University of Chinese Medicine, Nanjing, 210023, China , Nanjing (China)
  • 26 West China Hospital, Sichuan University, Chengdu, 610041, China , Chengdu (China)
  • 27 Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, China , Yantai (China)
  • 28 Hubei University of Medicine, Shiyan, Hubei, 442000, China , Shiyan (China)
  • 29 Peking University, Beijing, 100191, China , Beijing (China)
  • 30 Kaifeng Central Hospital, Kaifeng, Henan, 475000, China , Kaifeng (China)
  • 31 Beijing Electric Power Hospital, Beijing, 100073, China , Beijing (China)
  • 32 Central South University, Changsha, 410008, China , Changsha (China)
  • 33 Zhongnan Hospital, Wuhan University, Wuhan, 430071, China , Wuhan (China)
  • 34 Shanxi Medical University, Taiyuan, 030001, China , Taiyuan (China)
  • 35 Beijing You’an Hospital, Capital Medical University, Beijing, 100069, China , Beijing (China)
  • 36 McMaster University, Hamilton, Ontario, L8S 4L8, Canada , Hamilton (Canada)
Type
Published Article
Journal
Military Medical Research
Publisher
Springer Nature
Publication Date
Sep 04, 2020
Volume
7
Issue
1
Identifiers
DOI: 10.1186/s40779-020-00270-8
Source
Springer Nature
Keywords
License
Green

Abstract

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued “A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)”; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

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