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

      research-article
      1 , 2 , 3 , 4 , 5 , 6 , 7 , 4 , 8 , 4 , 9 , 10 , 11 , 4 , 12 , 13 , 14 , 4 , 15 , 4 , 16 , 17 , 16 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 16 , 32 , 10 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 1 , 1 , 6 , 40 , 1 , 41 , 1 , 6 , 6 , 42 , 1 , 1 , 21 , 1 , 6 , 1 , 1 , 40 , 1 , 6 , 42 , 1 , 1 , 1 , 1 , 1 , 1 , 43 , 1 , 6 , 1 , 4 , , 44 , , 4 , 45 , , 46 , , 1 , 4 , 40 , , Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM), Chinese Research Hospital Association (CRHA)
      Military Medical Research
      BioMed Central
      COVID-19, SARS-CoV-2, Recommendation, Chemoprophylaxis, Diagnosis, Treatment, Discharge management, Traditional Chinese medicine; guideline

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          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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          Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis

          Highlights • COVID -19 cases are now confirmed in multiple countries. • Assessed the prevalence of comorbidities in infected patients. • Comorbidities are risk factors for severe compared with non-severe patients. • Help the health sector guide vulnerable populations and assess the risk of deterioration.
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            A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)

            In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named “2019 novel coronavirus (2019-nCoV)” by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
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              Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial

              Summary Background Effective antiviral therapy is important for tackling the coronavirus disease 2019 (COVID-19) pandemic. We assessed the efficacy and safety of combined interferon beta-1b, lopinavir–ritonavir, and ribavirin for treating patients with COVID-19. Methods This was a multicentre, prospective, open-label, randomised, phase 2 trial in adults with COVID-19 who were admitted to six hospitals in Hong Kong. Patients were randomly assigned (2:1) to a 14-day combination of lopinavir 400 mg and ritonavir 100 mg every 12 h, ribavirin 400 mg every 12 h, and three doses of 8 million international units of interferon beta-1b on alternate days (combination group) or to 14 days of lopinavir 400 mg and ritonavir 100 mg every 12 h (control group). The primary endpoint was the time to providing a nasopharyngeal swab negative for severe acute respiratory syndrome coronavirus 2 RT-PCR, and was done in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT04276688. Findings Between Feb 10 and March 20, 2020, 127 patients were recruited; 86 were randomly assigned to the combination group and 41 were assigned to the control group. The median number of days from symptom onset to start of study treatment was 5 days (IQR 3–7). The combination group had a significantly shorter median time from start of study treatment to negative nasopharyngeal swab (7 days [IQR 5–11]) than the control group (12 days [8–15]; hazard ratio 4·37 [95% CI 1·86–10·24], p=0·0010). Adverse events included self-limited nausea and diarrhoea with no difference between the two groups. One patient in the control group discontinued lopinavir–ritonavir because of biochemical hepatitis. No patients died during the study. Interpretation Early triple antiviral therapy was safe and superior to lopinavir–ritonavir alone in alleviating symptoms and shortening the duration of viral shedding and hospital stay in patients with mild to moderate COVID-19. Future clinical study of a double antiviral therapy with interferon beta-1b as a backbone is warranted. Funding The Shaw-Foundation, Richard and Carol Yu, May Tam Mak Mei Yin, and Sanming Project of Medicine.
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                Author and article information

                Contributors
                zengxiantao1128@163.com
                lihongjun00113@126.com
                chzs1990@163.com
                yaoxia@mcmaster.ca
                wangxinghuan1965@163.com
                Journal
                Mil Med Res
                Mil Med Res
                Military Medical Research
                BioMed Central (London )
                2095-7467
                2054-9369
                4 September 2020
                4 September 2020
                2020
                : 7
                : 41
                Affiliations
                [1 ]GRID grid.413247.7, Center for Evidence-Based and Translational Medicine, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [2 ]GRID grid.415954.8, ISNI 0000 0004 1771 3349, National Clinical Research Center for Respiratory Diseases, , China-Japan Friendship Hospital, ; Beijing, 100029 China
                [3 ]GRID grid.415954.8, ISNI 0000 0004 1771 3349, Department of Pulmonary and Critical Care Medicine, , China-Japan Friendship Hospital, ; Beijing, 10029 China
                [4 ]Leishenshan Hospital in Wuhan, Wuhan, 430200 China
                [5 ]GRID grid.413247.7, Department of Critical Care Medicine, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [6 ]GRID grid.256922.8, ISNI 0000 0000 9139 560X, Institutes of Evidence-based Medicine and Knowledge Translation, , Henan University, ; Kaifeng, 475000 Henan China
                [7 ]GRID grid.459540.9, ISNI 0000 0004 1791 4503, Department of Medical Imaging, , Guizhou Provincial People’s Hospital, ; Guiyang, 550002 China
                [8 ]GRID grid.413247.7, Departments of Orthopedics, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [9 ]GRID grid.413247.7, Department of Hepatobiliary Surgery, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [10 ]GRID grid.412901.f, ISNI 0000 0004 1770 1022, National Clinical Research Center for Geriatrics, , West China Hospital of Sichuan University, ; Chengdu, 610041 China
                [11 ]GRID grid.412901.f, ISNI 0000 0004 1770 1022, Department of Geriatrics, , West China Hospital of Sichuan University, ; Chengdu, 610041 China
                [12 ]GRID grid.413247.7, Department of Radiology, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [13 ]GRID grid.413106.1, ISNI 0000 0000 9889 6335, Department of Clinical Laboratory, , Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), ; Beijing, 100730 China
                [14 ]GRID grid.4514.4, ISNI 0000 0001 0930 2361, Center for Primary Health Care Research, , Lund University and Region Skåne, ; 25002 Malmö, Sweden
                [15 ]GRID grid.413247.7, Emergency Center, , Zhongnan Hospital of Wuhan University, ; Wuhan, 403371 China
                [16 ]GRID grid.413247.7, Department of Allergology, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [17 ]GRID grid.413247.7, Department of Radiation and Medical Oncology, , Zhongnan Hospital of Wuhan University, ; Wuhan, 43071 China
                [18 ]GRID grid.412632.0, ISNI 0000 0004 1758 2270, Department of Critical Care Medicine, , Renmin Hospital of Wuhan University, ; Wuhan, 430060 China
                [19 ]GRID grid.452402.5, Department of Emergency Medicine and Chest Pain Center, , Qilu Hospital of Shandong University, ; Jinan, 250002 China
                [20 ]GRID grid.440226.6, Department of Respiratory and Critical Care Medicine, , Suizhou Central Hospital, Hubei University of Medicine, ; Suizhou, 441300 Hubei China
                [21 ]Department of Clinic Pharmacy, Second People’s Hospital of Huaihua City, Huaihua, 418000 Hunan China
                [22 ]GRID grid.452696.a, Department of Intensive Care Unit, , The Second Affiliated Hospital of Anhui Medical University, ; Hefei, 230601 China
                [23 ]GRID grid.207374.5, ISNI 0000 0001 2189 3846, Department of Internal Medicine, , Zhengzhou University Hospital, ; Zhengzhou, 450001 China
                [24 ]GRID grid.414011.1, Department of Respiratory and Critical Care Medicine, , Henan Provincial People’s Hospital, ; Zhengzhou, 450003 China
                [25 ]GRID grid.411333.7, ISNI 0000 0004 0407 2968, Department of Infectious Diseases, , Children’s Hospital of Fudan University, ; Shanghai, 201102 China
                [26 ]GRID grid.412901.f, ISNI 0000 0004 1770 1022, Department of Infectious Disease, , West China Second Hospital, Sichuan University, ; Chengdu, 610041 China
                [27 ]Department of Cardiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000 China
                [28 ]GRID grid.254148.e, ISNI 0000 0001 0033 6389, Department of Cardiology, , Yichang NO.1 Hospital, Renmin Hospital of China Three Gorges University, ; Yichang, 443000 Hubei China
                [29 ]GRID grid.413247.7, Department of Pediatrics, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [30 ]GRID grid.412793.a, ISNI 0000 0004 1799 5032, Department of Pharmacy, , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, ; Wuhan, 430030 China
                [31 ]GRID grid.460018.b, ISNI 0000 0004 1769 9639, Department of Pharmacy, , Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, ; Jinan, 250021 China
                [32 ]GRID grid.410745.3, ISNI 0000 0004 1765 1045, Laboratory of Integrated Acupuncture and Drugs, , Nanjing University of Chinese Medicine, ; Nanjing, 210023 China
                [33 ]GRID grid.412901.f, ISNI 0000 0004 1770 1022, Department of Periodical Press, , West China Hospital, Sichuan University, ; Chengdu, 610041 China
                [34 ]GRID grid.440323.2, Department of Clinical Laboratory, , Yantai Yuhuangding Hospital, Qingdao University, ; Yantai, 264000 Shandong China
                [35 ]GRID grid.443573.2, ISNI 0000 0004 1799 2448, Department of Radiology, Taihe Hospital, , Hubei University of Medicine, ; Shiyan, 442000 Hubei China
                [36 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, School of Nursing, , Peking University, ; Beijing, 100191 China
                [37 ]Department of Respiratory and Critical Care Medicine, Kaifeng Central Hospital, Kaifeng, 475000 Henan China
                [38 ]GRID grid.433158.8, ISNI 0000 0000 8891 7315, Department of Emergency, , Beijing Electric Power Hospital, ; Beijing, 100073 China
                [39 ]GRID grid.216417.7, ISNI 0000 0001 0379 7164, ICU Center, The Second Xiangya Hospital, , Central South University, ; Changsha, 410008 China
                [40 ]GRID grid.413247.7, Department of Urology, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [41 ]GRID grid.413247.7, Department of Haematology, , Zhongnan Hospital, Wuhan University, ; Wuhan, 430071 China
                [42 ]GRID grid.256922.8, ISNI 0000 0000 9139 560X, College of Nursing and Health, Henan Medical School, , Henan University, ; Kaifeng, 475000 Henan China
                [43 ]GRID grid.263452.4, ISNI 0000 0004 1798 4018, School of Nursing, , Shanxi Medical University, ; Taiyuan, 030001 China
                [44 ]GRID grid.24696.3f, ISNI 0000 0004 0369 153X, Department of Diagnostic Radiology, , Beijing You’an Hospital, Capital Medical University, ; Beijing, 100069 China
                [45 ]GRID grid.413247.7, Department of Respiratory Medicine, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [46 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Health Research Methods, Evidence, and Impact, , McMaster University, ; Hamilton, Ontario L8S 4L8 Canada
                Author information
                http://orcid.org/0000-0003-1262-725X
                Article
                270
                10.1186/s40779-020-00270-8
                7472403
                32887670
                44566d1b-cbdd-4faa-8be2-a5e33ff3c009
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 18 August 2020
                : 25 August 2020
                Categories
                Position article and Guidelines
                Custom metadata
                © The Author(s) 2020

                covid-19,sars-cov-2,recommendation,chemoprophylaxis,diagnosis,treatment,discharge management,traditional chinese medicine; guideline

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