8 Treatment

The treatments include isolation, symptomatic support, and close monitoring of condition changes, especially breathing rate and finger pulse oxygen saturation.

Every suspected case should be treated in single room, while confirmed cases can be admitted to the same ward.

Critical cases should be admitted to the ICU as soon as possible.

Antibiotics use: blind or inappropriate use of antibiotics should be avoided, especially in combination with broad-spectrum antibiotics.

Antiviral treatment: this edition adds the description of “no effective antiviral treatment is currently confirmed”. Based on trying drugs of alphainterferon aerosol inhalation and lopinavir/ritonavir, “or add ribavirin” is supplemented. After full discussion by the National COVID-19 Medical Treatment Expert Group, the dosage of ribavirin has been adjusted to 500 mg each time for adults with 2 to 3 times of intravenous infusions per day, considering the safety of its high-dose. At the same time, pay attention to lopinavir/ritonavir associated side effects, such as diarrhea, nausea,vomiting, liver damage, and the interactions with other drugs.

The key to reduce case fatality rate is successful treatment of severe and critical cases. Prevent and cure complications actively, treat basic diseases,prevent secondary infections, and provide timely organ function supports.Patients always feel anxious and frightened, psychological counseling should be strengthened.

On monitoring of disease, “cytokine detection is feasible for those people who have condition” has been supplemented.

Respiratory support:(1)Oxygen therapy: severe patients should be provided inhalation oxygen with facemask or nasal catheter, and timely assess whether respiratory distress and/or hypoxemia are relieved.(2)  High-flow nasal catheter oxygen therapy or non-invasive mechanical ventilation: when respiratory distress and/or hypoxemia cannot be relieved after standard oxygen therapy, high-flow nasal catheter oxygen therapy or noninvasive ventilation should be considered. It is highlighted that “if the condition does not improve or even worsen within a short time(1–2 hours),endotracheal intubation and invasive mechanical ventilation should be performed promptly”.(3)Invasive mechanical ventilation: lung protective ventilation strategies should be used, which means small tidal volume(4–8 ml/kg ideal weight)and low inspiratory pressure(platform pressure <30 cmH2O)for mechanical ventilation to reduce ventilator-related lungs injuries.(4)For patients with severe ARDS, it is recommended to perform lung expansion.If possible, prone position ventilation should be performed for more than 12 hours per day. For those with poor prone position ventilation, extracorporeal membrane oxygenation(ECMO)should be considered as soon as possible if conditions permit.

Circulation support: on the basis of adequate fluid resuscitation,improve microcirculation, use vasoactive drugs, and perform hemodynamic monitoring when necessary.

Other treatment measures: Glucocorticoids can be used in a short period of time(3–5 days)according to the severity of respiratory distress and the progress of chest imaging. The recommended dose of methylprednisolone should not exceed 1–2 mg/kg/day. It should be noted that higher doses of glucocorticoids would delay coronavirus clearance due to immunosuppressive effects. Xuebijing Injection(a traditional Chinese medicine)can be given intravenously 100 mL/day, twice a day for treatment. Microecological preparation can be used to keep the equilibrium for intestinal microecology and prevent secondary bacterial infection.Convalescent plasma therapy can be used. For critically ill patients with high inflammatory response, extracorporeal blood purification technology can be considered when conditions permit.

Chinese medicine treatment measures: COVID-19 belongs to the category of traditional Chinese medicine epidemic disease. It is caused by the epidemic pathogenic factors, and is located in the lung. The basic pathogenesis of COVID-19 is characterized by dampness, heat, poison,and silt. Different regions can refer to the following schemes for dialectical treatment according to the disease condition, local climate characteristics,and different physical conditions.