Translation: Management of Coronavirus Disease 2019 (COVID-19): Experience in Zhejiang Province, China

Abstract

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remains severe. As the National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital of the Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang Province. Based on the present expert consensus carried out by the National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on “Four-Anti and Two-Balance” for clinical practice. The “Four-Anti and Two-Balance” strategy includes antivirus, anti-shock, anti-hypoxemia, and anti-secondary infection, and maintaining of water, electrolyte and acid/base balance and microecological balance. Simultaneously, an integrated multidisciplinary personalized treatment is recommended to improve therapeutic effects. The importance of early viral detection, dynamic monitoring of inflammatory indexes, and chest radiographs has been emphasized in clinical decision-making. Sputum was observed with the highest positive rate by reverse transcription-polymerase chain reaction (RT-PRC). Viral nucleic acids could be detected in 10% of the patients’ blood samples at the acute phase and 50% of patients had positive RT-PCR results in their feces. We also isolated live viral strains from feces, indicating potential infectiousness of feces. Dynamic cytokine detection was necessary to timely identify cytokine storms and for the application of the artificial liver blood purification system. The “Four-Anti and Two-Balance” strategy effectively increased cure rates and reduced mortality. Early antiviral treatment alleviated disease severity and prevented illness progression. We found that lopinavir/ritonavir combined with abidol showed antiviral effects against COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system was able to rapidly remove inflammatory mediators and block the cytokine storm. Moreover, it also contributed to the balance of fluids, electrolytes, and acids/bases and thus improved treatment efficacy during critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid administration was supported. Patients with an oxygenation index below 200 mm Hg were transferred to the intensive care unit. Conservative oxygen therapy was preferred and noninvasive ventilation (NIV) was not recommended. Patients with mechanical ventilation were strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was prescribed rationally and was not recommended, except for patients with a long course of disease, repeated fever, and elevated procalcitonin, similarly secondary fungal infections were of concern. Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased genus such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should; therefore, be assessed for all patients. Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infections due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established a dynamic assessment and warning for psychological crises. We also integrated Chinese medicine in the treatment to promote rehabilitation. We optimized nursing processes for severe patients to promote their rehabilitation. Since viral clearance patterns after severe acute respiratory syndrome coronavirus 2 infections remained unclear, 2 weeks quarantine for discharged patients was required, and a regular following-up was also needed. These Zhejiang experiences and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work is warranted to further improve strategies of prevention, diagnosis, and treatment for COVID-19.

Assessment of Community Psycho-behavioral Responses during the outbreak of novel coronavirus (2019-nCoV): A cross sectional study

“…Moreover, 16.5%, 28.8%, and 8.1% of the respondents reported moderate to severe levels of depression, anxiety, and stress [11]. Also, Xu et al demonstrated that anxiety and fear were very prevalent among patients with (2019-nCoV) [12]. In another cross sectional study, Al-Rabiaah et al studied the impacts of the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic on medical students' perception and found that all of these students experienced stress [13].…”

“…Response options were "not at all," "several days," "more than half the days," and "nearly every day," scored as 0, 1, 2, and 3, respectively. The total anxiety score was divided into (0-4) = minimal anxiety, (5-9) = mild anxiety, (10)(11)(12)(13)(14) = moderate anxiety, and > 14 = severe anxiety). The scale had an Alpha reliability coefficient of 0.824.…”

Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China

“…Due to the serious adverse effects of glucocorticoids experienced by patients with SARS-CoV infections [28,29], it is questionable whether glucocorticoids should be used to treat patients with SARS-CoV-2 infections [30,31]. Our results showed that patients who received glucocorticoids had greater improvements of chest CT score and LY count.…”

Analysis on Diagnosis of Family Clustering Infection of SARS-CoV-2

“…Besides, the in vivo study of rhesus animal model also proved the prognosis improvement of combination of IFN and ribavirin [7,8]. Loutfy et al [9] compared clinical effects of IFN α combined with glucocorticoid and independent use of glucocorticoid in treatment of SARS-CoV infection. They pointed out that the IFN α combined with glucocorticoid could shorten relieving time of lung image by 50% (P = 0 .001) and improve oxygen saturation significantly (P = 0.02).…”

“…Currently, infected patients are viewed as the source of SARS-CoV-2 and asymptomatic patients might carry the virus [9]. Short-distance respiratory spraying and direct or indirect contact are major spreading ways of SARS-CoV-2, such as mouth, nose and eye mucous membrane infection with hands.…”