PROTOCOLS IN THE U.S VS CHINA

 

U.S

Identifying High Risk Patients:

Epidemiological (Category 1)

  1. Over 55 years old 

  2. Pre-existing pulmonary diseases  

  3. History of hypertension, cardiovascular disease, transplant, immunosuppression

  4. Chronic kidney disease

  5. HIV

Vital Signs (Category 2)

  1. Respiratory rate over 24 beats per min

  2. Heart rate over 125 beats per min

Suggested Treatments:

All patients in hospital

  1. Prescription of statins continues (might help promote antiviral innate immune response)

Patients with no risk factors

  1. Supportive care

Patients with risk factors

  1. Supportive care

  2. Frequent and close monitoring

  3. Possible application of remdesivir (RMV), a novel antiviral drug

Patients with moderate/severe disease

  1. Application of RMV

  2. Consider hydroxychloroquine

CHINA

Fever Clinic Setup:

  • Independent fever clinic

  • Movement of people in 3 zones: contaminated zone, a potentially contaminated zone and a clean zone

  • a pre-examination area for preliminary screening of patients

Protective Equipment:

Level 1: surgical cap (disposable), surgical mask (disposable), uniform, latex gloves (disposable)

Level 2: surgical cap (disposable), N95 surgical mask, uniform, disposable medical uniform, latex gloves (disposable), goggles

Level 3: surgical cap (disposable), N95 surgical mask, uniform, disposable medical uniform, latex gloves (disposable), full face protective gear

Diagnosis Techniques:

  1. Detection of SARS-CoV-2 nucleic acid

  2. Virus isolation and culture

  3. Detection of serum antibody

  4. Thoracic imaging

Patient Classifications:

Mild Cases: no symptoms, no signs of pneumonia

Moderate Cases: fever and pneumonia symptoms, sign of pneumonia on imaging

Severe cases: respiratory rate (equal or more than 30 breaths per min), oxygen saturation (equal or less than 93%)

Critical cases: respiratory failure, shock, organ failure

Treatment:

Antiviral treatment:

  • Basic: lopinavir/ritonavir with arbidol

  • If basic is not effective: chloroquine phosphate

Antishock/anti hypoxemia treatment:

  • Glucocorticoids if necessary

  • Artificial liver treatment (suppression of cytokine cascade)

  • Oxygen therapy for hypoxemia