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Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version).
Mil Med Res. 2020 09 04; 7(1):41.MM

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.

Authors+Show Affiliations

Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China. Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 10029, China.Leishenshan Hospital in Wuhan, Wuhan, 430200, China. Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China.Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, 550002, China.Leishenshan Hospital in Wuhan, Wuhan, 430200, China. Departments of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Leishenshan Hospital in Wuhan, Wuhan, 430200, China. Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China. Department of Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China.Leishenshan Hospital in Wuhan, Wuhan, 430200, China. Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Department of Clinical Laboratory, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, 100730, China.Center for Primary Health Care Research, Lund University and Region Skåne, 25002, Malmö, Sweden.Leishenshan Hospital in Wuhan, Wuhan, 430200, China. Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 403371, China.Leishenshan Hospital in Wuhan, Wuhan, 430200, China. Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, 43071, China.Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China.Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, 250002, China.Department of Respiratory and Critical Care Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, 441300, Hubei, China.Department of Clinic Pharmacy, Second People's Hospital of Huaihua City, Huaihua, 418000, Hunan, China.Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.Department of Internal Medicine, Zhengzhou University Hospital, Zhengzhou, 450001, China.Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, 450003, China.Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, 201102, China.Department of Infectious Disease, West China Second Hospital, Sichuan University, Chengdu, 610041, China.Department of Cardiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China.Department of Cardiology, Yichang NO.1 Hospital, Renmin Hospital of China Three Gorges University, Yichang, 443000, Hubei, China.Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pharmacy, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, China.Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Laboratory of Integrated Acupuncture and Drugs, Nanjing University of Chinese Medicine, Nanjing, 210023, China.National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China. Department of Periodical Press, West China Hospital, Sichuan University, Chengdu, 610041, China.Department of Clinical Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, Shandong, China.Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China.School of Nursing, Peking University, Beijing, 100191, China.Department of Respiratory and Critical Care Medicine, Kaifeng Central Hospital, Kaifeng, 475000, Henan, China.Department of Emergency, Beijing Electric Power Hospital, Beijing, 100073, China.ICU Center, The Second Xiangya Hospital, Central South University, Changsha, 410008, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China. Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Department of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China.Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China. College of Nursing and Health, Henan Medical School, Henan University, Kaifeng, 475000, Henan, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Department of Clinic Pharmacy, Second People's Hospital of Huaihua City, Huaihua, 418000, Hunan, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China. College of Nursing and Health, Henan Medical School, Henan University, Kaifeng, 475000, Henan, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. School of Nursing, Shanxi Medical University, Taiyuan, 030001, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. zengxiantao1128@163.com. Leishenshan Hospital in Wuhan, Wuhan, 430200, China. zengxiantao1128@163.com.Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China. lihongjun00113@126.com.Leishenshan Hospital in Wuhan, Wuhan, 430200, China. chzs1990@163.com. Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. chzs1990@163.com.Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada. yaoxia@mcmaster.ca.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. wangxinghuan1965@163.com. Leishenshan Hospital in Wuhan, Wuhan, 430200, China. wangxinghuan1965@163.com. Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. wangxinghuan1965@163.com.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

32887670

Citation

Jin, Ying-Hui, et al. "Chemoprophylaxis, Diagnosis, Treatments, and Discharge Management of COVID-19: an Evidence-based Clinical Practice Guideline (updated Version)." Military Medical Research, vol. 7, no. 1, 2020, p. 41.
Jin YH, Zhan QY, Peng ZY, et al. Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version). Mil Med Res. 2020;7(1):41.
Jin, Y. H., Zhan, Q. Y., Peng, Z. Y., Ren, X. Q., Yin, X. T., Cai, L., Yuan, Y. F., Yue, J. R., Zhang, X. C., Yang, Q. W., Ji, J., Xia, J., Li, Y. R., Zhou, F. X., Gao, Y. D., Yu, Z., Xu, F., Tu, M. L., Tan, L. M., ... Wang, X. H. (2020). Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version). Military Medical Research, 7(1), 41. https://doi.org/10.1186/s40779-020-00270-8
Jin YH, et al. Chemoprophylaxis, Diagnosis, Treatments, and Discharge Management of COVID-19: an Evidence-based Clinical Practice Guideline (updated Version). Mil Med Res. 2020 09 4;7(1):41. PubMed PMID: 32887670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version). AU - Jin,Ying-Hui, AU - Zhan,Qing-Yuan, AU - Peng,Zhi-Yong, AU - Ren,Xue-Qun, AU - Yin,Xun-Tao, AU - Cai,Lin, AU - Yuan,Yu-Feng, AU - Yue,Ji-Rong, AU - Zhang,Xiao-Chun, AU - Yang,Qi-Wen, AU - Ji,Jianguang, AU - Xia,Jian, AU - Li,Yi-Rong, AU - Zhou,Fu-Xiang, AU - Gao,Ya-Dong, AU - Yu,Zhui, AU - Xu,Feng, AU - Tu,Ming-Li, AU - Tan,Li-Ming, AU - Yang,Min, AU - Chen,Fang, AU - Zhang,Xiao-Ju, AU - Zeng,Mei, AU - Zhu,Yu, AU - Liu,Xin-Can, AU - Yang,Jian, AU - Zhao,Dong-Chi, AU - Ding,Yu-Feng, AU - Hou,Ning, AU - Wang,Fu-Bing, AU - Chen,Hao, AU - Zhang,Yong-Gang, AU - Li,Wei, AU - Chen,Wen, AU - Shi,Yue-Xian, AU - Yang,Xiu-Zhi, AU - Wang,Xue-Jun, AU - Zhong,Yan-Jun, AU - Zhao,Ming-Juan, AU - Li,Bing-Hui, AU - Ma,Lin-Lu, AU - Zi,Hao, AU - Wang,Na, AU - Wang,Yun-Yun, AU - Yu,Shao-Fu, AU - Li,Lu-Yao, AU - Huang,Qiao, AU - Weng,Hong, AU - Ren,Xiang-Ying, AU - Luo,Li-Sha, AU - Fan,Man-Ru, AU - Huang,Di, AU - Xue,Hong-Yang, AU - Yu,Lin-Xin, AU - Gao,Jin-Ping, AU - Deng,Tong, AU - Zeng,Xian-Tao, AU - Li,Hong-Jun, AU - Cheng,Zhen-Shun, AU - Yao,Xiaomei, AU - Wang,Xing-Huan, AU - ,, AU - ,, Y1 - 2020/09/04/ PY - 2020/08/18/received PY - 2020/08/25/accepted PY - 2020/9/5/entrez PY - 2020/9/6/pubmed PY - 2020/10/2/medline KW - COVID-19 KW - Chemoprophylaxis KW - Diagnosis KW - Discharge management KW - Recommendation KW - SARS-CoV-2 KW - Traditional Chinese medicine; guideline KW - Treatment SP - 41 EP - 41 JF - Military Medical Research JO - Mil Med Res VL - 7 IS - 1 N2 - 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. SN - 2054-9369 UR - https://www.unboundmedicine.com/medline/citation/32887670/Chemoprophylaxis_diagnosis_treatments_and_discharge_management_of_COVID_19:_An_evidence_based_clinical_practice_guideline__updated_version__ L2 - https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-020-00270-8 DB - PRIME DP - Unbound Medicine ER -