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Guidance for Corona Virus Disease 2019

Release Time:2020-03-16

The article is extracted from “Guidance for Corona Virus Disease 2019: Prevention Control, Diagnosis and Management” compiled by National Health Commission of the People’s Republic of China. The guidelines were written based on the study, analysis and summary of the treatment of COVID-19 cases, and are translated the latest Chinese guidelines and their relevant interpretations that help provide references for other countries affected by the COVID-19, and also promote the experience exchange and cooperation in disease prevention, control, diagnosis and management, thus promote the development of global health together. Part One Diagnosis and Treatment Plan of Corona Virus Disease2019 1. Source of Infection At present, the major source of infection is the patients with COVID-19, and asymptomatic 2019-ncov carriers seem also a potential source of infection. 2. Route of Transmission COVID-19 is mainly transmitted by droplets and contact. Aerosol transmission is possible when people have prolonged exposure to high concentrations of aerosols in relatively closed spaces. 3. Susceptible Individuals Humans of all ages are generally susceptible. 4. Clinical Manifestations Based on current epidemiological investigations, the incubation period of COVID-19 is ranged between I to 14 days, and generally within 3 to 7 days. Fever, fatigue and dry coughing are considered the main clinical manifestations, but symptoms such as stuffy nose, runny nose, pharyngalgia, myalgia and diarrhea are relatively less common. In severe cases, dyspnea and/or hypoxemi a usually occurs after one week of disease onset, and the worse can rapidly progresses to acute respiratory distress syndrome, septic shock, metabolic acidosis hard to correct, and hemorrhage and coagulation dysfunction, multiple organ failure, etc. It's worth noting that patients with severe or critical illness may have a moderate to low fever, or no fever at all. Mild cases only present with light fever, mild fatigue and so on without manifestation of pneumonia. From the cases treated currently, most of the patients have favorable prognosis. The elderly and people with chronic underlying diseases usually have poor prognosis while cases with relatively mild symptoms are common in children. 5. Diagnostic Criteria 5.1 Suspected Cases The suspected cases should be diagnosed through considering both the epidemiological histories and clinical manifestations: (1) Having a history of travel or residence in Wuhan and its surrounding areas or other communities with cases reported within 14 days before the patient's onset (2) Having a contact history with patients (a positive results of nucleic acid test of 2019-ncov) within 14 days before the patient's onset  (3) Having a contact history with patients with fever or respiratory symptoms from Wuhan and its surrounding areas, or the communities with cases reported within 14 days before the patient's onset  (4) Clustering occurrence of cases. 5.2 Clinical Manifestations  (1) Fever and/or respiratory symptoms:  (2) Having the imaging features of pneumonia described above  (3) In the early stage, a normal or decreased total white blood cell count and decreased lymphocyte count can be found. Patients who satisfy any one of the epidemiological exposure histories as well as any two of the clinical manifestations can be diagnosed as suspected cases. Patients with no definite epidemiological history can be diagnosed only if all the three clinical manifestations are met 5.3 Confirmed Cases The suspected cases with one of the following etiological evidences can be diagnosed as confirmed cases: 6. Treatment Determine the Treatment Place According to the Severity of the Disease Suspected and confirmed cases should be isolated and treated in designated hospitals with effective isolation and protective conditions. Suspected cases should be treated in single rooms, while confirmed cases can be admitted to the same ward. Critical cases should be admitted to ICU as soon as possible. Part Two Prevention and Control Plan of Corona Virus Disease 2019 1. Prevention and Control Plan of Corona Virus Disease 2019 The 2019-ncov belongs to the genus coronavirus and has distinct genetic characteristics from SARSR-COV and MERSR-COV. Coronaviruses are sensitive to ultraviolet rays and heat, and can be effectively inactivated when environmental temperature is 56C and lasts for 30 min, and lipid solvents such as ether, 75% ethanol, chlorine-containing disinfectant, eroxyacetic acid and chloroform except chlorhexidine. Based on current epidemiological investigations, the incubation period of COVID-19 is to 14 days, and generally within 3 to 7 days. At present, the major source of infection is the COVID-19 patients, and asymptomatic 2019-ncov carriers can also be the source of infection. The main routes of transmission are respiratory droplets and contact, while aerosol and fecal-oral transmission routes are yet to be verified. Humans of all ages are generally susceptible. 2. Prevention and Control Measures Improve the Prevention and Control Mechanism. Strengthen Organizational Leadership. The prevention and control of COVID-19 should be attached with great importance. Health administrative departments at all levels should follow the administrative government and strengthen the guidance of local epidemic prevention and control work, set up expert groups for COVID-19 prevention and control. In accordance with the "prevention in the first place, integrating prevention with control, scientific guidance, timely treatment"work principle, relevant departments should be organized to formulate and improve relative work and technological solutions, and standardize the COVID-19 prevention and control work. Strengthen joint prevention and control, improve inter- communication and cooperation among departments, conduct regular consultations to analyze epidemic development and discuss prevention and control policies. Health administrative department at all levels should be responsible for the overall guidance of epidemic control and the implementation of funds and materials. The responsibility of CDC at all levels includes organizing, coordinating, supervising and evaluating surveillance, for collecting, analyzing, reporting and providing feedback of monitoring data; conducting training of field investigations, laboratory examinations and other professional knowledge: carrying out public health education and risk evaluation, providing personal protection methods guidelines for the public and specific people, and guiding disinfection of special places. Medical institutions of all levels and types should be responsible for case detection, reporting, isolation, diagnosis, treatment and clinical management. as well as sample collection. 3. Strengthen the Prevention and Control Work of Key Places, Institutions and Populations Strengthen the multi-departments joint prevention and control work mechanism to minimize public gathering activities, and implement measures such as ventilation, disinfection and body temperature measurement in public gathering places including stations, airports, docks, shopping malls and closed transportation vehicles such as automobiles, trains and airplanes according to local conditions. To strengthen the COVID-19 prevention and control in collective living units, such as schools and nurseries morning examination system and absence registration system due to illness should be established. Strengthen the prevention and control work in cities with more movable people, and prepare for prevention and control of high COVID-19 risk after the Spring Festival holiday. Health education targeted for rural farmers, students, businessmen should also be strengthened. Part Three Guidelines for Prevention and Control of 2019-nCoV Part One Guide to prevention and control for specific populations: For the Elderly: 1.    Ensure that the elderly acquire awareness of personal protective measures, hand hygiene requirements avoid sharing personal items; pay attention to ventilation; and implement disinfection measures. Encourage the elderly to wash their hands frequently. 2.    When the elderly have suspicious symptoms such as fever, cough, sore throat, chest tightness, dyspnea fatigue, nausea and vomiting, diarhea, conjunctivitis, muscle soreness, etc. For Children: 1. Do not go to crowded places, and do not attend parties. 2. Wear a mask when going out, and remember to remind your parents and grandparents to do so. 3. Maintain a regular schedule and healthy diet. Wash your hands carefully before meals and after defecation. Take more exercises at home with your parents. 4. Cover your mouth and nose with a paper towel or by elbow when sneezing or coughing. For Students: 1.    During Winter Vacation: Students coming from high epidemic areas (such as Wuhan) should stay at home or in designated places for medical observation for 14 days once leaving such areas. 2. On the Way Back to School: Wear a medical surgical mask or a N95 mask when taking public vehicles. Guide to Prevention and Control in Specific Places: For Kindergartens (or schools) 1.    Those who have history of living or traveling in a high epidemic area (such as Wuhan) are suggested to have a 14 days period of home quarantine before returning to kindergart (schools). 2. After back to kindergartens() the body temperature and health status every day, minimize unnecessary going-out and avoid contact with other people. 3. Wear a medical surgical mask or a N95 mask correctly when closely contacting with other teachers and students, and minimize the scope of activities. For Nursing Home 1.    Daily Preventive Measures: ensure that staff and the residents understand relevant knowledge, avoid sharing personal belongings, pay attention to ventilation, and perform the disinfection measures. Health records should be established for the residents and the staff, and morning check-up should be conducted every day. 2. The Elderly with Suspicious Symptoms: The elderly with suspicious symptoms should be isolated in time in individual rooms, and his/her health status should be evaluated by medical workers. The patients should be transferred to a medical institution for treatment according to their conditions. All visiting activities should be suspended. For Work Places: 1.    Staff with suspicious symptoms should be required to leave work place. 2.    Public goods should be cleaned and disinfected regularly. 3.    Keep the environment cleaned and tidy, and clean up garbage in time. For Public Transports: 1.    Staff of public transports in epidemic areas should wear surgical masks or N95 masks and conduct daily health monitoring. 2.    It is recommended to equip with thermometers, masks and other items in vehicles. For Home Quarantine Living Space Arrangement: 1. People with suspicious symptoms need to live in well-ventilated single rooms and refuse all visits. Caregiver Arrangements: It is best to have a regular family member who is healthy and free of chronic diseases to take care of patients. Part Two Interpretation of the Guidelines for Prevention and Control of 2019-nCoV 1.    The Guidelines Focus Prevention and Control Suggestions on the Elderly, Children and Students: in China, there are a large number of aged people, who are the high-risk susceptible population of infectious diseases due to their weakening immune functions. Similarly, the elderly account for the most of critical cases in this epidemic. The elderly should understand personal protective knowledges, wear masks correctly, wash hands frequently, strengthen ventilation and disinfection of residences and avoid gatherings during the epidemic. People who have a fever or close contact with suspicious cases should get registration in the communi or local medical institutions timely, and receive quarantine and active health monitoring. After the confirmed cases leave, their residences should be thoroughly disinfected by the local CDC or a qualified third party. 2.    The Guidelines Propose Suggestions on Kindergartens (or Schools), Nursing Home, Office Space, Vehicles, Public Places and Home Quarantine: Kindergartens (or Schools) belong to a kind of children and adolescents densely populated places Students who have a history of living or traveling in a high epidemic area or have suspected symptoms are suggested to have a 14-day period of home quarantine before returning to school. School authorities should monitor students' body temperature twice a day and require students to wear masks correctly. If suspicious symptoms are found among students, school offices should cooperate with medical and health institutions to conduct management and disinfection for the close contacts. Large collective activities or gathering should be cancelled and ventilation and cleaning of relevant places should be strengthened. 3.    The Guidelines Propose Expert Advice on Medical Management of Integrated Traditional Chinese and Western Medicine for Patients with Fever at Home: respiratory infections have high incidence in winter and spring. Thus, patients without basic diseases or scvere obesity are suggested to be placed under home quarantine if they have mild symptoms including mild fever and cough, body temperature8, and stable vital signs.