Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version)
Authors: Jin Ying-Hui , Zhan Qing-Yuan , Peng Zhi-Yong , Ren Xue-Qun , Yin Xun-Tao , Cai Lin , Yuan Yu-Feng , Yue Ji-Rong , Zhang Xiao-Chun , Yang Qi-Wen , Ji Jianguang , Xia Jian , Li Yi-Rong , Zhou Fu-Xiang , Gao Ya-Dong , Yu Zhui , Xu Feng , Tu Ming-Li , Tan Li-Ming , Yang Min , Chen Fang , Zhang Xiao-Ju , Zeng Mei , Zhu Yu , Liu Xin-Can , Yang Jian , Zhao Dong-Chi , Ding Yu-Feng , Hou Ning , Wang Fu-Bing , Chen Hao , Zhang Yong-Gang , Li Wei , Chen Wen , Shi Yue-Xian , Yang Xiu-Zhi , Wang Xue-Jun , Zhong Yan-Jun , Zhao Ming-Juan , Li Bing-Hui , Ma Lin-Lu , Zi Hao , Wang Na , Wang Yun-Yun , Yu Shao-Fu , Li Lu-Yao , Huang Qiao , Weng Hong , Ren Xiang-Ying , Luo Li-Sha , Fan Man-Ru , Huang Di , Xue Hong-Yang , Yu Lin-Xin , Gao Jin-Ping , Deng Tong , Zeng Xian-Tao , Li Hong-Jun , Cheng Zhen-Shun , Yao Xiaomei , Wang Xing-Huan ,   Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM),   Chinese Research Hospital Association (CRHA)
Published: September 2020

AbstractThe 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.