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

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.