Standardization of critical care management of non-critically ill patients with COVID-19

The large global outbreak of coronavirus disease 2019(COVID-19)has seriously endangered the health care system in China and globally.The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists.Currently,the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit(ICU)physicians,who lack the required professional knowledge,training,and practice in critical care medicine,especially in terms of continuous monitoring of the respiratory function,intervention,and feedback on treatment effects.This clinical problem needs an urgent solution.Therefore,here,we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine.Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists,highlight the key patients,timely detection of disease progression,and early and appropriate intervention and organ function support,and thus improve the prognosis.Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19.The approaches suggested herein will facilitate the timely detection of disease progression,and thus ensure the provision of early and appropriate intervention and organ function support,which will eventually improve the prognosis.

COVID-19 patient with an incubation period of 27 d:A case report

BACKGROUND As a highly contagious disease,coronavirus disease 2019(COVID-19)is wreaking havoc around the world due to continuous spread among close contacts mainly via droplets,aerosols,contaminated hands or surfaces.Therefore,centralized isolation of close contacts and suspected patients is an important measure to prevent the transmission of COVID-19.At present,the quarantine duration in most countries is 14 d due to the fact that the incubation period of severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)is usually identified as 1-14 d with median estimate of 4-7.5 d.Since COVID-19 patients in the incubation period are also contagious,cases with an incubation period of more than 14 d need to be evaluated.CASE SUMMARY A 70-year-old male patient was admitted to the Department of Respiratory Medicine of The First Affiliated Hospital of Harbin Medical University on April 5 due to a cough with sputum and shortness of breath.On April 10,the patient was transferred to the Fever Clinic for further treatment due to close contact to one confirmed COVID-19 patient in the same room.During the period from April 10 to May 6,nucleic acid and antibodies to SARS-CoV-2 were tested 7 and 4 times,respectively,all of which were negative.On May 7,the patient developed fever with a maximum temperature of 39℃,and his respiratory difficulties had deteriorated.The results of nucleic acid and antibody detection of SARS-CoV-2 were positive.On May 8,the nucleic acid and antibody detection of SARS-CoV-2 by Heilongjiang Provincial Center for Disease Control were also positive,and the patient was diagnosed with COVID-19 and reported to the Chinese Center for Disease Control and Prevention.CONCLUSION This case highlights the importance of the SARS-CoV-2 incubation period.Further epidemiological investigations and clinical observations are urgently needed to identify the optimal incubation period of SARS-CoV-2 and formulate rational and evidence-based quarantine policies for COVID-19 accordingly.