Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

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 lopinavirritonavir,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.

Zero increase in peak discharge for sustainable development

For urban land development, some or all natural land uses （primarily pervious） are converted into impervious areas which lead to increases of runoff volume and peak discharge. Most of the developed countries require a zero increase in peak discharge for any land development, and the policy has been implemented for several decades. The policy of zero increase in peak discharge can be considered as historical and early stage for the low impact development （LID） and sustainable development, which is to maintain natural hydrological conditions by storing a part or all of additional runoff due to the development on site. The paper will discuss the policy, the policy implementation for individual projects and their impact on regional hydrology. The design rainfalls for sizing LID facilities that are determined in 206 weather stations in USA are smaller than design rainfalls for sizing detention basins.The zero-increase policy links to financial responsibility and sustainability for construction of urban stormwater infrastructures and for reducing urban flooding. The policy was compared with current practices of urban development in China to shine the light for solving urban stormwater problems. The connections and differences among LID practices, the zero-increase policy, and the flood control infrastructure were discussed. We promote and advocate the zero-increase policy on peak discharge for comprehensive stormwater management in China in addition to LID.