A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

A review and comment on the current situation of 2019 novel coronavirus prevention by traditional Chinese medicine

Objective:To provide some valuable research ideas for the prevention of 2019-nCoV through reviewing and commenting the Chinese herbs in existing prevention programs of TCM.Methods:Firstly,searching the prevention and treatment programs for 2019-nCoV issued before January 29,2020.There are only three sources that can be selected in,including national and provincial health commissions,research and clinical institutes of TCM and national famous TCM doctors.Secondly,from the collections of all prevention and treatment programs,we sorted out prevention parts within Chinese herbs or patent drugs.Thirdly,we divided these TCM prevention programs into three categories and the classification is based on the two aspects of Zhengqi and pathogenic factors.Results:We classified the herbs into three parts:dispelling pathogenic factors mainly,tonifying Zhengqi with dispelling pathogenic factors and syndrome differentiation according to the two most important aspects,Zhengqi and pathogenic factors in TCM prevention theory.Reviewing the above three parts according to TCM theories and introducing some modern pharmacological researches of these herbs.Some matters needing attention were pointed out in clinical application of traditional Chinese herbs.Comments and perspectives:We made the comments on shortcomings of the present situation and look forward to what can be done later from three aspects:collection of clinical data,clinical controlled study and modern pharmacological research.

The Sunspot Cycle Leads to Origin and Epidemic Mechanism of Novel Coronavirus COVID-19

Listed examples of virus transmission epidemics that can be strongly transmitted through the air caused by sunspot change cycle, analyzed the mechanism that promotes the generation of new viruses. From the schematic diagram of the changes in the combined force of the hydrodynamic effect of the sun sweeping the earth and the sweeping force, we obtain the places that are prone to light vortices are 30 degrees north latitude and 30 degrees south latitude on the east coast of the mainland creatively. The curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. And the curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. It is inferred that the light vortex produces the special amplified energy so that can make the virus mutate to produce a new highly infectious novel coronavirus. The earliest known place and time of the novel coronavirus origin are consistent with the reasoning of the new theory. Because the radius and frequency of the light vortex are different, the resulting virus strains are also different. Moreover, the fatality rate in the light vortex area is much higher than that in the non-light vortex area, indicating that the virus’s toxicity and lethality are higher in the light vortex area, so it can explain why Russia, India, and countries in the African equatorial region mortality are much lower than the United States, Italy, Spain and Brazil. Finally, preventive and recommended measures are proposed.

Analysis of status quo and research progress in nursing care for different typed coronavirus disease 2019: A literature review

At present,patients with coronavirus disease 2019(COVID‑19)are showing a surge in the world,to explore the clinical characteristics,treatment,and care of different types of COVID‑19.The authors reviewed the existing literature,selected,and analyzed the diagnosis and treatment records of 11 patients with COVID‑19 who were initially cured,including patient information,clinical manifestations,auxiliary examination results,treatment principles,nursing evaluation,nursing goals,nursing diagnosis,and nursing measures,and found clinical similarities and differences in the care of different types of patients.Among them,nine patients recovered and discharged after receiving treatment,and two died.As there is no specific medicine,only symptomatic treatment and supportive treatment can be given.Eleven common nursing measures and special nursing measures of different levels were carried out for patients diagnosed with mild,common,severe,and critical illnesses,and different treatment methods were given according to the severity of signs and symptoms.By summarizing the similarities and differences of clinical nursing interventions,we hope to help improve the quality of care for patients diagnosed with COVID‑19.

Home‑based treatment and nursing plan of a patient diagnosed with mild‑to‑common coronavirus disease 2019

To date,there are no known specific antiviral medicines recommended for coronavirus disease 2019(COVID‑19).The treatment mainly focuses on the improvement of the immunity of the individual and the application of palliative treatment.A case of a patient diagnosed with mild COVID‑19 and then later developed common COVID‑19 which was treated and closely monitored at home will be presented.The patient was advised for self‑quarantine with several prescribed medications.Nursing home and self‑care advice were given to the patient,including a change of lifestyle for the duration of the isolation,medication advice,symptomatic care,change of diet,how to monitor the progress of the disease,psychological care,and follow‑up instructions.During the course of the nursing plan,the patient showed significant improvements,and normal life functions were restored.On February 05,2020,novel coronavirus nucleic acid test showed negative after re‑examination;the patient was cured.Therefore,providing adequate nursing plan for home‑based self‑care treatment can effectively cure mild and common cases of COVID‑19.

The novel coronavirus outbreak in Wuhan,China

The novel coronavirus(2019-nCoV,or COVID-19)epidemic first broke out in Wuhan and has been spreading in whole China and the world.The numbers of new infections and deaths in Wuhan are still increasing,which have posed major public health and governance concerns.A series of mandatory actions have been taken by the municipal and provincial governments supported by the central government,such as measures to restrict travels across cities,case detection and contact tracing,quarantine,guidance and information to the public,detection kit development,etc.Challenges such as lacking effective drugs,insufficient hospital services and medical supplies,logistics,etc.have much alleviated with the solidarity of the whole society.The pandemic will definitely be ended with the continuous efforts of both national and international multi-sectoral bodies.

The novel coronavirus outbreak:what can be learned from China in public reporting?

The new coronavirus outbreak gets everyone’s attention.China’s national actions against the outbreak have contributed great contributions to the world.China has been learning from practice for better reporting and is fast to adapt itself.In this article we discuss China’s practice in public reporting and its implications to global health.Confirmed cases,dynamic suspected cases,recovered cases,and deaths have been reported both in accumulative numbers and their daily updates.Some ratio indictors reporting(fatality rate,recovery rate,etc.),trend reporting,and global surveillance have been applied as well.Some improvements can still be made.It is necessary to further explore the influential factors behind the indicators for interventions.Recommendations are made to the World Health Organization and other countries for better public reporting and surveillance.

连花清瘟治疗新型冠状病毒(2019-nCoV)肺炎网络药理学研究与初证

目的:通过网络药理学探究连花清瘟治疗新型冠状病毒(2019-nCoV)肺炎的作用靶点及信号通路,阐述其作用机制。方法:利用TCMSP、TCMID数据库和相关文献筛选出连花清瘟的活性成分及靶标;通过NCBI、GenCards数据库筛选2019-nCoV的预测靶点;将两者靶点进行映射;利用STRING数据库构建蛋白互作网络图并筛选出核心靶点;再通过David进行GO、KEGG基因富集分析,最后利用Cytoscape 3.7.2软件构建化合物-关键靶点网络图。结果:筛选后共获得连花清瘟活性成分378个,潜在作用靶点282个;与2019-nCoV共同靶点55个,获得392条GO生物学过程和105条KEGG信号通路,主要富集病毒感染、炎症和免疫力。结论:连花清瘟治疗2019-nCoV肺炎其作用机制可能与广谱抗病毒、抑菌退热、止咳化痰、调节免疫等有关。

渝西地区陈旧性心肌梗死患者2019-nCoV知信行调查研究

目的:了解新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情中易感人群(陈旧性心肌梗死患者)对新型冠状病毒(2019 novel coronavirus,2019-nCoV)相关知识的掌握情况、采取的预防措施和心理状态。方法:通过既往构建的心肌梗死随访体系,电话随访既往明确诊断为心肌梗死的患者,采用问卷调查对受访者进行询问。结果:共计随访610例患者,有高血压病史者占46.4%。知晓率方面,城镇受访者(58.4%)比农村受访者(41.6%)知晓率高,但无男女性别差异(98.7%vs.99.1%,P=0.647)。40.2%的农村受访者不知道此次病毒的传播途径,高于城镇受访者的31.7%(P=0.032)。农村受访者对防护措施的采取率方面也弱于城镇受访者,分别为佩戴口罩(75.2%vs.89.9%,P<0.001),避免聚会、避免人员聚集(58.3%vs.68.3%,P=0.011),勤洗手(55.9%vs.64.3%,P=0.036)。在性别方面,女性未采取任何防护措施的比例高于男性(14.2%vs.5.7%,P=0.001),女性佩戴口罩比例低于男性(76.1%vs.86.6%,P=0.002)。农村及城市受访者心理情绪均稳定,94.9%的受访者均坚信在国家强有力的控制措施下能战胜此次疫情。农村女性受访者较城市女性受访者在病毒传播途径知识及防控措施上均落后(P<0.05)。结论:陈旧性心肌梗死这一易感人群对此次疫情知晓率高,并采取了一定保护措施。农村居民和女性受访者对传播途径知晓度及采取防护措施方面均相对落后,是下一步防控工作的重心,但受访者均对成功控制此次疫情充满信心。

中国海关第一例新型冠状病毒(2019-nCoV)肺炎病例报道

2020-01-23内蒙古二连浩特市确诊了中国海关第一例新型冠状病毒(2019 novel Coronavirus,2019-nCoV)感染的肺炎。该患者当时无咳嗽、气短等呼吸道症状,也无发热、乏力等全身症状,不符合"新型冠状病毒感染的肺炎诊疗方案"(试行第三版)[1]中疑似病例的诊断标准,考虑到同车有发热的湖北籍疑似患者,且该病毒感染尚处于研究阶段,其临床表现可能存在复杂性,不除外无症状患者的存在,故对患者进行了胸部CT及血常规的初筛,结果该患者胸部CT及血常规均异常,后经核酸检测阳性确诊为新型冠状病毒感染的肺炎,并获得了成功救治,有效避免了患者进一步向国内外传播的风险,为传染病的防控提供了有益的借鉴,为中国海关检验检疫工作做出了表率。现将患者的诊治过程汇报如下。

新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版)

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV),因2019年12月发生在中国武汉的不明原因病毒性肺炎病例而被发现,并于2020年1月12日被世界卫生组织(World Health Organization,WHO)命名。在之后的1个月内,2019-nCoV在湖北省内、中国甚至其他国家传播,造成了数以千计病例的出现,同时也引起了民众一定程度的恐慌。本指南的制订希望能够从疾病流行病学、病因学、诊断、治疗、护理、医院感染控制等方面给临床医师、社区居民等提供医疗护理及居家照护的相关指导。

新型冠状病毒性肺炎(2019-nCoV)并发急性呼吸衰竭2例诊治分析

目的:总结新型冠状病毒性肺炎(2019-nCoV)并发急性呼吸衰竭的诊治经验。方法:回顾性分析2例新型冠状病毒性肺炎(2019-nCoV)患者的临床资料,分析诊断治疗过程。结果:2例患者以低热、干咳、乏力伴全身肌肉酸痛入院;患者病情进展相对迅速,早期出现胸闷及轻微呼吸困难症状,血氧饱和度下降,抗感染治疗无效;血常规淋巴细胞计数均减少;血气分析提示,急性呼吸衰竭;胸部CT提示双肺多发小斑片影及间质性改变并多发磨玻璃影、浸润影,以肺外缘为主,多考虑病毒性肺炎,早期给予α-干扰素雾化吸入、力托那韦口服抗病毒、抗菌药物治疗、补液、纠酸等综合治疗后,患者病情好转,胸部CT检查病变部分吸收,甘肃卫健委呼吸道分泌物核酸检测阳性,确诊为新型冠状病毒性肺炎。结论:对低热、干咳伴全身肌肉酸痛、胸部CT提示双肺多发小斑片影及间质性改变并多发磨玻璃影、浸润影、以肺外缘为主,且白细胞及中性粒细胞不高、淋巴细胞计数均减少的患者,在无病毒学诊断依据情况下,及早给予抗病毒为主的综合治疗可达到良好疗效。

2019-nCoV入胞机制及其抑制剂的研究进展

新型冠状病毒(2019 novel coronavirus,2019-nCoV)与急性呼吸综合征冠状病毒(severe acute respiratory syndromes coronavirus,SARS-Co V)的核酸和编码的病毒蛋白高度同源,预示其生物学功能也可能非常相似。2019-nCoV利用其刺突蛋白(spike protein,S)的S1亚基与宿主细胞表面的血管紧张素转换酶2(angiotensin converting enzyme 2,ACE2)受体结合,同时利用宿主蛋白酶切割S蛋白促进发生膜融合,进而内吞入胞。阻断2019-nCoV入胞过程的抑制剂主要可分为中和抗体/受体抑制剂、蛋白酶抑制剂和内吞调节因子抑制剂。目前,对2019-nCoV的认识仍然非常有限。相信随着研究的不断推进,能够更加深刻地认识病毒的致病机制,开发出更高效的抗病毒药物。

预防新生儿2019-nCoV感染的系统措施整合与探讨

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)是新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染引起的急性呼吸道传染性疾病,人群普遍易感。新生儿因免疫系统发育不完善以及潜在的母婴传播风险,需要给予特别关注。为预防和控制新生儿感染,专家们提出了许多建议和策略。本文就这些建议及策略进行整理总结,重点涉及新生儿感染的诊断、确诊和疑似新生儿的隔离防护与治疗原则等。

新型冠状病毒2019-nCoV的病毒学特征、传播途径及抵抗力

2019年12月以来,湖北省武汉市陆续出现了多例以发热、乏力、干咳和进行性呼吸困难为主要表现的“不明原因肺炎”患者。在不到一个月的时间内,经分离鉴定,确认病原体为一种新型冠状病毒,并被世界卫生组织(WHO)暂时命名为2019-nCoV。随后,由2019-nCoV引起的肺炎迅速蔓延至我国其他地区和境外,截至2020年2月11日,疫情仍在迅速发展。相关的基础和临床研究也迅速跟进,本文将对2019-nCoV的病毒学特征、传播途径、对环境的抵抗力和消毒方法做一简要综述,旨在为更好地控制当前疫情提供依据。鉴于时间所限和研究的迅速进展,本文所讨论的问题可能在今后的研究中会得到相应的更新和更正。

基于网络爬虫的2019-nCoV疫情数据的采集

2019年出现的新冠病毒正在全世界流行,每日的疫情数据成了人们几乎每天必看的关注点。本文分析如何使用EXCEL软件和PYTHON语言两种工具实现疫情数据的采集。为同类型的数据采集提供切实可行的方法和思路。

Current efforts and challenges facing responses to 2019-nCoV in Africa

The novel coronavirus is a pandemic that has started to creep into Africa thus making the virus a truly global,health security threat.The number of new 2019-nCoV cases has been rising in Africa,though currently lower than the cases reported outside the region.African countries have activated their Emergency Operations Centres to coordinate responses and preparedness activities to the pandemic.A series of measures such as restricting travel,case detection and contact tracing,mandatory quarantine,guidance and information to the public among other efforts are being implemented across Africa.However,the presence of porous borders,the double burden of communicable and noncommunicable diseases,poverty,poor health literacy,infodemic and family clustering,and most of all,weak health systems,may make containment challenging.It is important for African countries to continue to intensify efforts and address the challenges to effectively respond to the uncertainty the pandemic poses.

2019冠状病毒病(COVID-19)诊疗浙江经验

当前2019冠状病毒病(COVID-19)疫情仍处于胶着状态。浙江大学医学院附属第一医院是国家感染性疾病临床医学中心,浙江省COVID-19患者救治中心。疫情一线的专家集智攻关,以国家卫生健康委员会和国家中医药管理局发布的COVID-19诊治指南为依据,以抗病毒、抗休克、抗低氧血症、抗继发感染、维持水电解质和酸碱平衡、维持微生态平衡的“四抗二平衡”救治策略为核心,总结完善诊治方案,聚焦临床实践的一些具体问题,为COVID-19患者临床诊治提供借鉴。推荐以多学科协作诊治个性化治疗提高COVID-19患者救治质量。建议病原学检测、炎症指标监测和肺部影像学动态观察指导临床诊治。痰液的病毒核酸检测阳性率最高,约10%的急性期患者血液中检测到病毒核酸,50%的患者粪便中检测到病毒核酸,粪便中可分离出活病毒,须警惕粪便是否具有传染性;开展细胞因子等炎症指标监测有助于发现是否出现细胞因子风暴,判断是否需要人工肝血液净化治疗。通过以“四抗二平衡”为核心的综合治疗提高治愈率、降低病死率;早期抗病毒治疗能减少重症、危重症发生,前期使用阿比多尔联合洛匹那韦/利托那韦抗病毒显示出一定效果。休克和低氧血症多为细胞因子风暴所致,人工肝血液净化治疗能迅速清除炎症介质,阻断细胞因子风暴,对维持水电解质酸碱平衡也有很好的作用,可以提高危重型患者的疗效。重型病例疾病早期可适量、短程应用糖皮质激素。氧疗过程中,患者氧合指数小于200 mmHg时应及时转入重症医学科治疗;采用保守氧疗策略,不推荐常规进行无创通气;机械通气患者应严格执行集束化呼吸机相关性肺炎预防管理策略;氧合指数大于150 mmHg时,及早减、停镇静剂并撤机拔管。不推荐预防性使用抗菌药物,对于病程长,体温反复升高和血降钙素原水平升高的患者可酌情使用抗菌药物;要关注COVID-19患者继发真菌感染的诊治。COVID-19患者有肠道微生态紊乱,肠道乳酸杆菌、双歧杆菌等有益菌减少,推荐对所有患者进行营养和胃肠道功能评估,以营养支持和补充大剂量肠道微生态调节剂,纠正肠道微生态失衡,减少细菌移位和继发感染。COVID-19患者普遍存在焦虑和恐惧心理,应建立动态心理危机干预和处理。提倡中西医结合辨证施治;优化重型患者护理促进康复。严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染后病毒清除规律仍不明了,出院后仍须居家隔离2周,并定期随访。以上经验和建议在本中心实行,取得较好效果,但COVID-19是一种新的疾病,其诊治方案及策略仍有待进一步探索与完善。

硫酸羟氯喹治疗2019冠状病毒病(COVID-19)普通型患者的初步研究

目的:初步评价硫酸羟氯喹治疗2019冠状病毒病(COVID-19)普通型患者的疗效和安全性。方法:收集2020年2月6至25日在上海市公共卫生临床中心住院治疗的30例COVID-19普通型患者。患者1:1随机分配到试验组和对照组。对照组接受常规治疗,试验组在常规治疗的基础上口服硫酸羟氯喹(400 mg,1次/d)治疗,疗程为5 d。比较两组治疗第7天时咽拭子病毒核酸转阴率等指标。研究获上海市公共卫生临床中心伦理委员会批准,并登记注册(NCT04261517)。结果:在治疗过程中,试验组1例患者发展为重型。入组后第7天,试验组中13例(86.7%)和对照组中14例(93.3%)患者咽拭子病毒核酸检测为阴性(P>0.05)。在2周的访视期内,所有受试者的咽拭子核酸检测均转为阴性,其中试验组咽拭子核酸转阴时间为入院后第4(1,9)天,对照组为第2(1,4)天,差异无统计学意义(Z=1.27,P>0.05)。试验组在入院后第1(0,2)天体温恢复正常,对照组在入院后第1(0,3)天体温恢复正常。影像学检查结果显示,试验组5例(33.3%)和对照组7例(46.7%)患者均在入院3 d后的复查中出现了进展,所有患者在随后的复查中均提示病灶好转。试验组和对照组分别有4例(26.7%)和3例(20.0%)患者出现一过性的腹泻和肝功能异常等不良反应,两组不良反应发生率差异无统计学意义(P>0.05)。结论:目前COVID-19普通型患者预后较好,以病毒转阴率、重症化率为主要终点的研究难以对药物的疗效进行判断。开展后续的研究需要确定更合适的人群和终点事件,并充分考虑样本量等试验的可行性问题。

2019冠状病毒病(COVID-19)疑似患者合并焦虑和抑郁的临床分析

目的:分析2019冠状病毒病(COVID-19)疑似患者伴发焦虑、抑郁的危险因素以便早期干预以改善临床预后。方法:收集2020年1月31日至2月22日兰州大学第二医院发热隔离病房收治的COVID-19疑似患者76例,收集其临床资料并采用汉密尔顿焦虑量表评测患者焦虑情况,汉密尔顿抑郁量表评测患者抑郁情况,行多因素Logistic回归分析COVID-19疑似患者出现焦虑或抑郁的危险因素。结果:女性患者较男性患者更易伴发焦虑(OR=3.206,95%CI:1.073~9.583,P<0.05)和抑郁情绪(OR=9.111,95%CI:2.143~38.729,P<0.01);患者存在已知疫区及疫区人员接触史更容易伴发抑郁情绪(OR=3.267,95%CI:1.082~9.597,P<0.05)。结论:在COVID-19疑似患者隔离治疗期间,对于存在已知疫区及疫区人员接触史的女性患者应该早期进行心理干预,必要时提早给予药物治疗,以改善患者预后。