COVID-19 Diagnosis and Treatment Plan(Trial Version 6)

Translated by:  Zhang Yigang (章以钢)

Since December 2019, several cases of COVID-19 have been found in Wuhan City, Hubei Province. With the spread of the epidemic, such cases have also been found in other regions of China and overseas.

As an acute respiratory infectious disease, the disease has been included in Class B infectious diseases stipulated in the Law of the People's Republic of China on Prevention and Control of Infectious Diseases, and is managed according to Class A infectious diseases. With the in-depth understanding of diseases and the accumulation of diagnosis and treatment experience, we revised the "COVID-19 Diagnosis and Treatment Plan (Trial Version 5)" to form the "COVID-19 Diagnosis and Treatment Plan(Trial Version 6)

One. Etiological Characteristics

Novel coronavirus is a coronavirus belonging to β genus, with envelope, round or oval particles, often pleomorphic, with a diameter of 60-140nm. Its gene characteristics are obviously different with SARSr-CoV and MERSr-CoV . Current studies have shown that it shares more than 85% homology with SARS-like coronary virus in bats (bat- SL-CoVZC45). When isolated and cultured in vitro,2019-nCoV can be found in human respiratory epithelial cells within 96 hours, while it takes about 6 days to separate and culture in Vero E6 and Huh-7 cell lines.

Most of our knowledge about physicochemical properties of coronavirus comes from SARSr-CoV and MERSr-CoV research.The virus is sensitive to ultraviolet rays and heat. At 56℃ for 30 minutes, lipid solvents such as diethyl ether, 75% ethanol, chlorine-containing disinfectant, peracetic acid and chloroform can effectively inactivate the virus, while chlorhexidine cannot effectively inactivate virus.

Second, epidemiological characteristics

(1) the source of infection.

At present, the source of infection is mainly patients infected by the novel coronavirus. Asymptomatic patients may also become a source of infection.

(2) Ways of transmission.

The main route of transmission is respiratory droplets and close contact. There is the possibility of aerosol transmission when exposed to high concentration aerosol for a long time in a relatively closed environment.

(3) susceptible population.

The entire population is generally susceptible.

Three, clinical characteristics

(1) Clinical manifestations.

Based on the current epidemiological investigation, the incubation period is 1-14 days, mostly 3-7 days.

Fever, dry cough and fatigue are the main manifestations. A few patients were accompanied by symptoms such as nasal obstruction rhinorrhea, pharyngalgia, myalgia and diarrhea. Severe patients often suffer from dyspnea and/or hypoxemia one week after disease onset, and severe patients can rapidly progress to acute respiratory distress syndrome, septic shock, metabolic acidosis difficult to correct, coagulation dysfunction, multiple organ failure, etc. It is worth noting that severe and critical patients may have moderate to low fever or even no obvious fever during the course of the disease.

Mild patients showed only low fever, slight fatigue, etc., and no pneumonia.

Judging from the current cases, most patients have a good prognosis and a few are in critical condition. The prognosis of the elderly and those with chronic underlying diseases is poor. The symptoms of children cases are relatively mild.

(2) Laboratory examination.

In the early stage of the disease, the total number of white blood cells in peripheral blood was normal or reduced, and the lymphocyte count was reduced. Some patients may have elevated liver enzyme, lactate dehydrogenase (LDH), myoenzyme and myoglobin. Elevated troponin can be seen in some critically ill patients. C-reactive protein (CRP) and ESR were increased in most patients, while procalcitonin was normal. In severe cases, D-dimer were increased and peripheral blood lymphocytes were decreased progressively. Inflammatory factors often were increased in severe and critical patients.

Novel coronavirus nucleic acid can be detected in nasopharyngeal swabs, sputum and other lower respiratory tract secretions, blood, feces and other specimens.

In order to improve the positive rate of nucleic acid detection, it is suggested to take sputum specimen as much as possible, and collect secretions from lower respiratory tract of patients undergoing tracheal intubation, and send samples for examination as soon as possible after collection.

(3) Chest imaging.

In the early stage, there were multiple small patches and interstitial changes, especially in the outer lung. It further developed into multiple ground glass image and infiltration image in both lungs. In severe cases, consolidation of the lungs may occur, but pleural effusion was rare.

Four, diagnostic criteria

(1) suspected cases.

Comprehensive analysis combining the following epidemiological history and clinical manifestations:

1. Epidemiological history

• Travel or residence history in Wuhan city and its surrounding areas or other communities with case reports within 14 days before the onset of the disease;
• A history of contact with novel coronavirus infected persons (positive in nucleic acid assay) within 14 days before the onset of the disease;
• Contact with patients with fever or respiratory symptoms from Wuhan and surrounding areas or from communities with case reports within 14 days before the onset of the disease;
• Group infection.

2. Clinical manifestations

• Fever and/or respiratory symptoms;
• Having the above-mentioned imaging features of novel coronavirus pneumonia;
• The white blood cell count is normal or decreased and lymphocyte count is decreased in the early stage of the disease.

If it conforms any one crirerion in the epidemiological history and any two criteria in clinical manifestations. Or no clear epidemiological history, but conforms with three criteria the clinical manifestations of the three.

(2) Confirmed cases.

Suspected cases have one of the following etiological evidences:

1. Real-time fluorescence RT-PCR detection of novel coronavirus nucleic acid positive;

2. Gene sequencing confirms that the virus is highly homologous with known novel coronavirus.

Five, clinical classification

(1) mild type.

The clinical symptoms are mild and no pneumonia manifestation is found on imaging.

(2) Ordinary type.

Fever and respiratory tract symptoms are present, and pneumonia can be seen on imaging.

(3) severe type.

Meet any of the following:

• Shortness of breath, RR≥30 times/min;
• In the resting state, oxygen saturation ≤ 93%;
• Arterial partial pressure of oxygen (Pa02)/ Fraction of inspired oxygen (Fi02)<300mmlHg (1mmHg=0.133kPa)

For areas with high altitude (over 1000 meters above sea level), Pa02/Fi0 shall be corrected according to the following formula : Pa02/Fi02x[ Atmospheric Pressure (mmHg)/760]

If Pulmonary imaging shows that patients with obvious lesion progress > 50% within 24-48 hours then the patient should be managed according to severe type.

(4) Critical type.

Meet one of the following conditions:

• Respiratory failure occurs and mechanical ventilation is required;
• Shock;
• ICU monitoring and treatment are required for patients with other organ failures.

Six, Differential diagnosis

(1) Mild manifestations of novel coronavirus infection should be distinguished from upper respiratory tract infection caused by other viruses.

(2) Novel coronavirus pneumonia should be distinguished from influenza virus, adenovirus, respiratory syncytial virus and other known viral pneumonia and mycoplasma pneumoniae infection, especially for suspected cases, methods including rapid antigen detection and multiplex PCR nucleic acid detection should be adopted as far as possible to detect common respiratory pathogens.

(3) Novel coronavirus pneumonia should also be distinguished from non-infectious diseases such as vasculitis, dermatomyositis and cryptogenic organized pneumonia.

Seven. Discovery and Report of Cases

Medical personnel of all levels and types of medical institutions shall, after finding suspected cases that meet the definition, immediately treat the patient in single room isolation, followed by in-hospital expert consultation or chief physician consultation, if the patient is still considered as suspected case, then the case shall be reported online directly within 2 hours, Samples should be collected and tested for novel coronavirus nucleic acid, and suspected patients should be immediately transferred to designated hospitals on the premise of ensuring safe transfer. For patients who have close contact with infected persons with novel coronavirus, even if the common respiratory pathogens are positive, it is still recommended to carry out timely pathogen detection for novel coronavirus.

Eight. Treatment

(1) To determine the treatment site according to the condition of the disease.

1. Suspected and confirmed patients should be treated in designated hospitals with effective isolation and protection. Suspected patients should be treated in isolation in a single room, and confirmed patients can be treated together in the same room in designated hospital.
2. Critical patients should be admitted to ICU for treatment as soon as possible.

(2) General treatment.

1. Rest in bed, strengthen support treatment and ensure sufficient calories; Pay attention to the balance of water and electrolyte to maintain the stability of internal environment; Close monitoring of vital signs, oxygen saturation, etc.
2. Blood routine, urine routine, CRP, biochemical indexes (liver enzyme, myocardial enzyme, renal function, etc.), coagulation function, arterial blood gas analysis, chest imaging, etc. are monitored according to the disease condition.Cytokines assay can be conducted if conditions permit.
3. Timely and effective oxygen therapy measures, including nasal catheter, mask oxygen and nasal high flow oxygen therapy.
4. Antiviral therapy: α- interferon (5 million U or equivalent dose for adults each time, add 2ml sterilized injection water, twice daily atomized inhalation), lopinavir/ritonavir (200mg/50mg/ tablet for adults, 2 tablets each time, twice daily, treatment course not exceeding 10 days), ribavirin (recommended combined with interferon or lopinavir/ritonavir, adult 500mg/ time, intravenous infusion 2 to 3 times a day, course of treatment does not exceed 10 days), chloroquine  phosphate (adult 500mg, twice a day, course of treatment does not exceed 10 days), Abidor (adult 200mg, 3 times a day, course of treatment does not exceed 10 days). Attention should be paid to the adverse reactions related to lopinavir/ritonavir such as diarrhea, nausea, vomiting, liver function damage and other adverse reactions, as well as the interaction with other drugs. The efficacy of the currently used drugs should be further uated in clinical application. It is not recommended to use 3 or more antiviral drugs at the same time, and relevant drugs should be stopped when intolerant toxic and side effects occur.
5. Antimicrobial therapy: Avoid blind or inappropriate use of antimicrobial drugs, especially combined use of broad- spectrum antimicrobial drugs.

(3) Treatment of severe and critical cases.

1. Treatment principle: On the basis of symptomatic treatment, actively prevent and treat complications, treat basic diseases, prevent secondary infection, and timely support organ function.

2. Respiratory support:

(1) oxygen therapy: severe patients should receive nasal catheter or mask oxygen inhalation, and timely assess whether respiratory distress and/or hypoxemia is relieved.

(2) High-flow nasal catheter oxygen therapy or non-invasive mechanical ventilation: when respiratory distress and/or hypoxemia cannot be relieved after receiving standard oxygen therapy, high-flow nasal catheter oxygen therapy or non-invasive ventilation can be considered. If the condition does not improve or even deteriorate within a short period of time (1-2 hours), tracheal intubation and invasive mechanical ventilation should be carried out in a timely manner.

(3) invasive mechanical ventilation: lung protective ventilation strategy is adopted, i.e. small tidal volume (4-8ml/kg ideal body weight) and low inspiratory pressure (platform pressure < 30cmH2O) for mechanical ventilation to reduce ventilator-associated lung injury. Many patients are not synchronized with the ventilator, sedation and muscle relaxant should be used in time.

(4) Rescue therapy: For patients with severe ARDS, lung recruitment is recommended. Under the condition of sufficient human resources, prone position ventilation should be carried out for more than 12 hours every day. For patients with poor ventilation effect in prone position, extracorporeal membrane oxygenation (ECMO) should be considered as soon as possible if conditions permit.

3. Circulation support: On the basis of full fluid resuscitation, to improve microcirculation, with vasoactive drugs, and conduct hemodynamic monitoring when necessary.

4. Plasma treatment for recovered patients: applicable to patients with fast progress, severe and critical conditions. For usage and dosage, please refer to "Clinical Plasma Treatment Plan for Patients in Recovery Period (Trial Version 1)".

5. Other therapeutic measures

For patients with progressive deterioration of oxygenation index, rapid imaging progress and over-activation of body inflammatory response, glucocorticoid should be used for a short period of time (3-5 days) as appropriate. The recommended dose should not exceed 1-2 mg/kg/day equivalent to methylprednisolone. Attention should be paid to the fact that larger dose of glucocorticoid will delay the clearance of coronavirus due to immunosuppression. Xuebijing Zhusheye can be administered intravenously for 100ml/ time and twice daily. Intestinal microecological regulator can be used to maintain intestinal microecological balance and prevent secondary bacterial infection. For severe patients with high inflammatory reaction, plasma exchange, adsorption, perfusion, blood/plasma filtration and other extracorporeal blood purification technologies can be considered when conditions permit.

Patients often have anxiety and fear, so psychological counseling should be strengthened.

(4) Traditional Chinese Medicine (TCM) treatment.

This disease belongs to the category of "pestilence" in Traditional Chinese Medicine . The disease is caused by the feeling of "pestilence" . Various regions can refer to the following according to the conditions of the disease, local climate characteristics and different constitutions.

The treatment should be based on syndrome differentiation and according to the following schemes. If the dosage exceeds the limits in pharmacopoeia, it should be used under the guidance of doctors.

(1) Medical observation period

• Clinical manifestation 1: asthenia with gastrointestinal discomfort

Recommended Chinese patent medicine: Huoxiang Zhengqi Capsule (pill, water, oral liquid)

• Clinical Manifestation 2: Fatigue with Fever

Recommended Chinese patent medicines: Jinhua Qinggan Granule, Lianhua Qingwen Capsule (granule), Shufeng Jiedu Capsule (granule)

(2) Clinical treatment period (confirmed cases)

2.1 Qingfei Paidu Decoction

Scope of application: It is suitable for mild, common and severe patients, and can be reasonably used in the treatment of critical patients in accordance with the actual situation of patients.

Basic preion: ephedra 9g ,honey-fried licorice root 6g ,almond 9g, gypsum 15-30g(decocted first), cassia twig 9g, oriental waterplantain rhizome 9g, polyporus umbellatus 9g ,atractylodes rhizome 9g, poria cocos 15g, Bupleurum root 16g, scutellaria baicalensis 6g, Pinellia Rhizoma prepared by ginger 9g,ginger 9g,aster 9g,Flos Farfarae 9g, blackberry lily 9g,asarum 6g, Chinese yam 12g，fructus aurantii immaturus 6 g, Pericarpium Citri Reticulatae 6g, Herba Agastaches 9g traditional Chinese medicine decoction pieces are decocted in water. One dose per day, taken twice a day one in the morning and one in the evening (40 minutes after meal), taken with warm water, three doses for a course of treatment.

If conditions permit, half a bowl of rice soup can be added after taking the medicine each time, and full bowl of rice soup can be added for patients with tongue dryness and body fluid deficiency. (Note: If the patient does not have fever, the dosage of gypsum should be small, and the dosage of gypsum can be increased for fever or high fever). If the symptoms improve but yet fully recovered, then continue the second course of treatment. If the patient has special conditions or other basic diseases, at the second course of treatment the preion can be modified according to the actual situation, and discontinue if the symptoms disappear.

Source of preion: state administration of traditional chinese medicine Office of the General Office of the National Health Commission "On Recommending Treatment of COVID-19 with Combination of Traditional Chinese and Western Medicine"Notice on "Qingfei Paidu Decoction" (Letter of the State Administration of Traditional Chinese Medicine (2020) No.22).

2.2 Mild cases

(1) Syndrome of Cold and Damp Stagnation of pathogen in Lung

Clinical manifestations: fever, fatigue, body ache, cough, cough up phlegm, chest tightness, anorexia, nausea, vomiting, sticky stool. Tongue is pale and fat with teeth marks or reddish, coated with white fur, thick and greasy, and pulse is soft and floating or slippery.

Recommended preion: raw ephedra 6g,gypsum 15g, almond 9g, notopterygium root 15g , Pepperweed Seed 15g,cyrtomium rhizome 9g ,earthworm 15g,Paniculate Swallowwort Root 15g, agastache rugosa 15g ,eupatorium 9g, atractylodes rhizome 15g,poria cocos 45g,raw atractylodes rhizome 30g , charred triplet 9g each,magnolia officinalis 15g , burnt betel nut 9g,Simmer amomum 9g, ginger 15g

Method of administration: 1 dose per day, decocted in water for 600ml, taken in 3 times, one in the morning, one at noon and one in the evening, before meals.

(2) Syndrome of Damp-heat Accumulation in Lung

Clinical manifestations: low fever or no fever, slight aversion to cold, fatigue, head and body heaviness, muscle soreness, dry cough less expectoration, sore throat, dry mouth and no desire to drink more, or accompanied by chest tightness, epigastric fullness, no sweat or unsmooth sweating, or vomiting, nausea, loose stool or constipation. The tongue is pale red, coated with white fur, or thick, greasy tongue coated with thin yellow fur, and the pulse is slippery or soft and floating.

Recommended preion: areca 10g, tsaoko 10g, magnolia officinalis 10g, Rhizoma anemarrhenae 10g, scutellaria baicalensis 10g, Bupleurum root 10g, radix paeoniae rubra 10g, Fructus Forsythiae 15g, artemisia annua 10g (later decocted), atractylodes rhizome 10g, folium isatidis 10g, licorice root 5g.

Method of administration: 1 dose per day, decocting in water for 400ml, taking it twice, one in the morning and one in the evening. 

2.3 Common cases

(1) Damp toxin and lung stagnation syndrome

Clinical manifestations: fever, cough with little sputum, or yellow sputum, suffocation and shortness of breath, abdominal distension and constipation. The tongue is dark red and fat, the coating is yellow and greasy or dry, and the pulse is slippery or wiry.

Recommended preion: raw ephedra 6g, bitter almond 15g, gypsum 30g, raw coix seed 30g, atractylodes lancea 10g, cablin patchouli 15g, artemisia annua 12g, giant knotweed 20g, verbena 30g, dried reed rhizome 30g, Pepperweed Seed 15g, exocarpium citri grandis 15g, licorice root 10g.

Method of administration: 1 dose per day, decocting in water for 400ml, taking it twice, one in the morning and one in the evening.

(2) Syndrome of Cold-dampness Blocking Lung

Clinical manifestations: low fever, hiding fever, or no fever, dry cough, less phlegm, lassitude, chest tightness,

epigastric fullness, or vomiting, loose stool. Tongue is Pale or reddish, with white or greasy coating and soft and floating pulse.

Recommended preion: Rhizoma Atractylodis 15g, dried tangerine or orange peel 10g, Cortex Magnolia Officinalis 10g, Agastache rugosus 10g, Fructus Tsaoko 6g, Herba Ephedrae 6g, Notopterygium incisum 10g, Rhizoma Zingiberis Recens 10g, Penang Ladder 10g.

Method of administration: 1 dose per day, decocting in water for 400ml, taking it twice, one in the morning and one in the evening. 

2.4 severe cases

(1) Syndrome of Lung Closure Caused by Epidemic Poison

Clinical manifestations: flushed fever, cough, yellow and sticky sputum, or blood in sputum, shortness of breath, fatigue, lassitude, dry mouth, bitter and sticky, nausea, anorexia, constipation, and scanty dark urine . Red tongue, yellow and greasy coating, slippery and rapid pulse.

Recommended preion: raw ephedra 6g, almond 9g，gypsum 15g,  licorice 3g, agastache rugosa 10g (later decocted), magnolia officinalis 10g ,atractylodes rhizome 15g, tsaoko 10g, Rhizoma Pinelliae preparata 9g ,poria cocos 15g,raw rhubarb 5g(later decocted),raw astragalus 10g, Pepperweed Seed 10g，red peony root 10g.

Method of administration: 1-2 doses per day, decocted in water, 100 ml-200ml each time, 2-4 times a day, oral or nasal feeding

(2) syndromeof dual blaze

Clinical manifestations: polydipsia due to heat, dyspnea, ，delirium, blurred vision, or typhus, hematemesis, epistaxis, or limb twitching. The tongue is crimson with little or no coating, and the pulse is heavy and thin, or floating large and rapid.

Recommended preion: gypsum 30-60g (decocted first), Rhizoma anemarrhenae 30g, radix rehmanniae 30-60g, cornu bubali 30g (decocted first), radix paeoniae rubra 30g, radix scrophulariae 30g, fructus forsythiae 15g, cortex moutan 15g, coptidis Rhizoma 6g, folium bambusae 12g, Pepperweed Seed 15g, and Licorice Roots Northwest Origin 6g.

Method of administration: 1 dose per day, decocted in water, gypsum and buffalo horn are decocted first, followed by various drug ingredients, each time 100 ml to 200 ml, 2 to 4 times per day, oral or nasal feeding.

Recommended Chinese patent medicines: Xiyanping Injection, Xuebijing Injection, Reduning Injection, Tanreqing Injection and Xingnaojing Injection. Drugs with similar efficacy can be selected according to individual conditions, or two drugs can be used in combination according to clinical symptoms. Traditional Chinese medicine injection can be combined with traditional Chinese medicine decoction.

2.5 Critical Type (Syndrome of inner blocking causing collapse)

Clinical manifestations: dyspnea, frequent asthma or need of mechanical ventilation, accompanied by coma, dysphoria, cold limbs due to sweat, purple and dark tongue, thick greasy or dry coating, floating large and shallow pulse.

Recommended preion: ginseng 15g , black prepared lateral root of aconite 10g (fried first)， cornus officinalis 15g, taken with Suhe Xiang pill or angong niuhuang pill.

Recommended Chinese patent medicines: Xuebijing Injection, Reduning Injection, Tanreqing Injection, Xingnaojing Injection, Shenfu Injection, Shengmai Injection and Shenmai Injection. Drugs with similar efficacy can be selected according to individual conditions, or two drugs can be used in combination according to clinical symptoms. Traditional Chinese medicine injection can be combined with traditional Chinese medicine decoction.

Note: Recommended usage of TCM injections for severe and critical cases

The use of traditional Chinese medicine injections shall follow the principle of small dosage and gradual dialectical adjustment in the drug dosage. 

The recommended usage is as follows:

• Virus infection or combined with mild bacterial infection: 250ml of 0.9% sodium chloride injection plus 100mg of Xiyanping injection bid, or 250ml of 0.9% sodium chloride injection plus 20ml of Reduning injection, or 250ml of 0.9% sodium chloride injection plus Tanreqing injection bid
• High fever with consciousness disorder: 250ml of 0.9% sodium chloride injection plus Xingnaojing injection Liquid 20ml bid.
• Systemic inflammatory response syndrome or/and multiple organ failure: 250ml of 0.9% sodium chloride injection plus 100ml of Xuebijing injection bid.
• Immunosuppression: 250 ml of 0.9% sodium chloride injection plus 100ml of Shenmai injection bid
• Shock: 250 ml of 0.9% sodium chloride injection plus 100ml of Shenfu injection bid. 

 2.6 Recovery Period

(1) deficiency of lung and spleen

Clinical manifestations: shortness of breath, lassitude, anorexia, vomiting, fullness, weakness in stool, and loose stool .The tongue is pale and fat, and the coating is white and greasy.

Recommended preion: Rhizoma Pinelliae Preparata 9g, Pericarpium Citri Tangerinae 10g, Radix Codonopsis 15g, Radix Astragali Preparata 30g,

Fried atractylodes 10g, Poria 15g, Agastache 10g, Amomum villosum 6g (later decocted), Glycyrrhiza 6g.

Method of administration: 1 dose per day, decocting in water for 400ml, taking it twice, one in the morning and one in the evening.

(2) deficiency of both qi and yin

Clinical manifestations: fatigue, shortness of breath, dry mouth, thirst, palpitation, profuse sweating, poor appetite, low or no fever, dry cough and little sputum. The tongue is dry and less saliva, and the pulse is thin or weak.

Recommended preion: Radix Adenophorae and radix glehniae 10g each, Radix Ophiopogonis 15g, Radix Panacis Quinquefolii 6g, Fructus Schisandrae 6g, Gypsum Fibrosum 15g, Lophatherum gracile 10g, Folium Mori 10g, Rhizoma Phragmitis 15g, Radix Salviae miltiorrhizae 15g, Licorice Roots Northwest Origin 6g.

Method of administration: 1 dose per day, decocting in water for 400ml, taking it twice, one in the morning and one in the evening. 

Nine, isolation removal and matters needing attention after discharge

(1) remove isolation and discharge standards.

1. The body temperature returned to normal for more than 3 days;

2. Respiratory symptoms have improved obviously;

3. Pulmonary imaging shows obvious improvement of acute exudative lesions.

4. Two consecutive respiratory tract samples are negative for nucleic acid assay (sampling time interval of at least 1 Day).

Those who meet the above conditions can be released from isolation.

(2) matters needing attention after discharge.

1. Designated hospitals should make good contact with the primary medical institutions where the patients live, share medical records, and timely push the discharged patient information to the patient's jurisdiction or residence neighborhood committee and primary medical and health institutions.

2. After the patient is discharged from hospital, due to the low immune function of the body during the recovery period thus susceptible to other pathogens, so it is suggested that the patient should continue to carry out self-health monitoring for 14 days, wear a mask, and live in a well-ventilated single room if conditions permit, reduce close contact with his family, eat and drink separately, do a good job in hand hygiene, and avoid going out for activities.

3. It is suggested that follow-up should be conducted in the 2nd and 4th weeks after discharge.

Ten. principle of transfer

According to the COVID-19 cases transfer work plan (Trial)" issued by our committee.

Eleven, prevention and control of infection in medical institutions 

In strict accordance with the requirements of our Committee's Technical Guidelines for Prevention and Control of novel coronavirus Infection in Medical Institutions (First Edition) and Guidelines on the Scope of Use of Common Medical Protective Equipment in Protection against Pneumonia by novel coronavirus (Trial version).