It was on April 14, 2021, that the national health and Health Commission of China and the Bureau of traditional Chinese medicine jointly issued the protocol for the diagnosis and treatment of new coronavirus pneumonia (trial version 8, Revised).This article electively translates the methods about the specific treatment in the diagnosis and treatment program (containing the treatment program of traditional Chinese medicine, which is effective) for medical readers to refer to, the world epidemic ravages all over the world today, and the Chinese medicine formulas (herbal medicine) mentioned in the text are inexpensive and very suitable for reference by the wider and poorer people worldwide,It was hoped that the medicines mentioned in the text would be helpful to the populace.The treatment and treatment protocol of the original Chinese version, everyone can be found in the functional network of the Chinese national health and Health Commission.
Treatment
（1） Site of treatment was determined based on the condition.
1. Suspected and confirmed cases should be treated in site directed hospital isolation with effective isolation conditions and protective conditions, suspected cases should be treated in single single room isolation, and confirmed cases can be admitted in the same room for many people.
2. Severe cases should be admitted to the ICU as early as possible.
（2） General treatment.
1. Bed rest, strengthening of supportive care, and ensuring adequate energy intake;Note the balance of water and electrolyte to maintain homeostasis;Closely monitor vital signs, oxygen saturation, etc.
2. Monitor blood routine, urine routine, CRP, biochemical indicators (liver enzymes, myocardial enzymes, renal function, etc.), coagulation function, arterial blood gas analysis, chest imaging, etc. according to the condition.Cytokine assays are available for those with conditions.
3. Timely administration of effective oxygen therapy measures, including nasal cannula, face mask oxygen administration, and transnasal high flow oxygen therapy.Conditional may be treated with hydrogen oxygen mixed inhalation gas (H2 / O2: 66.6 / 33.3.
4. Antimicrobial therapy: avoid blind or inappropriate use of antimicrobials, especially in combination with broad-spectrum antimicrobials.
（3） Antiviral therapy.
During the course of antiviral emergency clinical trials, several clinical trials have been launched sequentially, and although no antiviral agent proven to be effective by rigorous “” randomized, double-blind, placebo-controlled studies “” has yet been identified, some agents that have been shown by clinical observational studies may have some therapeutic effect.The current consensus is that drugs with potential antiviral effects should be used early in the course of the disease, and recommendations focus on patients with high-risk factors for severe illness and a tendency to become critically ill.
Lopinavir / ritonavir and ribavirin alone and hydroxychloroquine or azithromycin in combination are not recommended.The following drugs can continue to be tried, and the efficacy is further evaluated in clinical applications.
oneα-Interferon: 5 million U or equivalent per dose in adults, add 2 ml of sterilized water for injection, twice daily, aerosolized for inhalation, course no longer than 10 days;
2. Ribavirin: it is recommended to be administered in combination with interferon (at the same dose as above) or lopinavir / ritonavir (200 mg / 50 mg / dose twice daily for adults, 500 mg / dose twice to three intravenous infusions twice daily for no more than 10 days;
3. Chloroquine phosphate: for use in adults aged 18-65 years.500 mg twice daily for 7 days for those with body weight greater than 50 kg;And those who weighed less than 50 kg, 500 mg twice daily on days 1 and 2, and 500 mg once daily on days 3 to 7;
4. Abidol: 200 mg three times daily for adults for a course of no more than 10 days.Attention should be paid to the adverse effects, contraindications, and interactions with other drugs mentioned above.Concomitant administration of more than 3 antivirals is not recommended, and relevant drugs should be discontinued in the event of intolerable toxic side effects.Treatment of the maternal patient should take into account weeks of gestation, choose medications that have a minor effect on the fetus when possible, and consider whether termination of pregnancy is followed by further treatment, with informed consent.
（4） Immunotherapy.
1. Convalescent plasma for convalescent, critically ill, and critically ill patients.Usage and dosage refer to the protocol for clinical treatment of plasma in the convalescent phase of rehabilitation of new crown pneumonia (trial version 2).
2. Intravenous covid-19 Human immunoglobulin: available on an urgent basis in more rapidly progressing common and severe patients.The recommended dose is 20 ml of common type, 40 ml of heavy weight, intravenous infusion, according to the patient’s condition improved, can be re infused every other day, the total number does not exceed five times.
3. Tocilizumab: it may be tried in patients with extensive lesions in both lungs and in severe patients who have elevated levels of laboratory measured IL-6.Specific usage: first dose of 4 to 8 mg / kg, recommended dose of 400 mg, 0.9 normal saline diluted to 100 ml, infusion time greater than 1 hour;In patients with a poor response to the first dose, additional applications may be made 12 hours after the first dose is administered (before the same dose), with a cumulative number of doses of up to 2 and a single maximum dose of no more than 800 mg.Be aware of allergic reactions and contraindicated in those with active infections such as tuberculosis.
（5） Glucocorticoid therapy.
For patients with progressive deterioration of oxygenation indices, rapid radiographic progression, and a hyperactivated state of the body’s inflammatory response, use glucocorticoids in the short term as appropriate (general recommendation 3 to 5, no more than 10), at the recommended dose equivalent to methylprednisolone 0.5 to 1 mg / kg / day, and care should be taken with larger doses of glucocorticoids due to immunosuppressive effects,May retard clearance of the virus.
（6） Treatment of severe, critical illness.
1. Treatment principle: on the basis of the above treatment, actively prevent complications, treat the underlying disease, prevent secondary infection, and timely organ function support.
2. Respiratory support:
(1) Nasal cannula or face mask oxygen inhalation
PaO2/FiO2 Heavy patients below 300 mmHg should all be offered oxygen therapy immediately.After receiving nasal cannula or face mask oxygen, close observation for a short period of time (1-2 h), if respiratory distress and (or) no improvement in hypoxemia should be achieved with nasal high flow oxygen therapy (hfnc) or noninvasive ventilation (NIV).
(2) Nasal high flow oxygen therapy or noninvasive ventilation
PaO2/FiO2 Below 200 mmHg nasal high flow oxygen therapy (hfnc) or noninvasive ventilation (NIV) should be administered.In patients receiving hfnc or NIV, without contraindications, simultaneous implementation of prone ventilation, i.e., awake prone ventilation, is recommended, and treatment time in the prone position should be greater than 12 hours.
Some patients have a high risk of failure to treat with hfnc or NIV, necessitating close observation of patients’ symptoms and signs.Failure to improve after short (1-2 hours) therapy, particularly if the subject is placed in a prone position, when hypoxemia remains unremarkable, or when breathing frequency, tidal volume, or inspiratory effort are low, often suggests that hfnc or NIV therapy is not effective and prompt invasive mechanical ventilation should be instituted.
(3) Invasive mechanical ventilation
In general, PaO2 / FiO2 Below 150 mmHg, tracheal intubation should be considered, and invasive mechanical ventilation should be implemented.However, given the atypical clinical presentation of hypoxemia in severe de novo coronavirus pneumonia, PaO2 / FiO2 should not be considered alone Compliance should be taken as an indication for endotracheal intubation and invasive mechanical ventilation, while it should be assessed in real time in combination with the patient’s clinical presentation and organ function.It is important to note that delays in endotracheal intubation, with potentially greater harms.
Early and appropriate treatment with invasive mechanical ventilation is an important therapeutic intervention in critically ill patients.Implementation of lung protective mechanical ventilation strategies.For patients with moderate to severe ARDS, or invasive mechanical ventilation FiO2 Above 50, lung recruitment therapy may be employed.And, based on the responsiveness to lung recruitment, to decide whether to repeatedly implement lung recruitment maneuvers.Some patients with new crown pneumonia should be noted to have poor lung recruitability, and excessive peep should be avoided to cause barotrauma.
(4) Airway management
Strengthening airway humidification, it is recommended to use active heating humidifiers, conditional use of loop heating guidewires to guarantee the humidification effect;Closed suction, with endotracheal suctioning if necessary, is recommended;Active airway clearance treatment, such as vibration phlegm drainage, high-frequency thoracic oscillation, and body position drainage;When oxygenated and hemodynamically stable, early passive and active activities should be initiated to promote sputum drainage and pulmonary rehabilitation.
(5) Extracorporeal membrane oxygenation (ECMO)
Timing of ECMO initiation.Under optimal mechanical ventilation conditions (FiO2 ≥ 80, tidal volume of 6 ml / kg ideal body weight, peep ≥ 5 cmH2O, and no contraindications), and with insufficient effectiveness of protective ventilation and prone position ventilation, and meeting one of the following, early consideration should be given to the implementation of ECMO:
① PaO2 / FiO2 < 50 mmHg over 3 hours;
② PaO2 / FiO2 < 80 mmHg over 6 hours;
③ Arterial blood pH < 7.25 and PaCO2 > 60 mmHg for more than 6 hours and respiratory rate > 35 breaths / min;
④ Arterial blood pH < 7.2 and plateau pressure > 30 cmH2O at a respiratory rate > 35 breaths / min;
⑤ Combined cardiogenic shock or cardiac arrest.
Critically ill patients, who meet the indications for ECMO and have no contraindications, should initiate ECMO therapy as early as possible, delaying timing and resulting in poor patient outcomes.
ECMO mode selection.Opt for veno venous mode ECMO (VV – ECMO) when respiratory support is only required and is the most commonly used modality;A veno arterial approach ECMO (VA-ECMO) was chosen if respiratory and circulatory support were required;The vav-ecmo mode can be adopted when head and arm hypoxia occurs with VA-ECMO.After implementation of ECMO, lung protective lung ventilation strategies were strictly implemented.Recommended initial settings: tidal volume < 4 to 6 ml / kg ideal body weight, plateau pressure ≤ 25 cmH2O, driving pressure < 15 cmH2O, peep 5 to 15 cmH2O, respiratory rate 4 to 10 breaths / min, and FiO2 < 50.Combined prone ventilation may be considered for patients in whom oxygenation is difficult to maintain or inspiratory effort is strong, consolidation of gravity dependent regions of both lungs becomes evident, or active airway secretion drainage is required.
Children have a weaker cardiopulmonary compensatory capacity than adults, are more sensitive to hypoxia, require the application of more aggressive oxygen therapy and ventilatory support strategies than adults, and the indications should be appropriately relaxed;Routine application of atelectasis is not recommended.
3. Circulatory support: critically ill patients may have combined shock and should be treated with vasoactive drugs on the basis of adequate fluid resuscitation, with close monitoring of changes in patient blood pressure, heart rate, and urine output, as well as lactate and base excess.Hemodynamic monitoring was performed when necessary to guide infusion and vasoactive drug use and improve tissue perfusion.
4. Anticoagulant therapy: Patients with severe or critical illness have a higher risk of combined thromboembolism.For those without contraindications to anticoagulation and with significantly higher D-dimer, prophylactic anticoagulation is recommended.In the event of thromboembolic events, anticoagulant therapy was administered in accordance with the corresponding guidelines.
five Acute kidney injury and renal replacement therapy: critical illness patients can be complicated by acute kidney injury, and etiological factors, such as hypoperfusion and medications, should be actively sought.While actively correcting the etiology, care is taken to maintain water, electrolyte, and acid-base balance.The indications for continuous renal replacement therapy (CRRT) include: ① hyperkalemia;② Severe acidosis;③ Pulmonary edema or water overload in which diuretics are ineffective.
6. Blood purification treatment: blood purification system including plasmapheresis, adsorption, perfusion, blood / plasma filtration, etc., can clear inflammatory factors, block “” cytokine storm “”, thereby alleviating the damage of inflammatory response to the body, which can be used for rescue treatment in the early and middle stages of cytokine storm in heavy and dangerous patients.
7. Multisystemic inflammatory syndrome in children: the principle of treatment is multidisciplinary cooperation, with early anti-inflammatory action, correction of shock and hemorrhagic coagulopathy, support of organ function, and anti infective treatment if necessary.Those with typical or atypical Kawasaki disease manifestations, similar to the classical treatment regimen for Kawasaki disease.Treatment with intravenous gamma globulin (IVIG), glucocorticoids, and oral aspirin is the mainstay.
8. Other therapeutic measures Xuebijing treatment may be considered;Intestinal microecological regulators can be used to maintain intestinal microecological balance and prevent secondary bacterial infections;IVIG may be considered as appropriate in pediatric severe cases.
Pregnancies complicated by heavy or critical illness should be aggressively terminated, and cesarean delivery is preferred.
Fear of anxiety is often present in patients, and psychological distancing should be reinforced, supplemented by pharmacological treatment if necessary.
（7） Traditional Chinese medicine treatment.
This disease belongs to the category of “” plague “” diseases in traditional Chinese medicine (TCM), because the Qi is felt “” and various regions can be differentiated based on the condition, local climate characteristics, and different constitution, with reference to the following scheme.Relates to supra compendial doses and should be used under physician guidance.
1. Medical observation period
Clinical Presentation1 > asthenia with gastrointestinal discomfort
Recommended Chinese patent medicines: Huoxiangzhengqi capsules (pills, water, oral liquid)
Clinical presentation2 > asthenia with fever
Recommended Chinese patent medicines: jinhuaqingsen granules, lianhuaqing distemper capsules (granules), Borrelia detoxification capsules (granules)
2. Clinical treatment period (confirmed cases)
two point one Qingfei detoxification Decoction
Scope: it is suitable for the light type, common type, heavy patients combined with the clinical observation of multiple doctors, in the rescue of critically ill patients can be combined with the patient’s actual situation and used reasonably.
Base formula: ephedra 9 g and Zhigancao 6 g and almonds 9 g and Seng plaster 15-30 g (first fried), Guizhi 9 g and Zezhi 9 g, porcine cocos 9 g and Baizhu 9 g, Poria cocos 15 g, bupleurum 16 g, Scutellaria baicalensis 6 g, Curcuma 9 g, Zingiberaceae 9 g, aster 9 g, origanhua 9 g, ejaculate dried 9 g, asarum 6 g, Chinese yam 12 g, citrus aurantium 6 g, Chenpi 6 g and hopane 9 G.
Conquering Law: Traditional Chinese medicine drinker tablets, decoction of water.Once a day, once in the morning and evening (forty minutes after meal), while warm and three for one course.
If conditional, a rice soup half bowl can be added with each pill completed, and those with deficient tongue dry fl uid can take up to one bowl more（Note: the amount of plaster is smaller if the patient is afebrile, and it is increased by fever or failure to thrive).If the symptoms improved and did not resolve, a second course was administered, if the patient had a special condition or other underlying condition, the second course could be amended on an actual basis, and the medication was discontinued if the symptoms disappeared.
Prescription source: Office Office of the national health and wellbeing commission the office of the national administration of traditional Chinese medicine regarding the recommendation of the use of “” Qingfei detoxin Decoction “” in the integrated traditional Chinese and Western medicine for the rescue of novel coronavirus – infected pneumonia (state medical administration policy letter [2020] No. 22).
two point two light
(1) Cold damp Yu pulmonary syndrome
Clinical manifestations: fever, fatigue, soreness of the body around the week, cough, expectoration, chest tightness and shortness of breath, nanosizing, nausea, vomiting, and greasy and unpleasant stools.The tongue is pale with thick dentate marks or pale red, greasy or greasy, and moistened or slippery.
Recommended prescription: cold dampness plague formula
Base formula: Radix Rehmanniae 6G, Radix rehydricum 15g, almond 9g, Radix Notopterygii 15g, cortex leprae 15g, Hypericum perforatum 9g, Dilong 15g, Chang Qing Xu 15g, Huoxiang 15g, pelan 9g, Rhizoma pallidum 15g, Yunling 45g, herbarhizoma Atractylodis 30g, Radix Dioscoreae 9g each, cortex Magnolia 15g, caramel areca 9 g, simmering grass fruits 9g, ginger 15g each.
Conquering Law: 1 dose daily, decoction 600ml in 3 divided doses, 1 each morning and evening, taken before meals.
(2) Dampness Yunfei syndrome
Clinical manifestations: low or no fever, micrognathia, fatigue, heavy head body drowsiness, muscle soreness, dry cough with little phlegm, pharyngeal pain, dry mouth without a desire to drink more, or accompanied by chest tightness epigastrium, no sweat or poor sweat, or see vomiting and cachexia, loose stools or loose stool.The tongue is light red, greasy or thin yellow, and its pulse slippage number or moistening.
Recommended prescription: areca nut 10 g, grass fruits 10 g, Magnolia officinalis 10 g, Anemarrhenae Rhizoma 10 g, Scutellaria baicalensis 10 g, bupleurum falcatum 10 g, Paeoniae Rubra 10 g, forsythia Forsythia 15 g, Artemisia annua 10 g (posteriorly inferior), Rhizoma Atractylodis 10 g, macrophylly macrocephala 10 g, and raw Glycyrrhiza 5 g.
Conquering Law: 1 dose daily, decoction 400ml in 2 divided doses, 1 each morning and night.
two point three Plain type
(1) Dampness Yu pulmonary syndrome
Clinical manifestations: fever, cough sputum less, or have yellow sputum, suppress tightness and shortness of breath, abdominal distension, constipation is not easy.The tongue is dark red, voluminous, greasy or yellowish, and has a smooth pulse number or stringiness.
Recommended prescription: Xuan lung sepsis recipe
Base formula: raw ephedrine 6 g, bitter almonds 15 g, raw plaster 30 g, raw coix seed 30 g, fescue 10 g, hopanel 15 g, Artemisia annua 12 g, Polygonum cuspidatum 20 g, verruciformis 30 g, dried rutile root 30 g, Prunella vulgaris 15 g, metamized orange red 15 g, raw licorice 10 G.
Conquering Law: 1 dose daily, decoction 400ml in 2 divided doses, 1 each morning and night.
(2) Cold dampness blocking lung syndrome
Clinical manifestations: low-grade fever, body heat, or not hot, dry cough, little phlegm, lassitude fatigue, chest tightness, epigastrium, or vomit and hurt, and loose stools.The tongue is pale or reddish, greasy or greasy, and moistened.
Recommended prescription: Rhizoma Atractylodis 15 g, Chen PI 10 g, Houpu Pu 10 g, Huoxiang 10 g, grass fruits 6 g, raw ephedra 6 g, Qiang 10 g, ginger 10 g and areca nut 10 G.
Conquering Law: 1 dose daily, decoction 400ml in 2 divided doses, 1 each morning and night.
two point four heavy
(1) Pneumoniae closed lung syndrome
Clinical manifestations: febrile face, cough, yellow and sticky sputum, or bloody sputum in the mouth, wheezing and shortness of breath, fatigue and lassitude, dry and sticky mouth, nausea and no food, loose stools, and shortness of breath.The tongue is red, greasy, and has a smooth pulse count.
Recommended prescription: moistened and septic formula
Base formula: raw ephedra 6 g, almond 9 g, raw plaster 15 g, liquorice 3 G, hopane 10 g (posterior inferior), Magnolia 10 g, Atractylodes 15 g, Herba Herba 10 g, Fabia 9 g, Poria cocos 15 g, raw rhubarb 5 g (posterior inferior), raw Astragalus 10 g, lepidotrichia 10 g, Radix Paeoniae Rubra 10 G.
Serving Law: 1-2 doses per day, decoction at 100 ml-200 ml per day, 2-4 times per day, orally or by nasogastric feeding.
(2) Gas-camp two hit syndrome
Clinical findings: fever with polydipsia, stridor with shortness of breath, delirium, mistargeting on objects, or a macular rash, or hematemesis, fl ushing, or extremity convulsions.The tongue was slightly lichenified or non lichenified, with fine veins, or was floating and numerous.
Recommended prescription: raw plaster 30-60g (fried first), Anemarrhenae 30g, Radix Rehmanniae 30-60g, water bull’s horn 30g (fried first), Radix Paeoniae 30g, Scrophularia 30g, forsythia 15g, Danpi 15g, Coptis chinensis 6G, bamboo leaf 12g, lipin 15g, Glycyrrhiza uralensis 6G.
Conquering Law: 1 dose per day, decoction of water, decoction of plaster first, water and cattle horn then lower the dose, 100ml to 200ml each time, 2 to 4 times per day, orally or by nasogastric feeding.
Recommended Chinese patent drugs: shiyanping injection, Xuebijing injection, heatoxining injection, tanzhiqing injection, Xingnaojing injection.Drugs with similar efficacy are selected either on an individual basis or in combination based on clinical symptoms.TCM injection can be combined with TCM Decoction.
two point five Critical
Inside out syndrome
Clinical findings: dyspnea, flaccid breaths or need for mechanical ventilation, accompanied by unconsciousness, irritability, cold sweat extremities, purplish tongue, thick or dry coat, and floating veins without roots.
Recommended prescription: Ginseng 15 g, heishunpian 10 g (first fried), Cornus 15 g, take Suhexiang pills or Angong Niuhuang pills.
In patients who are on mechanical ventilation with constipation or loose stools with abdominal distension, raw rhubarb 5-10 G may be used.With human-computer asynchrony occurring, 5-10 g of raw rhubarb and 5-10 g of Mangxiao may be used under sedation and muscle relaxant.
Recommended Chinese patent medicines: Xuebijing injection, xuexingning injection, tanshenqing injection, Xingnaojing injection, Shenfu injection, Shengmai injection.
Drugs with similar efficacy are selected either on an individual basis or in combination based on clinical symptoms.TCM injection can be combined with TCM Decoction.
Note: recommended usage of heavy and critically ill Chinese medicine injections
The use of TCM injections follows the principles of the drug specification beginning with a small dose and stepwise syndrome differentiation adjustment, and the recommended usage is as follows:
Viral infections or combined mild bacterial infections: 0.9 sodium chloride injection 250ml plus shiyanping injection 100mg bid, or 0.9 sodium chloride injection 250ml heated toxinin injection 20ml, or 0.9 sodium chloride injection 250ml plus tanzhiqing injection 40ml bid.
Hyperthermia with disturbance of consciousness: 0.9 sodium chloride injection 250ml plus Xingnaojing injection 20ml bid.
Systemic inflammatory response syndrome or / and multivisceral failure: 0.9 sodium chloride injection 250ml plus Xuebijing injection 100ml bid.
Immunosuppression: Glucose Injection 250ml plus Shenmai injection 100ml or Shengmai injection 20-60ml bid.
two point six convalescence
（1） Syndrome of qi deficiency in the lung
Clinical manifestations: shortness of breath, lassitude and fatigue, nadir and gagging, fullness, weak stools, and loose stools.The tongue is pale and greasy.
Recommended prescription: FABANXIA 9g, Chenpi 10g, Codonopsis 15g, zhihuangqi 30g, stir fried Baizhu 10g, Poria cocos 15g, Huoxiang 10g, sandren 6G (after lower), Gancao 6G.
Conquering Law: 1 dose daily, decoction 400ml in 2 divided doses, 1 each morning and night.
（2） Qi Yin two deficiency syndrome
Clinical manifestations: fatigue, shortness of breath, dry mouth, thirst, palpitations, sweaty, poor nose, low or no heat, dry cough with little phlegm.Tongue dry with oligophrenia, thin veins or nihilism.
Recommended prescription: 10 g each of North and South ginseng, 15 g each of Ophiopogon japonicus, 6 g of American ginseng, 6 g of Wuweizi, 15 g of raw plaster, 10 g of pale bamboo leaf, 10 g of mulberry leaf, 15 g of rutin root, 15 g of Salvia miltiorrhiza, and 6 g of raw Glycyrrhiza uralensis.
Conquering Law: 1 dose daily, decoction 400ml in 2 divided doses, 1 each morning and night.
（8） Early rehabilitation
It is important to pay attention to the early rehabilitation intervention of patients, aiming at the respiratory function, somatic function as well as psychological disorders of patients with new crown pneumonia, and to actively initiate rehabilitation training and intervention so as to recover the physical capacity, physical fitness and immune competence as much as possible.
12、 Care
According to the patient’s condition, clear focus of care and do basic care.Critically ill patients were closely observed for vital signs and state of consciousness, and blood oxygen saturation was focused on monitoring.In critically ill patients, 24-hour continuous electrocardiographic monitoring with hourly measurement of the patient’s heart rate, respiratory rate, blood pressure, SpO2, and every 4 hours with recording of body temperature was performed.Proper and proper use of venous access, and maintenance of patency and proper fixation of all types of lines.Bed ridden patients are timed to change position and prevent pressure injuries.According to the standard of care, the nursing care of non-invasive mechanical ventilation, invasive mechanical ventilation, artificial airway, ventilation in prone position, sedation and analgesia, and extracorporeal membrane oxygenation diagnosis and treatment were done.Special attention was paid to patient oral care and fluid access management, and patients on invasive mechanical ventilation were protected from aspiration.Awake patients should evaluate the psychological condition timely and do psychological care.
13、 Discharge criteria and postdischarge notes
（1） Discharge criteria.
1. Body temperature returned to normal for more than 3 days;
2. Respiratory symptoms significantly improved;
3. Lung imaging showed marked improvement in acute exudative lesions;
4. Two consecutive respiratory specimens with negative nucleic acid tests (sampling time at least 24 hours apart).
Those who meet the above conditions can be discharged.
For patients who meet the above criteria in lanes 1, 2, and 3, and whose nucleic acids remain positive for more than 4 weeks, it is recommended that the patient be discharged from the hospital after comprehensive evaluation of infectious agents by antibody testing, virus culture isolation, and other methods.
（2） Post discharge notes.
1. Site directed hospitals should have good contact with the primary care facility where the patient resides, share medical record materials, and promptly push discharge patient information to the patient jurisdiction or primary care health facility of residence.
2. It is recommended to continue 14 days isolation management and health status monitoring after discharge, wear masks, live conditionally in a well ventilated single room, reduce close contact with family members, divide meals and diet, make hand hygiene, and avoid out – group activities.
3. Recommended follow-up and return visit in hospital week 2, 4 after discharge.