Foreword
This is an unprecedented global war, and mankind is facing the same enemy, the novel coronavirus.
And the first battlefield is the hospital where our soldiers are the medical workers.
To ensure that this war can be won, we must first make sure that our medical staff is guaranteed
sufficient resources, including experience and technologies. Also, we need to make sure that the
hospital is the battleground where we eliminate the virus, not where the virus defeats us.
Therefore, the Jack Ma Foundation and Alibaba Foundation have convened a group of medical
experts who have just returned from the frontlines of fighting the pandemic. With the support of
The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU), they quickly
published a guidebook on the clinical experience of how to treat this new coronavirus. The
treatment guide offers advice and reference against the pandemic for medical staff around the
world who are about to join the war.
My special thanks goes out to the medical staff from FAHZU. While taking huge risks in treating
COVID-19 patients, they recorded their daily experience which is reflected in this Handbook. Over
the past 50 days, 104 confirmed patients have been admitted to FAHZU, including 78 severe and
critically ill ones. Thanks to the pioneering efforts of medical staff and the application of new
technologies, to date, we have witnessed a miracle. No staff were infected, and there were no
missed diagnosis or patient deaths.
Today, with the spread of the pandemic, these experiences are the most valuable sources of
information and the most important weapon for medical workers on the frontline. This is a
brand-new disease, and China was the first to suffer from the pandemic. Isolation, diagnosis,
treatment, protective measures, and rehabilitation have all started from scratch. WE hope that
this Handbook can provide doctors and nurses in other affected areas valuable information so
they don’t have to enter the battlefield alone.
This pandemic is a common challenge faced by mankind in the age of globalization. At this
moment, sharing resources, experiences and lessons, regardless of who you are, is our only
chance to win. The real remedy for this pandemic is not isolation, but cooperation.
This war has just begun.
Author(s): Tingbo LIANG
Edition: 1
Publisher: Zhejiang University School of Medicine
Year: 2020
Language: English
Tags: COVID-19; Coronavirus Treatment
Part One Prevention andControl Management
I. Isolation Area Management
1. Fever Clinic
2. Isolation Ward Area
II. Staff Management
1. Workflow Management
2. Health Management
III. COVID-19 Related Personal Protection Management
IV. Hospital Practice Protocols during COVID-19 Epidemic
1. Guidance on Donning and Removing Personal Protective Equipment (PPE) to manage COVID-19 Patients
2. Disinfection Procedures for COVID-19 Isolation Ward Area
3. Disposal Procedures for Spills of COVID-19 Patient Blood/Fluids
4. Disinfection of COVID-19 Related Reusable Medical Devices
5. Disinfection Procedures for Infectious Fabrics of Suspected or Confirmed Patients
6. Disposal Procedures for COVID-19 Related Medical Waste
7. Procedures for Taking Remedial Actions against Occupational Exposure to COVID-19
8. Surgical Operations for Suspected or Confirmed Patients
9. Procedures for Handling Bodies of Deceased Suspected or Confirmed Patients
V. Digital Support for Epidemic Prevention and Control
1. Reduce the Risk of Cross Infection when Patients Seek Medical Care
2. Lower Work Intensity and Infection Risk of Medical Personnel
3. Rapid Response to Emergency Needs of COVID-19 Containment
Part Two Diagnosis and Treatment
I. Personalized, Collaborative and Multidisciplinary Management
II. Etiology and Inflammation Indicators
1. Detection of SARS-CoV-2 Nucleic Acid
2. Virus Isolation and Culture
3. Detection of Serum Antibody
4. Detecting Indicators of Inflammatory Response
5. Detection of Secondary Bacterial or Fungal Infections
6. Laboratory Safety
III. Imaging Findings of COVID-19 Patients
IV. Application of Bronchoscopy in the Diagnosis and Management of COVID-19 Patients
V. Diagnosis and Clinical Classification of COVID-19
1. Mild Cases
2. Moderate Cases
3. Severe Cases
4. Critical Cases
VI. Antiviral Treatment for Timely Elimination of Pathogens
1. Antiviral Treatment
2. Course of Treatment
VII. Anti-shock and Anti-hypoxemia Treatment
1. Usage of Glucocorticoids when Necessary
2. Artificial Liver Treatment for Suppression of Cytokine Cascade
3. Oxygen Therapy for Hypoxemia
VIII. The Rational Use of Antibiotics to Prevent Secondary Infection
IX. The Balance of Intestinal Microecology and Nutritional Support
1. Microecologics Intervention
2. Nutrition Support
X. ECMO Support for COVID-19 Patients
1. ECMO Intervention Timing
2. Cathetering Methods
3. Mode Selection
4. Flux Set-value and Target Oxygen Supply
5. Ventilation Setting
6. Anti-Coagulation and Bleeding Prevention
7. Weaning from ECMO and Mechanical Ventilation
XI. Convalescent Plasma Therapy for COVID-19 Patients
1. Plasma collection
2. Clinical Use of the Convalescent Plasma
XII. TCM Classification Therapy to Improve Curative Efficacy
1. Classification and Stage
2. Therapy Based on Classification
XIII. Drug Use Management of COVID-19 Patients
1. Identification of adverse drug reactions
2. Therapeutic Drug Monitoring
3. Paying attention to the potential drug interactions
4. Avoiding medical damage in special populations
XIV. Psychological Intervention with COVID-19 Patients
1. The psychological stress and symptoms of 1. COVID-19 patients
2. Establishing a dynamic mechanism for evaluation and warning of psychologicalcrisis
3. Intervention and treatment based on the assessment
XV. Rehabilitation Therapy for COVID-19 Patients
1. Rehabilitation therapy for severe and critically ill patients
XVI. Lung Transplantation in Patients with COVID-19
1. Pre-transplantation assessment
2. Contraindications
XVII. Discharge Standards and Follow-up Plan for COVID-19 Patients
1. Discharge standards
2. Medication after discharge
3. Home isolation
4. Follow-up
5. Management of patients tested positive again after discharge
Part Three Nursing
I. Nursing Care for Patients Receiving High-Flow NasalCannula (HFNC) Oxygen Therapy
1. Assessing
2. Monitoring
3. Treatment of Secretions
II. Nursing Care for Patients with Mechanical Ventilation
1. Intubation Procedures
2. Analgesia, Sedation and Delirium Management
3. Prevention of Ventilator-Associated Pneumonia (VAP)
4. Sputum Suction
5. Disposal of Condensation from Ventilators
6. Nursing Care for the Prone Position Ventilation (PPV)
III. Daily Management and Monitoring of ECMO (Extra CorporealMembrane Oxygenation)
IV. Nursing Care of ALSS (Artificial Liver Support System)
1. Nursing Care during Treatment
2. Intermittent Care
V. Continuous Renal Replacement Treatment (CRRT) Care
1. Preparation before CRRT
2. In-treatment Care
3 .Postoperative Care
VI. General Care
Appendix
I. Medical Advice Example for COVID-19 Patients
1. Medical Advice of Mild COVID-19 Cases
2. Medical Advice of Moderate COVID-19 Cases
3. Medical Advice of Severe COVID-19 Cases
4. Medical Advice of Critical COVID-19 Cases
II. Online Consultation Process for Diagnosis and Treatment
2.1 Online Consultation for Diagnosis and Treatment
2.2 Online Doctors’ Communication Platform
Editorial Board
References
Overview of FAHZU
