About: Translation: Management of Coronavirus Disease 2019 (COVID-19): Experience in Zhejiang Province, China

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Attributes	Values
type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Translation: Management of Coronavirus Disease 2019 (COVID-19): Experience in Zhejiang Province, China
Creator	Huang, He Chen, Yu Li, Lanjuan Sheng, Jifang Hu, Shaohua Fang, Qiang Xu, Kaijin Liang, Yu Cai, Hongliu Li, Jianping Liang, Tingbo Ni, Qin Qiu, Yunqing Shen, Yihong Wang, Huafen Wei, Guoqing Zhou, Jianying
source	PMC
abstract	The current epidemic situation of coronavirus disease 2019 (COVID-19) still remains severe. As the National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital of the Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang Province. Based on the present expert consensus carried out by the National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on “Four-Anti and Two-Balance” for clinical practice. The “Four-Anti and Two-Balance” strategy includes antivirus, anti-shock, anti-hypoxemia, and anti-secondary infection, and maintaining of water, electrolyte and acid/base balance and microecological balance. Simultaneously, an integrated multidisciplinary personalized treatment is recommended to improve therapeutic effects. The importance of early viral detection, dynamic monitoring of inflammatory indexes, and chest radiographs has been emphasized in clinical decision-making. Sputum was observed with the highest positive rate by RT-PCR. Viral nucleic acids could be detected in 10% of the patients’ blood samples at the acute phase and 50% of patients had positive RT-PCR results in their feces. We also isolated live viral strains from feces, indicating potential infectiousness of feces. Dynamic cytokine detection was necessary to timely identify cytokine storms and for the application of the artificial liver blood purification system. The “Four-Anti and Two-Balance” strategy effectively increased cure rates and reduced mortality. Early antiviral treatment alleviated disease severity and prevented illness progression. We found that lopinavir/ritonavir combined with abidol showed antiviral effects against COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system was able to rapidly remove inflammatory mediators and block the cytokine storm. Moreover, it also contributed to the balance of fluids, electrolytes, and acids/bases and thus improved treatment efficacy during critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid administration was supported. Patients with an oxygenation index below 200 mm Hg were transferred to the intensive care unit. Conservative oxygen therapy was preferred and noninvasive ventilation (NIV) was not recommended. Patients with mechanical ventilation were strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was prescribed rationally and was not recommended, except for patients with a long course of disease, repeated fever, and elevated procalcitonin, similarly secondary fungal infections were of concern. Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased genus such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should; therefore, be assessed for all patients. Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infections due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established a dynamic assessment and warning for psychological crises. We also integrated Chinese medicine in the treatment to promote rehabilitation. We optimized nursing processes for severe patients to promote their rehabilitation. Since viral clearance patterns after severe acute respiratory syndrome coronavirus 2 infections remained unclear, 2 weeks quarantine for discharged patients was required, and a regular following-up was also needed. These Zhejiang experiences and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work is warranted to further improve strategies of prevention, diagnosis, and treatment for COVID-19.
has issue date	2020-04-17(xsd:dateTime)
bibo:doi	10.1097/im9.0000000000000023
has license	cc-by-nc-nd
sha1sum (hex)	db9b1a30d2e47bbf1c48accca3c3d87eefd69f8b
schema:url	https://doi.org/10.1097/im9.0000000000000023
resource representing a document's title	Translation: Management of Coronavirus Disease 2019 (COVID-19): Experience in Zhejiang Province, China
has PubMed Central identifier	PMC7227201
resource representing a document's body	covid:db9b1a30d2e47bbf1c48accca3c3d87eefd69f8b#body_text
is schema:about of	named entity 'Infectious Diseases' named entity 'electrolytes' named entity 'Bifidobacterium' named entity 'Some' named entity 'cytokine' named entity 'caused' named entity 'Nutritional' named entity 'antivirus' named entity 'probiotics' named entity 'support' named entity 'severe' named entity 'lopinavir/ritonavir' named entity 'dynamic assessment' named entity 'strains' named entity 'artificial' named entity 'electrolyte' named entity 'NEWLY' named entity 'CENTER' named entity 'NATIONAL' named entity 'SECONDARY INFECTION' named entity 'CYTOKINE ' named entity 'CLINICAL PRACTICE' named entity 'INDICATING' named entity 'SECONDARY INFECTIONS' named entity 'HEALTH' named entity 'STRAINS' named entity 'RECOMMENDED' named entity 'ACID' named entity 'BIFIDOBACTERIUM' named entity 'ELECTROLYTES' named entity 'GASTROINTESTINAL FUNCTION' named entity 'INTEGRATED' named entity 'BLOCK' named entity 'However' named entity 'The' named entity 'indicating' named entity 'supervised' named entity 'cytokine' named entity 'viral' named entity 'storms' named entity 'strategy' named entity 'antiviral treatment' named entity 'infection' named entity 'strategy' named entity 'rehabilitation' named entity 'regulate' named entity 'bacterial translocation' named entity 'needed' named entity 'secondary' named entity 'detection' named entity 'endotoxins' named entity 'COVID' named entity 'Officinal' named entity 'African green monkey kidney cells' named entity 'Zhejiang University' named entity 'balance' named entity 'base' named entity 'The' named entity 'liver' named entity 'COVID-19' named entity 'artificial' named entity 'detection' named entity 'acid' named entity 'progression' named entity 'positive' named entity 'secondary' named entity 'Early' named entity 'Since'

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