What's Shanghai experience of COVID-19 management?

Some experts suggest that among the family of chloroquines, the toxic side effect of Hydroxychloroquine is quite low. We have been using the maximum dose as per manufacturer's insert, 400mg QD. We have also consulted with rheumatology experts, they agree that Hydroxychloroquine is comparatively safe to use in a normal situations.

Therefore, the recommended medications in our Shanghai COVID-19 medical treatment guidelines was quite simple. Besides Hydroxychloroquine, there are also National treatment guidelines' recommended Chloroquine Phosphate, Arbitor and Interfron. Some people have questioned us as to why we do not recommend more drugs to use. The reason is that we truly felt Hydroxychloroquine is the specific drug of choice for COVID-19.

We have compared Phase I epidemic period and Phase II epidemic period patient outcomes. In Phase I period, there were high ratio of severe cases and critical cases. In Phase II period (admission after Feb 5th), There is a significant drop in the number of severe cases and critical cases, we have attributed this outcome to our extensive use of Hydroxychloroquine. We have basically reached our conclusion on this finding.

The usage of glucocorticoid and antibiotic drugs have been tightly restricted for COVID-19 patients in Shanghai. Experts have different opinions about the usage of glucocorticoid. But one uniform consensus had been reached that if it is to be used, only small dosage and short-term application should be applied.

Data showed that a group of patients who had use glucocorticoid, their viral shedding time were prolonged. We have also observed that thee group of patients who had used glucocorticoid, their nasopharyngeal swab viral shedding time compared to non-users were 15 days vs 8 days. Stool nucleic acid shedding time were also prolonged. Steroid-user vs non-users were 20 days vs 11 days. Therefore, we should refrain from the urge to use steroid.

With Hydroxychloroquine treatment, the use of antibiotics were significantly reduced. According to statistics, our "mild" case patients needed much less antibiotic drugs with our knowledge of the disease nature. We have boldly discontinued all the use of antibiotics. The result has been satisfactory.

For maintenance and support of patient's immune system functions, we propose the use of Thymosin in some cases, it has shown beneficial results, especially in patients with low CD4+ and younger age group in early stage use shown more obvious beneficial effects.

On the other hand, we had used gamma-Globulin in Phase I period, but in Phase II period, we have stopped it's usage. In theory and combined with our present experiences, gamma-Globulin effect is limited.

In the management of severe and critical pneumonia cases, we have 5 teams consist of 5 ICU experts. We have been using advanced technology and now treatment modalities. (I will skip this topic here.) For those patients who continue to shed virus, we used plasma extracted from convalescent patients and transfused to these patients. We are having some hope for this therapeutic approach.