What were revised in different versions of the Guidelines on the Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment?

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Following scientific, applicable and focused principles, China has continuously updated the Guidelines on the Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment based on the analysis, judgement and review of medical treatment. Up to now, China has issued seven versions of the Guidelines on COVID-19 Diagnosis and Treatment. The revision process featured the following major aspects.

First, the epidemiological characteristics are more comprehensive and accurate. The description of infection sources has gradually improved. The fourth edition considers the source of infection to be “mainly COVID-19 patients”. The fifth edition adds that “asymptomatic infected persons may also become the source of infection.” At the same time, the expression of transmission routes has become more accurate. The fourth edition writes that “respiratory tract droplets is the main way of transmission, and the virus can also be transmitted through body contact.” In the fifth edition, it was revised to “droplets through respiratory tracts and contact transmission are the main transmission routes, and the transmission routes such as aerosol and digestive tracts are yet to be confirmed.” In the sixth edition, the word “close” was added before “contact”, and it was added that “the possibility of transmission through aerosol exists in the case of relatively long-term exposure to high-concentration aerosol in a relatively closed environment.” In the seventh edition, fecal-oral transmission was included.

Second, the diagnostic criteria are more rigorous. The fifth version was revised the most in this regard. In this edition, the diagnostic criteria are different for Hubei and non-Hubei provinces. The criteria for suspected cases started to include “contact history with confirmed cases within 14 days before onset”. Suspected cases with pneumonia imaging features are considered to be confirmed cases in Hubei. The diagnostic criteria of suspected cases and confirmed cases in the sixth edition are unified nationwide. In the seventh edition, serological tests were added for confirmed cases in addition to nucleic acid testing and gene sequencing.

Third, the clinical symptoms are more detailed. Fever, dry cough, and fatigue have always been the main clinical manifestations, and the symptoms have been expanded from “nasal congestion, runny nose, and diarrhea” (4th edition) to include “pharyngeal pain” (5th edition) and “myalgia” (6th edition). The 4th edition includes incubation periods of “generally 3-7 days, sometimes up to 14 days”. The 4th edition divided the clinical classification into ordinary, severe and critical, and the 5th edition added mild.

Fourth, the treatment methods are more elaborate. This part is the focus of revisions. According to new progress in clinical treatment, treatment methods in the guidelines are gradually improved, and drug dosage and usage are adjusted. The third edition began to refine the treatment methods of traditional Chinese medicine. In the sixth edition, two drugs, chloroquine phosphate and abidor, were added, and plasma treatment was included. The seventh edition added treatment measures for children, pregnant women and other special groups.

Fifth, the discharge standards are tightened. The discharge criteria in the fourth edition is “normal body temperature in at least three consecutive days, significantly improved respiratory symptoms, and negative test results for two consecutive respiratory pathogen nucleic acid tests.” On this basis, the fifth edition added “obvious inflammation absorption seen in pulmonary imaging.” The 7th edition specified “respiratory pathogen nucleic acid detection” in “sputum, nasopharyngeal swabs, etc.” At the same time, it upgraded the follow-up management of patients after discharge from “14-day self-monitoring” (6th edition) to “14-day isolation” (7th edition) .

Reference:
[1] Guidelines on the Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (trial version) and trial 2 to 7 version

Author: Lin Weiwei, Institue of Medical Information, Chinese Academy of Medical Science

Translator: Dong Dandan, Center for International Knowledge on Development