Answer:
Monitor the coagulation function closely, some patients infected with COVID-19 suffered from coagulation disorder which manifested as thrombopenia or prolonged APTT, PT. Monitor patients’ liver/kidney/heart function and symptoms closely. If there is a hemorrhagic tendency, active peptic ulcer or any unexpected symptoms, you’d better stop it first, and consult your health provider as soon as possible. Avoid alcohol or amethopterin.
Answer:
We still use NSAID (e.g. ibuprofen or diclofenac) when patients’ temperature is higher than 38.5℃, which could help to relief patients’ symptom and hypoxia. There is no evidence to say NSAID could facilitate the virus attach to human cells. On the contrary, actin protein was suggested as a host factor that participates in cell entry and pathogenesis of 2019-nCoV, drugs modulating biological activity of actin protein (e.g. ibuprofen) were suggested as potential candidates for treatment of viral infection. More evidences from clinical and basic research were still needed.
Answer:
Higher incidence of arrythmias have been noticed while COVID-19 infection, especially the critical patients who has sepsis, hypoxia, or underlying cardiovascular disease. Sinus tachyarrythmia and atrium fibrillation were more frequently to be seen.
Answer:
There are no such reports.The clinical evidence of direct myocardial injury by COVID-19 is not sufficient. The use of VV mode in most ECMO patients is a good evidence, and the autopsy results do not support it.
Answer:
We do not advocate the use of antipyretic drugs in patients with fever but whose body temperature is below 38.5 because fever is an immune response when the virus replicates. In China, when the body temperature rises above 38.5, we mainly use diclofenac sodium suppository to reduce fever. Ibuprofen is an NSAIDs drug, and we do not believe that it is significantly different from other drugs such as tylenol in terms of antipyretic, nor do we believe that it is helpful for replication of SARS-CoV-2.
Answer:
Higher incidence of arrythmias have been noticed in patients with COVID-19 infection, especially in those critical patients who have sepsis, hypoxia, or underlying cardiovascular disease. Sinus tachyarrythmia and atrium fibrillation were more frequently to be seen.
Answer:
We recommend that doctors wear N95 masks during treatment of all patients to avoid iatrogenic infection during treatment. Because we cannot determine which patients are safe or are asymptomatic carriers of the new coronavirus or are in the incubation period. Therefore, we advise all doctors to wear an N95 mask and further protect themselves when treating all patients.
Answer:
We currently use chloroquine to treat patients with COVID-19 patients, but there is no clinical study on chloroquine. We conducted a RCT study of 180 patients with 400mg bid of hydroxychloroquine. The results are awaiting final analysis of clinical data. In general, side effects of hydroxychloroquine were lower than that of chloroquine phosphate. At present, no significant side effects were found in hydroxychloroquine with a dose of 400mg bid. Therefore, we consider hydroxychloroquine may be in a position to replace chloroquine phosphate.
Answer:
This is a controversial topic. I was infected with COVID-19 in January 2020. To study this problem, I took 4 mg perindopril 5 days after the onset of the disease. A few hours later, I continued to have high fever and a severe cough. Theoretically, COVID-19 invades the cells through ACE2, and some ACEI / ARB up-regulate ACE2, which may be beneficial to virus replication. Therefore, the consensus of cardiovascular experts in Hubei Province suggests that ACEI / ARB should be replaced with other antihypertensive drugs in the early stage of COVID-19.
Answer:
Because of the damage of alveoli and capillaries in the COVID-19 patients, we can see the formation of pulmonary microthrombus of the autopsy results of the patients. At the same time, microthrombus formation has also been observed in the blood vessels of critically ill patients, so the D-dimer is generally high in all patients. The results of our retrospective study showed that elevation of the D-dimer level was more significant in the non-survivors, and was an independent risk factor of death. If these patients have no contraindications for anticoagulants, we would recommend the routine use of low molecular weight heparin as an anticoagulant for critically ill patients. For critical COVID-19 patients who need to be bedridden for a long time or who are on a non-invasive/invasive mechanical ventilation ventilator, anticoagulants should be routinely used to prevent thrombosis in the lower extremities and pulmonary thrombosis.
Answer:
Yes, we are conducting clinical trials, and preliminary results show that remdesevir has a good therapeutic effect on COVID-19. However, the final results will come out at the end of April [2020] , and we are looking forward to the important research results. In addition, a report from Japan showed that the use of remdesevir was effective in 14 patients infected on the [cruise] ship.
Answer:
The most common symptoms were fever (98%). Among 52 critically ill patients, six (11%) did not experienced fever until 2–8 days after the onset of symptoms related to SARS-CoV-2 infection.(You Shang,Lancet Respir Med 2020)
Fever was present in 43.8% of the patients on admission but developed in 88.7% during hospitalization. (Nanshan Zhong N Engl J Med. 2020 Feb 28.)
The most common symptoms at onset of illness were fever (40 [98%] of 41 patients) ( Bin Cao, Lancet 2020; 395: 497–506)
Answer:
Hydroxychloroquine is safer than chloroquine, so there will be more clinical benefits (a personal opinion)
The most effective measures for managing staff morale are below:
1）the rapid establishment of field hospitals like Vulcan Mountain Hospital and Thunder God mountain hospital, which were built in just over a week.
2) more than 23,000 medical staffs came from all over the country to help us in Wuhan
3) enough medical supplies
Answer:
We did do echocardiograms for almost every patient, but most patients have normal echocardiograms with no evidence of new hypokinesis or reduced ejection fraction at all. Only individual patients had reduced ejection fraction. There were isolated patients with reduced ejection fraction, but these recovered rapidly as troponins decreased. So most ECG are normal, with isolated cases showing sinus tachycardia, or T wave inversion in precordial leads, but no dynamic evolution.
Answer:
Previous study has shown that interferon-alpha-2b could inhibit the replication of COVID-19 (doi: https://doi.org/10.1101/2020.03.07.982264） and it has been recommended in Protocols for Diagnosis and Treatment of COVID-19. In our department, we regularly used the interferon-alpha-2b for most of patients in the beginning and found that interferon-alpha-2b was beneficial for COVID-19 therapy. However, interferon-alpha-2b should be performed in negative-pressure wards rather than general wards due to the possibility of aerosol transmission. Therefore, we only used it for intensive and critical patients later in the general wards since we found that combination use of the oral antiviral drugs, like Arbidol and Lianhua Qingwen, was enough to make the COVID-19 RNA negative for most patients and this could reduce the possibility of aerosol transmission.
Answer:
Thank you for your questions. For question one, CT scan may be required in the following situations：
(1) To determine the confirmed cases：The nucleic acid detection for COVID-19 is important but not sensitive. It might be negative repeatedly even in those severe COVID-19 patients required for ventilator support，and CT scan could help in the situation. The antibody test for COVID-19 also helps if it is available. In the guideline of China, the suspected cases can be exclude if the IgM is still negative after 7 days.
(2) To determine discharge home for admitted patients: We did not use the CT scan to determine admission or discharge home for mild patients (which mainly depends on the symptom and whether they suffer from hypoxia). We use symptom, nucleic acid detection and CT scan to codetermine which admitted patient could be discharged, when nucleic acid detection is not sensitive. Besides, I believe the antibody test could help if CT scan is not available. CT scan contributes to following progression, but it is not necessary. The change of arterial blood gas analysis is more important. The lymphocyte is also important. Progressive lymphocyte decrease is very common in those severe patients, which means severe secondary bacterial infection is highly likely.
Answer:
1. We didn't use remdisivir for the COVID-19 patients in Wuhan Union Hospital. But right now there is a clinical trial undergoing in Wuhan. Hopefully the drug can work.
2. In late January 2020, in response to the coronavirus pandemic, Gilead began laboratory testing of remdesivir against SARS-CoV-2, stating that remdesivir had been shown to be active against SARS and MERS in animal models of CoV infection. It also provided remdesivir for treatment of a "small number of patients" in collaboration with Chinese medical authorities.
3. In late January 2020, Chinese medical researchers reported that remdesivir seemed to have "fairly good inhibitory effects" on SARS-CoV-2, after which requests to begin clinical testing were submitted.
4. On 6 February 2020, a clinical trial of remdesivir began in China.
5. On 17 March 2020, remdesivir was provisionally approved for use for COVID-19 patients in a serious condition in the Czech Republic.
6. WHO announced the launch of a large four-arm pragmatic clinical trial (SOLIDARITY trial) that includes one group of patients treated with remdesivir.
Answer:
Most doctors and researchers in China believe that the treatment for IL-6 can help though the evidence is limited. We measured IL-6 for all of our 87 COVID-19 patients as a routine. Most patients showed increased IL-6 level and three of which received Tocilizumab (one kind of monoclonal antibody of IL-6 receptor). The three were all discharge successfully in the end，but we are still not sure whether the treatment helped. The evidence is limited and we did not find any dramatic change in the three after the treatment.
Answer:
Some of the COVID-19 patients get better after being treated with chloroquine phosphate, which is one the recommendation drugs by National Health Commission of China.
Chloroquine, as an approved immune modulator, shows inhibitory effects against 2019-nCoV and is being evaluated in an open-label trial (ChiCTR2000029609).
Answer:
Unfortunately, the most recent trial showed a negative result in adult patients with severe COVID-19 treated with lopinavir–ritonavir. Though there were several limitations in the study, there are still some important findings
(https://www.nejm.org/doi/full/10.1056/NEJMoa2001282).
The unit of CRP is mg/L or ug/ml in most hospital. It is also depend on the model and manufacturer of machines and reagents.
Answer:
Swan catheterization was used in some critically ill patients who requiring ICU admission, to monitor the hemodynamics.
Answer:
Increased serum troponin I/T concentrations without recognizable acute coronary syndromes are well described in critically ill and deceased cases. We will not perform coronary angiogram for patients with Tape 2 MI. For COVID-19 patients who concomitant or complicated with STEMI or NSTEMI, if the patients without respiratory failure but the hemodynamic status is unstable, IABP is preferred. If the patients have respiratory and circulatory failure, V-A ECMO is routinely used. For a few patients who had respiratory failure complicated with fulminant myocarditis, ECMO combined with IABP was used.
Answer:
Most patients had VV ECMO, since viral pneumonia and ARDS is the major presentation of COVID-19. HFrEF is not a common cardiovascular complication in COVID-19 patients. From a single ICU observation of 6 patients with ECMO, 5 had VV and one with VA mode.
Answer:
Thrombolysis is currently the main treatment for STEMI patients. Interventional catheter room with negative pressure is required during PCI, but the conditions of negative pressure catheter room are not present in Wuhan, so thrombolysis is currently recommended. I think PPCI can still does if thrombolysis fails. The risk of exposure in a short period of time is not particularly high as long as you have tertiary protection .
Answer:
We still use NSAID (e.g. ibuprofen or diclofenac) when patients’ temperature was higher than 38.5℃, which could help to relieve patients’ symptoms and hypoxia. There is no evidence to show that NSAID can facilitate the virus to attach to human cells. On the contrary, actin protein was suggested as a host factor that participates in cell entry and pathogenesis of 2019-nCoV. Drugs modulating biological activity of actin protein (e.g. ibuprofen) were suggested as potential candidates for treatment of viral infection. More evidence from clinical and basic research are still needed.
Answer:
Monitor the coagulation function closely. Some patients infected with COVID-19 suffered from coagulation disorder which manifested as thrombopenia or prolonged APTT, PT. Monitor patients’ liver/kidney/heart function and symptoms closely. If there is a hemorrhagic tendency, active peptic ulcer or any unexpected symptoms, you’d better stop it first, and consult your health provider as soon as possible. Avoid alcohol or amethopterin.
Answer:
Among my patients, the elevated troponin is one of the most important negative prognostic indicators. However, the patients who have elevated troponins don’t show hypokinesis related to myocardial infarction and ECG changes from demand ischemia. I think the myocardial injury is another manifestation of multiple organ dysfunction caused by coronavirus. On the other hand, I do suspect that the coronavirus may have a predilection for attacking the myocardium over the liver and kidney. Additionally, the general duration of the virus is about 30-40 days, while the elevation of troponin always begin at the 10th day. Greater elevation in troponins is also clearly correlated with a worsening prognosis, so the protection of heart is necessary.
Answer:
No, anti-viral treatment is a regular and fundamental management for severe cases
Answer:
Hydroxychloroquine is safer than chloroquine, so there will be more clinical benefits (a personal opinion)
The most effective measures for managing staff morale are below:
1）the rapid establishment of field hospitals like Vulcan Mountain Hospital and Thunder God mountain hospital, which were built in just over a week.
2) more than 23,000 medical staffs came from all over the country to help us in Wuhan
3) enough medical supplies
Answer:
Because of the damage of alveoli and capillaries in the COVID-19 patients, we can see the formation of pulmonary microthrombus of the autopsy results of the patients. At the same time, microthrombus formation has also been observed in the blood vessels of critically ill patients, so the d-dimer is generally high in all patients. The results of our retrospective study showed that elevation of the D-dimer level was more significant in the non-survivors, and was an independent risk factor of death. If these patients have no contraindications for anticoagulants, we would recommend the routine use of low molecular weight heparin as an anticoagulant for critically ill patients. For critical COVID-19 patients who need to be bedridden for a long time or who are on a non-invasive/invasive mechanical ventilation ventilator, anticoagulants should be routinely used to prevent thrombosis in the lower extremities and pulmonary thrombosis.
Answer:
Autopsy of COVID-19 showed that the lungs are with varying degrees of consolidation. Serous fibrin exudate and hyaline membrane were seen in alveolar cavity. Focal hemorrhage and necrosis of lung tissue may occur by hemorrhagic infarction. Partial alveolar exudate is organized and interstitial fibrosis occurs. Thus, COVID-19 patients do not develop foamy respiratory secretions easily. Another hand, heart failure is definitely to be diagnosed in combination with clinical symptoms, such as foamy sputum, major physical examination and laboratory tests, etc.
Answer:
Paradoxically would patients on immunomodulating drugs for other conditions pre-coronavirus infection have a decreased instance of SIRS? If immnumodulators work should tx begin with these drugs early, or even if high likelihood of exposure, such as in hospitals workers?
Studies have shown that mesenchymal cells have the functions of anti-inflammatory and promoting tissue repair. At present, MSCs are used in the treatment of a variety of inflammatory diseases, graft-versus-host diseases, ARDS and so on. So, empirically, mesenchymal cells are recommended for COVID19 patients.
However，mesenchymal cell therapy is not yet clinically proven to be safe and effective for COVID19 patients. In addition, even it is proved to be safe and effective, it may not be mediated by immunomodulation.
Therefore, we do not recommend mesenchymal cell therapy to people without COVID pneumonia. For severe COVID patients, mesenchymal cell therapy can be tried.
Answer:
When patients developed ARDS and respiratory failure, we applied intubation and mechanical ventilation but not ECMO first. You know, some patients do not need ECMO necessarily and finally recovered. Intubation and mechanical ventilation has another advantage of sputum aspiration (in a closed aspiration equipment) and maintain opening of alveoli, which ECMO could not provide. Although intubation increased risk of exposure, but it was just less than a minute and we were well protected with N95 mask, faceplate and head cover. On the contrary, VV ECMO totally abandoned lung and that’s not physiological. A COVID-19 patient with ECMO and mask-protected mouth and nose, was regard to have higher risk for health providers than intubated patients (personal opinion).
Answer:
Extremely low. Experience were exchanged among difference centers, and the survival rate is about 10-20% in all patients with ECMO. I don’t quite catch what you refer to C-A ECMO. I suppose it V-A ECMO. V-A ECMO is used for patients combined with respiratory failure and cardiac shock. But most ECMO cases received V-V mode.
Answer:
The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.
Answer:
Usually, we will measure infection markers every other day at the initial of patients’ admission, and then every three to four days or even every week. But for patients, we will measure them every day or several times a day for patients have critical abnormalities.
Answer:
So far we have found more than 100 asymptomatic cases in Wuhan, especially in my hospital. Even if there were no symptoms, they have some signs and were at high risk of getting infected. For example, the cleaning people in Wuhan's hospitals. We are doing testing for every high risk close contact person to avoid a second wave of the epidemic.
Answer:
South Korea culturally is the same as China and you can see enough obedience to social distancing and isolation policies. When the government asked people to wear masks, you can see people wore them immediately. It is the same in all of East Asia, where we share the same Confucius culture. At the very begining, the virus broke out in a very specific small city with some regious groups in Korea. South Korea is also testing people and isolating confirmed and suspected people, and all people are wearing masks. You can see that in South Korea the case decreasement is not like Wuhan. Wuhan already reached 0 case.
Answer:
Prerequisite of isolation policy work: 1. Relevant laws and regulations formulated by the country; 2. Sufficient living materials, including drugs, food, water and electricity, and communication; 3. The rational allocation of medical resources, and the allocation of sufficient medical personnel to key epidemic areas; 4. The volunteer system, let strong young people go out to buy daily necessities for community residents. Long term hope is vaccine.
Answer:
1. Body temperature recovered for more than 3 days, 2. Respiratory symptoms improved significantly, 3. Pulmonary imaging showed that acute exudative lesions improved significantly, 4. Nucleic acid test was negative twice in a row, and the interval between two tests was more than 24 hours
Answer:
At present, there is not enough clinical data to answer this question. In a report on April 1, the virus in patients' samples was no longer infectious 9 days after symptoms onset.(Nature. 2020 Apr 1. doi: 10.1038/s41586-020-2196-x.)
Answer:
2 weeks. 14 days.
Answer:
In our hospital, if the nucleic acid is positive, recheck every 5 days. If the test result is negative, recheck after 24 hours. If the nucleic acid test is negative twice in a row and meets other discharge standards, the patient will be discharged
Answer:
No other effective malaria drugs have been found.
Answer:
1. When FiO2 > 90%, oxygenation index is less than 80mmHg, lasting for more than 3-4 hours; 2. airway platform pressure ≥ 35cmH2O.