Treatment and Prevention of Complications

Prevention of Ventilator-Associated Pneumonia

Recommendations:

• 1) Goal-directed sedation and analgesia, as mild as possible.
• 2) Endotracheal intubation should be preferred.
• 3) Lift bed head 30°-45°.
• 4) Adopt closed suction device.
• 5) Replace ventilator tube and humidification device immediately in case of contamination.

Prevention of Deep Vein Thrombosis

Recommendations:

• 1) If there is no contraindication, the first choice is LMWH 4000 U, subcutaneous injection, once a day.
• 2) For patients with anticoagulant contraindications, mechanical prevention can be used, such as intermittent pneumatic compression (IPC), graduated compression stockings (GCS), and so on.
• 3) For patients with severe renal insufficiency, ordinary heparin 5000 U can be selected and injected subcutaneously twice a day.
• 4) Early mobilization.

For details, please refer to the First Edition of Recommendations for Prevention and Treatment of COVID-19 Related Venous Thromboembolism (Trial) formulated by the Respiratory Society of Chinese Medical Association, Respiratory Physicians Society of Chinese Medical Doctor Association, and the National Collaborating Group on Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Disease.

Prevention of Catheter-Related Bloodstream Infection

Recommendations:

• 1) Take maximal sterile barrier precautions during arteriovenous catheterization.
• 2) Emphasize hand hygiene.
• 3) Assess daily whether the catheter can be removed.

Prevention of Stress Ulcers

Recommendations:

• 1) Early enteral nutrition.
• 2) H , receptor antagonists or proton pump inhibitors are used in patients with a high risk of gastrointestinal bleeding.

Prevention of ICU-Related Complications

Recommendations: Implement comprehensive management of ICU patients as far as possible, pay attention to sedation and analgesia, humanistic care, and early activity and exercise and prevent short and long-term complications such as ICU-related myasthenia, delirium, and post-ICU syndrome.

Traditional Chinese Medicine Treatment

In traditional Chinese medicine (TCM), COVID-19 falls under the category of “pestilences”. The disease is divided into medical observation and clinical treatment period (confirmed cases) according to the plan of the NHC, and the clinical treatment period is divided into mild cases, moderate cases, severe cases, critically severe cases, and convalescent period, and so on. For specific prescriptions, please refer to the contents of “TCM Treatment” in Section 1, Chapter 6.

Medication Observation

Clinical manifestations: fatigue with gastrointestinal discomfort or fatigue with fever.

Clinical Treatment (Confirmed Cases)

• 2.2.5.2J Mild Cases
• 1) Cold dampness stagnating in the lung.
• 2) Damp heat accumulating in the lung.
• 2.2.5.2.2 Moderate Cases
• 1) Damp toxin stagnating in the lung.
• 2) Cold damp obstructing the lung.
• 2.2.5.2.3 Severe Cases
• 1) Pandemic toxin blocking the lung.
• 2) Flaring heat in both qi and ying phases.
• 2.2.5.2.4 Critically Severe Cases
• 1) Internal blocking causing external collapse.
• 2.2.5.2.5 Convalescent Period
• 1) Qi deficiency of the lung and spleen.
• 2) Deficiency of qi and yin.

Criteria and Precautions after Being Discharged from the Hospital

Discharge Criteria

• 1) The body temperature returns to normal for more than 3 days.
• 2) Significant improvement in respiratory symptoms.
• 3) Pulmonary imaging shows a marked improvement in acute exudative lesions.
• 4) Sputum, nasopharyngeal swabs, and other respiratory specimens appear negative for two consecutive nucleic acid tests (at least a 24-hour interval between each test).

Patients who meet all the above conditions can be discharged.

Precautions after Being Discharged from the Hospital

• 1) The hospital should keep contact with the local medical and health institutions, tracing where the patients live, sharing the medical records, and sending the discharged patients’ information to the residential committee and the basic medical and health institutions in a timely manner.
• 2) After the patient is discharged from the hospital, it is recommended that the patient continue isolation management and health monitoring for 14 days, wear a mask, live in a well-ventilated single room, reduce close contact with family members, wash hands frequently, and avoid going out.
• 3) It is recommended to follow up and return to the hospital in the second and fourth week after discharge.

Re-Positive Nucleic Acid Conversion after Being Discharged from the Hospital

2.2.6.3.1 Analysis of Re-Positive Nucleic Acid Conversion

Re-positive nucleic acid conversion means that the nucleic acid test for COVID-19 patients who have been discharged changes from negative to positive. There are several explanations for this, including:

• 1) False negatives due to sampling and test kit.
• 2) The patients did not fully recover, and the virus still remains in the body.
• 3) The patients become infected again after recovery. Because COVID-19 is a new disease that humans have never been exposed to in the past, its exact cause requires further observation and research.

• 2.2.6.3.2 Management Measures
• 1) For symptomatic patients, the emergency center, also known as “120”, should be notified by the receiving medical institution, from which the patient shall be transferred to designated hospitals for treatment. The patient should be discharged when the discharge criteria are met again. Two weeks of isolation and rehabilitation observation are required after discharge.
• 2) For asymptomatic patients, they should be transferred to the relevant centralized isolation location. After 2 weeks’ centralized isolation and rehabilitation observation, patients who meet the quarantine-exit criteria may be released from quarantine.
• 3) Patients with re-positive nucleic acid tests have been included in the report of confirmed cases according to the national requirements at the first diagnosis, so they will not be repeatedly reported as new confirmed cases at the time of rediagnosis.
• 2.2.6.3.3 Treatment Measures for Patients with “Re-Positive” Nucleic Acid Tests
• 1) After transferring symptomatic patients to designated hospitals, specific treatment should be given according to patients’ specific conditions and laboratory tests. It is generally not recommended to continue the use of antiviral drugs for patients who have reached the maximum treatment course.
• 2) For asymptomatic patients, it is recommended to manage them according to convalescent period and improve the detection of COVID-19 antibody IgG and IgM to assess the overall condition of patients.
• 2.2.6.3.4 The Infectivity of Patients with

Re-Positive Nucleic Acid Tests

Presently, there is a big difference in the reinfection ratio among all reported data. The sputum, feces, and other specimens of the patients with reinfection were cultivated in P3 laboratory, but no live virus has been successfully cultivated. There have also been no reported cases from people who had close contact with repositive patients. Related problems need to be observed and studied further.

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