What are the guidelines for preventing and treating Covid 19 (Coronavirus disease 2019) in individuals at risk of contracting the disease?

COVID-19 Prevention and Treatment Guidelines

Prevention Strategies

Personal Protective Equipment for Healthcare Workers

Healthcare workers performing aerosol-generating procedures (intubation, bronchoscopy, suctioning, nebulized treatments, manual ventilation, proning, NIV, tracheostomy, CPR) on COVID-19 patients must use fitted N95 respirators (or FFP2 equivalent) along with gloves, gown, and eye protection (face shield or safety goggles). 1

• Surgical masks are insufficient for aerosol-generating procedures as they only block large droplets but not small particle aerosols (<5 μm) 1
• Powered air purifying respirators (PAPRs) can substitute when N95 fit testing fails or supplies are limited 1
• Tracheal intubation carries the highest transmission risk to healthcare workers, followed by tracheostomy/emergency airway procedures, non-invasive ventilation, and mask ventilation 1

General Public Prevention Measures

The most effective preventive behaviors are: wearing masks whenever outdoors, washing hands after outdoor activity and before touching the mouth/nose area, and avoiding high-risk gathering activities. 2

• Hand hygiene is critical: wash hands with soap and water for at least 20 seconds after outdoor activity, before eating, after using the toilet, and before touching the face 1, 2
• If soap unavailable, use alcohol-based hand sanitizers 1
• Wear medical masks (N95 preferred, surgical mask as alternative) when around others 1, 3
• Cover coughs/sneezes with tissue or bent elbow (not hands), then immediately wash hands 1
• Maintain physical distancing of at least 1 meter from others 1
• Avoid participating in high-risk gathering activities 2

Home Isolation for Suspected/Mild Cases

Patients with mild COVID-19 symptoms should isolate in well-ventilated single rooms for at least 5 days from symptom onset, with isolation ending when temperature normalizes for >3 days, respiratory symptoms significantly improve, and two consecutive negative nucleic acid tests (≥1 day apart) are obtained. 3

Patient Requirements:

• Restrict activity and limit visits by relatives/friends 1
• Maintain bed distance of at least 1 meter if single room unavailable 1, 3
• Clean and disinfect household articles daily using 500 mg/L chlorine-containing disinfectant 1
• Open windows for ventilation in shared areas (toilets, kitchens) 1
• Avoid sharing toothbrush, towel, tableware, bed sheets—keep patient items separate 1
• Wear medical mask when in presence of others 3
• Monitor body temperature and symptoms daily; seek medical attention if high fever persists or breathing worsens 3

Caregiver Precautions:

• Caregiver should be healthy family member without underlying diseases 1, 3
• Wear N95 masks (preferred) or disposable surgical masks when in same room with patient 1, 3
• Wear disposable gloves (double layers) when providing oral/respiratory care, handling feces/urine, or cleaning patient's room 1
• Wash hands before wearing and after removing gloves 1
• Avoid direct contact with patient's secretions, especially oral/respiratory discharges and feces 1
• Wash patient's clothes/linens with ordinary soap at 60-90°C or soak in low-concentration disinfectant before washing 1
• Place contaminated bedding in closed laundry bags without shaking 1
• Dispose patient waste in closed garbage bags, replaced frequently 1
• Monitor own body temperature closely 3

Treatment Guidelines

Antiviral Therapy

Remdesivir (VEKLURY) is FDA-approved for treating COVID-19 in hospitalized patients and non-hospitalized patients with mild-to-moderate disease at high risk for progression to severe COVID-19. 4

Dosing:

• Adults and pediatric patients ≥40 kg: 200 mg IV loading dose on Day 1, then 100 mg IV daily from Day 2 4
• Pediatric patients <28 days old and ≥1.5 kg: 2.5 mg/kg IV on Day 1, then 1.25 mg/kg IV daily from Day 2 4
• Pediatric patients ≥28 days old, 3-40 kg: 5 mg/kg IV on Day 1, then 2.5 mg/kg IV daily from Day 2 4

Duration:

• Hospitalized patients on invasive mechanical ventilation/ECMO: 10 days 4
• Hospitalized patients not requiring invasive ventilation/ECMO: 5 days (may extend up to 10 days if no clinical improvement) 4

Monitoring:

• Perform hepatic laboratory testing before starting and during treatment 4
• Monitor prothrombin time before starting and during treatment 4
• Administer only in settings with immediate access to medications for severe infusion/hypersensitivity reactions and ability to activate emergency medical system 4

Supportive Care

Patients require regular monitoring of vital signs, blood routine, organ function, and chest imaging, along with nutritional support providing 25-30 kcal/(kg·d) energy and 1.5 g/(kg·d) protein. 5

Oxygen Therapy:

• Provide effective oxygen therapy via nasal catheter, mask oxygen, high-flow nasal oxygen (HFNO), non-invasive ventilation (NIV), or invasive mechanical ventilation based on severity 5
• Consider ECMO for refractory hypoxemia unresponsive to protective lung ventilation 5

Additional Supportive Measures:

• For patients with nutrition risk scores ≥3 points, increase protein intake through oral supplements 2-3 times daily (≥18g protein/time) 5
• Use H2 receptor antagonists or proton pump inhibitors in patients with gastrointestinal bleeding risk factors 5
• Evaluate venous embolism risk and use low-molecular-weight heparin or heparin in high-risk patients without contraindications 5

Immunomodulatory Therapy

For patients with rapid disease progression or severe illness, methylprednisolone 40-80 mg per day can be considered (not exceeding 2 mg/kg daily), typically for short periods of 3-5 days according to degree of dyspnea and chest imaging progression. 5

• Use corticosteroids cautiously and for limited duration 5

Management of Complications

For septic shock, recognize early and administer vasopressors (norepinephrine as first choice) when shock persists after fluid resuscitation. 5

• For dyspnea, cough, wheeze, and respiratory distress due to increased secretions, use selective (M1, M3) receptor anticholinergic drugs to reduce secretion and improve pulmonary ventilation 5
• Avoid blind or inappropriate use of antibacterial drugs 5
• If bacterial infection cannot be ruled out, administer appropriate antibiotics 5
• For mild cases with suspected bacterial infection, consider antibiotics effective against community-acquired pneumonia (amoxicillin, azithromycin, or fluoroquinolones) 5

Testing Recommendations

For symptomatic individuals, nucleic acid amplification tests (NAATs) using nasopharyngeal, mid-turbinate, combined anterior nares plus oropharyngeal swab, saliva, or mouth gargle specimens are recommended. 3

• Anterior nares and mid-turbinate specimens can be self-collected or collected by healthcare provider 3
• A single NAAT is sufficient; routine repeat testing not recommended for individuals with initial negative test 3

Hospital Admission Criteria

Hospitalize patients with persistent high fever, dyspnea/respiratory distress, signs of pneumonia development/worsening symptoms, or comorbidities/risk factors for severe disease. 3

Discharge Criteria

Discharge when all four criteria are met: body temperature normal for >3 days, respiratory symptoms significantly improved, lung inflammation showing obvious absorption on imaging, and respiratory nucleic acid negative for two consecutive tests (≥1 day sampling interval). 5, 3

Common Pitfalls

• Handwashing duration is often insufficient—only 31.6% of individuals wash for the recommended 20 seconds 2
• Discrepancy exists between reported precautionary measures and actual behavior, particularly regarding consistency and specificity of implementation 6
• Perceived behavioral control associations with preventive behaviors are stronger for older adults than younger adults, requiring age-tailored messaging 7
• Treatment should be initiated as soon as possible after diagnosis of symptomatic COVID-19 4