LienTeh Guide: Family nursing of COVID-19 infection

Compilation purpose

During the global coronavirus（Covid-19） pandemic, we should provide nursing knowledge to ordinary people in underdeveloped countries and regions without access to medical resources in order to improve the survival rate.

This guide is a temporary guide. Please do not refer to it if you can get assistance from medical organizations.

• Keywords：Covid-19, self care in areas without medical conditions
• Purpose：About LienTeh
• Copyright：CC BY-NC-SA 4.0

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Diagnosis: how to judge infection?

Latency (pre onset) diagnosis

1. Etiological examination: New Coronavirus nucleic acid test (positive?)
2. Serological examination: New Coronavirus specific IgM antibody test (positive?)

Post onset diagnosis

1. Etiological examination: New Coronavirus nucleic acid test (positive?)
2. Serological examination: New Coronavirus specific IgM antibody test (positive?)
3. Chest imaging examination: pathological contrast (whether lung consolidation, rare pleural effusion, enlargement of heart shadow and pulmonary edema?)

For areas where there are no technical conditions, it depends mainly on the following characteristics to determine whether COVID-19 is infected:

Diagnosis of epidemic history

1. Travel history or residence history of the case reporting community within 14 days before the onset of the disease;
2. There was a history of contact with New Coronavirus infected or asymptomatic patients within 14 days before onset.
3. Patients with fever or respiratory symptoms who came into contact with their own case reporting community within 14 days before the onset of the disease;
4. Aggregation (2 or more cases of fever and / or respiratory symptoms in a small area such as home, office, school class and other places within 14 days)

Clinical manifestation diagnosis

All age groups should consider whether COVID-19 is infected if they have a fever and / or cough, accompanied by dyspnea or shortness of breath, chest pain or chest tightness, or unable to speak or act.

1.The most common symptoms of covid-19 are fever and / or respiratory symptoms, including:

• Fever
• Dry cough
• Fatigue

2.Other less common symptoms that may affect some patients include:

• Loss of taste or smell
• Nasal congestion
• Conjunctivitis (also known as red eyes)
• Sore throat
• Headache
• Muscle or joint pain
• Different types of skin rash
• Nausea or vomiting
• Diarrhea
• Chills or dizziness

3.Symptoms of severe covid-19 disease include:

• Shortness of breath
• Loss of appetite
• Confusion
• Persistent pain or pressure in the chest
• High temperature，above 38 °C

4.Other less common symptoms are:

• Irritability
• Confusion
• Reduced consciousness (sometimes associated with seizures)
• Anxiety
• Depression
• Sleep disorders

5.More severe and rare neurological complications, such as:

• strokes
• brain inflammation
• delirium
• nerve damage

Severe judgment (method without instrument and equipment)

1.Shortness of breath (increased breathing rate, difficulty breathing, start assisted breathing)

Respiratory rate (RR): the normal respiratory rate of adults is 16 ~ 20 times / min, and that of children is 30 ~ 40 times / min. the respiratory rate of children decreases to the adult level with age. RR was measured by card meter counting.

Adults (over 14 years old): shortness of breath, RR ≥ 30 times / min

Children (under the age of 14): shortness of breath

• < 2 months old, RR ≥ 60 times / min
• 2 ~ 12 months old, RR ≥ 50 times / min
• 1 ~ 5 years old, RR ≥ 40 times / minute
• 5 years old, RR ≥ 30 times / minute

2.Continuous high fever for more than 3 days

• High temperature, above 38 ° C
• Shock
• Respiratory failure: combined with functional failure of other organs

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Quarantine: isolation and de isolation, isolation room setting?

Quarantine

Covid-19 patients receiving care at home should be isolated in a separate room. If this cannot be done, keep a distance of at least 1m from the patients (if there is no separate room, a temporary isolation room can be set up with plastic cloth).

Visitors should not be allowed to enter the home. Patients and anyone else in the same room should wear medical masks.

The patient's isolation room and shared space shall be well ventilated, and the windows shall be opened when it is safe.

How to set up isolation room at home?

Try to select rooms that meet the following conditions as isolation rooms:

• Choose a room with windows. Open windows for ventilation at least twice a day for at least 30 minutes each time.
• Choose a room with a separate bathroom to store disinfection supplies.
• Select the innermost room of the whole family house, that is, enter other rooms without passing through the isolation room.
• Choose a room that is not facing the street and faces the direction with few people. The isolation room shall post a warning on the window or outside the window, as well as on the door: Xinguan isolation room, do not approach!
• Do not store daily necessities, such as clothes, except medical equipment in the room.

Set isolation room

Although it is difficult to set up a negative pressure room at home, an isolation room with directional exhaust can be set up.

Buffer chamber

Inlet air buffer isolation:

A small air buffer chamber shall be set at the entrance of the isolation room with plastic cloth or other high-density materials, and the partition cloth "Π" shall be fully sealed from the roof to the ground. When nurses enter and exit, first open the first layer of door curtain, put down the first layer of door curtain, and then open the second layer of door curtain to slow down the air flow when entering and leaving. The buffer area also serves as a protective equipment unloading area for nursing staff, placing a clothes hanger, disinfection storage cabinet and wash basin.

Door entry pad:

A pad that can absorb liquid is paved on the ground of the air buffer room, which can be made of cotton / hemp and other materials. You can spray "chlorine containing disinfectant" (Reference: environmental disinfection) on the pad to help disinfect the sole.

Buffer room shall be added at the door of toilet:

If you live in a building with new crown patients, set a buffer room at the door of the toilet, and wear a mask when entering the toilet. In addition, inform the residents of the whole building to do so.

Directional exhaust

Directional ventilation of electric fan:

Find a household desktop electric fan as the exhaust fan, remove the window glass diagonally / below the door, connect the fan to the window, face the window (windy side), seal the exhaust window with transparent glue or similar materials, turn on the fan power and adjust to the slowest gear.

Narrow tube directional exhaust:

If there is no electric fan, the directional exhaust device can be made by using the narrow tube effect, as shown in the following figure: nped made of waste coke bottles and cardboard. The small pipe opening is the air outlet, and the small pipe opening is facing out of the window. If possible, two npeds can be made, with air inlet from the upwind window and air outlet from the downwind window, so as to speed up the air flow in the isolated room. In tropical areas, nped can also reduce the temperature in the room.

Release of isolation: how long should new crown patients be isolated at home?

COVID-19 patients receiving care at home should be kept isolated. People with symptoms should be isolated for at least 10 days after the first day of symptoms until the disease is cured, and then isolated for another 3 days after the end of symptoms. The end of isolation criteria:

1. Body temperature returned to normal for more than 3 days: no fever
2. Respiratory symptoms improved significantly: no respiratory symptoms

If medical technology equipment is available:

1. Pulmonary imaging showed significant improvement in acute exudative lesions.
2. The nucleic acid test of respiratory tract samples was negative for two consecutive times (the sampling time was at least 24 hours).
3. People without symptoms should be isolated for at least 10 days after nucleic acid test is positive.

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Disinfection: nurses protect themselves, clean the environment and dispose of medical waste

Basic requirements for nursing protection

1.Nursing staff:

Set up an independent nursing staff, who can only contact patients. If possible, limit the number of nursing staff to people without basic diseases.

2.Patient's independent daily necessities:

The patient prepares a set of dishes, chopsticks, cups, pots and bedding separately. The patient's food can only be used by the patient and cleaned separately. If there is no chlorine containing disinfectant, use a separate pot as a disinfection pot and boil these daily necessities with boiling water.

3.Boiling disinfection method:

The daily necessities of patients should be boiled with 100 ℃ boiling water for 10 minutes (min). This method is used for the disinfection of general surgical instruments, rubber tubes and syringes, drinking water and tableware.

Nursing staff protection requirements

1.Protective equipment

Nursing staff shall wear the following protective equipment when entering the isolation area:

1. Medical protective mask above N95 (alternative: self-made mask with gauze or cotton cloth, with about 18 layers.)
2. Goggles (alternative: swimming glasses)
3. Protective face screen (alternative: motorcycle helmet)
4. Medical protective clothing (alternative: plastic raincoat)
5. Disposable nitrile rubber gloves (alternative: plastic gloves for dishwashing)
6. Special work shoes (rubber boots) (alternative: rain shoes)
7. Waterproof shoe cover (alternative: plastic garbage bag)

When the alternative scheme is adopted, wrap all gloves, raincoats, shoe bags, etc. with transparent tape without leaving gaps.

2.Wearing sequence

When nurses and patients are in the same room, they shall not touch their faces during the whole process. After leaving the room, they shall discard masks and wash their hands.

1. Remove personal clothes and accessories, and change into surgical clothes and washable work shoes (plastic or rubber) in the clean area (alternative: shared public space such as the living room at home, special long sleeved trousers.)
2. Enter the personal protective equipment wearing area (alternative: toilet at home)
3. Clean hands (alternative: wash with soap and tap water)
4. Wear disposable work cap (alternative: disposable plastic bag covering hair and ears)
5. Wear medical protective mask（ Alternative: make the mask with gauze or cotton cloth, with about 18 layers.)
6. Wear disposable medical gloves (latex or nitrile) (alternative: plastic gloves for dishwashing)
7. Wear disposable anti leakage one-piece protective clothing (waterproof apron if necessary) (alternative: rain shoes)
8. Wear disposable waterproof boot covers and waterproof boots if necessary (alternative: rain shoes)
9. Wear disposable protective face screen (alternative: motorcycle helmet)
10. Wear disposable nitrile gloves (alternative: plastic gloves for dishwashing)

3.Unloading sequence

The buffer zone is used as the unloading area. Two special plastic buckets with covers are prepared in the unloading area. For the unloaded protective equipment, one bucket for disposable equipment and another bucket for reusable equipment.

1. Disinfect Disposable Nitrile Gloves (before leaving the isolation room: 1. Scrub the whole hand with talcum powder; 2. Wash both hands with normal saline. The concentration of normal saline is 0.9%, that is, 0.9g sodium chloride is contained in 100ml of normal saline.)
2. Leave the isolation room and enter the unloading area paved with disposable waterproof mat（ Alternative: buffer as unload)
3. Remove Disposable Nitrile Gloves;
4. Sterile disposable medical gloves (ditto 1)
5. Take off the disposable protective screen;
6. Take off the disposable anti leakage conjoined protective clothing (first take off the waterproof apron) and disposable waterproof boot cover (or waterproof boot);
7. Sterile disposable medical gloves (ditto 1)
8. Then disinfect the washable work shoes (ibid. 1)
9. Sterile disposable medical gloves (ditto 1)
10. Take off disposable medical gloves (ditto 1)
11. Hand disinfection (ditto 1)
12. Wear disposable medical gloves;
13. Remove the medical protective mask;
14. Take off the disposable working cap;
15. Carefully roll up the disposable waterproof pad and put it into the garbage bag;
16. Hand disinfection (ditto 1)
17. Take off disposable medical gloves (ditto 1)
18. Hand hygiene（ Alternative: rinse with normal saline / soap and water, spray with 75% disinfectant alcohol)
19. Wear surgical clothing and work shoes and leave the protective equipment unloading area.

Disposable medical waste needs high-temperature steam sterilization technology. It is usually placed in a special stainless steel box, pushed into a high-temperature sterilization cabinet, and sterilized for 45 minutes under the pressure of 220 kPa and high temperature and high pressure of 134 ℃. Helmet, goggles and other equipment shall be soaked and cleaned with chlorine containing disinfectant (1000mg / L) and dried before use.

Alternative: the used disposable plastic bags shall be burned in a special brazier. The reusable protective equipment shall be boiled in a special pot for 45 minutes. For equipment such as helmets that cannot be boiled, spray disinfectant alcohol and place them in the sun for 45 minutes.

Disinfection Environment

1.Ultraviolet lamp (if any)

Environmental disinfection: the effective distance shall not exceed 2M and the time shall be 30-60min. Start timing from 5-7min after the lamp is on, because the lamp needs to be preheated, and it takes a certain time to ionize the oxygen in the air to produce ozone.

Disinfection of articles: the irradiation time is 20-30min at an effective distance of 25-60cm.

2.Chlorine containing disinfectant

• Wet cleaning shall be carried out for isolated rooms and other rooms every day (spray water on the ground without raising dust).
• Wipe the toilet, seats, door handles, furniture surfaces, countertops, etc. with chlorine containing disinfectant (500mg / L).
• Spray chlorinated disinfectant (500mg / L) on the floor mat of the buffer zone.

Chlorinated disinfectant, including:

• 84 disinfectant: prepared with sodium hypochlorite (NaClO), with a concentration of 5.5% ~ 6.5%. Hypochlorous acid water is preferred, which can be used to disinfect indoor air, hands, skin, mucous membrane and the surface of secondary water supply equipment.
• Liquid with bleach (alternative: do not touch skin)
• Or other chlorine containing disinfection powder, chlorine containing effervescent tablets, etc.

Scope of use:

• General object surface:During preventive disinfection, disinfectant with effective chlorine concentration of 250-500mg / l can be used to wipe, soak and spray disinfection on the surface of various clean objects for 10-30 minutes.The surfaces of objects contaminated by infectious disease pathogens can be wiped, soaked and sprayed with disinfectant with effective chlorine concentration of 1000-2000mg / L for 10-30 minutes; When the object surface is polluted by organic substances such as blood and mucus, the effective chlorine concentration of disinfectant can be increased to 2000-1000mg / L.

• Tableware:Preventive disinfection is not recommended. The tableware used by patients with infectious diseases can be soaked and disinfected with disinfectant with effective chlorine concentration of 250mg / L on the basis of cleaning for 20 minutes. After disinfection, rinse the residual disinfectant with clean water.

• Fabric: for preventive disinfection, the effective chlorine concentration can be 250-400mg / L. Immerse the fabric in the disinfectant for 20 minutes. After disinfection, rinse the residual disinfectant with clean water. For the disinfection of fabrics contaminated by infectious disease pathogens, the disinfectant with an effective chlorine concentration of 500mg / l can be used to immerse the fabrics for 30 minutes. After disinfection, rinse the residual disinfectant with clean water.

• Fruits and vegetables: during preventive disinfection, wash the fruits and vegetables first, then soak, rinse and disinfect them with disinfectant with effective chlorine concentration of 100-200mg / L for 10 minutes, and rinse the residual disinfectant with clean water after disinfection.

• Water: add an appropriate amount of chlorine containing disinfectant (about 0.5-10g) to each cubic meter of water, and keep the residual chlorine at 0.3-05mg/l after 30 minutes. In case of drinking water disinfection, the water quality after disinfection shall meet the drinking water standard.

• Air: Generally speaking, except hypochlorous acid water, other disinfectants can not be used for air disinfection. Remove the pollution source, close the doors and windows, and use the hypochlorous acid aqueous solution with an effective concentration of 100mg / L in combination with a special aerosol atomizer to reduce the original solution to 10 ~ 20ml / m when there is no one ³ Dosage, spray disinfection, action for 30 minutes, can be put into use.

• Hand: Generally speaking, except hypochlorite water, other chlorine containing disinfectants can not be used for hand disinfection. Hypochlorous acid aqueous solution with an effective concentration of 150mg / is used. Hand disinfection: take sufficient disinfectant to completely cover or immerse the parts to be disinfected for 1 minute; Surgical hand disinfection: after surgical hand washing, take an appropriate amount of disinfectant and evenly apply it to the skin under the hands, forearms and upper arms for 3 minutes.

• Skin and mucous membrane: Generally speaking, except hypochlorous acid water, other chlorine containing disinfectants can not be used for skin and mucous membrane disinfection. Use hypochlorous acid aqueous solution with an effective concentration of 100mg / L to spray wine on the part to be disinfected until it is evenly covered; Or wipe with sterile cotton swab or gauze soaked in disinfectant.

Disinfection of patient's articles

1.Thermometer, sphygmomanometer, oxygen tank and other equipment (if any)

• Soak or wipe the thermometer with 75% alcohol for 1 minute.
• For equipment that cannot be soaked, wipe it with 75% alcohol for 1 minute.

2.Daily necessities for patients

1) Patients' wastes, such as paper towels, should be put into closed bags before disposal (special garbage cans and disposable plastic bags, refer to disinfection).

2) Special tableware for patients: plates, cups, tableware, etc. shall be disinfected in the following ways:

• Soak the disinfectant with an effective chlorine concentration of 250mg / L for disinfection for 20 minutes, and rinse the residual disinfectant with clean water after disinfection. Or,
• Rinse with soapy water, then rinse with clean water, and then boil in a special pot at high temperature for 10 minutes

3) Bedding and toiletries

Towel, bed sheet, bedding and other fabrics shall be immersed in disinfectant with effective chlorine concentration of 500mg / L for 30 minutes. After disinfection, rinse the residual disinfectant with clean water.

4) Patient excreta

The special barrel shall be used for carrying, and shall not be directly discharged into the sewer.

• Usually, 50g bleaching powder or 2000ml disinfectant solution with effective chlorine concentration of 20000mg / l can be added to disinfect the patient's thin secretion and / or excreta every 2000ml.
• The excretion and vomit of New Coronavirus pneumonia patients can be added with bleach Powder 100g or containing effective chlorine (bromine) 20000mg/L disinfectant solution 4000ml per 2000ml.
• For viscous secretions and / or excretions, disinfectant with an effective chlorine concentration of 50000mg / l can be used. According to 2 parts of disinfectant and 1 part of secretions and / or excretions, mix and stir and stand for more than 120 minutes.

3.In the isolated room

Surfaces frequently contacted by patients should be cleaned and disinfected at least daily.

4.If there is not enough chlorine containing disinfectant

Alternatives:

• Waste can be incinerated outdoors (keep away from water source).
• Daily necessities and protective equipment that need to be reused shall be boiled in a special pot for 10 minutes.
• For equipment that cannot be boiled, spray disinfectant alcohol and place it in the sun for 45 minutes.

Disposal of medical waste

If there is no local public health system to deal with such wastes, prepare a box or dig a pit (keep away from the water source), prepare a disinfection isolation layer inside, put the treated wastes into the box, close the box, or bury them in the pit.

The structure is as follows:

• After sprinkling hydrated lime, close the box or fill it with soil
• Placement: Waste
• Top layer: hydrated lime (hydrated lime)
• Middle layer 1: pebble layer (fist sized pebble)
• Middle layer 2: charcoal layer (self fired)
• Lowest layer: fine sand and gravel (finger size gravel)

If there are the bodies of the unfortunate victims in the local area, they need to be treated on site, burned or buried in the above way.

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Treatment: standard care

In the absence of special medical equipment at home, the nursing principles are as follows:

Basic nursing and nutritional support

1. bed rest: the patient is resting in the isolation room

2. ensure nutrition and moisture

• Ensure adequate energy intake: take sugar water
• Electrolyte balance: light saline can be taken
• Light diet: to ensure protein supply, you can take steamed eggs, vegetables and fruit juice, etc.
• Supplements: multivitamins, or vitamin C, zinc supplements, nicotinic acid supplements, etc

3.Temperature detection: the normal temperature range is 36°2 ~ 37°3

• Axillary mercury thermometer, measuring time about 5 minutes.
• For electronic thermometer, refer to its manual.
• High fever state: measure the body temperature once every 1-2 hours, and record the time and temperature during measurement.
• Non high fever: measure the body temperature every 4 hours.

Medication

The drug list provided below, including but not limited to the approval and clinical drug list of local medical regulatory authorities in the United States, the European Union, China, Japan and India, may not be approved locally or the drug cannot be obtained. Therefore, the following list is for reference only.

List of antiviral drugs

It is not recommended to use more than three antiviral drugs at the same time. In case of intolerable toxic and side effects, the use of relevant drugs should be stopped. For the treatment of pregnant and parturient patients, we should consider the number of gestational weeks, choose drugs that have little impact on the fetus as far as possible, and consider whether to treat after termination of pregnancy, and inform them.

The following [1-6] are antiviral drugs that have been on the market for many years with relatively high price and accessibility:

1、 Interferon-alpha，IFN-α

For adults, 5 million U or equivalent dose each time, add 2ml of sterile water for injection twice a day, atomize inhalation, and the course of treatment shall not exceed 10 days;

2、Ribavirin+IFN-α（The dose is the same as above）

Ribavirin adult 500mg / time, intravenous infusion 2 to 3 times a day, the course of treatment shall not exceed 10 days;

3、Ribavirin+Lopinavir/Ritonavir

Lopinavir/ritonavir adult 200mg/50mg/capsule, 2 capsules each time, twice a day.

• Novel coronavirus pneumonia, Lopinavir/Ritonavir commercial brand Kaletra, in March 24, 2020, according to FT, AbbVie abandoned Kaletra (Lopinavir/Ritonavir) patents to face the shortage of drug supply brought by the global epidemic of new crown pneumonia.

Combined application: ribavirin 500mg / time for adults, intravenous infusion 2 to 3 times a day, and the course of treatment shall not exceed 10 days;

4、Chloroquine Phosphate

For adults aged 18 ~ 65. For those weighing more than 50kg, 500mg each time, twice a day for 7 days; If the body weight is less than 50kg, 500mg each time on the first and second days, twice a day, 500mg each time on the third to seventh days, once a day;

5、Arbidol

Adult 200mg, 3 times a day, the course of treatment shall not exceed 10 days.

6、Azithromycin

On March 19, 2020, the team of Didier raoulta, a French scientist, was accepted by the peer-reviewed scientific journal International Journal of antimicrobial agents. A clinical research paper published showed that hydroxychloroquine sulfate had a significant effect on covid-2019 patients.

In a clinical trial involving 36 patients with covid-2019 (6 asymptomatic, 22 symptomatic of upper respiratory tract infection and 8 symptomatic of lower respiratory tract infection), the negative rate of nasopharyngeal swab virus in patients on day 6: 100% were treated with hydroxychloroquine and Azithromycin; 57.1% of the patients only received hydroxychloroquine monotherapy; The control group was 12.5% (P < 0.001), and the drug efficacy of symptomatic patients was more significant than that of asymptomatic patients.

The biggest improvement of this clinical trial and the previous one is that it is found that the efficiency of virus elimination is significantly higher when combined with macrocyclic lipid antibiotic azithromycin. It even turns negative on the third day after enrollment, and completely turns negative on the sixth day, which is much shorter than the time reported in the previous Literature (covid-19, the average time of virus turning negative in Chinese patients is 20 days, The longest duration is even 37 days).

• The dose of hydroxychloroquine was 200 mg orally, 3 times a day for 10 days.
• The dose of azithromycin was 500 mg orally on day 1 and 250 mg daily on days 2 to 4.

The following item [7-12] is a relatively new list of drugs developed specifically for the treatment of COVID-19 infection. [7-11] most of them are biological agents and injection preparations. They usually require cold chain transportation and storage. 12, oral preparations can be transported and stored at room temperature.

7、Ronapreve（Casirivimab&Imdevimab）Treatment&PEP

Casirivimab & imdevimab is called regen-cov in the United States and ronapreve in other countries and regions.

On 2021 07, 20, the MHLW approved Ronapreve to treat patients with mild to moderate COVID-19 infection via intravenous infusion.

On July 30, 2021, FDA of the United States updated the regen-cov emergency use authorization (EUA) for covid-19 antibody cocktail therapy: people with high risk of developing into severe covid-19 were given post exposure prophylaxis (PEP). These people were not fully vaccinated or were not expected to produce sufficient immune response to the vaccination, and were exposed to sars-cov-2 infected people Or because the infection occurs in the same institutional environment (such as nursing home or prison), the risk of contact with infected persons is high.

Regen-cov was administered once a month to those who needed repeated administration due to continuous exposure.

8、Remdesivir：After the outbreak, first new drugs were specially designed for the treatment of COVID-19.

Veklury (remdesivir) is invented by the antiviral Institute of Gilead based company in the United States. Veklury has broad spectrum antiviral activity in animal and in vitro, and can fight against many new viral pathogens, including Ebola virus, SARS virus, Marburg virus, Middle East respiratory syndrome and SARS-CoV-2 virus causing New Coronavirus pneumonia.

On October 8, 2020 (US time), the New England Journal of Medicine (NEJM) published the final results of the phase 3 actt-1 clinical study of the National Institute of allergy and infectious diseases (NIAID). This is a double-blind, placebo-controlled trial to study Gillie's Science in the development of antiviral drug Reed Veklury for adults hospitalized with mild or severe New Coronavirus pneumonia. On the basis of the preliminary results published on NEJM in May 2020, the final results of the ACTT-1 trial showed that in the multiple outcome assessments for New Coronavirus pneumonia, Reed's showed a consistent and clinically significant benefit compared with placebo. The final results of the trial showed that the recovery time of patients treated with redcivir was faster than previously reported.

There are nearly 30 pharmaceutical factories around the world producing general-purpose remdesivir.

9、Sotrovimab 

Formerly known as vir-7831 or gsk4182136, it is a single dose monoclonal antibody against sars-cov-2. It targets the conserved epitope of "spike" protein, which is unlikely to mutate over time (which may make drug resistance more difficult). Sotrovimab combines xencor's xtend technology and is also designed to achieve high concentration in the lungs to ensure optimal penetration into the airway tissue affected by sars-cov-2 and has an extended half-life. Preclinical data show that it may not only block the virus from entering healthy cells, but also remove infected cells.

On May 26, 2021, GlaxoSmithKline and vir biotechnology announced that the U.S. FDA granted sotrovimab emergency use authorization (EUA) for the treatment of mild to moderate covid-19 adult and pediatric patients (aged 12 and over, weighing at least 40 kg). These patients tested positive for sars-cov-2 virus, And has a high risk of progression to severe covid-19, including hospitalization or death.

10、Etesevimab （LY-CoV555）

Etesevimab is a recombinant human monoclonal neutralizing antibody. It binds to sars-cov-2 surface spike protein receptor binding domain with high affinity and specificity, and can effectively block the binding between the virus and host cell surface receptor ACE2. The R & D team introduced point mutation into natural human IgG1 antibody to remove adverse effects such as tissue damage.

11、Bamlanivimab （JS016 or LY-CoV016）

Bamlanivimab is a powerful and neutralizing IgG1 monoclonal antibody against sars-cov-2 spike protein. Its research and development aims to prevent the virus from attaching and entering human cells, so as to neutralize the virus and potentially prevent and treat covid-19. Bamlanivimab is an antibody identified from a blood sample collected from the first covid-19 rehabilitation patients in the United States.

On February 9, 2021 (US Eastern time), Eli Lilly and company announced that the US FDA had granted neutralizing antibody combination therapy: bamlanivimab (ly-cov555) 700 mg and etesevimab (js016 or ly-cov016) 1400 mg emergency use authorization (EUA) for the treatment of mild and moderate covid-19 patients aged 12 and over with high risk of progression to severe or hospitalization.

Bamlanivimab alone has been authorized in several countries, while the joint programme of bamlanivimab and etesevimab has been authorized for emergency use in the United States and Italy.

12、Favipiravir（Oral tablet）

Favipiravir research and development code T-705, developed by FUJIFILM Toyama Chemical Co., Ltd., FFTC, Japan, is an antiviral drug for the treatment of drug-resistant influenza in Japan. It is being studied for the treatment of other types of viral infections, including Ebola virus (Ebola virus), COVID-19 (SARS-COV-2), Lhasa virus (T-705), and Toyama. Middle East respiratory syndrome (mers COV).

In 2020 06, Reed and Remdesivir (favipiravir) were approved in India for the treatment of severe acute coronavirus (COVID-19) infection.

The usual course of treatment for adults with favipiravir is 5 days. 1600mg once on the first day, twice a day; From day 2 to day 5, 600 mg once, twice a day.

There are nearly 100 pharmaceutical factories in the world to produce the general version of favipiravir.

List of immunotherapeutic drugs

COVID-19 infection causes the body's immune system to attack itself, causing inflammation and inflammation. Patients need to use immunosuppressive agents to fight inflammation.

1.Convalescent plasma

It is suitable for patients with rapid disease progression, severe and dangerous severe.

2.Intravenously injected covid-19 human immunoglobulin

It can be used in emergency for ordinary and severe patients with rapid disease progression. The recommended dosage is 20ml for ordinary type and 40ml for heavy type, which can be infused again every other day according to the improvement of the patient's condition, and the total number of times shall not exceed 5.

3、Actemra （Tocilizumab）

Tocilizumab can be used in patients with extensive lesions of both lungs and severe patients, and the level of IL-6 is increased in the laboratory. Specific usage: the first dose is 4 ~ 8mg / kg, the recommended dose is 400mg, 0.9% normal saline is diluted to 100ml, and the infusion time is more than 1 hour; For those with poor curative effect for the first time, they can be applied 14 times after the first dose is applied 12 hours (the dose is the same as the previous), the cumulative number of administration is up to 2 times, and the maximum dose of a single dose is not more than 800mg. Pay attention to allergic reaction. It is forbidden for those with active infection such as tuberculosis.

On 06 2021, 25, Roche announced that the United States FDA granted its intravenous IL-6 receptor inhibitor Actemra/RoActemra (tocilizumab) emergency use authorization (EUA) to treat adults hospitalized with COVID-19 (COVID-19) infection and children aged two and over. These patients are receiving systemic corticosteroids and require adjuvant oxygen supply, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

4、ALZUMAb（Itolizumab）

Itolizumab is an immunomodulatory anti-cd6 IgG1 monoclonal antibody. It was approved to market in India in 2013. It is also the first anti-cd6 monoclonal antibody in the world.

On 2020, 07, 10, Bicon, India biopharmaceutical company, announced that the India Drug Administration (DCGI) had approved ALZUMAb (Itolizumab) 25mg/5mL intravenous preparation for the treatment of moderate to severe acute respiratory distress syndrome (ARDS) caused by New Coronavirus pneumonia (COVID-19) and treated with cytokine release syndrome (CRS).

5、Baricitinib （Oral tablet）

Baricitinib is a JAK inhibitor, which is widely used in the treatment of various inflammatory diseases.

On July 29, 2021, the US FDA revised the emergency use authorization (EUA) of baricitinib, and now authorizes baricitinib to be used alone in the treatment of hospitalized adults and pediatric covid-19 patients aged 2 or above who need auxiliary oxygen supply, noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO).

• According to the revised EUA, baricitinib no longer needs to be administered with veklury.
• Baricitinib has not been officially approved by FDA for the treatment of covid-19.

6、Tofacitinib（Oral tablet）

Tofacitinib, a JAK inhibitor, has not been approved or authorized for the treatment of patients with covid-19.

On July 30, 2021, the results of the phase 3 clinical trial stop-covid (nct04469114) of oral JAK inhibitor tofacitinib in the treatment of covid-19 pneumonia inpatients were published in the International Medical Journal New England Journal of Medicine (NEJM).

The results showed that tofacitinib significantly reduced the risk of death or respiratory failure in hospitalized patients with covid-19 compared with placebo.

Rapid progress in the treatment of severe and dangerous cases

Treatment principle: actively prevent and treat complications, treat basic diseases, prevent secondary infection, and provide organ function support in time.

1.Glucocorticoid therapy: Methylprednisolone

For patients with progressive deterioration of oxygenation index, rapid imaging progress and excessive activation of body inflammatory response, glucocorticoids should be used in a short term (generally recommended for 3 ~ 5 days, no more than 10 days). The recommended dose is equivalent to 0.5 ~ 1mg / kg / day of methylprednisolone. It should be noted that a large dose of glucocorticoids due to immunosuppressive effect, It may delay the clearance of the virus.

2.Respiratory support: oxygen production and respiratory equipment are required

• Nasal catheter or mask for oxygen inhalation
• Transnasal high flow oxygen therapy or noninvasive ventilation
• Invasive mechanical ventilation
• Airway management: airway humidification, sputum aspiration by tracheoscopy when necessary;
• Extracorporeal membrane oxygenation (ECMO)

Most ordinary families do not have the above equipment and rescue conditions, which are for reference only.

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Emergency: alternative therapy

If you need to use the contents of this section and believe that the patient is already in the "desert of medical resources", please believe that you can survive.

Treatment of high fever

When the patient has a high fever (temperature above 38.5 °C ), symptomatic treatment.

1 .Gypsum

If there is gypsum, boil 15 ~ 30g gypsum with water, filter out the gypsum, take the liquid, once in the morning and once in the evening (40 minutes after meals), take it gently, and take it for 3 days. If the symptoms improve but do not recover, continue to take it for the second course of treatment.

If the patient has slight fever, the dosage of gypsum should be small, and the fever symptoms are strong. The dosage of gypsum can be increased.

2 .Radix Bupleuri

Ingredients in some plants can promote perspiration and lower body temperature, such as taking Radix Bupleuri extract juice.

3. Physical cooling

If there is no cooling medicine, wet the hot water with a towel (the water temperature is about 40°C) and wipe the armpits, forehead, soles of feet, palms and other parts, which can play a physical cooling effect.

Inhibit virus

The components in some plants have the function of inhibiting bacteria and viruses. They can be extracted and taken with liquid to fight bacteria and viruses, such as:

• Strobilanthes cusia (Nees) Kuntze blade
• Banlangen root
• Heartleaf houttuynia herb blade
• Polygonum tinctorium blade
• Isatis indigotica fortune blade
• Indigofera tinctoria Linn stem and leaf

Immunosuppression

Components in some plants have immunosuppressive function and can be extracted and taken with liquid to fight inflammation, such as:

• Glycyrrhiza uralensis Fisch
• Folium Perillae
• Scutellaria baicalensis Georgi
• Zingiber officinale Rosc
• Belamcanda chinensis （L.）Redouté

Mash the plant, soak in water for 30 minutes, filter out impurities and take it.

Expectorant

If the patient has sputum:

• Ephedra sinica Stapf
• Aster tataricus L. f.
• Tussilago farfara L.

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Equipment: how to make oxygen?

The best option is to receive treatment in the hospital. The second is to buy household oxygen generator. Finally, electrolytic water is relatively dangerous for people without technical knowledge. Usually, it may be difficult for families to make enough oxygen, and the international minimum medical oxygen concentration standard is more than 82%.

If the patient is critically ill, be sure to make oxygen by yourself, please follow the following technical points:

1. Using direct current to electrolyze water is to electrolyze with the electricity of the battery. The electricity of the power system can be charged into the battery and then electrolyze water.
2. The DC voltage is not higher than 30V, which is relatively safe. Electrolytic reserve oxygen in advance.
3. Select copper plate as the electrode. Remember that the positive electrode produces oxygen and the negative electrode produces hydrogen. There are two barrels for electrolytic water, the middle is connected with a pipe, and the barrel with negative electrode to produce hydrogen is placed outdoors. Remember that hydrogen pre fire will burn and explode, and there shall be no fire source around.

For a more detailed operation guide, you can search for self-made oxygen tutorials and videos on the Internet.

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Appendix

Reference resources

1. China National Center for 《Disease Control and prevention New Coronavirus pneumonia diagnosis and treatment plan (trial version 8)》
2. WHO COVID-19 Coronavirus disease (COVID-19) Pandemic

Edition

The document version number consists of five parts:

• Part 1 is the project name
• Part 2 is the description of the document
• Part 3 is the main version number of the language: the version number of simplified Chinese is "0"
• Part 4 is the date version number
• Part 5 is the phase version number

Different language versions are as follows:

• English：LienTeh.Covid.11.2021081001.1
• 简体中文【Simplified Chinese】：LienTeh.Covid.0.20210801.1
• 繁体中文【Traditional Chinese】：LienTeh.Covid.1.20210804.1
• Tiếng Kinh【Vietnamese】：LienTeh.Covid.5.20210809.1
• Bahasa-Malay【Indonesian】：LienTeh.Covid.9.20210812.1
• ภาษาไทย【Thai language】：LienTeh.Covid.6.20210811.1
• ພາສາລາວ【Laotian language】：LienTeh.Covid.4.20210814.1
• မြန်မာဘာသာစကား［Myanmar’s Burmese］：LienTeh.Covid.2.20210828.1
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• देवनागरी （Hindī-Nepali）：LienTeh.Covid.10.20210831.1

Content iteration: the content of the document will be continuously updated with the progress of the medical community.

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