Epidemic Information

Summary of Key Revisions and Updates to the COVID-19 Diagnosis and Treatment Protocol (Trial Version
• To further improve COVID-19 medical treatment and enhance standardized, homogeneous diagnosis and treatment, the National Health Commission (NHC) and the National Administration of Traditional Chinese Medicine (NATCM) organized experts to revise the COVID-19 Diagnosis and Treatment Protocol (Trial Version 8, Revised Edition), resulting in the COVID-19 Diagnosis and Treatment Protocol (Trial Version 9), issued on March 14, 2022, for nationwide implementation. Key revisions and updates are as follows:

  1. Virological Characteristics (Section I)

  • Omicron Dominance: Omicron has replaced Delta as the predominant variant. Evidence shows Omicron is more transmissible than Delta but less pathogenic. China’s routine PCR testing remains accurate, though some monoclonal antibodies may have reduced neutralizing efficacy against Omicron.

  2. Transmission Routes (Section II, Epidemiology, 2)

  • Explicit Routes:
    1. Primary transmission via respiratory droplets and close contact;
    2. Aerosol transmission in relatively enclosed spaces;
    3. Infection through contact with virus-contaminated objects.

  3. Clinical Manifestations (Section III, 1)

  • Vaccinated/Omicron Cases: Asymptomatic or mild symptoms predominate, including low-to-moderate fever, sore throat, nasal congestion, and runny nose (upper respiratory symptoms).

  4. Diagnostic Principles (Section IV, 1)

  • Primary Diagnostic Criterion: Positive nucleic acid test remains the gold standard. For unvaccinated individuals, specific antibody tests may serve as reference; for vaccinated or previously infected individuals, antibodies are no longer used as diagnostic evidence.

  5. Suspected Case Definition (Section V, 1, 2)

  • Epidemiological History Adjustment: Removed "contact with asymptomatic asymptomatic carriers" from the 14-day exposure history, retaining only "contact with COVID-19 感染者 (confirmed cases)".

  6. High-Risk Groups for Severe/Critical Illness (Section VII)

  • Age Adjustment: Changed from "individuals over 65 years old" (Version 8) to "individuals over 60 years old".

  7. Differential Diagnosis (Section IX)

  • New Requirement: Close contacts of COVID-19 patients must undergo nucleic acid testing even if common respiratory pathogen tests are positive.

  8. Case Detection and Reporting (Section X)

  • Process Streamlining:
    • Suspected cases or those with positive antigen tests undergo immediate nucleic acid testing or closed-loop transfer for testing, with single-room isolation during processing.
    • Positive cases are centrally isolated or hospitalized, with mandatory online reporting.
      - Criteria for Excluding Suspected Cases: Two consecutive negative nucleic acid tests (≥24-hour interval), removing the requirement for IgM/IgG antibody testing.

  9. Management of Mild Cases (Section XI, 1)

  • Isolation Adjustment: Mild cases are managed in centralized isolation facilities (not designated hospitals), separate from imported cases and close contacts. Symptomatic treatment and condition monitoring are required, with transfers to hospitals for deterioration.

  10. Antiviral Therapy (Section XI, 3)

  • New Drug Additions: Two NMPA-approved therapies included:
    • PF-07321332/ritonavir tablets (Paxlovid);
    • Monoclonal antibody therapy (amubarvimab/romlusevimab injection).

  11. Convalescent Plasma (Section XI, 3, 4)

  • Indications and Dosage Specified: Recommended for high-risk, high-viral-load, rapidly progressing patients in early disease course. Dose: 200–500ml (4–50ml/kg), with possible re-infusion based on individual conditions.

  12. MIS-C Treatment (Section XI, 8, 5)

  • Pediatric Protocol: Multidisciplinary management focusing on early anti-inflammation, shock/coagulation correction, and organ support.
    • Non-shock cases: First-line IVIG (2g/kg); add methylprednisolone (1–2mg/kg/day) or tocilizumab for non-responders.
    • Shock cases: IVIG + methylprednisolone (1–2mg/kg/day).
    • Refractory cases: High-dose methylprednisolone (10–30mg/kg/day) or additional immunotherapy.

  13. TCM Updates (Section XI, TCM Content)

  • Non-Pharmacological Therapies: Added "recommended acupuncture acupoints" for clinical use.
  • Pediatric Guidance: New section on TCM treatment tailored for children.

  14. Isolation Release Criteria (Section XII, 1)

  • Ct Value Adjustment:
    • Mild cases may end isolation with two consecutive nucleic acid tests showing Ct values ≥35 (for N and ORF genes, PCR cutoff 40, ≥24-hour interval) or two negative tests (cutoff <35, ≥24-hour interval).

  15. Discharge Criteria (Section XII, 2)

  • Same as Isolation Release: Updated to align with new Ct value standards (identical to Section 14).

  16. Vaccination Emphasis (Section XVI, 1)

  • Strong Recommendation: Vaccination reduces infection, severe illness, and mortality. All eligible individuals should receive primary and booster shots as applicable.
  
  
  For the full text of the COVID-19 Diagnosis and Treatment Protocol (Trial Version 9), click the link below:
  [COVID-19 Diagnosis and Treatment Protocol (Trial Version 9)]
  
  
  Source: Electronic Journal of Emerging Infectious Diseases | Emerging Infectious Diseases Network
  March 16, 2022
2022-03-28 Visited: 1768