On March 3, 2020, the National Health Commission released the “Diagnostic and Treatment Plan for New Coronavirus Pneumonia (Trial Version 7)” (hereinafter referred to as the “Version 7”), which is interpreted as follows. I. Preamble In the preamble, add “Through a series of preventive control and medical treatment measures, the rising momentum of the epidemic in China has been curbed to a certain extent, and the epidemic has eased in most provinces, but the number of cases outside the country is on the rise.” “With the depth of understanding of the clinical manifestations of the disease, pathology and the accumulation of experience in diagnosis and treatment, in order to further strengthen the early diagnosis and treatment of the disease, improve the cure rate, reduce the rate of deaths, and maximize the likelihood of avoiding hospital-acquired infections, but also to pay attention to the spread and proliferation of the disease caused by the imported cases outside the country.” Second, the transmission route to add “due to feces and urine can be isolated in the new coronavirus, should pay attention to feces and urine on the environmental pollution caused by aerosol or contact transmission.” Pathologic changes” was added to describe “lungs, spleen and hilar lymph nodes, heart and blood vessels, liver and gallbladder, kidneys, brain tissue, adrenal glands, esophagus, stomach and intestinal tubes, and other organs” according to the general view and microscopic view respectively. Lung and immune system damage is predominant. Other organs vary according to the underlying disease, and most of the damage is secondary. Clinical manifestations (a) Increase the description of the clinical manifestations of pregnant women and children. For example, “the clinical process of pregnant women is close to that of patients of the same age.” “Some children and newborns may have atypical symptoms, such as vomiting, diarrhea and other gastrointestinal symptoms, or only mental weakness and shortness of breath.” (ii) Pathogenetic testing. Delete “To increase the positive rate of nucleic acid detection, it is recommended that sputum be retained as much as possible, and lower respiratory secretions be collected from patients undergoing endotracheal intubation”, add “using RT-PCR or/and NGS methods” for nucleic acid detection, and emphasize that “Detection of lower respiratory tract specimens (sputum or airway extracts) is more accurate.” (iii) Increased serologic testing. Novel coronavirus-specific IgM antibodies are mostly positive after 3-5 days of onset, and IgG antibody titers increase 4-fold or more during the recovery phase compared to the acute phase. V. Diagnostic Criteria (a) Explanation of “clustering” in the epidemiologic history, i.e., “2 or more cases of fever and/or respiratory symptoms within 2 weeks in a small area, such as a home, office, or school class, etc.”. (ii) The phrase “decreased lymphocyte count” in Clinical Presentation is amended to read “normal or decreased lymphocyte count”. (c) In addition to the original nucleic acid test and sequencing, “serologic test” is added as the basis for confirming the diagnosis, i.e., “positive for novel coronavirus-specific IgM antibody and IgG” or “positive to negative for novel coronavirus-specific IgG antibody”. The diagnosis can also be confirmed if the IgG antibody turns from negative to positive or is 4 times or more elevated in the recovery phase compared with the acute phase. VI. Clinical classification is still divided into “light type, common type, heavy type and critical type”. Severe cases are defined according to “adults” and “children”. There is no change in the criteria for adults, and the criteria for children are added: 1. Shortness of breath (<2 months old, RR ≥60 beats/min; 2~12 months old, RR ≥50 beats/min; 1~5 years old, RR ≥40 beats/min; >5 years old, RR ≥30 beats/min), except for the effects of fever and crying; 2. Oxygen saturation ≤92% at rest; 3. Assisted respiration (groaning, flaring of the nostrils, the three concave signs), cyanosis, and intermittent breathing. concave sign), cyanosis, intermittent apnea; 4. the presence of lethargy, convulsions; 5. refusal to eat or feeding difficulties, signs of dehydration. VII. Add “severe and critical clinical warning indicators” according to adults and children respectively. (1) Adults: 1. peripheral blood lymphocytes are declining; 2. peripheral blood inflammatory factors, such as IL-6 and C-reactive protein, are rising; 3. lactic acid is rising; and 4. lung lesions are progressing rapidly in a short period of time. (ii) Children 1. Increased respiratory rate; 2. Poor mental response and lethargy; 3. Progressive elevation of lactate; 4. Imaging showing bilateral or multilobar infiltration of the lungs, pleural effusion, or rapid progression of lesions in a short period of time; 5. Infants less than 3 months of age or those who have underlying diseases (congenital heart disease, bronchopulmonary dysplasia, respiratory malformations, abnormal hemoglobin, severe malnutrition, etc.), immune deficiencies or hypoplasia (long-term use of immunosuppressive drugs). Addition of exclusion criteria for suspected cases. The exclusion of suspected cases must meet the following criteria: two consecutive negative nucleic acid tests for novel coronavirus (sampling time at least 24 hours apart), and IgM and IgG antibodies specific for novel coronavirus are still negative after 7 days of the onset of illness. Nine, treatment (a) the general treatment of oxygen therapy measures, add “conditions can be used to hydrogen and oxygen mixed inhalation gas (H2 / O2 : 66.6% / 33.3%) treatment.” (ii) Antiviral treatment. Delete “Lopinavir/ritonavir-related adverse reactions such as diarrhea, nausea, vomiting, and liver function impairment” and replace with “Attention should be paid to the adverse reactions, contraindications, and interactions with other drugs of the above medications.” Add “The treatment of maternal patients should take into account the number of weeks of gestation, choose drugs with less effect on the fetus as far as possible, and the question of whether to terminate the pregnancy before treatment, and informed notification.” (C) Treatment of heavy and critical cases.1. According to the pathology, mucus and mucus plug formation can be seen in the airway, and in order to improve ventilation, invasive mechanical ventilation should be added: “According to the airway secretion, select closed suction, and if necessary, carry out bronchoscopy to take appropriate treatment.” 2. add “extracorporeal membrane pulmonary oxygenation (ECMO) related indications”: ① at FiO2>90%, the oxygenation index is less than 80mmHg, lasting for more than 3-4 hours; ② airway plateau pressure ≥35cmH2O. 3. circulatory support emphasizes “non-invasive or invasive hemodynamic monitoring, in the process of rescue and treatment. Dynamic monitoring, in the course of treatment, pay attention to fluid balance strategy, avoid over and under.” 4. 4. add “renal failure and renal replacement therapy”: in addition to finding the cause of renal impairment, continuous renal replacement therapy (CRRT) can be chosen for severe patients with renal failure, and treatment indications are given at the same time.5. For heavy and critical patients with cytokine storm, in order to remove inflammatory factors and block the “cytokine storm”, it is necessary to remove inflammatory factors. “For heavy and critical patients with cytokine storm, in order to remove inflammatory factors and block cytokine storm, “blood purification therapy” is added. 6. “Tolizumab” is added for immunotherapy: the indication is “patients with extensive lesions in both lungs and patients with severe disease, and the treatment indication is given. Add “tolizumab” for immunotherapy: the indications are “patients with extensive lesions in both lungs and patients with severe disease and elevated IL-6 levels in laboratory tests”. Specific usage and dosage are given, and attention should be paid to allergic reactions, and those with active infections such as tuberculosis are prohibited.7. Other therapeutic measures are added: “Intravenous gammaglobulin may be considered in children with severe or critical cases. Pregnant patients with severe or critical cases should actively terminate the pregnancy, and caesarean section is preferred.” (d) Chinese medicine treatment has increased the use of traditional Chinese medicine in the case of critical type with mechanical ventilation with abdominal distension and constipation or fecal impaction, as well as in the case of human-machine asynchrony. X. “Discharge from isolation criteria” has been changed to “discharge criteria”. (1) The discharge criteria are still four, the first three remain unchanged. Article 4 added “sputum, nasopharyngeal swabs, etc.” respiratory specimen nucleic acid test negative for two consecutive times, the sampling time of at least “an interval of 1 day”, changed to “at least 24 hours apart”. (ii) Post-discharge precautions. In view of the fact that a small number of discharged patients have been retested positive for nucleic acid, in order to strengthen the health management and isolation of discharged patients, the phrase “should continue to carry out self-monitoring of their health status for 14 days” should be changed to “should continue to carry out isolation management and monitoring of their health status for 14 days”. “, and at the same time require the wearing of masks, living in well-ventilated single rooms if possible, reducing close contact with family members, eating separate meals, practicing good hand hygiene, and avoiding outdoor activities. Content source: Medical Council of Hong Kong