How to fight against COVID-19

The First Affiliated Hospital, Zhejiang University School of Medicine has treated 104 patients with confirmed COVID-19 in the past 50 days, and their experts wrote real treatment experience when combating the virus night and day, and quickly published this Handbook of COVID-19 Prevention and Treatment.

In order to win this inevitable battle and fight against COVID-19, we must work together and share our experiences around the world.

Part One Prevention and Control Management

I.Isolation Area Management

1 Fever Clinic
1.1  Layout
(1)  Healthcare facilities shall set up a relatively independent fever clinic including an
exclusive one-way passage at the entrance  of  the hospital with a visible sign;
(2)  The  movement  of  people shall  follow  the principle  of  "three zones and two passag-
es" : a contaminated zone, a potentially contaminated zone and a clean zone provided
and clearly demarcated, and two buffer zones between the contaminated zone and the
potentially contaminated zone;
(3)  An  independent passage shall be equipped for contaminated items; set up a visual
region for one-way delivery  of  items from  an  office area (potentially contaminated zone) to
an  isolation ward (contaminated zone);
(4)  Appropriate procedures shall be standardized for medical personnel to put  on  and take
off  their protective equipment.  Make  flowcharts  of  different zones, provide full-length
mirrors and observe the walking routes strictly;
(5)  Infection prevention and control technicians shall  be  assigned to supervise the medical
personnel  on  putting  on  and removing protective equipment  so  as  to prevent contamination;
(6)  All items  in  the contaminated zone that have not been disinfected shall not  be  removed.
1.2  Zone Arrangement
(1)  Set  up  an  independent examination room, a laboratory,  an  observation room, and a
resuscitation room;
(2)  Set  up a pre-examination and triage area to perform preliminary screening  of  patients;
(3)  Separate diagnosis and treatment zones: those patients with an epidemiological history
and fever  and/or  respiratory symptoms shall be guided into a suspected  COVID-19  patient
zone; those patients with regular fever but no clear epidemiological history shall be guided
into a regular fever patient zone.
1.3  Patient Management
(1)  Patients with fevers must wear medical surgical masks;
(2)  Only patients are allowed to enter the waiting area in order to avoid overcrowding;
(3)  The  duration  of  the patient's visit shall  be  minimized  so  as  to avoid cross infections;
(4)  Educate patients and their families about early identification  of  symptoms and essential
preventative actions.
1.4  Screening, Admission and Exclusion
{1) All healthcare workers shall fully understand the epidemiological and clinical features  of
COVID-19  and screen patients  in  accordance with the screening criteria below  (see  Table 1  );
(2) Nucleic acid testing  (NAT)  shall  be  conducted on those patients who meet the screening
criteria for suspected patients;
{3) Patients who do not meet the screening criteria above,  if  they do not have a confirmed
epidemiological history, but cannot be ruled out from having  COVID-19  based  on  their
symptoms, especially through imaging, are recommended for further evaluation and to obtain a
comprehensive diagnosis;
(4) Any patient  who  tests negative shall  be  re-tested  24  hours later. If a patient has  two  negative
NAT  results and negative clinical manifestations, then  he  or  she  can be ruled out from having
COVID-19  and discharged from the hospital. If those patients cannot be ruled out from having
COVID-19  infections based on their clinical manifestations, they shall be subjected to additional
NAT  tests every  24  hours until they are excluded or confirmed;
(5) Those confirmed cases with a positive  NAT  result shall  be  admitted and treated collectively
based  on  the severity  of  their conditions (the general isolation ward or isolated  ICU).

2 Isolation Ward Area
2.1  Scope  of  Application
The  isolation ward area includes an observation ward area, isolation wards, and an
isolation  ICU  area.  The  building layout and workflow shall meet the relevant requirements
of  the hospital isolation technical regulations. Medical providers with negative pressure
rooms shall implement standardized management  in  accordance with relevant require-
ments. Strictly limit access to isolation wards.
2.2  Layout
Please refer to fever clinic.
2.3  Ward  Requirements
(1) Suspected and confirmed patients shall be separated in different ward areas;
(2) Suspected patients shall be isolated in separated single rooms.  Each  room shall be
equipped with facilities  such  as  a private bathroom and the patient's activity should be
confined to the isolation ward;
(3) Confirmed patients  can  be arranged  in  the same room with bed spacing  of  not less than
1.2  meters (appx 4 feet).  The  room shall be equipped with facilities such  as  a bathroom and
the patient's activity must be confined to the isolation ward.
2.4 Patient Management
(1) Family visits and nursing shall  be  declined. Patients should  be  allowed to have their
electronic communication devices  to  facilitate interactions with loved ones;
(2) Educate patients to help them prevent further spread  of  C0VID-19, and provide instruc-
tions  on  how  to  wear surgical masks, proper handwashing, cough etiquette, medical
observation and home quarantine.

II.Staff Management

1 Workflow Management
(1)  Before working  in  a fever clinic and isolation ward, the staff must undergo strict training
and examinations to ensure that they know how to put  on  and remove personal protective
equipment. They must pass such examinations before being allowed to work in these
wards.
(2)  The  staff should  be  divided into different teams.  Each  team should be limited  to  a ma-
ximum  of  4 hours  of  working in an isolation ward.  The  teams shall work  in  the isolation
wards (contaminated zones) at different times.
(3)  Arrange treatment, examination and disinfection for each team  as  a group to reduce the
frequency  of  staff moving  in  and out  of  the isolation wards.
(4)  Before going off duty, staff must wash themselves and conduct necessary personal hy-
giene regimens to prevent possible infection  of  their respiratory tracts and mucosa.


2 Health Management
(1)  The  front-line staff  in  the isolation areas - including healthcare personnel, medical
technicians and property  &  logistics personnel - shall live  in  an  isolation accommodation
and shall not go out without permission.
(2)  A nutritious diet shall be provided to improve the immunity  of  medical personnel.
(3)  Monitor and record the health status  of  all  staff  on  the job, and conduct health monitor-
ing for front-line staff, including monitoring body temperature and respiratory symptoms;
help address any psychological and physiological problems that arise with relevant experts.
(4)  If the staff have any relevant symptoms such  as  fever, they shall be isolated immediately
and screened with an  NAT.
(5)  When  the front-line staff including healthcare personnel, medical technicians and property
&  logistics personnel finish their work  in  the isolation area and  are  returning to normal life,
they shall first  be  NAT  tested for  SARS-CoV-2.  If negative, they shall  be  isolated collectively at
a specified area for  14  days before being discharged from medical observation.

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