Introducing the New Versions of Chinese Diagnosis and Treatment Protocol for COVID-19

Since the first outbreak of COVID-19 in January 2020, the pandemic has lasted already for 2½ years, causing 564,126,546 confirmed infections and 6,371,354 confirmed deaths worldwide by July 22, 2022.¹ In addition to the large number of deaths caused by the disease, the COVID-19 pandemic has also had a huge impact on the world economy. Not only have the transportation, tourism, catering, cultural and entertainment industries, and other personnel-intensive industries been directly impacted, but also a large number of people have been isolated and controlled or accepted home office work, which in turn affected all walks of life. According to the World Economic Outlook Report released by the International Monetary Fund in October 2021,² the world economy has declined by 3.1% year-on-year in 2020, of which developed economies has declined by 4.5% and emerging market and developing economies by 2.1%.

In the process of containing the COVID-19 epidemic, different countries have adopted different antiepidemic strategies, and the results achieved have been variable. China's antiepidemic containment strategies have proven highly effective. Wuhan, as the city where the outbreak was first reported, faced the rapid dissemination of an unknown pathogen. After the initial chaos, the situation was quickly stabilized with the support of personnel and materials from all over the country. Under the organization of the Chinese National Health Commission, the experience and lessons of epidemic prevention and control and clinical treatment have continuously been summarized and updated in national guidelines. Between January 16 and March 3, 2020, eight versions (the Trial Versions 1 to 7 and the Revised Trial Version 5)^3–8 of the Diagnosis and Treatment Protocol for COVID-19 have been released and updated within a short period of 48 days, providing guidance for controlling the spread and timely treatment of COVID-19 patients. As a result, the mortality rate of COVID-19 in China (0.428%; 22,994 deaths/5,366,822 confirmed cases, up to July 22, 2022) is much lower than the global average (1.129%; 6,371,354 deaths/564,126,546 confirmed cases, up to July 22, 2022).¹ After that, the Chinese National Health Commission released the Trial Version 8, the Revised Trial Version 8, and the Trial Version 9 of the Diagnosis and Treatment Protocol for COVID-19 on August 18, 2020, April 14, 2021 and March 14, 2022, respectively. ^9–11 During the interval between the release of the new versions, research progress and updated knowledge of virus mutations, vaccination efficacy, symptoms of infected persons, drug development and clinical treatment measures have continuously been absorbed and summarized, which has made positive contributions to the prevention and control of sporadic and local outbreaks in China.

Compared with the previous versions, the latest ninth version added a summary of the transmissibility, pathogenicity, detection accuracy and human immune responses to new virus variants (such as delta and omicron); the description of pathological changes and clinical characteristics is more accurate; the case discovery and reporting standards have been adjusted, and the criteria for ending isolation and considerations after ending isolation have been added. The biggest difference between the ninth version and the eighth version is in the treatment section. In terms of antiviral drugs, PF-07321332/ritonavir tablets and the monoclonal antibody ambavirumab/romisvirumab injection are now recommended, whereas α-interferon, ribavirin, chloroquine phosphate and arbidol, included for trial use in the eighth version, are no longer included in the ninth version. The ninth version also removed the “Blood purification treatment” section. In terms of traditional Chinese medicine treatment, in addition to the original syndromes and prescriptions, the ninth version also listed recommended Chinese patent medicines, recommended acupuncture points for acupuncture, and moxibustion treatment, as well as traditional Chinese medicine treatment plans and principles for children.

In line with the purpose of helping the global antiepidemic work, our journal Infectious Microbes and Diseases (IMD) published the English version of the Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7) in April 2020 (translated by the World Health Organization Representative Office in China).¹² The Trial Version 8 has also been translated into English by the World Health Organization Representative Office in China and can be accessed online.¹³ The Revised Trial Version 8 and the latest Trial Version 9 have not yet been released in English. Based on the English version of the Trial Version 7, IMD has translated and published the two new versions to provide reference and support for the fight against the COVID-19 pandemic.^14,15