China's COVID-19 diagnosis and treatment protocol revised

China has updated the COVID-19 diagnosis and treatment protocol for the first time in two years.

The National Health Commission's Bureau of Medical Administration released the 9th edition of the "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia" on Tuesday.

The updated edition has been revised based on the study of variants like Delta and Omicron, optimized case finding, hospital admission, antiviral therapy, TCM treatment and nucleic acid testing standards.

It added antigen testing as a supplement to the current nucleic acid testing to enhance the early discovery of cases. People who test positive on antigen are required to receive nucleic acid tests as soon as possible.

It has also included two new antiviral drugs for treatment: Paxlovid and domestically developed BRII-196 / BRII-198. TCM's role in the treatment is also underlined, such as acupuncture and TCM treatment for children.

The relaxation in hospital admission and nucleic acid testing standards are aimed to ease the stress on medical resources and help relieve Shanghai's recent COVID-19 prevention pressure.

New hospital admission rules

The confirmed COVID-19 cases with mild symptoms on the Chinese mainland will be put under central quarantine at designated sites, where arrivals from overseas or close contacts of previous cases won't be quarantined at the same time.

The previous treatment guideline called for all confirmed and asymptomatic cases to be treated at designated hospitals.

"Many Chinese regions have reported that a vast majority of asymptomatic and mild infections of the Omicron variant require no treatment," the commission said. "Sending them to designated hospitals will take up substantial medical resources."

The patients will receive treatment and their conditions will be monitored during the quarantine. If their conditions get worse, they will be moved to designated hospitals.

An asymptomatic case is one that tests positive for COVID-19 but shows no clinical symptoms. A small portion of such cases might show symptoms later and become a confirmed case.

In Shanghai, asymptomatic cases are quarantined at the Shanghai Public Health Clinical Center just like confirmed cases, though most require no treatment since they show no clinical symptoms, said Hu Bijie, director of the infectious diseases department at Zhongshan Hospital and a member of Shanghai's COVID-19 treatment experts team.

Other cases – normal, severe, critical, highly critical – will be treated at designated hospitals. The critical and highly critical cases and those who tend to develop critical conditions should be sent to the intensive care unit as soon as possible.

Experts said the majority of Omicron cases are asymptomatic and have mild infections. They don't need much treatment. Even at the hospital, there's no medication for them. As a matter of fact, medicines are only for normal, critical, and highly critical cases.

At a press briefing on Tuesday, Jiao Yahui, director of the National Health Commission's Bureau of Medical Administration, said: "As of this morning, a total of 8,201 cases are in hospitals in Jilin Province. More than 95 percent of them are mild cases, or showed no symptoms at all."

It means that 95 percent of them don't need to be hospitalized.

New nucleic acid testing standards

Previously, people who tested negative in two consecutive tests (at least 24 hours apart) were allowed to leave quarantine or hospital. The new directive describes negative as Ct values ≥35.

"Previously, Ct values ranging from 0 to 40 were considered positive. But studies have found that when the reading exceeds 35, close contacts of confirmed cases won't be infected. It means these confirmed cases cannot spread the virus. It's a waste of resources to quarantine them," an expert told Shanghai-based news outlet Yicai. "The mark was set at 40 to find more infections and curb the pandemic as soon as possible. But it is not suitable for current Omicron-dominated infections."

The updated 9th version also reduced the home quarantine after discharge from the hospital. After being discharged from a hospital, people will undergo a seven-day home quarantine, rather than two weeks of quarantine and medical observation as previously stipulated.