Expert Advices on Medical Management of Integrated Traditional Chinese and Western Medicine for Patients with Fever at Home in Communities(First Edition)

Corona virus disease 2019(COVID-19)epidemic was detected in Wuhan City, Hubei Province in December 2019. Current data shows that most patients are ordinary cases. At the same time, the late winter and early spring each year is also the period of high incidence of cold and flu. Thus,recently, there are a high number of crowds in fever clinics and wards.Some fever patients chose home isolation due to fear of cross-infection risk.According to the Diagnosis and Treatment Plan of Corona Virus Disease 2019(Tentative Fourth Edition), Prevention and Control Plan of Corona Virus Disease 2019(Third Edition)and Scheme for Diagnosis and Treatment of Influenza(2019),etc., we make this recommendation to guide patients with fever under home quarantine.

1.Screening Recommendations of Home Quarantine for Patients with Fever

Respiratory infections have high incidence in the winter and spring.Typical cold, flu, and COVID-19 can cause fever, but the symptoms are different. For example, the typical cold usually manifests as obvious upper respiratory tract symptoms such as sneezing, runny nose and throat discomfort, but systemic symptoms are mild, such as no fever or only transient fever. The flu usually causes high fever, severe systemic symptoms,with chills, headache, systemic aches, nasal congestion, runny nose, dry cough, chest pain, nausea and loss of appetite. The COVID-19 manifests as fever, fatigue, and dry cough. A small number of patients have symptoms such as nasal congestion, runny nose, and diarrhea.

If fever, cough and other symptoms occur, people are suggested to be placed under home quarantine once the following conditions are met:

1.1 Mild symptoms, with body temper ature <38 °C; with no obvious shortness of breath, chest tightness, difficult breathing; and with stable vital signs such as breathing, blood pressure, and heart rate.

1.2 Without severe basic diseases of respiratory and cardiovascular systems and severe obesity.

2.Medical Management Recommendations for Patients with Fever at Home

2.1 More rest, keep balanced diet without fat, oil and sugar.

2.2 Drink warm water rather than cold beverage to ensure normal spleen and stomach function.

2.3 Avoid overuse or inappropriate use of antimicrobials.

2.4 Wear masks correctly, have meals separately from family members,and keep a distance of more than 1.5 meters from family members.

2.5 People with chills can choose Chinese patent medicines with antipyretic and cold-dispelling properties.

2.6 People with chills, fever, muscle soreness, and cough can choose Chinese patent medicines with heat clearing and detoxifying, ventilating the lung and arresting cough.

2.7 People with fatigue, nausea, decreased appetite, and diarrhea can choose Chinese patent medicines of dehumidification.

2.8 People who have fever with obvious sore throat can choose Chinese patent medicines with clearing heat and detoxifying.

2.9 Fever with constipation can additionally use diarrhea-inducing,fever-appeasing preparations.

2.10 When a body temperature is higher than 38.5 °C, physical cooling measures such as warm towels or ice sticks can be taken. People with this condition are recommended to take antipyretic and analgesics or take antipyretic and detoxifying medicines.

The specific drugs above can refer to the recommended drugs in the Diagnosis and Treatment Plan of Corona Virus Disease 2019(Tentative Fourth Edition).

3.Family Prevention and Control Measures for Patients with Fever

3.1 Recommend a period of 7 days for home quarantine.

3.2 Keep the indoor environment clean and ventilated for half an hour,one to three times per day. Pay attention to keep warm when ventilating.

3.3 Wear masks correctly, cover mouth with tissues or elbow rather than hands when coughing and sneezing, wash hands frequently(do not touch mouth, nose, eyes, etc. with dirty hands)and put down the toilet lid before flushing.

3.4 Avoid gatherings, dine-parties and reduce stay time in crowded places as shorter as possible.

3.5 People with fever, cough and other symptoms should be aware of the methods of self-quarantine, such as single-room isolation; if not permitted,patients should keep a distance of at least 1.5 meters from family members;close the door to avoid air convection between rooms; do not use central air conditioner.

3.6 On the way to hospital, all people should wear masks.

3.7 Masks used by patients should be sealed in a bag and then placed in a trash can.

4.Main Symptoms Monitoring of Patients with Fever during Home Quarantine

4.1 Measure and record body temperature at least twice a day.

4.2 Whether there is chest tightness, shortness of breath, polypnea,increased heart rate and so on.

4.3 Whether the digestive system symptoms such as diarrhea and vomiting are aggravated.

5.Suggestions on the Management of Abnormal Symptoms When during Home Quarantine

5.1. If the following conditions occur, it is recommended to go to the designated hospitals and fever clinics to seek medical care:

(1)High body temperature lasts for more than 2 hours.

(2)Chest tightness and shortness of breath occur.

5.2 If respiratory frequency ≥30 breaths/min occurs, accompanied with respiratory difficulty and cyanosis of the lips, etc., immediately dial 120 for help. Patient should be transferred to the designated hospital or fever clinic by emergency medical staff.

This Expert Advice will be further revised based on evidence from clinical practice and should be used specially according to the relevant characteristics of each region.