新型冠状病毒感染的肺炎

防治知识手册

Handbook of Prevention and Treatment of the Pneumonia Caused by the Novel Coronavirus (2019-nCoV）

天津市互联网信息办公室

微医互联网总医院

微医天津互联网医院

2020年1月

Cyberspace Administration of Tianjin

WeDoctor Digital General Hospital

WeDoctor Tianjin Digital Hospital

January 2020

第一部分病原特点

Part I Pathogen Characteristics

1.什么是冠状病毒?

1. What are coronaviruses?

冠状病毒是自然界广泛存在的一大类病毒，是目前已知核糖核酸(RNA)病毒中基因组最大的病毒，该病毒形态在电镜下观察类似于王冠而得名。冠状病毒仅感染脊椎动物，与人和动物的多种疾病有关，可引起人和动物呼吸道、消化道和神经系统疾病。

Coronavirus is a kind of virus widely existing in nature. It is the largest known RNA virus in the genome and is named coronavirus, as its form is similar to the crown under the electron microscope. Coronavirus only infects vertebrates and is related to many diseases of humans and animals. It can cause respiratory tract, digestive tract, and nervous system diseases of humans and animals.

2.冠状病毒有什么样的理化特性?

2. What are the physical and chemical characteristics of the coronavirus?

冠状病毒对热敏感，56℃30分钟、乙醚、75%乙醇、含氯消毒剂、过氧乙酸和氯仿等脂溶剂均可有效灭活病毒。

Coronavirus is sensitive to heat and can be effectively inactivated by 56 ℃ for 30 minutes, ethyl ether, 75% ethanol, chlorine-containing disinfectant, peracetic acid, and chloroform.

3.可感染人的冠状病毒有哪些?

3. What are the coronaviruses that can infect people?

迄今为止，除新型冠状病毒外，共发现6种可感染人类的冠状病毒(HCoV-229E、HCoV-OC43、SARS-CoV、HCoV-NL63、

HCoV-HKU1和MERS-CoV)。其中4种在人群中较为常见，致病性较低，一般仅引起类似普通感冒的轻微呼吸道症状。另外2种是我们熟知的SARS (严重急性呼吸道综合征) 冠状病毒和MERS (中东呼吸综合征) 冠状病毒。

So farI in addition to the new coronavirus, we have found six kinds of coronaviruses such like HCoV-229E, HCoV-OC43, SARS-CoV, HCoV-NL63, HCoV-HKU1, and MERS-CoV that can infect humans. Four of them are common in the population, with low pathogenicity, generally only causing mild respiratory symptoms similar to the common cold. The other two are well-known SARS (Severe Acute Respiratory Syndrome) coronaviruses and MERS (Middle East Respiratory Syndrome) coronaviruses.

4.什么是新型冠状病毒感染的肺炎?

4. What is the pneumonia caused by a novel coronavirus?

新型冠状病毒感染的肺炎是2019年12月在中国中部湖北省武汉市发现的，证实由一种新型冠状病毒引起的急性呼吸道传染病。此新型冠状病毒是以前从未在人体中发现的冠状病毒新毒株，世界卫生组织将该冠状病毒命名为2019-nCoV，即新型冠状病毒。

Pneumonia caused by the novel coronavirus was found in central China’s Wuhan City, Hubei Province in December 2019. It has been proved to be an acute respiratory infectious disease caused by a new type of coronavirus. The new coronavirus is a new strain of coronavirus that has not yet been previously found in the human body. The World Health Organization named the coronavirus 2019-nCov, namely a new coronavirus.

5. 感染新型冠状病毒的患者临床表现有哪些?

5. What are the clinical manifestations of someone infected with a novel coronavirus?

以发热、乏力、干咳为主要表现。鼻塞、流涕等上呼吸道症状少见。约半数患者多在一周后出现呼吸困难，严重者快速进展为急性呼吸窘迫综合征、脓血症休克、难以纠正的代谢性酸中毒和出凝血功能障碍。值得注意的是重症、危重症患者病程中可为中低热，甚至无明显发热。部分患者起病症状轻微，可无发热，多在1周后恢复。多数患者预后良好，少数患者病情危重，甚至死亡。

Fever, weakness and dry cough are the main manifestations. Nasal obstruction, runny nose and other upper respiratory symptoms are rare. About half of the patients develop dyspnea after one week, and the severe cases develop rapidly into ARDS (Acute Respiratory Distress Syndrome), septic shock, difficult-to-tackle metabolic acidosis and bleeding and coagulation dysfunction. It should be noted that the course of severe and critical patients can be moderate to low fever or even no obvious fever. Some patients have mild onset symptoms. These patients may have no fever and recover after 1 week. Most patients have a good prognosis, while a few patients are in critical condition or even death.

6.有针对新型冠状病毒的疫苗吗?

6. Is there a vaccine for a novel coronavirus?

针对新疾病，目前尚无可用疫苗。开发新疫苗可能需要相当长时间。

There is no vaccine available for the new disease. It may take a long time to develop a new vaccine for it.

7. 与患者密切接触者如何定义?

7. How to define whether a person is in close contact with the patient?

密切接触者是指与病例共同居住、学习、工作或其他有密切接触的人员；诊疗、护理、探视病例时未采取有效防护措施的医护人员、家属或其他与病例有类似近距离接触的人员；病例同病室的其他患者及陪护人员；与病例乘坐同一交通工具并有近距离接触人员；现场调查人员调查后经评估认为符合条件的人员。

Close contacts refer to people who live, study, work or have close contact with the case; medical staff, family members or other people who have similar close contact with the case without taking effective precautions when diagnosing, treating, nursing or visiting the case; other patients and caregivers in the same ward with the case; people who take the same vehicle with the case and have close contact with the case; and people who are evaluated as the qualified by the field investigators.

8.为什么要对密切接触者医学观察14天?

8.Why should close contacts be observed for 14 days?

参考其他冠状病毒所致疾病潜伏期，此次新型冠状病毒病例相关信息和当前防控实际，将密切接触者医学观察期定为14天，并对密切接触者进行居家医学观察。

Referring to the incubation period of other diseases caused by coronaviruses, the new coronavirus case-related information, and current prevention and control practice, the medical observation period of close contacts was set as 14 days, and the close contacts should be observed at home.

9.如果接到疾控部门通知，您是一位密切接触者，该怎么办?

9.If you are informed by the disease control department that you are a close contact, what should you do?

按照要求进行居家医学观察，不用恐慌，不要随便外出，做好自我身体状况观察，定期接受医生的随访，如果出现发热、咳嗽等异常临床表现，及时向当地疾病预防控制机构报告，在其指导下到指定医疗机构进行排查、诊治等。

You can carry out home medical observation as required. Don't be panic. Don't go out casually, and do a good job of observing your physical condition. Receive regular follow-up visits from doctors. In case of abnormal clinical manifestations such as fever and cough, report to local disease prevention and control institutions in time, and under their guidance, go to designated medical institutions for troubleshooting, diagnosis, and treatment, etc.

10. 新型冠状病毒感染能治疗吗?

10. Can the novel coronavirus infection be treated?

世界卫生组织已发布了针对疑似新型冠状病毒感染造成严重急性呼吸道感染的临床处置指南。目前对于新型冠状病毒所致疾病缺乏特异治疗方法，但采用国家卫健委推出的诊疗方案，采用一些抗病毒药物可能具有一定效果。另外，结合SARS的治疗经验教训，充分发挥我国独特的医疗体系优势，采用中西医结合可能具有重要的价值。此外，对感染者的辅助护理可能非常有效。

The World Health Organization (WHO) has released a clinical guideline for severe acute respiratory tract infection caused by suspected novel coronavirus infection. At present, there is no specific treatment for the disease caused by 2019-nCoV. But using the diagnosis and treatment launched by the National Health Commission, using some antiviral drugs to treat patients may have a certain effect. In addition, combined with the experience and lessons of SARS treatment, we can know that we could give play to the unique advantages of China's medical system by using the combination of traditional Chinese and Western medicine which may have important value. In addition, supplementary care for infected people may be very effective.

11.新型冠状病毒感染重症病例基本的应对策略有哪些?

11. What are the basic coping strategies for severe cases of novel coronavirus infection?

预检分诊，识别并分类严重急性呼吸道感染(SARI)患者；立即实施正确的感染预防与控制措施(IPC)；早期支持治疗与监控；采集临床标本用于实验室诊断；处理低氧性呼吸衰竭及急性呼吸窘迫综合征(ARDS)；脓毒性休克的管理；并发症的预防；抗病毒治疗；妊娠患者的特别注意事项。

Set up pre-examination triage, so that the patients with severe acute respiratory infection (SARI) can be identified and classified; immediately implement the correct infection prevention and control measures (IPC); early support treatment and monitoring; collect clinical specimens for laboratory diagnosis; deal with hypoxic respiratory failure and acute respiratory distress syndrome (ARDS); management of septic shock; prevention of complications; antiviral treatment; special precautions for pregnant patients.

第二部分 疫情形势

Part II Epidemic Situation

12.当前疫情发展态势是什么?

12. What is the current situation of epidemic evolution?

近期，湖北省武汉市等多个地区发生新型冠状病毒感染的肺炎疫情。截至2020年1月30日24时，国家卫生健康委收到31个省（自治区、直辖市）和新疆生产建设兵团累计报告确诊病例9692例，现有重症病例1527例，累计死亡病例213例，累计治愈出院病例171例，共有疑似病例15238例。目前累计追踪到密切接触者113579人(北京市核减21例），当日解除医学观察4201人，共有102427人正在接受医学观察。累计收到港澳台地区通报确诊病例28例：香港特别行政区12例，澳门特别行政区7例，台湾地区9例。

Recently, 2019-nCoV infected pneumonia outbroke in Wuhan City, Hubei Province, and other regions. As of at 24:00, January 30th, the National Health Commission received the information from 31 provinces (areas and cities) and Xinjiang Production and Construction Corps that there were 9,692 confirmed cases, of which 1,527 severe cases, 213 death cases, and 171 cases who have been cured.There are 15,238 suspected cases now. At present, there are 113,579 close contacts (Beijing removed 21 cases after double-check), and 4,201 people who have been removed from medical observation, 102,427 people who have been put under medical observation. 28 confirmed cases have been reported from Hong Kong, Macao and Taiwan, including 12 in Hong Kong Special Administrative Region, 7 in Macao Special Administrative Region, and 9 in Taiwan.

经国务院批准，国家卫生健康委将新型冠状病毒感染的肺炎纳入《中华人民共和国传染病防治法》规定的乙类传染病，采取甲类传染病的预防、控制措施；并纳入《中华人民共和国国境检疫法》规定的检疫传染病管理。

Upon approval from the State Council, the National Health Commission includes 2019-nCoV-infected pneumonia into category B infectious disease specified in the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases, and prevention and control measures for category A infectious diseases are taken; quarantinable disease management specified in Frontier Health and Quarantine Law of The People's Republic of China are followed.

13. 为什么短短几天增加了这么多确诊病例?

13. Why are confirmed cases increasing so quickly in just a few days?

因为有了病毒核酸检测试剂盒。近日，国家相关科研机构迅速研发出病毒核酸检测试剂盒，核酸检测试剂盒能通过PCR的方法快速确定病例的样品中是否有特定的基因序列的存在。也就是说，新型冠状病毒相当于有了身份证，病例的样品只要一对比就可以快速判断。

Because a virus nucleic acid detection kit has been developed. Recently, the related national scientific research institutions developed a virus nucleic acid detection kit rapidly. The detection kit can confirm whether there is a specific gene sequence in case samples or not by using a PCR-based approach. In other words, a novel coronavirus can be identified by detection kit; samples of cases can be judged quickly by comparison.

14.防控疫情的关键在哪里?

14. What is the key to prevent and control the outbreak?

防治的关键是防止出现超级传播者。武汉市减少输出是非常重要的一个方面，武汉市会有很严格的筛查检测措施，特别是体温检测，体温高的不建议离开武汉市。2020年1月23日凌晨，武汉市采取了封城措施，这是至关重要的防控关键步骤。

The key is to prevent "super spreaders”. Reducing the outflow of the people in Wuhan City is very important, and strict screening detection measures are taken in Wuhan City, especially body temperature detection. Those who have high body temperature are not recommended to leave Wuhan. The city limited inflow and outflow of people on January 23, 2020，which was the key measures to prevent and control the outbreak.

15.当前防控最有效的办法是什么?

15. What is the most effective way to prevent and control the outbreak at present?

早发现、早报告、早诊断、早隔离、早治疗是最有效的。对已经确诊的病人进行有效隔离治疗，减少接触是极为重要的。

Early detection, early reporting, early diagnosis, early isolation, and early treatment are the most effective measures. It is extremely important for the confirmed cases to get an effective isolation treatment to decrease transmission.

16.新型冠状病毒传染源是什么?

16. What is the infection source of novel coronavirus?

目前新型冠状病毒传染源尚未找到。这次发现的新型冠状病毒基因序列与SARS冠状病毒接近，而SARS冠状病毒已经证实起源于野生动物(蝙蝠)携带的冠状病毒，目前收治病例多数有武汉市"华南海鲜市场”暴露史，这个市场同时还销售活体野生动物，摊主和顾客都有机会接触野生动物携带的冠状病毒。

The infection source of 2019-nCoV has not yet been found. The gene sequence of 2019-nCoV is similar to the SARS coronavirus. However, SARS coronavirus has been proved to stem from the coronavirus that wild animals (bat) carry. At present, most cases admitted have exposure history of "Huanan Seafood Market," where the wild animals were sold, and vendors and customers there have the chance to be in contact with wild animals-carried coronavirus.

17.新型冠状病毒人传人吗?

17. Can novel coronaviruses be transmitted from person to person?

武汉市和广东省均发现人传人病例，截止到1月21日，武汉市已有15名医务人员感染，这证实了疫情可以人传人。

The cases by human-to-human transmission were found in Wuhan City and Guangdong Province; as of January 21, 2020, there were 15 health care workers infected in Wuhan City, which confirmed the virus could have human-to-human transmission.

18.人会通过哪些途径被传染?

18. By which ways will people be infected?

2020年1月27日，由国家卫生健康委员会办公厅、国家中医药管理局办公室联合印发的《新型冠状病毒感染的肺炎诊疗方案（试行第四版）》指出，经呼吸道飞沫传播是主要的传播途径，亦可通过接触传播。

On January 27, 2020, the Diagnosis and Treatment of Pneumonia Infected by Novel Coronavirus (4th trial edition) pressed by the General Office of the National Health Commission and the General Office of the National Administration of Traditional Chinese Medicine points out that the main transmission route is droplet transmission, plus contact transmission.

19.新型冠状病毒会变异吗?

19. Will the novel coronavirus mutate?

新型冠状病毒是以前从未在人体中发现的冠状病毒新毒株，病毒变异仍需严密监控。

The 2019-nCoV is a new strain of coronavirus that has not yet been previously found in human body, so the virus mutation still needs to be monitored closely.

20.新型冠状病毒是否会像SARS一样凶猛?

20. Will the novel coronavirus be as fierce as SARS?

研究显示，新型冠状病毒与SARS具有同源性，相似性约为70%，与MERS相似性约为40%。新型冠状病毒与SARS相比传染性较弱，但与人体呼吸道上皮细胞仍具有较强亲和力，提示其对人体有一定感染能力。

The studies show that 2019-nCoV is homologous with SARS, with the similarity of about 70% and with MERS, about 40%. Compared with SARS, 2019-nCoV has weak infectivity, but a good affinity with human respiratory epithelial cells, indicating certain infectivity for humans.

第三部分 防控常识

Part III Prevention and Control Knowledge

21.新型冠状病毒感染肺炎的病例监测措施主要有哪些?

21. What are the main monitoring measures for the pneumonia caused by the novel coronavirus?

各级各类医疗机构在新型冠状病毒感染的肺炎监测和日常诊疗过程中，应提高对新型冠状病毒感染的肺炎病例的诊断和报告意识，对于不明原因发热、咳嗽等症状的病例，应注意询问发病前14天内的行踪或可疑暴露史，野生动物接触史，及其与类似病例的密切接触史。

In the course of pneumonia monitoring and daily diagnosis and treatment of 2019-nCoV infection, medical institutions at all levels and of various types should enhance the awareness of diagnosis and reporting of pneumonia cases of 2019-nCoV infection. For cases with fever, cough and other symptoms of unknown causes, they should pay attention to inquiring about the suspected exposure history within 14 days before the onset of the disease, the history of contact with wild animals, and the history of close contact with similar cases.

22.如何预防被新型冠状病毒感染?

22. How to prevent the novel coronavirus infection?

(1)做好冬春季呼吸道传染病预防

(1) Make efforts to prevent respiratory infectious disease in winter and spring

目前正处于冬春季传染病高发季节，市民要增强卫生健康意识，加强锻炼，规律作息，提高自身免疫力。

It is presently in the high-incidence season of the winter and spring infectious diseases, the public should enhance health awareness, do more exercise, have a regular work and rest to improve their immunity.

注意保持室内空气流通，避免到封闭、空气不流通的公众场合和人多集中地方，外出时可佩戴口罩。

Keep proper indoor ventilation, avoid poorly ventilated and crowded places; medical masks shall be worn when going out.

外出回家后，及时洗手、洗鼻。如有发热和其他呼吸道感染症状，特别是持续发热不退，及时到医疗机构就诊。

Wash hands and nose when coming home. If fever and other respiratory symptoms, especially persistent fever occurs, go to hospitals as soon as possible.

(2)正确佩戴口罩

(2) Wear medical masks correctly

戴口罩是阻断呼吸道分泌物传播的有效手段。选择医用外科口罩能很好地预防呼吸道疾病。一次性医用口罩佩戴时，要将折面完全展开，将嘴、鼻、下颌完全包住，然后压紧鼻夹，使口罩与面部完全贴合。

Wearing medical masks is an effective way of interrupting respiratory droplets transmission. Medical masks can prevent respiratory diseases properly. When wearing disposable medical masks, fully unfold folded surface, and cover mouth, nose, and lower jaw entirely, then compress nose clip, so masks and face are in full contact with each other.

戴口罩前应洗手，或者在戴口罩过程中避免手接触到口罩内侧，减少口罩被污染的可能。分清楚口罩的内外、上下，浅色面为内，应该贴着嘴鼻，深色面朝外；金属条(鼻夹)一端是口罩的上方。

Wash hands before wearing medical masks or avoid touching the inner side of masks while wearing masks to reduce masks pollution risk. Distinguish the inside and outside and up and down of masks, i.e., the light surface is the inside of masks, which closes to mouth and nose, and the dark surface is the outside of masks; the metal strip (nose clip) side is the upside of masks.

要定期更换、不可戴反，更不能两面轮流戴。

Replace masks regularly; avoid wearing reversely, and even both sides.

(3)正确洗手

(3) Wash hands properly

在餐前便后、外出回家、接触垃圾、抚摸动物后，要记得洗手。洗手时，要注意用流动的水和使用肥皂(皂液)洗手，揉搓的时间不少于15秒

Remember to wash hands before eating, after toilet, coming home, coming into contact with garbage and touching animals. When washing hands, use running water and soap (liquid soap), with no less than 15 seconds for rubbing hands.

为了方便记忆，揉搓步骤简单归纳为七字口诀: "内-外-夹-弓-大-立-腕”。

For the convenience of memory, rubbing steps are as follows.

- Both hands rub with palm to palm

- Both hands cross and rub with palm to hand back

- Fingers cross and rub with palm to palm

- Fingers entwine and rub rotationally

- Rub hands rotationally with thumb in the palm

- Rub hands with fingertip in the palm

- Wash wrist

23.接触动物有什么特别需要注意的事项?

23. What should be paid special attention to when coming into contact with animals?

避免接触野生禽畜、野生动物及其排泄物和分泌物，避免购买活禽和野生动物；避免前往动物农场和屠宰场、活禽动物交易市场或摊位、野生动物栖息地等场所。必须前往时要做好防护，尤其是职业暴露人群；避免食用野生动物。

Avoid coming into contact with wild livestock, wildlife, and their droppings and secretions, and avoid the purchase of live poultry and wildlife. Avoid visiting animal farms and slaughterhouses, live poultry and animal markets or stalls, wildlife habitats and so forth. People, especially occupationally exposed persons must take precautions when having to go the places mentioned above,. Avoid eating wild animals.

24.当出现了发热、咳嗽等症状时，一定要去医院吗？

24. When there are fever, cough and other symptoms, do you have to go to the hospital?

普通的感冒、流感、急性的上呼吸道感染、咽炎、支气管炎及扁桃体炎都可能出现咽痛、咳嗽、鼻塞、流涕、打喷嚏等症状。当出现以上症状时，一般判断是普通的呼吸道感染。而感染新型冠状病毒的患者临床主要表现为发热、乏力、干咳，较少出现鼻塞、流涕等上呼吸道症状。

The symptoms such as pharyngeal pain, cough, nasal congestion, runny nose, sneezing, and so on may occur in the common cold, influenza, acute upper respiratory tract infection, pharyngitis, bronchitis, and tonsillitis. When the above symptoms appear, it is generally a common respiratory tract infection. However, the patients infected with the 2019-nCoV mainly have fever, fatigue, and dry cough with less symptoms of the upper respiratory tract such as nasal congestion, runny nose.

当出现了发热、咳嗽等症状，而自己又无法准确判断时，建议通过微医互联网总医院在线问诊后再做决定。目前一些城市的医院聚集了大量的呼吸道疾病患者，如果直接去医院就诊，不但不能有效的获取有用信息，还容易造成交叉感染。

When a person has fever, cough, and other symptoms, and cannot accurately judge by himself, it is recommended to make a decision based on the WeDoctor's Digital general hospital online consultation. At present, hospitals in some cities gather a large number of patients with respiratory diseases. If they go to the hospital directly, they cannot effectively obtain useful information and are prone to get cross-infection.