Chinese expert consensus on diagnosis and treatment strategies for novel coronavirus infection in immunocompromised populations (2023 edition)

Since the coronavirus disease 2019 (COVID-19) was identified in 2019, it has caused more than 664 million confirmed cases and more than 6.7 million deaths globally by January 20, 2023. So far, the novel coronavirus has undergone mutations from the original, Alpha, Delta, and Omicron strains. Omicron was first detected in South Africa in November 2021 and has since spread rapidly to more than 100 countries around the world, leading the World Health Organization (WHO) to classify it as a “variant of concern” for COVID-19. Due to its stronger infectivity, faster transmission, and higher reinfection rate, it is more likely to cause immune evasion and infection breakthrough in the vaccinated population. Omicron has replaced Delta strain as the main epidemic strain imported from overseas and in China. People with immunodeficiency are more susceptible to the novel coronavirus due to abnormal immune function, and viral infections tend to be more lasting and severe. In addition, due to the existence of underlying diseases, most people with immunodeficiency have been taking immunosuppressants and other related drugs for a long time, and there are different degrees of interaction between novel coronavirus treatment drugs and original drugs, which brings great challenges to the diagnosis and treatment of people with immunodeficiency after infection with novel coronavirus. According to the Novel Coronavirus Infection Diagnosis and Treatment Protocol (Trial 10th Edition) issued by the National Health Commission, which emphasizes “strengthening the protection of key groups,” people with immune deficiency belong to the high-risk groups of severe or critical disease. Based on the evidence of evidence-based medicine and after many discussions by experts from multiple disciplines (Department of Respiratory and Critical Care, Department of Organ Transplantation, Department of Rheumatology, Department of Hematology, Department of Infection, Department of Critical Care Medicine, etc.), 13 recommendations are summarized to provide theoretical and practical reference for the diagnosis and treatment strategy of this special population.