I'd like to suggest not using ibuprofen, or any other anti-inflammatory (NSAID or steroid: also includes aspirin, cortisone, etc. with the presumed exception of pre-prescribed steroids for e.g. asthma).
This is on the basis of this article from the BMJ. In summary, there are a handful of COVID-19 specific cases of young fit people becoming severely ill following ibuprofen use, combined with small studies on SARS-CoV and other illnesses.
Paracetamol should probably be used instead of ibuprofen/NSAIDs.
This seems like a cheap switch as they're likely roughly equivalent in symptom control excepting this effect. Please let me know if you see or read any reason this may be dangerous/untrue. (Is this an appropriate place to post this? Or does it belong in the generalised advice thread?)
paracetamol a.k.a. acetaminophen appears the safest thing to take but if you have a high temperature I would avoid any anti-pyretic medications.
A fever is a good thing - it's making the body inhospitable for viruses when they start invading.
Suppressing this immune response at the early infection "fever stage" potentially allows the virus to get hold.
Ride it out, help your body by curling up in a blanket.
Stay hydrated and let your body's defences work.
I had to look it up: https://en.wikipedia.org/wiki/Antipyretic
So to be clear, you're saying that paracetamol is probably safer than NSAIDs, but avoid even that if you can?
I am trying to keep my wording simple - not managed it here so thanks for asking.
pyrexia = fever.
pyro ~ heat, fire (from both Latin and Greek) pyromaniac a more familiar word?
so anti-pyretic is something "against-fever" i.e. treats a fever/reduces temperature.
I would not take anything to reduce my temperature and I would recommend the same to friends and family, so yes I suggest avoiding paracetamol too.
Personal note - I eat a clove of raw garlic if I think I've picked something up. Giving it a really good crunch between the teeth to release the juices. Not pleasant (even to a garlic lover, and a little easier to take wrapped in bread) but great for keeping people away for a few hours....
Garlic has been shown to have anti-viral properties, no idea if it has any affect on the coronavirus but unless there's a reason not to take it, it's worth a shot. (I wouldn't bother with garlic tablets - just fresh)
Fwiw Chris Masterjohn (see below) also recommends garlic. He recommends crushing it before eating though:
180 micrograms per day of stabilized allicin; or one clove of fresh, raw garlic, crushed, exposed to open air for ten minutes, and eaten without cooking or mixing with other ingredients; or 4 grams of garlic powder, mixed with water, exposed to open air for ten minutes, and eaten without cooking or mixing with other ingredients.
...
Garlic does not contain allicin itself. Rather, it contains alliin, which is converted to allicin within ten minutes when raw garlic is crushed, or when garlic powder is mixed with water, and either are allowed to sit at room temperature in the open air for ten minutes.
Having been in isolation for the last 10 days with a possible covid19 case (gut says no, head says hope so because we're past the worst).
I felt a bit rough yesterday.
Temperature 36.6 C which is normal sublingual (under the tongue) reading for our thermometer.
I crushed some garlic (oh 1st world problems not being able to find the inner bit of the garlic press).
Whilst giving it 10 minutes to brew I decided digital application to the nasal mucosa might be an efficient way to use the juice, targeted application a primary infection site.
(yes - I stuck my finger in the juice and then up my nose. Different finger for each nostril, gotta maintain some standards!)
I personally do recommend avoiding NSAIDS (but not other painkillers) for any cold, common or uncommon, and I have an anecdote to base my choices on.
In 2018, I got a cold (no idea whether rhino or corona), and I figured I'd take a single ibuprofen because the inside of my nose felt sore where it was pumping out the mucus. Within a day it turned into a horrible chest cold. Not only was the mucus I coughed and sneezed unpleasantly thicker, so was the mucus I was swallowing, despite my usual cold hydration routine. At night, I had to lie prone (on my belly) and cough for ten to twenty minutes into the trash can to clear my lungs enough to stop coughing and sleep. By the time I fell asleep, I felt like I'd jogged a quarter mile.
Even after all other symptoms faded away after two weeks, I had to continue this nighttime routine. I just wasn't getting better. And then the daytime cough turned into a dry persistent cough. It took me another two weeks of this hell to finally see a doctor. They prescribed a mucus reducer and cough reflex suppressor, both with the potential for serious side effects which I didn't experience. This worked, though my usual back-of-the-throat mucus remained sludge-like for another month.
I will never take an ibuprofen during a cold again. Even if it did something for the pain inside my nose, any pain reduction was overshadowed by the other symptoms, and the possibility that it somehow exacerbated the symptoms would be enough to make me avoid it even if it were the only painkiller available.
For every cold since, I've taken one 50mg zinc pill (with food) as soon as I noticed the characteristic sinus dryness/thirst that heralds the arrival of a cold, and DayQuil/NyQuil generics during the day and night respectively during the symptoms. None of these colds have resulted in more than two days of work missed, and none have become chest colds.
In March, I had a cold I caught at the post office that started with the same nasal pain I remember from 2018, plus slightly thicker mucus and a lack of taste for salt, so I plan to get a COVID-19 antibody test as soon as it's available to see if I accidentally killed the big one with my usual cold routine.
Some notes / proposed additions or clarifications:
Also, "viable virus could be detected" seems potentially different from "you could get infected from handling it" (in either direction). Your immune system is more robust than the cell culture they use to detect, so many 'detectable levels of virus' are still safe, and the detection method requires diluting the contaminated swab, which means that you coming into contact with the undiluted thing might have nonzero risk even when the test can't detect anything.
But based on my limited understanding of what's going on, the threshold is within a doubling or two of what's sensible; not diluting at all should correspond to the 10^0 line on the graph, which their model suggests should be hit within 20-45 (point estimate: 30) hours of when virus is deposited on the box. So unless you're somehow managing to concentrate the virus, that's the point at which it couldn't infect a cell culture without an immune system.
I'm annoyed at the paper authors because I knew to look for this (due to our earlier conversation) and I checked and the phrasing was just that misleading.
Have fixed.
Thanks, I am not best pleased about relying on data from a paper that turns out to have been so sloppy. (I guess a rush was understandable under the circumstances, but I think checking all the calculations twice was also arguably imperative under the circumstances! And the misleading abstract was just dumb.)
I'm glad that they ran this experiment, since this is a core uncertainty, and think we should accept that the price of posting drafts is that you have to read them carefully to spot potential errors; having the graph of the raw data a few days earlier was worth having to eyeball the analysis myself to check their numbers.
Yeah, agreed overall. I would not want to discourage literally our only source of direct data on this from doing it again. But ugh, why can't everyone in the entire world please be like, significantly more careful about everything, all the time? (Preceding sentence is rhetorical and is me making fun of myself for making unreasonable demands.)
According to this article, it seems clear by now that low oxygen is in fact dangerous even when you feel fine, so buying a pulse oximeter is useful.
https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html
Related to treating newly delivered packages as contagious:
Something I've been more worried about than packages are products bought in the store (who knows how long ago that bag of spinach was coughed on?)
If you're doing proper self-quarantining, this won't be something you encounter very often, but it'll still be something to address.
I've been keeping a spray bottle of rubbing alcohol outside of my apartment. Anything I bring inside gets sprayed down before coming in.
Thankfully, most foods come in packaging, so a quick spray down doesn't affect most groceries. Plus, they're easy to rinse off when you get in. It's a bit of a pain spraying each individual item you buy before bringing it inside, but it doesn't actually total more than a few minutes.
It's also good to have the rubbing alcohol outside so that you can spray your hands down before entering your home and touching surfaces. Ideally, anything that comes inside gets at least a mist of rubbing alcohol; this includes my jacket, a quick spray on my jeans and my shirt.
Chris Masterjohn, who was endorsed by Will Eden once I believe, recently sent an email to his list about the coronavirus where he says among other things
For example, I always recommend vitamins A and D during cold and flu season. I see people making the same recommendations for the coronavirus. But after looking at the research, I'm actually restricting vitamins A and D while the coronavirus threat remains high or uncertain.
He's selling a report he put together which has more details here.
Later edit: Masterjohn seems more keen on Vitamin D nowadays https://chrismasterjohnphd.com/covid-19/finally-confirmed-vitamin-d-nearly-abolishes-icu-risk-in-covid-19
He's now made public the list of what he's doing, just with a lot less detail. https://chrismasterjohnphd.com/what-im-doing-for-the-coronavirus
To be clear, he recommends for getting normal levels of vitamin D and A, but against supplementing. For someone likely to be deficient, I guess that might mean supplementing small amounts, or larger amounts every few days.
I've skimmed it; he sounds very convincing,[1] and he previously turned me on to zinc. I'm not capable of following the science directly. I wonder if it's worth trying to convince him to release it freely (possibly with a lump sum of money), but first I'd want someone more knowledgable than me to evaluate it. When I raised the possibility on the EA coronavirus facebook group, I mostly got the reaction that he seems sketchy (which, yeah, looking at his website he absolutely does); and that nutritionists in general are unreliable even when they seem to have good science. I'm not sure how much weight to assign to those.
Copying from what I wrote on facebook:
So the argument against vitamin D supplementation is that it increases the amount of ACE2 on our cells. ACE2's normal role is in blood pressure and keeping the lungs and heart healthy. (There's a lot more detail on that in the "detailed scientific analysis" section.) But SARS-Cov-2 gets into cells by hijacking ACE2. It has this in common with regular SARS and only one other known human coronavirus (NL63). Specifically the claim seems to be that ACE2 currently docked on cell surfaces would allow viral entry, and ACE2 that's been shed from cell surfaces ("serum ACE2") "is likely to be protective or irrelevant", though that bit doesn't have a citation.
The evidence that vitamin D increases ACE2 seems to be mostly based on rat studies. There were three supporting this, three contracticting (of which one was on humans). But two of the contradicting studies (including the one on humans) looked at serum ACE2 which may not correlate with docked ACE2. The other one had a thing going on with kidney injury that could have caused the effect. He concludes that "On the balance, vitamin D is likely to increase ACE2 expression" and recommends against supplementing it.
(I think the argument against vitamin A supplementation is also that it increases ACE2, but I haven't looked closely at that.)
So I guess concrete(ish) questions that I have:
- Does SARS-CoV-2 indeed get into cells by taking advantage of ACE2, and specifically ACE2 docked on the cell surface? Wikipedia on ACE2 says "ACE2 receptors have been shown to be the entry point...", and points out that receptors are different from ACE2 itself.
- Are there experimental/observational studies on the effects of Vitamin D supplementation on SARS?
- Two of the rat studies showed that "calcitriol, the active metabolite of vitamin D ... synergizes with diabetes to increase ACE2 protein" in different parts of rats. Does that mean they only tested on diabetic rats, and would that make the studies not generalize very well?
- Does this kind of argument have a history of predicting experimental/observational results? I'm reminded of Scott's recent post on the fat diet, which I think roughly concluded "yah that seems like a solid theoretical argument, but all the empirical evidence seems to contradict it so???"
The citations offered for SARS-CoV-2 getting into cells by ACE2 docked on the cell surface: https://science.sciencemag.org/content/early/2020/03/03/science.abb2762 https://science.sciencemag.org/content/309/5742/1864.long
The second one apparently is free, but behind a login screen.
Also, citations for vitamin D raising ACE2:
- Xu, J. et al. Vitamin D alleviates lipopolysaccharide-induced acute lung injury via regulation of the renin-angiotensin system. Mol. Med. Rep. 16, 7432–7438 (2017).
- Lin, M. et al. Calcitriol regulates angiotensin-converting enzyme and angiotensin converting-enzyme 2 in diabetic kidney disease. Mol. Biol. Rep. 43, 397–406 (2016).
- Cui, C. et al. Vitamin D receptor activation regulates microglia polarization and oxidative stress in spontaneously hypertensive rats and angiotensin II-exposed microglial cells: Role of renin-angiotensin system. Redox Biol 26, 101295 (2019).
- Andersen, L. B. et al. Vitamin D depletion aggravates hypertension and target-organ damage. J. Am. Heart Assoc. 4, (2015).
- Ali, R. M., Al-Shorbagy, M. Y., Helmy, M. W. & El-Abhar, H. S. Role of Wnt4/β-catenin, Ang II/TGFβ, ACE2, NF-κB, and IL-18 in attenuating renal ischemia/reperfusion-induced injury in rats treated with Vit D and pioglitazone. Eur. J. Pharmacol. 831, 68–76 (2018).
- Anguiano, L. et al. Circulating angiotensin-converting enzyme 2 activity in patients with chronic kidney disease without previous history of cardiovascular disease. Nephrol. Dial. Transplant 30, 1176–1185 (2015).
The first three are pro, the others are con.
[1] By which I mean, he sounds like he's done lots of research, weighed it up, and followed where it took him. He includes disclaimers like "as a hedge" and "here are some studies disagreeing, which I think is because..."
And since I had to look it up: the RDA is only 600 IU, assuming no sun exposure. (600 IU = 15μg)
I've read it, and I'm guessing it's worth $10. I'm making some adjustments to my supplements based on the advice.
Mask supply via alibaba/aliexpress seems to have ramped. I predict no shortage within a few weeks.
I recall there being some concern that a residue can build up on the copper tape making it less effective. Certainly the tape on the back of my phone is discolored now.
If the tape ended up being not effective but it made people complacent such that they didn't clean the surfaces as much, that could be worse?
Did this get resolved?
I write this atop a mound of copper tape.
Everything I've seen so far seems to suggest that copper oxide is still anti-microbial, but I haven't really attempted to research this, so take that for what it's worth (which is little.) (I've actually become curious whether having it on my hands -- which are visibly turning a bit blue-green where they rub against the copper -- might have further antimicrobial benefits. But this is idle speculation I do not intend to do anything with.)
The one potential downside of copper is that it may have reduced efficacy when cleaned multiple times using normal cleaning products.
In a study where copper surfaces were inoculated with bacteria in 1% solutions of albumin, dried, and subsequently cleaned with 70% ethanol or 1% sodium hypochlorite, there was a build-up of residues and a concomitant decrease in killing efficiency (1). On the other hand, it was reported that copper surfaces remained active when soiled (42). Also, it was found that there was no reduction in killing efficiency over 30 cycles of bacterial inoculation, followed by cleaning with a 1% nonionic detergent solution (M. Solioz and C. Molteni, unpublished observations).
https://drive.google.com/file/d/1-nXiUm-WdhapbqngHkM8tXOovuIZuPoW/view?usp=drivesdk
Might want to try metal cleaning products like Brasso or Neverdull, instead--with the caveat that you definitely want gloves and possibly want ventilation while using those.
I'm not sure this has been mentioned so, if you've got a thermometer ...
Get to know your normal temperature.
Take it when you get up, middle of the day and before bed. (clean with alcohol after each use) Nice chance to make a graph.
There's daily fluctuations in temperatures and method of taking it influences the readings so stay consistent. (rectal most accurate method but might be the least popular site - especially if sharing equipment!)
My normal sublingual temperature is 36.6 C
If you know what's normal for you then you'll know if it's increased.
Another electrolyte option: Snake Juice . I've used this while fasting 4+ days several times, and it is a massive improvement over just salt. I make it in partial batches, more concentrated, and then drink plain water until I feel balanced:
khafra twist on snake juice--1tsp baking powder, 1 tsp No-Salt, 1/2tsp Himalayan salt, 20-30oz water. Take a magnesium pill with it, and drink water slowly over the next hour until it feels right.
Don't know if I should advise it, but covid has nudged me into finally buying two overalls (one for the summer and one for cooler weather). Very convenient, I just come inside, take it off and place it under the clothes rack in almost a single motion. And it doesn't have all these additional surfaces that a combination of a coat and trousers or skirt has, which I used to touch without paying attention.
Then it's just a step into the shower and I'm free to come into the living space. I would buy a thicker one for even colder weather, but currently my priorities are a bit different.
The drawback of the light one is it doesn't have sleeves; but it cost ridiculous money and I just throw on a light shirt, and it's very easy to hand-wash. The drawback of the heavy one (jeans) is the fact that it makes me look like some kind of technician on a mission :) so I just think of it as my spacesuit. Maybe people who keep track of fashion will have better luck. It was also significantly more expensive, so I bought it for my birthday.
Buying overalls via internet is a bit tricky, since you have to estimate how your trunk's length fits in it (not that it's hard, you just have to remember not to rely only on your height), but the seller can be a great help.
New to LessWrong, but the mission for this site very much speaks to me :) I wanted to chime in to mention that I did a fair bit of research before buying a pulse oximeter. There are a lot of low-priced options, but in reviewing Reddit posts from medical professionals, they did not seem to be trusted. Some recommended the Masimo MightySat, which I got and would recommend. You can buy it directly from Masimo, but it is also sold on Amazon and by Apple. Masimo provides medical devices to hospitals, and the MightySat is one of the two products that they have made available to consumers. Hope that is helpful!
If a person doesn't have health insurance, then is now the time to sign up for temporary health insurance to avoid getting slammed in case you have to go to the emergency room in the future?
You’ve tested your vitamin D recently and levels were normal or high (as a fat soluble vitamin, it is possible to overdose on)
As somebody who hasn't tested my vitamin D level and doesn't know how (I assume this isn't something you can easily do with standard household materials?) and is worried about the possibility of overdose if I suddenly start supplementing - how should I calibrate on my "likely current vitamin D level" and what level of supplementation is safe?
FWIW, I started taking Vitamin D without measuring my blood levels after reading https://www.gwern.net/Longevity#vitamin-d . I take 2000 IU/day; the NIH site says the "tolerable upper intake level" is 4,000 IU, so I think I have pretty good margins. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional
OOPS! I misread Chris Masterjohn's advice. He recommends NO vitamin D supplements until the coronovirus threat is reduced.
You can get vitamin D from sunlight. You can't overdose this way, but you could get a sunburn, which has its own problems. An app like dminder can help you time your sun exposure.
find others in your area who have similar sun exposure to you, and see if any of them were tested
ask a local doctor about local levels
see the maps/prevalences here:
https://docs.google.com/document/d/1q5IH2hGjjdPi-vcs4zOBlArgFJ9iSDdZVoceevUPI9c
More on supplements (especially vitamin D and selenium) here:
https://docs.google.com/document/d/1q5IH2hGjjdPi-vcs4zOBlArgFJ9iSDdZVoceevUPI9c/
and humidity by beds and desks here:
https://docs.google.com/document/d/1olkOb6IMxE1zYBqvv5XAI2gREbg2O-0QUq0EfUr5_tM
LA Times article mentions the nicotinamide riboside/PARP10 connection from Brenner's paper. Taking NR is probably important and certainly safe.
https://www.latimes.com/california/story/2020-05-01/promises-covid-19-vaccine-therapeutics-cure
Perhaps you could also wind thin-ish non-stranded copper wire around a door handle, as if on a spool. This might easier to obtain for some people (or they already have it at home) and won't have the sharp edged that can cut your hand. If it does not want to stay in place, perhaps also put double-sided adhesive tape under it? Haven't had the opportunity to try this yet, just speculating
Plan: continue to avoid contact with others as practicable, if sick, treat at home exactly as I would any other flu-like illness (rest, electrolytes, etc), begin using pulse oximeter if sickness progresses to shortness of breath, if number hits 90 or less, put on n95 mask and go to hospital.
Keep the inside of your car infection free. Put methylated spirits, and 10% glycerol in a trigger bottle and spray your hands (do the hand wash routine), your keys, and the door handles before entry from risky environments.
Two weeks ago Ben Pace and I asked for practical advice on what to do about coronavirus, with the requirement that advice be justified in some way- ideally full blown models informed by empirical data, but at a minimum, an explanation of why it was helpful. The resulting thread had wonderful advice but makes for, uh, inefficient reading, at best. This post is an attempt to take the best of the Justified Practical Advice Thread and present it in a clear, easy-to-digest format.
It’s important to note that neither the original post nor this one are attempting to give comprehensive advice. If you’re looking for that, I suggest checking out the Guide/FAQs/Intros tab on the LessWrong Coronavirus Link Database. This is for advice that fell through the cracks.
Though I will briefly mention the standard advice. From what I can tell, the most important (and luckily widely publicized advice) is the following:
The rest of this post will summarise the interesting ideas that went beyond these basic recommendations. But if you haven't done (or at least seriously considered doing) all of the above, I would recommend you prioritise the things listed above.
Many of the below recommendations involve buying things. When possible I’ve included a link to a particular amazon page. This is not a strong recommendation for that particular product: it’s an attempt to lower activation energy for acting on a recommendation. If you have reason to believe a particular model is better than what I linked to, please comment and I’ll update if appropriate. Speaking of which, if you think of anything else I missed or got wrong, please comment with that too.
That said, here is the top advice from the Coronavirus Justified Practical Advice thread.
This was the clear winner of JPA Olympics– it’s cheap, effective, and very few people had heard of it before. In fact we were hoping for a highly polished, intensely researched post on just this; unfortunately no one has the time right now.
In its place, please enjoy these links:
Benefits
Costs
Why you might not do this
The 2’’ is from personal experiences: I got a variety of sizes up to 1’’, and even that was often inconveniently small. I basically never wanted smaller except to patch up gaps, and they’re not so much better than just tearing a small piece off of 2’’ for that.
At the time I posted this, we had very little information on the risks of contamination via packages. I based my recommendation on studies showing other coronaviruses survived for a very long time on other surfaces. Since then someone has released a pre-print on this specific coronavirus on cardboard in particular, which found a half-life of ~2-5 hours. What that means your safety depends on exactly how much your mailman sneezes on it and what the infectious threshold is, which we don’t actually know. However at the concentrations that paper was using, concentration dipped below detection by 48 hours.
Here are the specific recommendations for handling potentially infected packages:
Benefits
Costs
Why you might not do this
Vitamin D deficiency has a surprisingly strong link with respiratory infection.
While this hasn’t been verified for COVID-19 in particular, it does seem plausible that it applies, and that a supplement can treat it.
Benefits:
Costs:
Why you might not do this:
COVID-like illnesses frequently cause loss of electrolytes through sweating and diarrhea, which are not replenished from food due to appetite suppression. Insufficient electrolytes can lead to digestive and neurological problems.
The exact form of this is up for debate: some people feel that salt, maybe with sugar, honey, or molasses, is sufficient. Others thought that the magnesium and potassium from a dedicated electrolyte powder/concentrate/drink, or the ease of consumption while sick, was beneficial. Once you’ve gone that road, there are lots of electrolyte supplements with additional vitamins and minerals you might also be missing, leading to something of a paradox of choice for me.
No one disagreed that some form of electrolyte is good to drink to once sick, just what exact form that should take. Choosing any one of these is more important than which one you choose.
Forms you might take, with approximate cost:
Benefits
Why you might not do this
Coronavirus moves from unpleasant to dangerous when your blood oxygen saturation level is too low. A pulse oximeter can tell you when that is happening, providing a clearer line for when to seek medical attention, which is especially important as the risks to contact with the medical system rise. However many people felt that you should ignore a low pulse ox if you felt fine or a high one if you felt short of breath, so it didn’t add anything to the process, an argument I find pretty compelling.
Benefits
Costs
Why you might not do this
Thank you to Raemon and Ben Pace for comments on this document.
Thank you very much to Julia Wise, Finan Adamson, Connor Flexman and Connor Flexman for this justified practical advice.