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What should we do once infected with COVID-19?

by Elizabeth1 min read18th Mar 202058 comments

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We’ve talked a lot about preparations and prevention, but statistically some of us, or people we care about, are going to actually get sick. What do we do once that happens?

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Epistemic status: I am not a doctor. This is based on a combination of the most rigorous medical lit searches I could do over several hours, and individual reports that may or may not be based on anything. Wherever possible I’ve provided links to my sources so you can form your own opinions.

This is based on my best knowledge right now. I could be missing things, or new information could come to light, in which case I will update this as quickly as possible (and appreciate holes being pointed out).

Before you get sick

Uncontroversial

  1. Buy zinc lozenges (acetate or gluconate)
  2. Buy electrolytes in some form.
  3. Buy a thermometer.
    1. Take your temperature several times over several days to get a sense of your baseline.
  4. Buy a pulse oximeter if you can’t trust your subjective sense of “am I getting enough air?”, e.g. if you get panic attacks.
    1. ETA 4/22/20: Looks like at least some subset of people can be dangerously oxygen-impaired without noticing, making this a much better idea..
    2. Measure your oxygen saturation several times over several days to get a sense of your baseline.
  5. Look for COVID-19 related drug trials in your area, so you will have the information if you need to join one later
  6. Form care arrangements (for yourself, pets, kids, parents, etc) with people who will be able to follow through.
  7. You’re already quarantined, right?
  8. Buy gloves and masks for the person taking care of you (yeah, this is kind of aspirational at this point)
  9. Buy something to bring down your fever (an antipyretic). France is recommending against NSAIDs and against ibuprofen in particular. I will be very surprised if that ends up being born out (and WHO agrees with me), but if you believe them, you’ll want acetaminophen. If you don’t, any NSAID will work
  10. Buy pseudoephedrine (the real stuff, which is behind the counter in the US. Sudafed PE is useless).

Controversial

  1. Research drugs you might like to take if you got sick. I am deliberately not linking to more information on this because nothing is sufficiently certain right now that I feel comfortable recommending it to people who haven’t done their own research.
  2. Find a sketchy online pharmacy and buy drugs and medical equipment you feel confident self-administering.

At The First Sign of Illness

What are the signs?

That's an excellent question, but the more I research it the less confident I am in any particular answer. My eventual conclusions will be going up at this question, although right now I think the answer is going to be "feel sick? then maybe."


Uncontroversial

  1. Start taking zinc lozenges (gluconate or acetate. The terrible taste and loss of sense of smell says it’s working, unless you already lost your sense of smell to COVID).
  2. Set up your environment so it is easy to frequently drink small amounts of liquid, ideally with electrolytes.
  3. Rest, rest, rest
  4. Look for RCTs and drugs you might want to ask your doctor for, if you haven’t already.
  5. Restrict contact with other members of your household. Even if you've already exposed them, dosage matters, and you can spare them as much exposure as you can.
  6. Alert your care team. If anyone seems flakey, start looking around for new members.
  7. Check in with your doctor. They probably can’t do anything, but maybe you’ll get a test out of it, and that’s useful to your friends.
  8. Contact anyone you had contact with to warn them. Ask them to contact people they’ve contacted recently. Hopefully the number is small because you’ve been practicing good isolation.
  9. Take pseudoephedrine if you have unpleasant sinus pressure.

Controversial

  1. Do any research you told yourself you would do between buying sketchy drugs or medical equipment from sketchy online retailers and actually using them.
  2. Start any drugs acquired from sketchy online pharmacies that you have researched thoroughly enough to be willing to accept the consequences of your choice.

While Continuing to be Sick

  1. Continue to rest and hydrate, with electrolytes.
  2. Monitor your temperature. Let your fever play out unless it’s over Nº, at which point it’s legit dangerous to you and you should take the antipyretic you bought.
    1. I went looking for an exact value for N, but couldn’t find good studies on it, especially in adults. I was taught 103ºF, some people say 104ºF, that’s probably the range.
  3. (Optional) monitor your oxygen saturation.
  4. Continue to eschew human contact as much as possible.

When should I seek medical attention?

This depends in part on how functional your medical system is. If you’re in a place where you can get a drive by test and your doctor will order you experimental drugs over the phone, maybe do that. If you’re in the US, I don’t expect calling a PCP to do much even if you have one, which many people don’t. So your choice is “When do I go to the hospital?” keeping in mind that the hospital is well over capacity and that if you don’t have COVID going in, you’re likely to catch it there.

So I personally wouldn’t go to a hospital unless I clearly needed something I couldn’t get at home, which basically means oxygen or whatever they do when your fever is dangerously high for too long, which means “when I struggle to breathe” or “when my temperature is over Nº and antipyretics won’t bring it down”.

In a few places above I advise you to call your primary care physician, knowing full well many people don’t have one and that there’s not a lot they can do for COVID. That’s more ass-covering and future-proofing than anything; I’d feel really bad if it turned out they could do something and you missed out because I told you not to.

> It is probably too late though.

That might be technically true but I think it's misleading - I'm not clear on how common it was in China for one member of a household to get sick and others to stay well, but from anecdotal reports in the US I think it's fairly common for one person to get it and not spread it to e.g. their spouse and children.

So I'd think if one member of a household has symptoms, it's well worth quarantining within the household instead of assuming it's not worth trying to limit spread.

It's also important not to think of infection as binary, all-or-nothing: minimizing your cohabitants' inoculum may reduce the likelihood they get a severe case (I don't really know, I would just suggest that it's a possibility worth checking.)

2Elizabeth8moGood point, I changed it.
4Ruby8moI'm concerned about this one as advice. I think it's fine to say it's a likelihood ratio of 20x against, but the in presence of severe fever, cough, and difficulty breathing, I think a person should still place non-negligible probability on it being COVID-19 notwithstanding having had a runny nose at some point. I'm worried people about hearing the "runny nose != COVID" updating too hard that they don't have it. 1 in 20 people isn't that rare. I think it's more reasonable to say that if you don't have fever and do have runny nose, the odds are probably in your favor, but the runny nose alone shouldn't be an overriding diagnostic consideration.
4Ruby8moSome additional thoughts: I have a lot of uncertainty when hearing the 5% runny nose figure from data. Things like: 1) how did they define runny nose, maybe their cut off is much more stringent? If the paper defines this, it isn't getting passed along. 2) It's possible that different strains/mutations of coronavirus elicit different symptoms? I don't know enough to judge how likely that is. Same for whether different populations might present differently. 3) Allergies might cause runny nose independently of COVID-19.
2Elizabeth8moYou're right, I changed it.
3leggi8moThis image looks like a good guide of when to seek medical attention for a fever: https://share-cdn-prod.azureedge.net/wp-content/uploads/2016/10/HBEAT506220_CopyUpdateFeverTreatmentGuidelinesInfographic_V1.png [https://share-cdn-prod.azureedge.net/wp-content/uploads/2016/10/HBEAT506220_CopyUpdateFeverTreatmentGuidelinesInfographic_V1.png]
2Ruby8moAs I reach for the Ibuprofen and hesitate: Which part of the WHO status makes you think they don't think it will be born out? It says they're recommending what France says for now even though they don't currently have evidence that it's a problem.
4Elizabeth8moThat tweet says "WHO does not recommend against the use of of ibuprofen." . Where are you seeing them agree with France?
8Ruby8moAh, the problem is my brain is not working today. I missed the word "not" despite intentionally looking for its presence or absence. My bad. Question retracted.
1helohe7moI would advise against taking zinc lozenges. Zinc may at best shorten the duration of a cold caused by rhinovirae by 1 day. But the side effect may be a permanent loss of smell. AFAIK there are no studies showing it to have any measure-able effect on COVID. Chloroquine does not seem to be useful against COVID whatsoever. Initial studies of it were flawed and had a too small sample size. Taking Chloroquine probably does more harm than good.

Take chloroquine or hydroxychloroquine along with zinc ASAP (so you can avoid being hospitalized). ETA: Preferably after talking to your doctor about it. See references below for more details. If you didn't buy chloroquine/hydroxychloroquine ahead of time, beg your doctor for a prescription, or call doctors around you until you find someone willing to give you a prescription (because unlike China and South Korea, it doesn't seem to be part of the standard treatment for COVID-19 in the US).

ETA: Some relevant information from the CDC:

Based upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently recommended for treatment of hospitalized COVID-19 patients in several countries. Both chloroquine and hydroxychloroquine have known safety profiles with the main concerns being cardiotoxicity (prolonged QT syndrome) with prolonged use in patients with hepatic or renal dysfunction and immunosuppression but have been reportedly well-tolerated in COVID-19 patients.

[...] Hydroxychloroquine and azithromycin are associated with QT prolongation and caution is advised when considering these drugs in patients with chronic medical conditions (e.g. renal failure, hepatic disease) or who are receiving medications that might interact to cause arrythmias.

Quoting Rob Wiblin:

"DO NOT TAKE IT OUTSIDE MEDICAL SUPERVISION: "Chloroquine is very dangerous in overdose.""

https://www.facebook.com/photo.php?fbid=886113990345&set=a.509700885225&type=3&theater

Just because something is dangerous in overdose doesn't mean that medical supervision is needed: for example acetaminophen, or even water. The relevant thing is that the therapeutic dose is close to the lethal dose for chloroquine, and chloroquine dosing is complicated.

Hydroxychloroquine is 40% less toxic while still being effective, according to this article: https://www.nature.com/articles/s41421-020-0156-0

Medical supervision may not be available if current trends continue, so we must carefully weigh the options available to us.

This sounds like a prime opportunity for people with medical expertise to write guidelines on how to use it for civilians.

9Adele Lopez8moWei Dai's first link was a doc with medical guidelines written by people with medical expertise (though not (explicitly) for civilians, I would expect legal risk to deter medical professionals from making guidelines for civilian use). That link is now dead, but archived here [https://web.archive.org/web/20200319023745/https://docs.google.com/document/d/e/2PACX-1vTi-g18ftNZUMRAj2SwRPodtscFio7bJ7GdNgbJAGbdfF67WuRJB3ZsidgpidB2eocFHAVjIL-7deJ7/pub#ftnt7] . It included the South Korean guidelines: My current strategy is to follow these guidelines (with hydroxychloroquine + zinc) if medical treatment is unavailable, there's strong evidence that the illness is COVID-19, and serious COVID-19 symptoms are present. I'll also have activated charcoal on hand to help mitigate accidental overdoses. I'm trying my best to familiarize myself with the risks involved so that I can make good decisions if the situation calls for it. Of course, my primary strategy is prevention in the first place.
4Ben Pace8moThat's great, thanks for the info.

Here's a negative study about hydroxychloroquine that just came out: http://www.zjujournals.com/med/EN/10.3785/j.issn.1008-9292.2020.03.03 (archive link because the website seems to be down)

5Rob Bensinger3moWhat's your current epistemic state re hydroxychloroquine?
4Wei_Dai3moI haven't been following developments around hydroxychloroquine very closely. My impression from incidental sources is that it's probably worth taking along with zinc, at least early in the course of a COVID-19 infection. I'll probably do a lot more research if and when I actually need to make a decision.
3Rob Bensinger3moA couple minutes after I wrote this question I found out Scott Alexander said July 29 [https://www.reddit.com/r/slatestarcodex/comments/hzoxh1/learned_epistemic_helplessness_covid19_and_hcq/fzlkb6e/?context=3] :
1Theodore Ehrenborg3moLast week I read [http://lettertok.com/index.php/2020/08/26/rethinking-hydroxychloroquine/] the literature and concluded: The 10% is a relative reduction, not absolute. I don't know how Scott Alexander defines "clinically significant". Some authors thought that "significant" meant a 50% or 90% relative reduction in cases, although I personally think that a 10% reduction matters. But I have no medical experience and no medical training. If you read Stat News, you know more about medicine than I do. I also conclude: And: That fact comes from a large (n = 4716) randomized controlled trial, which found that hydroxychloroquine is almost certainly unsafe for treating patients who have been hospitalized with COVID-19. The drug caused about a 7% relative increase in deaths. Bear in mind that I redid some of the statistics from the studies because I thought they were incorrectly concluding that hydroxychloroquine had no effect. If you don't trust my math (I wouldn't trust a stranger's math), you can see my work here [https://share.cocalc.com/share/949ddd254812fe99536345c87e051585b07eebb1/Theodore_Ehrenborgs_Public_Notebooks/Hydroxychloroquine%20statistics.ipynb?viewer=share] . And I wrote the post for an audience who might not know what Bayes is.
5Sjcs8moI think this is unsafe advice, specifically using chloroquine and hydroxychloroquine without medical supervision. These are not benign drugs (chloroquine being worse) and you are advising people use it while unwell with an emerging and poorly understood disease that could potentially alter its safety and pharmacokinetic/dynamic profile, and without any consideration for potential other health issues people have or medications people are taking (eg many antidepressants and anyone with diabetes). If you have chloroquine/hydroxychloroquine, you should go see your healthcare provider before taking it do the baseline tests and discuss relevant side effects for your individual situation. If you have COVID-19 and have chloroquine/hydroxychloroquine, you should not be taking them without medical supervision. If you are young and healthy, you are more likely to have side effects from the drugs than have a severe infection. If you are unwell enough to be admitted to hospital, bring your drugs with you and ask the doctors to prescribe it while you are an inpatient, with appropriate monitoring, using your own supply (and keep it with you, rather than in the hospital's drug cupboard - lots of theft of hospital supplies happening) Edit: for formatting
5Wei_Dai8moI've added some information about possible side effects to my comment. Obviously "with medical supervision" would be preferable, so sure talk to your doctor on the phone about it first if you can. (I think visiting a doctor's office is too risky at this point.) But if your doctor can't or won't talk to you about taking chloroquine/hydroxychloroquine, and you don't have preexisting conditions that make chloroquine/hydroxychloroquine more dangerous for you, it seems to me safer to take it than not. Unfortunately I'm unable to find quantitative information about the risk of side effects (UpToDate [https://www.uptodate.com/contents/chloroquine-drug-information?search=chloroquine-drug-i&topicRef=468] says "Frequency not defined" under "Adverse Reactions"), so it's hard to make a really informed decision about this. Perhaps to be safer, one could take chloroquine/hydroxychloroquine at home at a lower dosage than is recommended for severely sick hospitalized patients? Would you agree with that, or do you think "young and healthy" should refrain from taking any dosage, absent medical supervision? If so, what is that based on? (E.g., are you a doctor with first-hand experience or some other source of information about chloroquine side-effects?)
3Sjcs8moHydroxychloroquine is pretty well tolerated from what I've seen (never seen chloroquine given we have a safer alternative). The most common side effect is nausea/vomiting/diarrhoea and this is the only thing I could find a rate on (~10%). There are also a collection of rare, severe side effects. Some of my concerns are: * Most of our safety data would be targeted at use in relatively well patients with rheumatological or dermatological disease, not acutely unwell infective patients (I have no idea about its safety profile in malaria other than it's not really used anymore due to resistance) * Unknown dosage - as you suggested a lower dose might be safer but could also be below the therapeutic dose (the studies DO seem to use a fairly high dose) * The chloroquines come with a risk of QT prolongation; coronavirus comes with a risk of myocarditis - I would expect one would have much higher rates of arrhythmias. Also worsened by the other QT prolonging medication one would be on by then (azithromycin), and electrolyte abnormalities present in critical illness/from GI side effects of the drugs and infection. Admittedly, myocarditis seems to be a late development and the patient would be in ICU already, rather than early in the disease Most of this probably comes down to the unknown - this is extremely early days into the investigation of using hydroxychloroquine for COVID19. I don't think we know enough about this to be using it outside of the medical setting. Maybe my risk threshold would be for its earlier use in those over 60 or those with isolated hypertension? I'm unsure. This could all change within 1-2 weeks as I'd expect there'll be significantly more data.
4Elizabeth8moOf the initial 26 in the treated group: * three patients were transferred to intensive care unit, * one transferred on day3 post-inclusion * one patient died on day3 post inclusion * one patient stopped the treatment no one left the control group. "We left out four patients who got definitively worse" seems like a big flaw in the analysis.
4Adele Lopez8moYou can buy hydroxychloroquine here still (as of March 20th): https://fixhiv.com/shop/coronavirus-drugs/hcqs-400-hydroxychloroquine-400-mg/ [https://fixhiv.com/shop/coronavirus-drugs/hcqs-400-hydroxychloroquine-400-mg/] which imports it from India. This site also lets you easily buy a prescription for it, FWIW. Check for G6PD deficiency before taking chloroquine (can be done through the 23-and-me interface) as it can cause haemolysis. Apparently not an issue with hydroxychloroquine: https://www.ncbi.nlm.nih.gov/pubmed/28556555 [https://www.ncbi.nlm.nih.gov/pubmed/28556555]
4Adele Lopez8moBTW, the google doc appears to have been taken down due to a TOS violation.
3habryka8moHuh, that's quite weird. I wonder whether we can ping any of the people at Google we know about this, since I thought that document was quite good, and I linked to it a few times.
3Rudi C8moNote that antimalarial drugs seem to be bad for psoriasis.
1Liam Donovan8moThe google doc seems to be down
5habryka8moSee this comment thread: https://www.lesswrong.com/posts/F3q7eL7pdQqhWFTYh/what-should-we-do-once-infected-with-covid-19?commentId=yei98MRd4cjqcDYEp [https://www.lesswrong.com/posts/F3q7eL7pdQqhWFTYh/what-should-we-do-once-infected-with-covid-19?commentId=yei98MRd4cjqcDYEp]

EDIT: Changed blood oxygen numbers thanks to Jay Molstad Comment

What I would do if I had COVID-19? ( I am NOT a medical professional)

Ok. So you're sick. Maybe you have a fever and a bit of a cough. This may be COVID-19 and this may be something else like a seasonal flu. Even if you have COVID-19 the most likely outcome is that the symptoms are mild enough that you can deal with them at home. The South Korean Health Minister says 10%, so 90% you recover at home.

  • Dealing with mild symptoms at home:
    • Rest
      • You shouldn't be doing anything strenuous. Just let your body fight off the virus. Maybe enjoy some shows or video games while you're at it.
    • Keep drinking fluids
      • Staying hydrated is important generally, but especially important when you're sick and may not be drinking and eating regularly. I would do this by drinking water, tea, and drinks made from electrolyte powders. Do make sure you're getting electrolytes somehow (LW discussion of electorlytes).
    • Ask someone to check in with you regularly in case you do get worse.
      • A housemate or a friend could message you to check in every day or two. Being sick sucks and possibly your judgement is impaired by a fever. If you and your friend are comfortable with it you can offload the decision making on when you should be worried enough to go to the hospital.
    • There is some discussion of using chloroquine and/or zinc. I have not looked deeply into this. My immediate thoughts here are zinc seems low cost to take and chloroquine seems high cost to take.

  • When should I go to the hospital?
    • I'm going to write what I'd be looking for, but ultimately you must make your own decision. I am not a medical professional.
      • Blood Oxygen Levels
        • Maybe you got a pulse oximeter.
        • Normal blood oxygen levels are 90-95%, but can be lower if you have other factors like sleep apnea.
        • The WHO has been recommending to doctors to start giving oxygen therapy if the blood oxygen levels fall below 90%
          • Based on Jay Molstad's comment below I would probably head to a hospital if my blood oxygen was below 90% and I was having trouble breathing or below 85% with or without trouble breathing.
          • Note, you may have blood oxygen at a lower than normal range
      • Shortness of Breath/Difficulty Breathing
        • If you are having short painful breaths or having trouble breathing.
      • Fever above a certain point.
        • Sites vary here. Mayo Clinic says if the fever is above 103oF consistently or above 102oF for more than 3 days. This other site says 104oF and above is dangerous and you should seek immediate medical attention at 106.7oF
      • It may take a few days before you know if you're going to have severe symptoms. For hospitalized patients these were some of the timelines observed.
        • from first symptom to → Dyspnea (Shortness of breath) = 5.0 days
        • from first symptom to → Hospital admission = **7.0 days*

  • Maybe hospitals are overloaded.
      • Measures like the shelter in place order in the bay area will help a lot with decreasing the load on hospitals, but it's still possible we end up with a peak at some point.
      • You may want to try to get in anyway. If you're experiencing severe symptoms and have been turned away from a hospital you may want to try some things on your own.
      • Some people have been buying oxygen concentrators. If your blood oxygen falls below ___ or you are having a difficult time breathing. Using one or seeing if a friend has one may be helpful. I want to note again I am not a medical professional. Oxygen toxicity is a thing so it's not like using an oxygen concentrator is risk free.
        • If I had an oxygen concentrator and a pulse oximeter I would consider starting at a low flow rate and slowly increasing until my blood oxygen levels were above 90%, but being careful not to continue oxygen therapy if my levels returned to normal (90-95%, could be lower if you have other factors like sleep apnea).
        • WHO recommendations to clinicians were.
          • Start at 5 L/min and titrate flow rates to reach target SpO2≥90% in non-pregnant adults and SpO2≥92-95 % in pregnant patients.
          • It’s unclear to me what concentration of oxygen they were using.

I asked my dad, a doctor (internal medicine). My blood oxygenation is usually around 92-93%. It can vary for a number of reasons. Anything under 90% is considered hypoxia, but the high 80s can be "normal" in a long time smoker.

The hospital is likely to be very busy and not have time for mild cases. Blood oxygenation of 92% does not warrant their attention. I'd give my doctor (or the emergency room) a call at 90% oxygenation. At 85% it's definitely time to go to the hospital (unless they tell you otherwise). Below 80% brings a severe risk of organ failure, so that's a life threatening emergency.

Use common sense - if your doctor is telling you one thing an a random internet comment is telling you differently, believe the doctor. Also, if your readings are going down rapidly, call your doctor. Don't drive if you're significantly impaired.

5Connor_Flexman8moBlood oxygen can certainly vary between people, but I think this gives a misleading picture for many people. Most of my friends have blood oxygenation of >98, and getting to 90 would imply rampant infection and warrant hospitalization if the hospitals aren't overrun yet. Certainly 90-95% is not "normal", as the OP now says (the link specifically says it's not normal). I think people should be considering hospitalization once they've dropped 6% in SpO2 AND they've dropped below 92% SpO2. More thoughts are in my longer comment here [https://www.lesswrong.com/posts/LwcKYR8bykM6vDHyo/coronavirus-justified-practical-advice-thread?commentId=ExmzvJpqozjjsFsBg] . This covers people with unnaturally low SpO2 to begin with, while also acknowledging that many people do start from ~100% and should not wait until they have such an infection that their lungs have dropped past chronic smoker levels of impairment.
4Jay Molstad8moThat all seems solid, but I'd still call ahead before going to the hospital. If they have more critical cases than they can handle, a mild case could wind up waiting indefinitely. P.S. Medical types use the word "normal" to mean "not meeting the criteria for a diagnosis".
4Sjcs8moNormal blood oxygen saturation is 95% and above; without a history of fairly significant lung disease I'd be surprised if you were persistently under this level - note that an oximeter can give very variable readings due to artefact from all sorts of things including movement, ambient light, temperature (probably a significant one in the context of an infection if you are having a fever/rigoring/very cold fingers), and the number it spits out is the average over the last 3-12s. If you are short of breath with coronavirus it is worth talking to a healthcare provider. If you are a generally well human and have persistent sats around 90%, go to hospital. If you have oxygen sats of 85% you are severely hypoxic and should consider an ambulance. (I didn't downvote your post and I applaud that you went to the effort to find out more and make actual thresholds for action)
2Jay Molstad8moPersonally my oxygen saturation always reads 91-93%. I'm 47 years old with no known lung problems who never smoked. People vary. I'm an unusually large man, so it may be a square-cube law effect or a finger-thickness effect. It may be some other confounder. Under normal circumstances I would agree with the rest. In the very near future healthcare providers are expected to be absolutely swamped with coronavirus cases; apparently corpses have been piling up in Italy [https://www.theguardian.com/world/2020/mar/19/generation-has-died-italian-province-struggles-bury-coronavirus-dead] . I think my thresholds for action are stricter than yours because I'm trying to minimize strain on the system. But at 90% your plan is to go to the hospital and my plan is to call a doctor to find out if I should go to the hospital. That's not a huge difference. Related: the mayor of Baltimore has requested his citizens avoid senseless gun violence [https://baltimore.cbslocal.com/2020/03/18/we-need-those-beds-baltimore-mayor-urges-people-to-put-down-guns-after-violence-continues-during-covid-19-pandemic/] for similar reasons. Things are getting weird out there.
3willbradshaw8moI'd appreciate knowing why someone downvoted this.
2Jay Molstad8moMe too. If there's something wrong with my plan, I'd prefer to find out the easy way.
3leggi8moIt's a bit of a peeve of mine this down voting without explanation, but I'm getting used to it! I up-voted yesterday :) blood oxygen - Hb/O2 dissociation curve. [https://www.lesswrong.com/posts/vXiSYqtECvrt5aqQj/pulse-oximetry-and-the-oxygen-haemoglobin-dissociation-curve] Edited to add: It probably wouldn't bother me so much if it wasn't giving out negative "karma" - that's not something I'd dole out to anyone. Or if it didn't just take one vote (not everyone here is always as rational as they'd like to think) to remove comments from general view.

I read a lot of recommendations for electrolytes but found all of the explanations kind of vague, so I did 2 hours of digging (plus more research from Eli Tyre). This is what I found

What are electrolytes?

An electrolyte is a substance that produces an electrically conducting solution when dissolved in a polar solvent, such as water. When applied to humans and health, it typically refers to sodium (Na+), potassium (K+), calcium (Ca2+), magnesium (Mg2+), chloride (Cl−), and is used for nerve signals and maintaining the right osmotic pressure in cells.


How does illness affect electrolytes?

Electrolytes are lost in sweat, including from fevers, environmental heat, and exercise. They can also be lost through diarrhea and vomiting- a big problem with bulimia.

Additionally, too much fluid can throw your electrolyte balance off, so if you’re following the advice to hydrate without taking electrolytes, you can make things worse.


What’s so bad about low electrolytes?

Your nerves will be worse at firing, leading to cramps, mental issues, and cardiac issues.

In extreme cases it can lead to spasms of the muscles in the throat (leading to difficulty breathing), stiffening and spasms of muscles (tetany), seizures, abnormal heart rhythms, and kidney failure (hypocalcemia, hypoatremia, hypokalemia). But you’re not going to let it get that far.

More speculatively, because calcium-based signalling is a key component in immune response activation, low calcium may weaken your immune system.


How speculative is this?

Not. Electrolytes are part of the standard routine in hospitals for COVID-19 and fevers in general.


Can I hurt myself with this?

Yes, but not easily. There is a level at which too much of any electrolyte is bad for you. My experience and the experience of many people I know is that you can tell by taste- electrolyte-enhanced water tastes amazing when you need them and unpleasantly salty when you don’t. Also barring certain specific problems like hypothyroidism, your body is pretty good at evening out your electrolytes as long as you give it the raw materials and time, so this is another reason to space out your fluid consumption.


The theory seems sound, what about the practice?

I looked for RCTs of electrolyte supplementation vs. not, but what I found was mostly studies of different types of rehydration therapies, always in children, and most for diarrhea induced imbalances rather than fever. The best I found was this meta-review showing isotonic IV fluid led to low sodium less often than low sodium IV fluid did

If you’re curious about the pediatric diarrhea studies...


How much do I need and when do I need it?

The literature was not very forthcoming on this, and I’m not a great person to ask because I put salt in my water by default. My folk wisdom is to add it to your water that you should also be drinking to taste.




Thanks to Eli Tyre for help with the research for this comment.

2vidro38mois something like pedialyte a reasonable OTC solution for electrolytes or would you suggest mixing out own concoctions?
3Elizabeth8moAFAIK Pedialyte is a perfectly good solution for the problem of electrolytes, if maybe on the expensive side. I've heard more complaints about its flavor than the other options, but if you know you like it that's not an issue. The liquid form is also bulky, so if it were me I'd get a powder or drops, but maybe you have lots of space in which case it doesn't matter.
1romeostevensit8moeasy way is (per litre of water) 1 tsp nusalt or no-salt (potassium chloride) 1/2 tsp salt 1/8 tsp epsom salt (food grade) (it's okay to eyeball small amounts of this, high therapeutic index) 6 tsp sugar
2leggi8moAny electrolyte losses due to having a fever for a few hours/days is not clinically significant which is why you can't find relevant studies. The body is capable of coping with a bout of pyrexia. published in 1938: ELECTROLYTE BALANCES DURING ARTIFICIAL FEVER WITH SPECIAL REFERENCE TO LOSS THROUGH THE SKIN [http://content-assets.jci.org/manuscripts/101000/101039/JCI39101039.pdf] Plain water is usually sufficient to maintain hydration during a a fever + a little salt if sweating a lot. (I have said this before but it was voted down out of view - too simple and practical?). Taking electrolytes (within recommended dosage) isn't going to hurt but it is not necessary for a fever.

Take zinc at the first symptom.

Other people (Scott, PhilH, knzhou Cochrane Review) have gone into the science before and I don't have much to add to their research, but here's my adaptation for COVID-19 in particular.

My synthesis:

  • The method of action is zinc ions attaching to your throat. So pills are useless. It has to be a lozenge.
  • This implies that zinc is only helpful with infections of the throat, not nose or lungs. According to a source I can't find because I read it before starting the links DB, COVID-19 often starts in the upper respiratory track and becomes dangerous when it moves into the lungs. If that's true, a good zinc lozenge might inhibit COVID-19 from turning serious even if it can't prevent infection entirely (note that under this model you would still be contagious and should take appropriate precautions).
  • Chris Masterjohn claims only zinc-gluconate and -acetate work. I don't know if this is true, but the only studies I found used gluconate and acetate, so it seems wise to prefer them.
  • I need to stop chewing my lozenges to make the process faster.
  • I hope you already bought the right kind because it's all sold out right now.

Caveats:

  • "A cold" can be caused by coronaviruses, rhinoviruses, or other. None of the studies I skimmed tried to different between causes. It's possible that zinc works amazing for rhinoviruses but does nothing for coronaviruses, or is amazing for some coronaviruses but not SARS-CoV-2.
  • The loss of sense of taste and smell says it's working.

Should I take zinc prophylactically?

My first-principles, completely unverified guess is that if you take zinc all the time your body will adapt and it will become less useful. Also you will lose your sense of smell. I'm not taking it while in isolation, but I definitely would if I was a medic or grocery clerk right now.

I was under the impression that loss of sense of smell was primarily happening to people who take zinc intranasally. (I don't have numbers handy.)

My impression was that the effect of the zinc was supposed to be on the virus (or the virus's interaction with your cells), not on the body. Which (if true) would seem to imply that prophylactic use shouldn't cause adaptation.

This paper appears to be a discussion of a Cochrane review from 2011, and supports prophylactic use (and also generally supports use, and provides more info):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/

The 2011 version of the Cochrane review in question: https://www.ncbi.nlm.nih.gov/pubmed/21328251 / http://sci-hub.tw/10.1002/14651858.CD001364.pub3

(Irritatingly, there have been a number of subsequent versions of the Cochrane review, but several of them have been withdrawn, for reasons that are hard for me to interpret, although one at least involved an accusation of plagiarism from another meta-review on the same topic. It feels to me like there may be some kind of political fight over ownership of this Cochrane review.)

ALSO, while looking through Cochrane reviews, I found this one in favor of Vitamin C for

... (read more)
4John_Maxwell8moI have a few extra lozenges I can share, although if you're in the Bay Area, you'll have to drive to a different state to get them. Send me a personal message if you're interested.

Listing / summarizing some things I've seen elsewhere:

This general summary post by Sarah Constantin: https://srconstantin.github.io/2020/03/27/home-care-mild-COVID19.html

A post by SC specifically on "non-invasive ventilation", meaning CPAP and BiPAP machines (which some people may already have at home), with positive conclusions: https://srconstantin.github.io/2020/03/20/non-invasive-ventilation.html

A document by Matt Bell with information about chloroquine phosphate / hydroxychloroquine: https://docs.google.com/document/d/160RKDODAa-MTORfAqbuc25V8WDkLjqj4itMDyzBTpcc/


One of the most intriguing things I saw was about "proning": https://emcrit.org/pulmcrit/proning-nonintubated/

The author of that post is Josh Farkas, a pulmonologist (i.e. lung specialist) and assistant professor of critical care and pulmonary disease (i.e. lung disease.)

"Prone" here means a face-down lying position, the opposite of "supine" which means face-up. The author says "Typically we prone intubated patients." From context, I am reading "we" to mean his hospital / department, and "prone" to mean "rotate into the prone position for 6-18 hours per day." The commonality of this practice seems to vary among hospitals.

The post, however, is a discussion of proning for awake, non-intubated patients, and concludes that it appears safe and effective. There is a lot of uncertainty around how effective it is, but it looks to me like, if you have pneumonia and hospital treatment is not available to you, there is some evidence that -- perhaps counterintuitively -- you will breathe better lying on your belly, vs. on your back.

(The main counterpoint I have seen to this is that frequently moving around and changing positions is best. I can't tell whether the post is largely about patients who are too out-of-it to do that. I have seen it suggested that, if you're able, sitting up is better than lying down (I have no cite handy for this.) There seems to be overall agreement, at least, on this one point: lying stationary on your back for long periods of time is NOT good when you have lung problems.)

Idea I saw someone float:

If [a COVID-19] case becomes severe & ventilator access is limited, postural drainage is a thing I would be trying (seems low-cost & fits my models about what sort of thing should help). https://www.healthline.com/health/postural-drainage

Relatedly, if you're showing COVID-19 symptoms, I think I would recommend that you start lying on your chest if you can sleep and rest well in that position, using pillows for support as needed. I base this on an NY doctor working in a non-ICU COVID-19 unit who says:

Proning [i.e., having patients lay on their stomach] is now standard in our ICU and I tried hard to get my sicker patients to do it too to head off intubation. [...]

https://twitter.com/SepsisUK/status/1243236007346163712 [...]

[in reply to "Is proning something we can do at home to help with milder symptoms? My brother is short of breath but not at ICU level, should he try this?":]

Yes, can’t hurt, likely help

I only looked at these studies briefly, but they suggest that ARDS patients benefit from lying on their stomach:

Find an RCT for COVID-19 treatment. This seems like a good compromise between "buy drugs from a sketchy foreign pharmacy and base dosage on a handful of papers" and "I dunno, my GP seems pretty on the ball".

One place I have found to find RCTs is https://clinicaltrials.gov/ . Normally I would verify the details of how to join but I assume they are busy right now. If you do try this, please report back.

Like Elizabeth, I remember reading somewhere that COVID-19 often starts in the upper respiratory track and becomes dangerous when it moves into the lungs. In line with that, one idea is to try to control the illness in the upper respiratory tract through sinus rinse/nasal irrigation (be sure to sterilize the water first). I haven't done much nasal irrigation, but I've found gargling with warm salt water to be really helpful for colds. This study found that simply gargling water for 15 seconds 3 times a day reduced upper respiratory tract infections by 36%! Breathing in steam or making use of a humidifier might also be helpful.

This pdf was linked from the 80K podcast. There are treatment instructions starting on page 8. There's also a section on what Traditional Chinese Medicine says you should do :P

There's also a thread on the slatestarcodex subreddit on what to do if you have a severe case and there's no room in the hospital. Another thread on that sub.

Agree with the Vitamin D, C, and zinc. Also take nicotinamide riboside (a B3 variant) to raise PARP10 levels. (Recent paper on this):

https://www.biorxiv.org/content/10.1101/2020.04.17.047480v2


And don't forget to stagger around the neighborhood biting everyone... millions of movie fans have been waiting for this for decades.

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Hello - this is the best resource I have found! I am currently on day 7 of presumed covid-19. I wanted to make some suggestions about viral pneumonia, which is often experienced by those who become ill when their conditions start to worsen. Viral pneumonia alone is not admissible criteria for EMD at this point.

My first sign that I had it was on day 3 if my illness, by far my most severe day. I was awoken by the sound of my own breathing, the sounds also caused my dog to scare and bark. I could hear purring/snoring/perculating/crackling from my lungs when I laid on my back, only when I was exhaling. Sometimes it sounded like a strip of explosive firecrackers going off. My PCP gave me no helpful information for palliative support or home remedies. She encouraged me to go to the ER without ever talking to me in person. They would have sent me home because I was never sick enough to be there.

Some things I found online to support at home care of pneumonia are:

  • Consuming a cup of regular coffee daily as caffeine is a bronchial dilator.

  • Avoiding all cough suppressants and instead take an expectorant. I took extra strength 12-hour Mucinex twice a day and was coughing up watery phlegm nonstop. Sorry for the visual.

  • Lying down prone and forcing yourself into coughing.

  • When sleeping, avoid your back and try to sleep on your right side as this is less pressure for your lungs and heart.

  • Use it cool humidifier or warm mist vaporizer.

  • Get up from bed and do light stretching every few hours. Take a few deep breaths and hold them for 10 seconds. Don't let your lungs become rigid.

If you are able to validate or research any of these suggestions, or add to the list, I think it would greatly help people. I am finally turning a corner and my pneumonia has not yet turned into respiratory distress. Thanks for the hard work you put into this.

Some intriguing stuff on hot/cold therapy here (https://youtu.be/EFRwnhfWXxo) and here (https://youtu.be/H1LHgyfPPQ8). I know nothing more than what's there. Also haven't read through every comment so forgive me if this is redundant. Take care!