Check the active ingredient of your hand sanitizer. You may have one that contains benzalkonium chloride, which does not work against at least one type of coronavirus. (This turns out to be the case for one of the hand sanitizers I've been using.) Get one that has "greater than 60% ethanol or 70% isopropanol" instead, as recommended by CDC.

ETA: I didn't bother to check this until today, because why would the FDA approve or fail to pull from the market, hand sanitizers that don't work against an important group of viruses? And why hasn't there been any arti

... (read more)

I'm pretty sure this can't be correct--they claim benzalkonium chloride has zero effectiveness, which is less than plain water! I think it has to be a data entry error.

This review cites some other studies that show benzalkonium chloride to be comparable to other disinfectants, although alcohol is still best by a considerable margin.

5Thomas Kwa13dThat study is on inanimate surfaces, and benzalkonium chloride is the main ingredient of Clorox, Lysol and other disinfectant wipes. So it might be a good idea to switch to isopropanol wipes for surfaces too.

[ Question ]

Coronavirus: Justified Practical Advice Thread

by Ben Pace, Elizabeth 1 min read28th Feb 2020332 comments

231


(Added: To see the best advice in this thread, read this summary.)

This is a thread for practical advice for preparing for the coronavirus in places where it might substantially grow.

We'd like this thread to be a source of advice that attempts to explain itself. This is not a thread to drop links to recommendations that don’t explain why the advice is accurate or useful. That’s not to say that explanation-less advice isn’t useful, but this isn't the place for it.

Please include in your answers some advice and an explanation of the advice, an explicit model under which it makes sense. We will move answers to the comments if they don't explain their recommendations clearly. (Added: We have moved at least 4 comments so far.)

The more concrete the explanation the better. Speculation is fine, uncertain models are fine; sources, explicit models and numbers for variables that other people can play with based on their own beliefs are excellent. 

Here are some examples of things that we'd like to see:

  1. It is safe to mostly but not entirely rely on food that requires heating or other prep, because a pandemic is unlikely to take out utilities, although if if they are taken out for other reasons they will be slower to come back on
  2. CDC estimates of prevalence are likely to be significant underestimates due to their narrow testing criteria.
  3. A guesstimate model of the risks of accepting packages and delivery food

One piece of information that has been lacking in most advice we’ve seen is when to take a particular action. Sure, I can stock up on food ahead of time, but not going to work may be costly– what’s your model for the costs of going so I can decide when the costs outweigh the benefits for me? This is especially true for advice that has inherent trade-offs– total quarantine means eating your food stockpiles that you hopefully have, which means not having them later.

231

New Answer
Ask Related Question
New Comment

47 Answers

Since COVID usually kills via pneumonia, and insufficient vitamin D appears to be a surprisingly large risk factor in respiratory infection, it’s probably pretty important to keep vitamin D levels sufficient (which in most people means supplementing it specifically, esp if there’s any quarantine that affects food).

Amazon link

Studies:

  • Study says 4x rate of respiratory infection in the very deficient, but doesn’t see an obvious effect in the partially deficient, so slightly weird statistics.
  • Study says very large effects in children
  • WHO says linked
  • Study says no effect from supplementing after already sick, so get on this before infection

Advice: Use gloves or wash your hands after handling delivery packages, and be careful not to touch your face while handling them.

Model:

  • Packages have been handled by many people, who have economic incentives to come to work even when sick
  • Coronavirus has a long asymptomatic but infectious period
  • -> Once coronavirus is at all prevalent, your packages will be exposed
  • Coronavirus can live on surfaces for many days (my research)
  • Cardboard is hard to sterilize (I'm still investigating this one)
  • -> You're likely to pick up virus particles on your hand from handling packages
  • Washing is effective at clearing virus particles off of your hands
  • Unless you've already transferred them to mucous members by touching your face.

Tl;dr Putting copper tape on commonly-touched surfaces is a high-value thing to do in the case you’re actively trying to avoid infection, since copper kills viruses and ~~50% of viral disease is from hand-to-surface-to-face contact (h/t Adam Scholl for hypothesis) [ETA: coronavirus seems to have mostly (?) respiratory droplet transmission, so this prior is less relevant but still worth intervening upon]

Amazon link (sadly, probably one Amazon item that won’t go out of stock)

Metals killing bacteria is well-documented, like all the very consistent results in this paper comparing 9 metals (lead kills slightly better than copper but that unfortunately extends to the humans; zinc and some other metals also kill pretty well, only two did not). Within an hour, copper dropped CFU from 10^6->10^1 (the measurement threshold). Zinc took 2 hours, nickel 4.

Unfortunately, this isn’t in widespread use in hospitals yet. But when it does, copper on the most-touched surfaces of an ICU appears to reduce infections by about half (bed handles, chair armrests, nurse call buttons, and a few others). But these are in very high-germ-load environments. What happens in a normal home?

First, how much of disease spread is from hand-to-surface vs airborne or hand-to-hand? I lost the citation and it wasn't well backed, but apparently you don't catch colds through suspended particles very often (someone has to sneeze within 6 feet or exhale in your face lots). And hand-to-hand contact spreads it more efficiently but (one paper said) less frequently than hand-to-surface-to-hand, especially in environments without lots of high-fiving and hand-shakes. Plus, the study saying 50% infection reduction from copperizing main surfaces would fit well with a base rate of ~70% hand-to-surface infections and, of these, ~70% of touches in the ICU got sanitized by the dangerous surface metal coverings. But 70% sounds like a lot so I’m going to be a little conservative and just say 50%.

Now, it’s hard to figure out how many things you’d need to cover with copper to reduce most of this. But some typical commonly-touched shared items are:

  • doorknobs (brass is probably ok, steel is not) [ETA: comment below points out brass not ok]
  • light switches
  • faucets
  • toilet handles
  • refrigerator
  • drawer handles
  • writing implements
  • backs of chairs

Depending on how many people you are sharing touch-space and not air-space with, I expect covering these in copper could reduce infection by anything from 1 to 50%, though I expect in a typical house of four people who sometimes venture outside and don’t know about never touching your face, you’d get an effect roughly between 15 and 40%.

Edit: Sounds like this isn't very useful because you'll be able tell if you're having trouble breathing? See comment below.

Advice: Get a pulse oximeter to be able to triage at home.

Reasoning: If you're mildly sick, you probably don't want to go to a medical office (both because you'll be clogging up an overcrowded system, and because you'll be around people who are even sicker). But you need to know when you're sick enough to need medical care.

One way medical professionals triage is by vital signs. Most of them are obvious either to you or to other people (shortness of breath, paleness, dizziness, turning blue) but oxygen saturation (how well-oxygenated your blood is) is not. If you think you might have pneumonia (one of the common effects of coronavirus), low oxygen saturation is one of the things that would indicate that, and lower numbers should move you toward getting medical care. 95% and above is normal (at sea level) and lower numbers mean it's likely your lungs aren't working properly (with outcomes being worse the lower the number is).

The device is cheap and easy to use.

Note that you might still be very sick and need medical care even if your oxygen level is fine, so this is a way to rule in being sick enough to need medical care but doesn't rule it out.

Guide to using and what levels are normal

More detailed instructions for troubleshooting

Article on lower oxygen saturation meaning worse outcomes for pneumonia

(I'm not a medical professional and would appreciate it if someone who is would double-check the logic here, or some risk I'm not thinking of in terms of people reading it wrong and coming to wrong conclusions)

Hospitalization and oxygen therapy thresholds

Tl;dr: Not knowing much about this, my current policy is to go to a hospital if PaO2 drops below ~92% and my hospital isn’t completely overrun, unless my PaO2 is naturally low or some other extenuating circumstance. If I was forced to use an oxygen concentrator outside of a hospital, I would target a ~~94-96% PaO2 range, trying very hard to make sure I didn’t hit 99%

If you do have COVID and shortness of breath, when do you go to a hospital?

Hopefully you already have a pulse oximeter as Julia Wise recommends. But sources say anywhere between 90 and 95% PaO2 is the threshold for hospitalization (WHO says <= 93% is classified as severe, ctrl+f “O2”), while other sources say you should threshold on trouble breathing and shortness of breath, not the actual PaO2 number.

It seems to me that using “trouble breathing” as the indicator would track the lung blockages and thus immune response relatively well, while O2 as an indicator would track the danger metric directly (if in fact the primary source of death is insufficient oxygen; if anyone knows this, would be useful).

The benefit of looking at trouble breathing is that it’s an advance indicator. Usually people progress from oxygen therapy to ventilators relatively quickly. If you have naturally low PaO2, your O2 might drop under threshold (say, 93%) in the early stages with mild trouble breathing, but you wouldn’t have much of a dangerous immune response until later. In this case, you’d have wanted to use difficulty breathing as your indicator instead of PaO2.

That being said, having low oxygen seems pretty bad for you, both by common sense and science. For example, 92% or lower is associated with increased morbidity in pneumonia patients; <90% is increased with 36% increased morbidity. Since it’s hard to measure even moderate effects due to the treatment-correlated-with-severity issue, my guess is that there’s some general bodily harm from reduced oxygen even at levels like 95%, though I don’t know how much. So at some PaO2 threshold, I think you want to be supplementing oxygen even if your breathing doesn’t feel that difficult.

Unfortunately, it seems like you can’t supplement oxygen at 95%, because over-oxygenating causes neuronal damage. Standard targets appear to be 94-98% or 92-96%. This study says it seems bad to set your target range during oxygen therapy to greater than 92-96%, because one inevitably exceeds the upper target occasionally. This review/musing muses that it’s a difficult problem, evidence for hyperoxaemia being pretty bad is “comparatively strong”, but not strong enough to warrant especially conservative oxygen titration. Because of these numbers, I think 92-93% is a reasonable threshold to self-hospitalize, since anything above this means they probably shouldn’t be oxygenating you anyways.

If hospitals are overloaded and you have to do oxygen therapy yourself (really try not to do this), I think the targets above are still reasonable, subject to your ability to titrate well with the machine. If you have lots of trouble, of course be conservative. However, you may be able to do better than hospitals: the first study above says that “even in a research setting in the intensive care unit, in which patients receiving mechanical ventilation are closely monitored, most patients who were randomized to an SpO2 target of 90–92% and were receiving supplementary oxygen did not have their inspired oxygen reduced if the SpO2 was 99% or 100%.” So—seems like you could easily do better monitoring than this if you were oxygenating at home. This is why I would probably shoot for 94-96% myself.

You should have some kind of electrolyte powder or electrolyte drinks on hand. When sick with any disease that can cause a fever (Fever is one of the symptoms of COVID-19 that pretty much everyone gets), staying hydrated is possibly the most important thing for you to be doing. You may be losing fluids from sweating and you may not be paying much attention to how much you are drinking. You will do a better job staying hydrated if everything you need to be hydrated can be right next to your bed. Once you have a fever it will really suck to go acquire stuff and you should be staying at home anyway.

The aim of your quarantine procedure and other actions should be to delay your exposure to coronavirus until after the peak has passed. It is unlikely to be possible to delay it indefinitely, especially if we are going to have a return to normalcy.

With every epidemic there is likely to be a peak - a period of exponential growth, climaxing in a peak and then a slowdown. Your goal should be to get exposed after the peak period. During the peak, medical supplies will be stretched very thin and hospitals may be overflowing. After the peak, medical professionals have a lot of experience dealing with the disease and we will know the landscape of outcomes and treatments. As long as the medical systems are not destroyed by the virus, that may be the best time to get it.

I modeled a logistic growth equations for a population of 7 million (bay area) and different estimates of the doubling rate I found in the literature - for a doubling rate of every 3 days, the peak seems to come after about 2 months from initial exposure. For a doubling rate of every 7 days, the peak comes about 4 months after initial exposure. Since the virus has likely been circulating for several weeks already, we can predict the peak in the bay area is 1-3 months out. How it actually plays out will vary a lot based on containment measures, public events, lifestyle of the populace, etc.

This is all extremely speculative but gives me a goal to shoot for - before I was trying to figure out what is the goal of quarantine for myself, if I was ever going to rejoin society. Now I have a model for why I should avoid getting it.

Hand sanitizer is becoming hard to find. Here are some WHO guidelines on making your own :

https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf

Formula 1:

• Ethanol 96%: 8333 ml • Hydrogen peroxide 3%: 417 ml • Glycerol 98%: 145 ml

Formula 2:

• Isopropyl alcohol 99.8%: 7515 ml • Hydrogen peroxide 3%: 417 ml • Glycerol 98%: 145 ml

Edit: Top off with distilled water until you get 10L of product.

My justification is argument from authority. I have no explicit model. Although both formulas use high concentrations of alcohol which are known to be effective disinfectants.

[EDIT: enough has been learned since I made this model that it is now deprecated. I am now working from home, indeed 2 weeks after the answer was first composed]

A guesstimate model I made to determine whether I should stay home from work. Most of the innovation is in collecting guesses/gut feelings and then doing the calculations. Based on my guesses, I shouldn't bother working from home for a few months. [EDIT: for complicated reasons it's probably more like one month] [EDIT: after further adjustments, partly to parameters and partly to the structure, it's now like 2 weeks] https://www.getguesstimate.com/models/15212

A 2 weeks supply of food sounds like far too short a supply. The first case of 'atypical pneumonia' was noticed in Wuhan in late Dec. It is now late Feb. They have by now organized themselves in Wuhan to the point where all of the ill people are getting sent to 'local' (temporary) 'hospitals' and the 'local hospitals' are triaging and sending seriously ill people onto actual hospitals with the capacity to care for people who are seriously ill (like requiring oxygen). But this level of organization is a fairly recent situation. Even 2 weeks ago, sick people were literally walking to hospitals, because ambulances were swamped; they were being turned away from hospitals for lack of beds and supplies, and medical personnel to look after them; they were sitting in hospital waiting rooms for hours being cross exposed to other sick people, etc. So, even with massive efforts on the part of the government, it took about 2 months for them to get their act together in a real hot spot of infection. If you are unfortunate enough to end up in a similar type 'hot spot' to Wuhan, (but still live in a first world country) it probably won't take longer than 2 months for the government to get its act together, but I wouldn't assume they will do much better than that... so, if you are planning on buying a little insurance, I'd suggest that a 2 month supply of food, etc, is about minimum of what you would need to get through a (1st world) worst case scenario, rather than 2 weeks.

And a 3 months supply would probably be a better choice than a 2 month supply. It's not like Wuhan is virus free or anything close to it, today, 2 months in...

A 3 month's supply of food sounds crazy, and, true, you probably won't need it. But, it's almost cost free to supply yourself with it. No one at all is suggesting power outages. So, you can probably just stock up on food and supplies you normally use anyway, at least for frozen, canned, and non-perishable type things. That obviously won't do for stuff like milk and fresh fruits and salad stuff, so you'll have to make some substitutions there, but for most other stuff you should be OK if you just buy extras of things you normally buy anyway. The only cost is the inconvenience of buying it all at once, and finding a convenient place to stack it down until you need it.

Recommendation: cover the back of your smartphone in copper tape.

Reasoning: in addition to the reasoning for putting copper on all commonly touched surfaces, your phone is an especially good choice because of the "copper halo effect", in which copper ions move from copper surfaces to nearby surfaces (like, say, your hands), leaving them much less hospitable to microbes. [Edit: As MalcolmOcean points out, this mechanism for the halo effect isn't supported by the Wikipedia page below. I made a leap to this explanation without realizing it. That said, I do think that copper (and copper oxides) will get on your hands as a result of this tape, partly because I've seen my hands turning a bit blue.]

https://en.m.wikipedia.org/wiki/Antimicrobial_copper-alloy_touch_surfaces

A downside is that your hands may turn slightly blue. [Also: See the comment below about uncertainty about how much copper you'll eat as a result of this; tldr: I don't know but I think it's probably fine]

[This is a signal boost for Lady Jade Beacham's response to Connor_Flexman, but the idea was originally introduced to me by James Payor]

Cabin fever is unnecessary.

According to the CDC the coronavirus is thought to spread similarly to how the common cold spreads: person-to-person spread, and contact with infected surfaces or objects. There are certainly ways to get out of the house without coming in close contact with other people and without coming into contact with surfaces that others have touched. For example, going for a walk or a bike ride. (In densely populated cities this will certainly be harder.)

Furthermore, socializing with friends who you trust shouldn't be too risky. From the CDC:

People are thought to be most contagious when they are most symptomatic (the sickest).
Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.

So then, if you know/trust that your friends are asymptomatic, and you trust that they are hygienic (wash their hands, wipe their counters, etc.), socializing with them shouldn't be too risky.

Advice: Apply lotion after washing your hands.

Reasoning: Heavy handwashing can dry out your hands, which can lead to cracks forming, which are more vulnerable to infection. You can fight this by applying lotion after washing your hands.

Sources: have experienced dry hands -> cuts personally, a dermatologist told me it was a vulnerability.

For me personally, self quarantine seems pretty unnecessary at this point, but I would act differently if I were in a different age group. Given the below death rates I would self quarantine if I were over 40. I would like to note I expect these death rates to be somewhat high because they are largely based on confirmed cases, which I expect to be disproportionately the worse cases that ended up in hospitals.

There was one case of Covid-19 in Solano county (CA) that couldn't be traced directly to travelers, which indicates community spread may be happening and Covid-19 may be spreading in the bay area.

Age  Death Rate
80+ years old  14.8%
70-79 years old 8.0% 
60-69 years old 3.6% 
 50-59 years old 1.3%
 40-49 years old0.4% 
 30-39 years old0.2% 
 20-29 years old0.2% 
10-19 years old 0.2% 
 0-9 years oldno fatalities 

If the local case rate is not yet high enough to warrant quarantine, and you're hosting or attending events, then in addition to asking people to not come if they are sick or coughing, you also might want to implement fever screening.

Three studies of nCoV symptoms cited here found fever in 83%, 98%, and 98.6%. Studies are less precise on the exact timing of symptom manifestation, but fever appears to show up early. To screen people for fever, you need either an oral thermometer plus disposable probe covers, or a contactless infrared thermometer. A contactless thermometer is faster, but less reliable; if you use one, you will want to also have an oral thermometer plus probe covers to deal with false positives.

Buying a bipap + O2 concentrator + capnometer + Y juntures + tubing can decrease chance of death given being infected by about a third.

Reasoning:

  1. Hospitals are going to be extremely overcrowded
    • Doctor I talked to said they would be in "big trouble" if even double the number of patients.
  2. There is a 5% chance of getting critical form of COVID (source: WHO report)
  3. Given you have a critical form and you cannot get access to a ventilator, there is a high chance that you will die (doctor I talked to have said ~70%)
  4. For any ICU patient in a ventilator, there's a non-trivial chance that that patient can survive with a bipap + O2 condenser

You probably need around 5L/min of 90% O2, which theoretically requires a medical grade condenser that requires a prescription. I, however, see no reason why getting 5 normal O2 condensers that can deliver 1L/min of 90% O2 and connecting them all with Y junctions won't work.

[Edit: you can probably do with 4L/min of 70% O2, so you'll need 2 O2 condensers. This advice is mostly based on priors and like 20 minutes of research. The crucial point is that you'll likely need at least 2 O2 condensers]

These devices should all be relatively easy to use. Many people use a bipap for sleep apnea. Many people with respiratory problems have their own O2 condenser that they use. The capnometer I'm less sure of, but there should be a simple flow chart on what to do. If there isn't, I will make one by talking to doctors.

The reason you need the capnometer is because giving people too much O2 also has its own host of problems.

Here's a model of the expected value of buying such a system for only 1 individual: (https://www.getguesstimate.com/models/15306)

This model assumes that there is 0 hospital capacity and it's only for 1 person. Model also doesn't take into account reduce quality of live because of the chance of chronic fatigue syndrome. Model also assumes 20% chance of getting COVID, which is pretty low. Disjunctions are more probable, so the value goes up rapidly with more people, but has a max because it can only be used on one person at at a time.

Bear in mind that the probability that a 2nd person you care about getting COVID conditioning on 1 person you care about getting COVID is pretty high because the people you care about hang out together.

The total cost is about 2k for the bipap, 5 * 400 for the O2 condensers, and 1k for the capnometer for 5k total.

If you think that more than 10% of the world is going to get COVID, buying 1 such setup for like 20 people is an obviously correct move given the model.

Things to watch out for: cheap chinese models of both of these devices.

Edit: took Daniel Filan's suggestion of adding Y juntures and tubing to the first line.

If you develop a dry cough, do take cough drops and sip liquids to prevent yourself from coughing.

Reasoning: I've seen one doctor claim this is helpful because one of the causes of severity is how deep into the respiratory system the virus is able to travel. Apparently lower respiratory infections are more severe because the immune system has a harder time fighting it. Coughing tends to drive the virus deeper into the respiratory system.

Figure out now who will take care of you if you get extremely sick and who you will take care of if they get extremely sick.

Making these expectations explicit could pay off. Different people have different norms around what level of care vs avoidance should happen when someone is sick. If you became extremely sick, you might lose the coherence necessary to arrange help for yourself.

I started to self-quarantine from 25 January, reasons: uncertainty in mortality and the need of a test run. At that moment the situation with mortality was not as clear as it is now. I still don't exclude higher mortality level (than in the table) as for many patients the disease is around one month long and this data is not accumulated yet. I also more than 40 years old and have hypertension which is a risk factor.

My observations about self-isolation: I eat more, and as a result my stockpile is going quicker than I expected. And also I gained weight. Also, sometimes I feel my self like in a prison and want to go out despite any risks. After I go out eventually, I felt more tired as possibly first sign of atrophy of muscles. All this means that long term self-isolation has its own risks, mostly cardio-vascular and mental state.

This test-run of self-quarantine helped me to perfect protocols of cleaning things after I went out and of proper wearing masks. Not all masks fit equally well, and it depends on the shape of the face.

When getting restaurant takeout or delivery, put the food in an oven and bake at at least 70C/160F for 30 minutes to kill the virus. To minimize contamination, I put the whole package containing the meal into the oven, wash my hands, then operate the oven. (This assumes that only the packaging and outside of the food is likely to be contaminated, because the inside is hot enough to kill the virus already. If this is not true for the meal you're getting, increase the oven temperature or time enough to thoroughly heat the food to 70C for 30 minutes.)

This also works for mask reuse (which is where I got the idea from originally). (This article says "The new coronavirus is sensitive to heat. It can effectively inactivate the new coronavirus by heating for 30 minutes at 56 degrees Celsius." but does not cite a source for this. I wasn't able to find a study for the COVID-19 virus, but did find the following data for SARS: https://link.springer.com/article/10.1007/s00430-004-0219-0/tables/1)

I just thought of this idea: carry a box of disinfectant wipes everywhere, and whenever you want to touch a surface that's touched by many people (handrail, door handle, elevator button, touchscreen kiosk...) give it a quick wipe-down first. That protects you, helps protect other people, shows them how to do the same, and also disinfects your hands many times a day. Any problems with this?

Advice: have disposable wipes by the front door and use them to wipe your smartphone and then manipulate your handwashing sink each time you arrive home.

Model: You are touching your smartphone while out, and to whatever extent possible you want surfaces inside your home to be controlled. CDC recommends disinfecting touchscreens but many people don't because disinfectant can damage special coatings. One can bite the bullet or consider adding on another screen cover.

I think you should try to get antibiotics, antivirals, and/or antifungals for secondary infections in case hospitals are full and you need to treat yourself. According to this study, “When populations with low immune function, such as older people, diabetics, people with HIV infection, people with long-term use of immunosuppressive agents, and pregnant women, are infected with 2019-nCoV, prompt administration of antibiotics to prevent infection and strengthening of immune support treatment might reduce complications and mortality.” About what treatment people in Wuhan were given, the study says:

Most patients were given antibiotic treatment (table 2); 25 (25%) patients were treated with a single antibiotic and 45 (45%) patients were given combination therapy. The antibiotics used generally covered common pathogens and some atypical pathogens; when secondary bacterial infection occurred, medication was administered according to the results of bacterial culture and drug sensitivity. The antibiotics used were cephalosporins, quinolones, carbapenems, tigecycline against methicillin-resistant Staphylococcus aureus, linezolid, and antifungal drugs. The duration of antibiotic treatment was 3–17 days (median 5 days [IQR 3–7]). 19 (19%) patients were also treated with methylprednisolone sodium succinate, methylprednisolone, and dexamethasone for 3–15 days (median 5 [3–7]).

I think this sort of treatment might be one of the biggest factors in lower mortality for people with access to hospitals, so I suspect that getting your hands on some prescription antibiotics beforehand could be quite valuable. Some of the pharmacies that Wei Dai recommends here could be good bets, though I'm still currently trying to figure out what the best way is to do this—if anyone has any ideas let me know.

Work out at home instead of at the gym.

According to the CDC the coronavirus is thought to spread similarly to how the common cold spreads: person-to-person spread, and contact with infected surfaces or objects. The gym is a place where you'll be in close proximity with other people, and where you'll be touching surfaces that many other people have touched, and thus is a place where the risk of getting infected is high.

On top of that, the downside to working out at home seems quite low. There is so much that you can do without gym equipment (burpees are awesome if you don't mind the intensity), and there are large diminishing returns to exercising more and to exercising more efficiently. Plus, changing up your routine is good for both effectiveness and for fun.

Check the active ingredient of your hand sanitizer. You may have one that contains benzalkonium chloride, which does not work against at least one type of coronavirus. (This turns out to be the case for one of the hand sanitizers I've been using.) Get one that has "greater than 60% ethanol or 70% isopropanol" instead, as recommended by CDC.

ETA: I didn't bother to check this until today, because why would the FDA approve or fail to pull from the market, hand sanitizers that don't work against an important group of viruses? And why hasn't there been any articles in the MSM about this?

Do cardio exercise—at home or jogging (not gym for transmissibility reasons, as mentioned in this other answer.)

Why cardio, and why now? My thinking is: a primary reason for COVID hospitalization is not being able to get enough oxygen (cf this answer), and its primary treatment is with concentrated oxygen or (in more severe cases) mechanical ventilation, and the nightmare scenario is not having concentrated oxygen equipment etc. for the number of people who need it (I guess some appreciable fraction of the 20% of cases that require hospitalization). So it seems highly plausible to me that starting from a state of good cardiovascular health (hence high blood volume, high lung capacity, efficient heart pumping, etc.) would give the body some extra slack such that COVID can gunk up the lungs slightly more and for slightly longer, before you suffocate and die. This speculation is also compatible with the COVID death rates being apparently higher in populations that I would guess have generally worse cardiovascular health (in terms of age, pre-existing conditions, etc.). Again, to be clear, I have no proof of a causal connection, or even proof of correlation, just a vague suggestion and plausible-seeming mechanism (to my non-medically-knowledgeable mind).

By the way, my experience is that, after a long exercise hiatus, there's clear improvement in "not feeling out of breath" over the course of even the first couple weeks of cardio exercise, so it's not too late to get started. :)

Here's my personal tips on (what I find to be) a practical and sustainable home cardio exercise routine, and injury-free jogging. Also see comments on this answer.

In the worst case that it does nothing to help with COVID, hey, starting an exercise routine is still an awesome idea for mental health, longevity, etc. :)

(PS: Don't overdo it, I hear overtraining is counterproductive.)

Update March 4

I've done an extensive analysis of the disease and Impact of a Pandemic. http://tinyurl.com/sv5v4vc

I'll excerpt my On Masks Section as I suspect the reasoning contained within will be the most appropriate and interesting to this thread. But there is good stuff throughout, I've built things for lay readability, and am not a technical expert, I would appreciate thoughts and advice. I don't have variables for mask exposure, but I think my reasoning is solid and useful. You can tweet me @qastokes

About N95 Masks

All non-N95 face masks, such as medical masks, (of the dental kind), are relatively useless for self-protection, as they lack a seal. Please donate your excess to medical facilities. These are very useful for containing the spreading of all illness, those who are sick and coughing, regardless of disease, should find and wear these type masks. Containing spread is far more effective than reducing exposure for managing the risks.

Please understand N95 isn't prevention, it's odds increase. When properly fitted and used it reduces exposure, but technically it's only 95% efficient. An N95 might keep a doctor with constant exposure alive, but won't help Joe who's out shopping much. Wearing a mask could theoretically increase your risk if used wrong, by being a capture of virus that moves along with you and extends your exposure time. It is not generally helpful, compared with handwashing and effective prevention protocols.

It is true there is benefit to be had by using a mask. But it is only significant if you are competent in following the use protocol. It is better by far to learn & to carefully follow all the other higher impact protocols, especially handwashing. By far the greater benefit, for you individually considering your total exposure risk across time regarding the disease and it's spread, around you to managing your personal exposure will be for those managing the disease directly to have the best protection they can. Hence my advice to donate extra masks to those at highest risk.

Think about this along the lines of "the more the disease spreads, the greater your total exposure risk, regardless of managing your personal exposure risks."

Note: For really significant improvement in your exposure chances, I & wearing a mask effectively, you will need to carefully follow the behavior protocol for a disposable full body exposure management system. A protocol which includes gloves, a hooded tyvek particulate suit, and goggles, along with the mask, this is only really applicable in an extremely exposing environment. Additionally, a P100 would be the optimal mask of choice for this situation and protocol.

The biggest risk management benefit comes from one complete set of masks and a full body exposure management system for every one of your loved ones. This allows you the freedom to make one situation optimizing decision in a worst case scenario.

This would look like: The family is out of food. Healthcare is overburdened to the point the death rate has matched the critical cases rate. You must move with high risk of high exposure.

Alternately, with planning these suits can also be burned one use at a time in a clean room caring for a loved one, allowing for several days of constant and very direct care with low gain viral load & exposure risk for those still without symptoms or as yet uninfected.

Note for completeness: of all the routine contexts to wear a mask, high droplet spray environments are the ones the mask will help in the most, especially if you sanitize your clothes afterwords. I would strongly consider wearing one in a crowded subway, if there is a known outbreak in your city. This would only significantly help if you wear the mask correctly, sanitize clothes, & don't touch your face and are meticulous about hand washing.

TLDR You may be able to use a rice cooker, instant pot or pressure cooker to sanitize disposable masks after wearing them, although this will slightly damage the mask.


Due to the worldwide mask shortage, it seems inevitable that many people are going to have to reuse masks. Personally I have 2 masks per member of my household which seems troubling low.

It may be possible to decontaminate masks - I found a paper that reviewed 5 mask decontamination methods, both a review of how they affected the mask, and a review of how effective they were at decontaminating. The papers are very technical, so please double-check my interpretation


Takeaway - here are the 5 methods in the first paper:

  • Rice Cooker
  • Autoclave (similar to pressure cooker)
  • 10-minute submersion in 70% ethanol
  • 10-minute submersion in 100% isopropanol
  • 10-minute submersion in 0.5% bleach solution

All methods of decontamination damaged the masks. It seems that alcohol and bleach significantly damaged overall filter quality (ratio 0.30 to original), but rice cooker and autoclave relatively preserved it (0.98 to original). I can't see the results for the IPA method on their chart but I expect it to be similar to the other chemical methods.


The other paper on sanitizing efficiency also looked at UVC and UVA light. It found "Bleach, UVC, an autoclave, and a <rice cooker> provide better biocidal efficacy than ethanol and UVA".


My conclusion in this is that rice cookers, pressure cookers and especially the instant pot - which offer comparable performance to commercial autoclaves can be used in an emergency situation to sterilize masks for a few uses. Be very careful about the way you don and doff the mask and handle them generally.

A lot of stores are using touchscreens now meaning you're touching the same spot as literally the entire flow of customers before you and no one ever cleans those. But you can use a touch screen stylus. I got one with a cap so that I can carry it more easily without contaminating other surfaces.

Advertise that you are seeing the smoke.

From the article:

As Eliezer reminded us, most people sitting alone in a room will quickly get out if it starts filling up with smoke. But if two other people in the room seem unperturbed, almost everyone will stay put. That is the result of a famous experiment from the 1960s and its replications — people will sit and nervously look around at their peers for 20 minutes even as thick smoke starts obscuring their vision.

and

The goal of this post is twofold. First, if you’re the sort of person who will keep sitting in a smoke filled room until someone else gets up, I’m here to be that someone for you.

If results of the experiment are real, I think we can expect 1) people to hesitate to take the coronavirus seriously, 2) people to take it more seriously if they know that you are taking it seriously. We want people to take it seriously, and so advertising that you take it seriously — as Jacobian did — seems like a good thing to do.

This could mean texting your family and friends, or posting on social media (in such a way that doesn't incite panic).

Consider that some people may be higher yield targets of your advertising than others. Someone who is capable of changing their mind, has the option of working from home and who lives in a densely populated area is an example of a high yield target.

Nutrition seems to have some influence on the effects of viruses.

Make sure you're not deficient in selenium or vitamin E. One brazil nut per day is enough to give you more than the RDA for selenium.

Note that selenium deficiency is relatively common in central China. The average selenium level in Hubei isn't low, but it has a large range of levels, and the person with the lowest level in that study was from Hubei.

There are also some reports that vitamin C might be valuable. But there's some concern that large doses of vitamin C are risky if you have high iron levels (usually measured by a blood test for ferritin).

I expect that nutrition has a pretty low probability of helping, but it also has a pretty low cost.

It is recommended to avoid touching your eyes, nose, and mouth[1]. People tend to inadvertently touch their eyes, nose, and mouth many times per hour[2]. If you think you can substantially reduce the number of times you touch your face by training yourself to avoid doing it, in some low-effort way, go for it. If it takes time to become good at not touching one's face, it may be worthwhile to start training at it now even if where you live is currently coronavirus-free.

--

[1]: The CDC (Centers for Disease Control and Prevention) writes:

The best way to prevent illness is to avoid being exposed to this virus. However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

[...]

  • Avoid touching your eyes, nose, and mouth.

[2]: The video by the CDC that Davidmanheim linked to claimed: "Studies have shown that people touch their eyes, nose, and mouth about 25 times every hour without even realizing it!"

Advice: Humidifiers. We need them now, and everywhere that people gather in temperate climates. There's a reason why the common cold, influenza, and indeed SARS all die out as summer approaches in seasonal climates--relative humidity over 40% is the best method for controlling airborne viruses.

Influenza season has been ending every spring, (https://journals.plos.org/plospathogens/article/file?type=printable&id=10.1371/journal.ppat.1003194) long before DNA tests, masks, or alcohol sprays. Humidity under 30% like we regularly encounter in buildings during winter occurs naturally very rarely. It degrades our immune defenses and increases the longevity of airborne viruses.

"The present study allowed us to assess viral infectivity under various levels of relative humidity and showed that one hour after coughing, ∼5 times more virus remains infectious at 7–23% relative humidity (RH) than at ≥43% RH." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583861/

"Low ambient humidity impairs barrier function and innate resistance against influenza infection" https://www.pnas.org/content/pnas/116/22/10905.full.pdf

Need to get the news out. I wrote a Medium article on it: https://medium.com/@crissmanloomis/the-end-of-the-covid-19-outbreak-d578092282c8

If you have long(-ish) hair, wear something that will keep your hair off your face.

Rationale: I'm training myself not to touch my face, and more often than not, I want to do so to get my hair out of the way.

Also, I touch my hair very often (to fix its position) but I wash my hair much less than I wash my hands, so if my hair regularly touches my face, it's plausible that I'm at greater risk of catching the virus through my hair rather than through my hands.

It seems like you should never touch buttons outside your house with your fingers. Carrying around an object like a pen that's wrapped in copper tape to push buttons allows you to use buttons without touching them with your fingers.

When it's hard or impossible to avoid touching one's face or staying 2 meters away from others, wear a combination of ski mask, safety or medical goggles, and surgical mask. This would prevent touching one's face and having droplets land on one's face.

Track your sleep quality and make sure you are getting enough. There are smartphone apps (like Sleep Cycle) that can do this. Your immune system is one of the first things to go with even mild sleep deprivation, which makes you more susceptible to infection. You may have to adjust the timing or dose of your caffeine intake. You might also consider melatonin (see Scott Alexander's guide for optimal timing and dose).

Gargling (even with water) might be a relatively good intervention: https://pubmed.ncbi.nlm.nih.gov/16242593/

Here's a guesstimate model I made to try and figure out when hospitals will become overwhelmed. Lots of model uncertainty here that I'd appreciate advice on, but the current prediction is that there will be a hospital bed for you if you get infected in the bay area within the next 6 days (95% confidence within the model: actual confidence is much lower).

https://www.getguesstimate.com/models/15278

If hospitals are overwhelmed, it's valuable to have a component of the hospital treatment plan for pneumonia on-hand to treat either yourself or others who have it especially bad. One of these is oxygen concentrators, which are not sold out yet and are ~$400 on Amazon. This doesn't deal with especially severe cases, but for cases which fall in the "shortness of breath, low blood oxygen" class without further medical complications, it'd probably be useful if you can't or don't want to go to a hospital due to overload. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected mentions oxygen treatment as the first thing to do for low blood oxygen levels.

Do your shopping in bulk in order to minimize the time you spend public. Or do your shopping online and have it delivered.

The more time you spend in public, the higher the risk you get infected. Shopping in bulk minimizes the time you spend in public, and thus lowers the risk that you get infected. For example, stocking up at Sam's Club versus going to the supermarket twice a week.

I suspect that for most people, the downside of shopping in bulk or shopping online is going to be very minimal. In many cases I suspect that it is optimal even without the coronavirus being a thing.

Also consider the experimental benefit. If you don't have much experience with shopping in bulk or online, trying it out for a few weeks will give you a better sense of what your true preferences are.

Advice: now may be a good time to learn to meditate. Deaths from coronavirus are due mostly to breathing problems from pneumonia, which is the main explanation for why older people are more likely to die. There is evidence that meditation is good for pneumonia specifically http://www.annfammed.org/content/10/4/337.full and lowers oxygen consumption generally https://journals.sagepub.com/doi/full/10.1177/2156587213492770. I didn't read the studies carefully to see how trustworthy they are, but this conforms well with my understanding and limited experience of meditation. Meditation is also known to be good for mitigating stress, which will obviously be beneficial in the coming months.

There's a theory that BCG vaccine (TB) helps strengthen you against corona, I'd recommend getting it if you haven't, or especially for your older relatives (given that the cost/side effects is well-understood and near-zero, whereas the benefits based on the below could be serious):

https://www.mpg.de/14610776/immune-boost-corona-virus https://www.sciencemag.org/news/2020/03/can-century-old-tb-vaccine-steel-immune-system-against-new-coronavirus

https://foreignpolicy.com/2020/03/24/coronavirus-vaccine-health-care-workers-bcg/
https://www.france24.com/en/20200326-australians-trial-tb-vaccine-to-fight-coronavirus
https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1
(looking at the correlation between vaccination rates by country and corona spread).

Very speculative: there are different strains of BCG, and allegedly the old (Soviet/Japan/Brazil) type/types is better. This could theoretically explain the different corona case loads between West/East Germany and between Japan + Thailand + Taiwan vs China + Iran (different vaccine strains).


Here are images showing differing corona case loads between East/West Germany (East uses/used the Soviet vaccine), supposedly the population density does not explain this (though note travel patterns, testing rates, etc. are probably all different):


https://upload.wikimedia.org/wikipedia/commons/thumb/a/af/COVID-19_outbreak_Germany_per_capita_cases_map.svg/1024px-COVID-19_outbreak_Germany_per_capita_cases_map.svg.png

https://1.bp.blogspot.com/-gy6Hqe8f2aM/Xn1KqOJ5wII/AAAAAAAA0EQ/rIhBVz2uM5A1q3lH3FFGnsXeTTTyjVpZgCLcBGAsYHQ/s1600/germany.png


Much more at https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html?fbclid=IwAR2MKAgIt2IRjPSf_S9F4HozW4z7BWjH9_9D5p3RmGGJtdh2wp5gkpdzOj8&m=1. If someone who actually understands vaccines could read this and provide thoughts and vet, that'd be great. If it does end up making sense, please do spread, given the high expected value benefit here. I just don't know how easy it'd be to find old (Soviet etc.) style vaccines in the West.

This is likely to: (a) last for months, not weeks - so don’t bother stockpiling, you can’t store enough to outlast it. (b) affect 60-80% of an unimmunised population (all of us) with a doubling time in confirmed cases of 2-3 days initially. (c) produce minimal symptoms in the majority of cases (by minimal I mean nothing you cannot handle with over the counter analgesics, plenty of rest and your favourite hot drinks) just like the currently endemic corona viruses. (d) be moderately lethal for older people, especially smokers & those with existing respiratory / cardiovascular conditions. (e) become endemic (annual, like flu & colds) unless we get a vaccine.

Solution? Keep calm & carry on, hoping your government is transparent and has your best interests at heart.

If it's more important for you to avoid contracting the virus right now than it is for others, schedule any doctor's appointments you are going to for first thing in the morning. Reasoning: seems like hospital contamination should rise throughout the day as more and more people pass through and then drop during nightly cleanings. Similarly for any needed outings, do it in the morning, because though the virus can survive for days on surfaces, presumably it's safer to touch just after an 8 hour break from people than just after a 2 minute break from people. No idea of effect size but I don't see why these mechanisms would be wrong.

While I suspect the option for non-cash payment will remain it is possible that in some cases having cash on hand might be needed. If so, you probably don't want to go to the bank/ATM and get something that may have passed though a bunch unknown hands.

I am thinking that suggests two things.

1) Make an assessment of your potential cash needs and get them sooner rather than later. Two reasons here. Lowers the chances of being contaminated. You can then set it aside as well as do some sterilization and let sit (to dry?).

2) You might not want to get large bills but more smaller denomination. That way you can simply leave the change and not worry about accepting anything back.

Again, might have been suggested but a quick search on cash and currency didn't get any hit.

Advice: drink a mouthful of water every 15 minutes. This is speculative (facebook post from a friend of a friend). The rationale is that if you have virus particles in your mouth, rinsing them into your stomach (where the stomach acid kills them) will prevent them from getting into your respiratory system. [edit: retracted, seems to be downstream from a fake news article. Drinking water is still good, but looks like this pathway is not realistic]