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Should I self-variolate to COVID-19

by elityre2 min read25th May 202019 comments

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[This is currently in the speculative phase. I am not planning to do anything rash without very careful consideration.

Please do not read this question as an endorsement of the plan described herein.

Please use common sense and don't take dangerous actions without doing due diligence and carefully weighing the costs, benefits, and risks.]

As the coronavirus situation develops, it is becoming more plausible that the pandemic won't meaningfully end for months.

There travel that I would like to do (in the continental US), this year. But, even if I carefully self-isolate, I think it would be socially irresponsible for me to travel from place to place in the country, potentially being a vector for intercity transmission. (Not to mention that I would be visiting committed EAs, who I especially don't want to infect.)

I think the only way that it would be socially responsible for me to travel, is if I knew with very high confidence that I wasn't carrying the virus*. And the only way that I can have that confidence is if I have already caught it, recovered, and now have antibodies against the virus.

I am young (26), healthy, and currently in self isolation. My personal risk of death or disfigurement from catching the virus seems low. (One crux for that is that the risk of developing permanent chronic fatigue is low.)

I'm tempted to intentionally expose myself to (ideally, a controlled dose of) the virus, strictly self-isolate for the contagious period (with careful regular testing of my symptoms), confirm my resistance to the virus with an antibody test, and then travel freely, knowing that I am not a vector for the virus.

I'm wondering if this plane is actually practical.

* - I suppose that another possibility is that, in every city that I visit I could rent an AirBnB and strictly self isolate for 14 days. That seems both expensive and onerous.

The most important question:

Is this a stupid idea?

More specifically,

  • What is the best up to date information on the fatality risk to different age groups?
    • I'm still using the 0.2% fatality rate for 20 to 29 year olds, from China, early in the pandemic. Do we have better numbers now? How much does that figure overestimate, because of asymptomatic cases that are not counted among the "number of infected" denominator?
  • Do we have good information about how much a low initial viral load reduces the probability of developing symptoms or the probability of hospitalization?
    • Do we have anything like the response curve to different initial exposure levels?
  • What is the state of the evidence for long term chronic fatigue resulting from COVID? Did that question get settled?
  • Are there risks that I'm failing to account for?

Logistical questions:

  • Are there any existing variolation projects that I can join?

If not,

  • What is the best way to intentionally catch COVID?
    • Is there a way that a private citizen can get their hands on a sample of the virus?
    • If not, what strategy would result in my catching the virus with high reliability, but low initial viral load? (I would rigorously self-isolate as soon as I was exposed, so it would be really annoying if the virus didn't take hold, but I went into strict isolation needlessly, and then needed to expose myself and isolate again.)
  • What is the ideal dose for a mild case?
  • For how long, counting from the moment I'm exposed to the virus, am I at risk of being contagious? What is the maximum length of time that I could reasonably still be contagious? I would use an antibody test to confirm, but I would probably only have limited tests, and would want to time when to use them.
  • Is there anything else that I'm neglecting here?

I haven't been following this situation closely since entering self isolation, so I would be happy to read answers that merely link to existing articles or LessWrong answers that address my questions.

Again, please don't do anything stupid because I asked this question!

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4 Answers

I think the only way that it would be socially responsible for me to travel, is if I knew with very high confidence that I wasn't carrying the virus*. And the only way that I can have that confidence is if I have already caught it, recovered, and now have antibodies against the virus.

I didn't read all of your post, but I want to mention that people do buy tests (I think like a couple hundred dollars per test but maybe less), and I expect if you looked into it you could find some. I think I know someone who bought some, I know the Joe Rogan podcast gives its guests a test before they come on the show, and also I think that if you know the right people you can just make tests. I mean, it's probably illegal because everything is illegal, but the government primarily finds out when labs try to do mass testing and publish results, so you can probably get a bunch for personal use and nobody will notice.

Then you can take a flight, go to a hotel for one night, use a test, and probably find out pretty quickly (I'd guess either within an hour or within a day but I don't know) whether you're infected. 

I expect this to cost more time and money, but if you're able to take careful precautions in travel (such as those I listed here) I expect there's a large probability that this would be better than getting the disease, especially with the unknown long-term effects and plausibility of a vaccine within 12 months.

2elityre6moThis is a helpful answer. Thanks.
2Ben Pace6moYou're welcome.
2elityre6moI'm going to look into myself, if not, but does anyone happen to know how soon after exposure a test will show positive for COVID?
7Anon User6moAnother issue to consider is that the test could have a high false negative rate (I have seen reports as high as 15% - e.g. https://www.npr.org/sections/health-shots/2020/04/21/838794281/study-raises-questions-about-false-negatives-from-quick-covid-19-test [https://www.npr.org/sections/health-shots/2020/04/21/838794281/study-raises-questions-about-false-negatives-from-quick-covid-19-test] ), and it appears that false positives are more likely for asymptomatic people.
2elityre6moHm. That seems pretty relevant. It also matters if (or rather, how much) the false positives correlate. If they are close to being independent samples, then you could take two tests or more tests to increase your confidence. But if false positive are more likely for asymptomatic people, then the tests must be at least somewhat correlated.
1Anon User6moI saw guidelines along the lines of "You can stop self-quarantining if you had two negative tests taken more than 24hrs apart, with first test at least 3 days after an exposure". I do not know where this came from, but I saw it from an org that I would expect to be fairly sane in making evidence-based decisions.
1Sherrinford6moI am a bit confused what kind of test Ben is referring to here. If this is about smear tests, RKI [https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Vorl_Testung_nCoV.html] says that it may be possible to show evidence for an infection about 2-3 days before symptoms begin. However, medical professionals warn that it's not trivial to take the smear test and that therefore laypeople conclusions may lead to wrong negatives. If it's about blood antibody tests, there may be false positives because antibodies may those formed against other corona virus infections.
3greylag6moAccording to Harvard [https:] //www.health.harvard.edu/diseases-and-conditions/if-youve-been-exposed-to-the-coronavirus [//www.health.harvard.edu/diseases-and-conditions/if-youve-been-exposed-to-the-coronavirus] So this sounds like, with a smear or swab or saliva test, you’d want to wait up to 4 days after potential exposure, and a false negative remains possible. I believe I’ve seen elsewhere that the saliva test is comparable to a swab in accuracy, but is more foolproof (because you don’t have to take a sample from your throat).
2elityre6moAlso, if anyone reading this has COVID tests to sell, or could make tests, please get in touch. I would probably buy at least a few, so that I have them in reserve. That way (regardless of if I end up doing any travel) if I'm unavoidably in a situation where it seems like I might have been exposed, I can shorten my mandatory strict self isolation.

At 26, you can expect to life around 55 more years. Let's trade off against waiting for a vaccine, assuming the vaccine is 100% safe and effective, and also assume your quarantining strategy is 100% effective.

By giving yourself COVID-19, you're losing about 55 years * 52 weeks per year * .002 chance of death = 6 weeks of life in expectation. That's not counting the risk of chronic fatigue, or the time you might spend being sick.

Your motivations seem basically selfish, moderated by a desire to be socially responsible. If so, then consider that we'll also probably have faster and more widespread testing in the coming months. More efficacious treatments may emerge. These may permit socially responsible travel prior to the arrival of a vaccine. Then consider that some people may not want you around even if you tell them you're immune. And of course, the world's going to continue being shut down even if you have antibodies in your system.

Does social distancing suck so bad for you that this trade off feels like it makes sense? What is the concrete activity you'd like to be able to do, that you can't do without antibodies in your system?

4elityre6moNo. Actually, social isolation is awesome for me. I'm getting so much done! But I have a number of quite important long-form conversation to have, the outcome of each might make a substantial difference for my work or my personal life over the coming years. I can't really have those conversations over video call. I really I need to be in the same place as the other person and commit several hours to several days. Because the world is slow now, this would be an ideal time to do that...until one accounts for the reason the world is slow.
2CellBioGuy6moI would be worried about straight up lung, kidney, blood vessel, and heart damage in addition to the already stated chronic fatigue.
2elityre6moGood analysis. This is a good point. I think the people I'm concerned with will have basically the same epistemic standards as myself, and so the question is can I have sufficient confidence that I am in fact immune?

If deliberately infecting yourself, consider taking measures to check and to optimize your immune response.

Nutritionally rich diet, protein, vitamin D3/sunshine, etc.

Are there any existing variolation projects that I can join?

FWIW, there is this I know of: https://1daysooner.org/

That said, last time I've got an update from them (~1 month ago), any execution of these trials was still at least a few months away. (You could reach out to them via the website for more up to date information.) Also, there is a limited number of places where the trials can actually take place, so you'd have to check whether there is anything close to where you are.

(Meta: This isn't necessarily an endoresement of your main qusetion.)

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I believe one of your assumptions could stand to be examined; the final risk to others should be multiplied by the chance that the immunity typically conferred by having antibodies will hold true for this variation of corona and any mutations that now or will then exist. Antibody effectiveness is probably the case, and I haven't heard anything about this virus being an especially rapid mutator, but I'm personally not more than 90% certain of all this.

The latest data I read was that it averages 1 mutation every other transmission. I don't know how this compares to other viruses, but with 7 and a half million confirmed cases, that's a lot of mutations (running in parallel).

You could sign up for one of these human challenge trials, then your exposure might help with vaccine development, and you'd probably be safer because they'd probably give you a low dose and do close monitoring after.