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What should we do once infected with COVID-19?

Hydroxychloroquine 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.

How long should someone quarantine to be sure they aren't contagious with Covid?

TL;DR We don't know, it's variable case to case, and could be longer than 25 days from symptom onset if you get sick

In patients admitted to hospital with COVID-19, there are cases (Korea, Singapore) of viral RNA detectable up to 25 days after symptom onset. This is not the same as still being infective, so we don't really know.

In people exposed to SARS-CoV-2, 14 days is an estimation that the vast majority will have developed symptoms by this time (here). However, this doesn't take into account cases that remain asymptomatic throughout their infection (maybe 15-20% from Diamond Princess data)

What should we do once infected with COVID-19?

I 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

Coronavirus: Justified Practical Advice Thread

1000-2000IU on average per day for an adult, depending on your size. You add this up and take it instead every 2-3 days likely without any issues (e.g. I take 3000-4000IU every 2-3days)

If you have lighter toned skin and get regular sun exposure you may not need any supplementation

What should we do once infected with COVID-19?

Normal 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)

Sarah Constantin: Oxygen Supplementation 101

Most potential at-home oxygen supplementation methods will aerosolize the virus and increase contagiousness nearby, and are not allowed in a healthcare setting as a result. Default to assuming this applies.

I don't think this is correct; (almost) all at-home devices will be oxygen concentrators providing supplemental oxygen at low flow rates (majority 1-6L/min) via (low flow) nasal prongs or masks (not the non-rebreather style mask mentioned later). Clinically significant aerosolization of respiratory droplets requires higher flow - like the high flow nasal prongs (30-70L/min flow), CPAP/BiPAP machines (NIV), or high respiratory tract flows (shouting/heavy coughing/puffing from shortness of breath etc).

Part of the problem with this outbreak is that deterioration from requiring supplemental O2 to requiring intubation can be sudden, so while home oxygen would potentially free up a lot of beds/space/workload, lack of monitoring for deterioration and travel time back to the hospital would probably worsen mortality in that subgroup. I'm unsure how this risk/benefit equation would play out overall.

The thing is, I don’t mean “it’s okay” as something to think. I mean it more like an instruction, like “look up” in the cell phone parable. Trying to understand the meaning is analogous to Alex posting a photo of their phone and then scrolling above it in the text chat.
Another way I could try to say the “it’s okay” thing is something like, “The world is real in your immediate experience before you think about it. Set aside your interpretations and just look.” The trouble is, most people’s thinking system can grab statements like this and try to interpret them: if you think something like “Oh, that’s the map/territory distinction”, then all I can say is you are still looking at your phone.

Is this related to non-judgemental observation/awareness that is talked about in the spheres of mindfulness? Ie, the things that are happening just... Are, and we are observing that the Are. While these things may ellicit emotion and judgement in ourselves, we can put that aside to another part of our minds and just observe how they Are. Is this what you are experiencing with Looking, or a precursor to it/part of it?

(I may just be replacing "It's okay" with "It just Is", without the positive conotations of okay)

Bet or update: fixing the will-to-wager assumption

This is one way to make your beliefs pay rent


Puns aside, great post!

Open thread, March 13 - March 19, 2017

As a bit of a tangent to 2)

Certainly using visualisation as practice has some evidence (especially high-fidelity visualisation increasing performance at comparable rates to actual practice; one course I've been to advocated for the PETLEPP model in the context of medical procedures/simulation) - in this sense it may help achieving an endeavor but 1. It's got nothing (much) to do with positive visualisation and 2. It feels like its moving the goal-posts by interpreting the 'endeavor' as 'performing better'.

I've definitely also heard people discussing positive and negative visualisation as tools for emotional stabilisation and motivation - although the more persuasive (read: not sounding like new age/low brow self help BS) usually favour using both together or just negative visualisation - see gjm's and Unnamed's posts

[Video] The Essential Strategies To Debiasing From Academic Rationality

You could record the audio on a separate device at the same time placed much closer. I'd suggest recording the audio in a lossless format (I used wavpack but only because it was convenient), then converting to WAV format (lossless but no compression so large filesize). In WAV format the audio can be processed by CN Levelator to improve the quality. Then convert to whatever format you want (eg for podcast) or directly replace the video's audio with your improved recording using any video editing software. It's a annoying series of steps but may get you much better audio quality and is free.

Alternative is buying a better microphone. Probably almost any external microphone will get you much better quality, just consider whether you need a directional or omnidirectional microphone (one person talking vs multiple people plus background noise).

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