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).
Take your temperature several times over several days to get a sense of your baseline.
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.
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..
Measure your oxygen saturation several times over several days to get a sense of your baseline.
Look for COVID-19 related drug trials in your area, so you will have the information if you need to join one later
Form care arrangements (for yourself, pets, kids, parents, etc) with people who will be able to follow through.
You’re already quarantined, right?
Buy gloves and masks for the person taking care of you (yeah, this is kind of aspirational at this point)
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
Buy pseudoephedrine (the real stuff, which is behind the counter in the US. Sudafed PE is useless).
Controversial
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.
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
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).
Set up your environment so it is easy to frequently drink small amounts of liquid, ideally with electrolytes.
Rest, rest, rest
Look for RCTs and drugs you might want to ask your doctor for, if you haven’t already.
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.
Alert your care team. If anyone seems flakey, start looking around for new members.
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.
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.
Take pseudoephedrine if you have unpleasant sinus pressure.
Controversial
Do any research you told yourself you would do between buying sketchy drugs or medical equipment from sketchy online retailers and actually using them.
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
Continue to rest and hydrate, with electrolytes.
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.
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.
(Optional) monitor your oxygen saturation.
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.
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.
I’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.
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.
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)
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.
Ah, 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.
I 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.
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
Buy zinc lozenges (acetate or gluconate)
Buy electrolytes in some form.
Buy a thermometer.
Take your temperature several times over several days to get a sense of your baseline.
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.
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..
Measure your oxygen saturation several times over several days to get a sense of your baseline.
Look for COVID-19 related drug trials in your area, so you will have the information if you need to join one later
Form care arrangements (for yourself, pets, kids, parents, etc) with people who will be able to follow through.
You’re already quarantined, right?
Buy gloves and masks for the person taking care of you (yeah, this is kind of aspirational at this point)
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
Buy pseudoephedrine (the real stuff, which is behind the counter in the US. Sudafed PE is useless).
Controversial
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.
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
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).
Set up your environment so it is easy to frequently drink small amounts of liquid, ideally with electrolytes.
Rest, rest, rest
Look for RCTs and drugs you might want to ask your doctor for, if you haven’t already.
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.
Alert your care team. If anyone seems flakey, start looking around for new members.
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.
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.
Take pseudoephedrine if you have unpleasant sinus pressure.
Controversial
Do any research you told yourself you would do between buying sketchy drugs or medical equipment from sketchy online retailers and actually using them.
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
Continue to rest and hydrate, with electrolytes.
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.
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.
(Optional) monitor your oxygen saturation.
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.)
Good point, I changed it.
I’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.
Some 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.
You’re right, I changed it.
This 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
As 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.
That tweet says “WHO does not recommend against the use of of ibuprofen.” . Where are you seeing them agree with France?
Ah, 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.
I 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.