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)

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.

Hospitalization and oxygen therapy thresholds

Tl;dr: Not knowing much about this and not a doctor, my current policy is to go to a hospital if SpO2 drops below ~92% and my hospital isn’t completely overrun, unless my SpO2 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% SpO2 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% SpO2 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 SpO2 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 SpO2, 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 SpO2.

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 SpO2 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.

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.

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.