Coronavirus Justified Practical Advice Summary

Two weeks ago Ben Pace and I asked for prac­ti­cal ad­vice on what to do about coro­n­avirus, with the re­quire­ment that ad­vice be jus­tified in some way- ideally full blown mod­els in­formed by em­piri­cal data, but at a min­i­mum, an ex­pla­na­tion of why it was helpful. The re­sult­ing thread had won­der­ful ad­vice but makes for, uh, in­effi­cient read­ing, at best. This post is an at­tempt to take the best of the Jus­tified Prac­ti­cal Ad­vice Thread and pre­sent it in a clear, easy-to-di­gest for­mat.

It’s im­por­tant to note that nei­ther the origi­nal post nor this one are at­tempt­ing to give com­pre­hen­sive ad­vice. If you’re look­ing for that, I sug­gest check­ing out the Guide/​FAQs/​In­tros tab on the LessWrong Coron­avirus Link Database. This is for ad­vice that fell through the cracks.

Though I will briefly men­tion the stan­dard ad­vice. From what I can tell, the most im­por­tant (and luck­ily widely pub­li­cized ad­vice) is the fol­low­ing:

  • Wash your hands a lot, and wash them to a hos­pi­tal stan­dard (spend 20 sec­onds and fol­low these in­struc­tions).

  • So­cially iso­late your­self, and don’t be around other peo­ple un­less re­ally nec­es­sary. Avoid groups of peo­ple, es­pe­cially large gath­er­ings. Really don’t go to bars, clubs, restau­rants or other places that lots of peo­ple pass through (like pub­lic trans­porta­tion).

  • If you are sick, use a mask. They are prob­a­bly also effec­tive at pre­vent­ing the dis­ease when you are not sick, but most of the west­ern world cur­rently has mas­sively limited sup­ply, so leave the masks to health work­ers and sick peo­ple.

The rest of this post will sum­marise the in­ter­est­ing ideas that went be­yond these ba­sic recom­men­da­tions. But if you haven’t done (or at least se­ri­ously con­sid­ered do­ing) all of the above, I would recom­mend you pri­ori­tise the things listed above.

Many of the be­low recom­men­da­tions in­volve buy­ing things. When pos­si­ble I’ve in­cluded a link to a par­tic­u­lar ama­zon page. This is not a strong recom­men­da­tion for that par­tic­u­lar product: it’s an at­tempt to lower ac­ti­va­tion en­ergy for act­ing on a recom­men­da­tion. If you have rea­son to be­lieve a par­tic­u­lar model is bet­ter than what I linked to, please com­ment and I’ll up­date if ap­pro­pri­ate. Speak­ing of which, if you think of any­thing else I missed or got wrong, please com­ment with that too.

That said, here is the top ad­vice from the Coron­avirus Jus­tified Prac­ti­cal Ad­vice thread.

  • Cover your high-touch sur­faces with cop­per tape.

  • Treat newly de­liv­ered pack­ages as con­ta­gious for 48 hours.

  • Take vi­tamin D sup­ple­ments daily.

  • Buy elec­trolytes to drink if you get ill.

  • Maybe: Buy a pulse oxime­ter.

Prac­ti­cal Advice

Get 2-inch cop­per tape and cover high-touch sur­faces with it, es­pe­cially shared high-touch sur­faces (Con­nor Flex­man)

This was the clear win­ner of JPA Olympics– it’s cheap, effec­tive, and very few peo­ple had heard of it be­fore. In fact we were hop­ing for a highly pol­ished, in­tensely re­searched post on just this; un­for­tu­nately no one has the time right now.

In its place, please en­joy these links:

  • This pre-print showed that this coro­n­avirus in par­tic­u­lar had a half life of 2.4-5.11 hours on cop­per, in con­trast to 10.5-16.1 on steel or 13-19.2 on plastic

  • This re­view showed H1N1 de­creased by 4 logs (a fac­tor of 10^4) in 6 hours;

  • This study showed vac­ci­nia and mon­key­pox viruses re­duced by 6 logs (a fac­tor of 10^6) in 3 minutes

  • This study showed murine norovirus was de­stroyed in 30 min­utes, though it doesn’t work very well at 4C;

  • This re­view says that cop­per ox­ide filters neu­tral­ize all of “bac­te­riophages [58-62], In­fec­tious Bron­chitis Virus [63], Po­liovirus [61,64], Junin Virus [59], Her­pes Sim­plex Virus [58,59], Hu­man Im­mun­odefi­ciency Virus Type 1 (HIV-1) [11,65-67], West Nile Virus [11], Cox­sackie Virus Types B2 & B4, Echovirus 4 and Simian Ro­tavirus SA11 [68]. More re­cently, the in­ac­ti­va­tion of In­fluenza A [55,65], Rhinovirus 2, Yel­low Fever, Measles, Re­s­pi­ra­tory Syn­cy­tial Virus, Parain­fluenza 3, Punta Toro, Pich­inde, Ade­n­ovirus Type 1, Cy­tomega­lovirus, and Vac­ci­nia [65]”.

Benefits

  • Re­duces sur­face-to-hand-to-face transmission

Costs

  • $11, half an hour to ap­ply tape (this may be a re­cur­ring cost, but we don’t know at what in­ter­val)

  • Risk of cuts while ap­ply­ing tape (this hap­pened to me once)

  • Risk of cuts from ap­plied tape (0 for me, but other peo­ple have re­ported lots). This is not just a con­ve­nience is­sue- small cuts are breaks in your defenses that microbes can en­ter.

Why you might not do this

  • You are wor­ried about the risks of ex­po­sure to copper

    • You might be are allergic

    • Some peo­ple have re­ported hand ir­ri­ta­tion and dis­col­ora­tion when they put it on their phones and laptops

    • I poked at this and my take­away was you’d need to be hooked up to skin in­fu­sion IV to get as much cop­per as you con­sume via food. Ad­di­tion­ally cop­per IUDs are a com­mon form of birth con­trol, so it can’t be *that* dan­ger­ous.

  • You think sur­face-to-hand-to-face trans­mis­sion is not sig­nifi­cant.

  • You don’t think the re­sults of tests on other viruses ap­ply to coronavirus

The 2’’ is from per­sonal ex­pe­riences: I got a va­ri­ety of sizes up to 1’’, and even that was of­ten in­con­ve­niently small. I ba­si­cally never wanted smaller ex­cept to patch up gaps, and they’re not so much bet­ter than just tear­ing a small piece off of 2’’ for that.

Treat newly de­liv­ered pack­ages and mail as con­ta­gious for 48 hours (Eliz­a­beth)

At the time I posted this, we had very lit­tle in­for­ma­tion on the risks of con­tam­i­na­tion via pack­ages. I based my recom­men­da­tion on stud­ies show­ing other coro­n­aviruses sur­vived for a very long time on other sur­faces. Since then some­one has re­leased a pre-print on this spe­cific coro­n­avirus on card­board in par­tic­u­lar, which found a half-life of ~2-5 hours. What that means your safety de­pends on ex­actly how much your mail­man sneezes on it and what the in­fec­tious thresh­old is, which we don’t ac­tu­ally know. How­ever at the con­cen­tra­tions that pa­per was us­ing, con­cen­tra­tion dipped be­low de­tec­tion by 48 hours.

Here are the spe­cific recom­men­da­tions for han­dling po­ten­tially in­fected pack­ages:

  • Do not touch your face be­tween touch­ing a pack­age and wash­ing your hands or tak­ing off gloves.

  • Spray de­liv­er­ies with dis­in­fec­tants.

    • Note that dis­in­fec­tants are typ­i­cally less effec­tive on porous ma­te­rial like card­board. I know of no hard num­bers on this.

  • Leave pack­ages ex­posed to the sun for 1-3 days (this can prob­a­bly be short­ened given the newest in­for­ma­tion) or a UV lamp for shorter

  • Just don’t touch them for sev­eral days.

Benefits

  • Re­duces pack­age-to-hand-to-face transmission

Costs

  • Adds time and an­noy­ance to han­dling packages

  • UV re­quires a sterilizer

  • Leav­ing out­side may risk theft

  • Let­ting pack­ages sit takes time and space.

  • Dis­in­fec­tants are pen­nies/​spray.

Why you might not do this

  • You think sur­face-to-hand-to-face trans­mis­sion isn’t im­por­tant.

  • You’re ex­tremely con­fi­dent your de­liv­ery per­son is not con­ta­gious.

  • You think there is lit­tle enough ini­tial con­tam­i­na­tion pre-de­liv­ery that it will have de­graded by the time the pack­age reaches you.

Take vi­tamin D sup­ple­ments (Con­nor Flex­man)

Vi­tamin D defi­ciency has a sur­pris­ingly strong link with res­pi­ra­tory in­fec­tion.

  • 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 vi­tamin D sup­ple­men­ta­tion may re­duce res­pi­ra­tory in­fec­tions in children

  • Study says no effect from sup­ple­ment­ing af­ter already sick, so get on this be­fore infection

While this hasn’t been ver­ified for COVID-19 in par­tic­u­lar, it does seem plau­si­ble that it ap­plies, and that a sup­ple­ment can treat it.

Benefits:

  • Re­duces res­pi­ra­tory in­fec­tions, via un­clear mechanism.

Costs:

  • 2.5 cents/​day us­ing the brand I recom­mended (recom­mended to me by a doc­tor but not oth­er­wise ver­ified), cheaper prob­a­bly available.

Why you might not do this:

  • You’ve tested your vi­tamin D re­cently and lev­els were nor­mal or high (as a fat sol­u­ble vi­tamin, it is pos­si­ble to over­dose on)

  • You don’t think the re­sults from gen­eral res­pi­ra­tory in­fec­tions trans­fer to COVID-19 in par­tic­u­lar.

  • You think you get enough vi­tamin D from the sun, and will con­tinue to do so dur­ing pe­ri­ods of iso­la­tion.

  • You don’t be­lieve sup­ple­ments can con­vey health benefits.

Have elec­trolytes on hand and use once ill (tragedy­ofthecom­ments)

COVID-like ill­nesses fre­quently cause loss of elec­trolytes through sweat­ing and di­ar­rhea, which are not re­plen­ished from food due to ap­petite sup­pres­sion. In­suffi­cient elec­trolytes can lead to di­ges­tive and neu­rolog­i­cal prob­lems.

The ex­act form of this is up for de­bate: some peo­ple feel that salt, maybe with sugar, honey, or mo­lasses, is suffi­cient. Others thought that the mag­ne­sium and potas­sium from a ded­i­cated elec­trolyte pow­der/​con­cen­trate/​drink, or the ease of con­sump­tion while sick, was benefi­cial. Once you’ve gone that road, there are lots of elec­trolyte sup­ple­ments with ad­di­tional vi­tam­ins and min­er­als you might also be miss­ing, lead­ing to some­thing of a para­dox of choice for me.

No one dis­agreed that some form of elec­trolyte is good to drink to once sick, just what ex­act form that should take. Choos­ing any one of these is more im­por­tant than which one you choose.

Forms you might take, with ap­prox­i­mate cost:

Benefits

  • Prevent elec­trolyte in­suffi­ciency, which can lead to neu­rolog­i­cal and di­ges­tive issues

Why you might not do this

  • Per­sonal ex­pe­rience hat­ing electrolytes

  • In­abil­ity to dis­t­in­guish when you’ve had “enough” (since too much is also dan­ger­ous)

Maybe: Buy a pulse oxime­ter (ju­li­a­wise)

Coron­avirus moves from un­pleas­ant to dan­ger­ous when your blood oxy­gen sat­u­ra­tion level is too low. A pulse oxime­ter can tell you when that is hap­pen­ing, pro­vid­ing a clearer line for when to seek med­i­cal at­ten­tion, which is es­pe­cially im­por­tant as the risks to con­tact with the med­i­cal sys­tem rise. How­ever many peo­ple felt that you should ig­nore a low pulse ox if you felt fine or a high one if you felt short of breath, so it didn’t add any­thing to the pro­cess, an ar­gu­ment I find pretty com­pel­ling.

Benefits

  • Cer­tainty in when to seek med­i­cal at­ten­tion, es­pe­cially if you can’t trust your in­ter­nal sense of be­ing out of breath (due to e.g. panic at­tacks).

Costs

  • $30

Why you might not do this

  • You trust your in­ter­nal sense of be­ing out of breath or not.

  • You ex­pect med­i­cal care to be un­available or net-nega­tive no mat­ter what.


Thank you to Rae­mon and Ben Pace for com­ments on this doc­u­ment.

Thank you very much to Ju­lia Wise, Fi­nan Adam­son, Con­nor Flex­man and Con­nor Flex­man for this jus­tified prac­ti­cal ad­vice.