What to do

How to not get infected

Stay home

The world is a big place; expect different regions and different individuals to handle risks differently. The most effective intervention is to limit crowds and physical proximity with other people. If your local officials recommend staying home, do this as much as possible. If restrictions in your area have been lifted, it doesn’t mean that everything is back to normal. It means that there is hopefully ICU capacity to accommodate you if you need it. Alternatively, if your local restrictions have been lifted it could reflect popular demand, rather than ICU capacity per se.

Taken together, making safer sustainable everyday choices on average – not just this week but for the next several months – can flatten the curve. Continue to support your local economy, but go off peak; waiting for even 15 minutes can reduce both crowding and contact. Everything from restaurants to museums to public transport will be less risky (and more pleasant!) off peak.

There are no bright lines of risk. Risks and their mitigations are varied and incompletely understood. So aim to lower risk and to make them count.

Lowest risk Intermediate risk Highest risk
Home Small gatherings Large gatherings
Outdoors * Well ventilated indoors ** Poorly ventilated indoors
Average households Stores Care homes, prisons, meat packing facilities, hospitals
Distanced encounter Close encounter Intimate encounter
Shorter exposure time Moderate exposure time Longer exposure time
Two people each wearing a face covering Two people, one wearing a face covering Two people, neither wearing a face covering
Encounter where local transmission is low Encounter where local transmission is moderate Encounter where local transmission is high

Note that any of these above risks are higher where the mixing of the contact pools are also higher.

’* Note that even when outside the more intense the sunlight, the safer the encounter. Humidity levels may not play an especially strong role.

‘** For more information see https://publichealth.yale.edu/research/covid-19/schools/

Avoiding large public gatherings is going to put a massive economic burden on musicians, actors, artists, and anyone else who puts on or helps stage live appearances. Consider supporting their work on Patreon or directly (via PayPal/Venmo/GoFundMe), promoting them on social media, and buying their work directly. Attend smaller shows if they offer them.

Avoid crowds

It is best to stand at a distance from people. 6 feet or more is safest from infectious droplet spread. The higher your underlying risk factors (age, recent major surgery, cancer, immunocompromised, asthma, chronic lung disease, diabetes, dialysis treatment, liver disease, severe obesity, etc), the more you should avoid crowds.

CDC has recommended that older adults ‘stay at home as much as possible’. But keep in mind that over the longer term, this isolation could have negative impacts on many people’s mental health. Cultivating meaningful relationships is a well established but under-appreciated determinant for all health outcomes. So DO see the people you love, but consider doing so via lower-risk activities. For instance, go for a walk outside with a smaller group of people rather than attending an event indoors. Go to the beach. Ride bikes. Golf. Picnic more. This is not going away in one week, so pace yourself.

Wash your hands

>20 seconds with soap and warm water. Here are great options of songs to sing to help you pass the time. Unlike some really stubborn viruses (like polio), viruses in the coronavirus family typically don’t survive longer than a few hours on most surfaces hard surfaces; though it can be up to days. Bleach or ethanol are more effective at decontaminating surfaces than they are disinfecting humanskin. So don’t hoard the hand sanitizer, that should be used only when you do not have any access to a soap and water sink. At a restaurant? Wash your hands. At school? Wash your hands. Vigorous handwashing with soap really is vital to reduce transmission; the awesome science of why is here. If you do nothing else at all, do wash your hands.

Do not touch your face

This is a way that the virus can enter the body. It is really hard to avoid; this is also why we advise staying home and avoiding crowds. It is also why top-down measures (event cancellation and imposed quarantine etc) work. The average person, even ones with baseline good hygiene, touch their faces constantly already without thinking about it. Especially with allergy season coming up, please keep this in mind.

Wear a facemask when in public

The US Center for Disease Control “recommends wearing cloth face coverings in public settings”. According to the World Health Organization’s top emergencies expert, Mike Ryan, “using respiratory coverings or mouth coverings to prevent coughing and sneezing projecting disease into the environment and towards others…is not a bad idea”. In addition, there are at least “34 scientific papers indicating basic masks can be effective in reducing virus transmission in public”. As a result, many countries have started making mask-wearing (including scarves and bandanas) mandatory in public areas, such as the Czech Republic, Slovakia, Vietnam, Austria, Israel, and some American cities such as New York and Los Angeles. N95 and surgical masks are the most effective, but homemade masks are still beneficial. Consider donating any N95s to local healthcare workers if there is a shortage in your area and making homemade masks for your own household. See these written instructions and this or this video to learn how to make your own using a sewing machine.

Do not shake hands

Some fun alternatives are:

…are best.

One awesome side benefit is that contactless greetings don’t even need to be agreed-upon in advance. Unlike handshakes, hugs, kisses, etc, there is no need to have an understood protocol. Do what works for you.

Do not touch public surfaces

Where possible, use knuckles rather than finger tips (e.g., for elevator buttons, light switches, etc.). Open doors with your hips rather than your hands. You may use your elbows to open door handles, if it’s an option. Use a sleeve to open a doorknob if needed.

Get enough vitamin D

There is sufficient evidence to conclude that Vitamin D deficiency is associated with the severity of respiratory infections in general. In addition, a retrospective cohort study in the journal Infectious Diseases, concluded that “deficient vitamin D status was associated with increased COVID-19 risk”. Unfortunately, a sizable fraction (perhaps 41.6% according to this study) of Americans are deficient. Fortunately though, according to a randomized study in The Journal of Steroid Biochemistry and Molecular Biology, “administration of calcifediol or 25-hydroxyvitamin D to hospitalized COVID-19 patients significantly reduced their need for Intensive Care United admission” and “seems to be able to reduce severity of the disease”. The two main ways to ensure you are getting enough of this essential vitamin are to (1) get enough sunlight and (2) take vitamin D supplements. Some research suggests darker-skinned people may need significantly more sun exposure to get adequate vitamin D. The US Institute of Medicine suggests taking 400–800 IU of vitamin D daily, but many experts think 1,000 IU or more is needed if you don’t have regular sun exposure.

Household practices and preparation

Do not hoard supplies

Items can easily become in short supply due to hoarding. Common products experiencing shortages include toilet paper, bottled water, and medical supplies.

Avoid purchasing large quantities of products, particularly those in short supply. Get what you need for 2-4 weeks. Leave the rest for others who need it. If you have a large quantity of surgical/N95 masks or other supplies consider donating it to groups in need such as healthcare providers or a local food pantry.

Keep your home clean and disinfect

Surface contamination while possible has not been shown to be the main mechanism of infection. That said, in laboratory environments, research the virus has been shown to survive on surfaces. Therefore if you’re at high risk or work in a high-risk environment, is still a good idea to have a ‘staging’ area for clean entry into your home. Remove shoes, outerwear. Isolate your mail, packages and purchases at least a few hours, especially if you don’t need them right away.

Prepare a hot zone in your home in case someone falls ill

Prepare your home for the possibility you’ll need to isolate and care for an infected member of your household. Stock the room in advance with food that the infected person can consume with zero preparation and without face-to-face interaction with others. If you have a dedicated bathroom for the infected person, that is best. Realistically, given shortages you won’t have access to a surgical mask, but if you do have one, prioritize its use on the infected person rather than caretakers. Consider use of a cloth mask for the infected person as well as for the uninfected in the same household.

Do not mix cleaning products

These cleaning products become dangerous when mixed:

Products Negative outcome
Bleach + Vinegar Produce chlorine gas
Bleach + Ammonia VERY toxic gas
Bleach + Alcohol chloroform
Hydrogen Peroxide + Vinegar corrosive acid

Sources: American Chemistry Society and Good Housekeeping

Shopping carefully

If you can afford to have groceries delivered, or can have someone shop for you, do so. Else, if you are elderly or immunocompromised go to the store first thing in the morning when things are less touched.

Some stores are extending their hours or dedicating special hour(s) for these vulnerable populations, more info here.

Arrange a “pandemic pal”

Especially if you live by yourself and during peaks of transmission in your area, call each other daily. If anyone is sick, call them twice daily and have an agreed-upon contactless plan for delivering food, pain relief, and prescribed medications as well as for back up care of dependents.

This is a good opportunity to think about longer term versions of these care contingency plans.

What to do if you get sick

Do not go out if you are sick

A good idea — even if it is not coronavirus. Health systems need every available capacity. Don’t cause unnecessary panic. Don’t assume it is just a common cold. Definitely stay home if you have a fever or cough.

Call ahead to your doctor

Do NOT go directly to the hospital. More guidance from CDC here.

Call centers are understandably overwhelmed right now with the “worried well” so please try to leave those lines open for the people who really need them.

Know when to go to hospital

Compiled from this WHO report
Common symtoms

symptom percentage symptom percentage symptom percentage
Fever 88% Fatigue 38% Shortness of breath 18%
Dry cough 68% Phlegm production 33.4% Sore throat 14%
Headaches 14% Muscle aches 14% Chills 11%

Only go to hospital when you have trouble breathing or you are short of breath (sitting, going to bathroom, walking, etc).

Gastrointestinal Symptoms (rare): Diarrhea, nausea, vomiting, or abdominal discomfort are all possible early symptoms. They may appear a couple of days BEFORE the respiratory symptoms.

Timeline

  • Mild cases usually clear up in 7 days (no hospitalization).
  • It can take 2-14 days for the first covid19 symptom to develop. 88% of them eventually have fever. For nearly half of the hospitalized patients, fever may not develop before you need to be admitted to hospital.
  • By day 5, patients of preconditions may have trouble breathing (go to hospital).

Recovery time: (for all patients that develop pneumonia)

  • Mild: a few days.
  • Severe: 2-1/2 weeks.
  • Critical (with ARDS): 30-40% fatal. Recovery could take months.

Symptom tracking apps:

How to support your community

Cancel non-essential medical visits

If your local situation and health status dictates, carefully consider which medical visits to postpone or undertake in other ways. For instance, hospitals can be hot spots for transmission; get your vaccinations at a pharmacy rather than at the doctor. Where possible, find ways to do your physical therapy outdoors or at home.

Telemedicine professionals, this is your time to save the day, for everyone’s benefit but especially those in rural areas who are hard hit and without easy access to medical care. https://doxy.me and https://vsee.com/clinic/ provide free HIPAA compliant video platforms for telehealth.

Do not spread misinformation

Be informed, and do not spread rumors and speculation. Only promote factual information from reputable sources.

Do not be racist

Racist assumptions lead to racist behaviors. Racist behaviors divide us, and in this pandemic situation, definitely work against us. If we divide ourselves according to race, ethnicity, or nationality, the virus wins and we all lose, plain and simple. If we unite ourselves regardless of race, ethnicity, or nationality, the virus loses and we all win.

Be kind to others

At all times, be kind to each other and be mindful of other people’s worries. You may be in a low risk group and feel this is nothing to fret about, but your 80-year old neighbor or your friend with recent heart surgery may feel quite differently. Every person matters; no one is “expendable.”

In many areas of the world, healthcare professionals are still running short of N95 masks, gloves, and other personal protetive equipment. If you have a surpluss of these supplies, consider donating them. Consult your local hospital for instructions on how to do so.

Tips to reduce stress

Ignore “secret treatments” and home remedies

Be good to your body. Expect companies to capitalize on your fear. Don’t put your trust in products or pharmaceuticals that are not backed by rigorous clinical testing. Expect to hear individuals who claim that crystals, essential oils, etc. have helped them; the folks sharing these products may have the best intentions, or they may be predatory. But the idea is the same: many patients spontaneously do get better on their own because most cases are mild and resolve without pharmaceutical intervention. Instead of worrying about remedies, eat good food. Exercise. Meditate. Rest. Don’t neglect your mental health and don’t use your anxiety as an excuse for poor behavior towards others.

Do not binge on news or social media

Once you’ve done everything you can, step back. Way back. Watch something funny. Read a good book. Learn an instrument. Garden. Hug your kid. Call your mom. Hug your mom. Call your kid. Be present. Take this moment to be grateful that you are alive on this amazing planet. We are in this together; look after each other.

Myths

It’s just the flu.

It isn’t! The severity is more similar to pneumonia. Many patients require respiratory support. It is also more contagious than the common flu. (source)

I’m young and healthy so I don’t need to care.

Young and healthy people are generally less likely to die if infected, but this is not the point! Treatable conditions easily become deadly if the health system collapses. We are not equipped to handle hundreds or thousands of respiratory patients at the same time. In places where the outbreak is full-blown, the medical facilities are completely overwhelmed. Patients are in hallways and gymnasiums. Doctors are being forced to ration limited resources like ventilators, oxygen, and even basic supplies like surgical masks and gloves. You might be lucky, but it will likely be at the expense of others in your community.

There are no infections near me.

There are almost definitely infections near you! But you cannot see them yet because there is a two week delay between the time of infection and when someone shows symptoms. During that time, the infected person is contagious and spreading the infection. For every single diagnosed case of COVID-19, there are likely hundreds of undiagnosed cases. For this reason, our only chance to avoid a massive public health disaster is if we take preventative measures before we see it everywhere. (source)

I cannot afford to stay home or close my business.

This is both a public health and economic crisis. Historically, effective public health interventions have enabled enable economies to get back to ‘normal’ faster and better. No one can opt out of this pandemic, but we can opt out of unnecessary risk of infection.

The media is overblowing this. People are just panicking.

There has been a lot of misinformation and the media is predisposed to fearmongering. But this does not change the fact that the situation is very serious. Panicking is dangerous and unproductive, but so is ignorance and inaction.

There’s no point in staying home because some people aren’t.

The goal of social distancing is to slow the rate of infections and more is better, but it is not “all or nothing.” In the context of an exponential growth pattern, even small reductions have large effects. If the well-being of your greater community doesn’t motivate you, remember that you are risking infecting yourself and your family.