Right, so I promised a while back that I’d write about the coronavirus. This ended up being several times longer than the short article I thought it would be. That happens a lot.
I want to emphasize, first off, that the worst thing you can do right now would be to not take this seriously. The second and third worst things would be panicking and TP-ing someone’s house, respectively.
So here I’m going to go over how bad this pandemic really is, how to stay healthy including home workouts and staying sane when you’re isolated, what to do if you think you have it, what and how much to stockpile, and a few specific things to buy.
So How Bad Is it?
On the one hand, the people who have tried to downplay the virus have clearly been proven wrong at this point, and hopefully you were smart enough not to listen to them a few weeks ago.
Sure, the coronavirus hasn’t killed as many people as the flu…because it’s new. The thing is, humans don’t intuitively grasp exponential growth. You have to do the math to see how quickly a hundred deaths turn into a million.
The number of infections in the U.S. is estimated to have been doubling every 5-6 days. However, that was before we started shutting stuff down over the past couple weeks. Note that the rate of reported cases is doubling faster than that in many areas– however, that’s largely because testing is rapidly being scaled up right now.
A lot of the most apocalyptic projections are based on the assumption that we– both the government and individuals– do absolutely nothing about the virus. That study from a couple weeks ago that said 1.6 million Americans could die? It assumed absolutely zero quarantine, business shut-downs, or voluntary social distancing, even after people start dropping like flies. In short, it’s worse than any plausible worst-case scenario. Of course we’ll react.
Gavin Newsom’s statement this week that 56% of Californians will have the virus within 8 weeks is in the same vein– it’s what would happen if we have at least ten to twenty thousand infections now (which we probably do), and the count keeps doubling every five to six days, which it won’t now that we’re quarantining.
Likewise, the statement by an Ohio health official that 100,000 people in Ohio could have the virus already has now been admitted to be a “guesstimate.” In fact, if you take that number and apply the 5-6 day estimated doubling period– or hell, even a 4-day period, working backwards, it would imply that the coronavirus had arrived in Ohio back in early December, before it is even known to have spread outside of Wuhan.
Bear in mind that state and local officials often have an ulterior motive to spread overly pessimistic numbers. Not only do they want to motivate people to self-isolate, but they also use these numbers to support requests for aid from the federal government. Newsom, for instance, cited that 56% figure at the same time that he asked President Trump to deploy a navy hospital ship to Los Angeles.
Speaking as someone who lives in Los Angeles, I suspect Seattle needs the help more than we do.
The actual coronavirus death rate.
Estimates of the death rate have varied from less than one percent, all the way up to around eight percent. However, the highest of those numbers are “case fatality rates,” meaning the death rate only among diagnosed cases.
It’s estimated that only around one-tenth of infections get diagnosed– this obviously varies a lot by country, but it means the likely death rate is a bit under one percent, or ten times as high as the flu.
Realistically, the U.S. death toll will be at least a few thousand, and may well get into the tens of thousands. While it’s a bit early to tell, at the rate things are progressing right now, it probably won’t reach a hundred thousand.
That said, severe but non-fatal cases can cause permanent lung damage, so even healthy people need to take treatment seriously if they get the virus. More on that later.
How long will the coronavirus pandemic last?
Estimates still vary a lot, as you would expect for an equation with a lot of unknown, exponential variables. Cases in the U.S. will peak sometime between May and August, but we won’t be completely rid of it until next year.
Bear in mind also that “flattening the curve” means that we’re actually trying to make this last longer, in order to reduce peak demand on the health care system and buy time to find treatments.
Worldwide, some countries are behind us, and may not be over this until late 2021.
Testing is rapidly scaling up. The good news here is that the more we test people, the more we can specifically quarantine people who actually have the virus, as opposed to making everyone self-isolate. That means blanket shut-downs and “shelter in place” rules might start being relaxed as early as May, even if the actual number of infections hasn’t quite peaked by then.
As a further bit of good news, drug treatments are starting to be developed, with the first clinical trial results expected in April. Hopefully we’ll have drug treatments by April or May. A vaccine is expected sometime in 2021.
However, reports that we already have effective drugs now are premature. While Trump recently announced that the anti-malarial drug chloroquine has been approved for use, the FDA isn’t backing him up on that.
One study a while back did find chloroquine to be effective in treating the coronavirus, but it had numerous flaws including non-random sampling, dropouts, and double standards in how the experimental and control groups were tested, as this reddit commend summarizes.
Also, the Chinese tried chloroquine, and immediately found it to be highly dangerous; the side effects are severe, and the lethal dose is only twice as high as the effective dose.
Is the Coronavirus Seasonal?
While experts haven’t come to a consensus yet, it’s starting to look like the virus thrives in specific weather conditions. It started out during the height of flu season, and has spread mostly to areas in the northern hemisphere between 30 and 50 degrees latitude. It seems to find purchase most easily in cool, wet climates.
Notably, the southern hemisphere has done better than the northern hemisphere overall, as you can see from the map and country statistics on Wikipedia.
As Nate Silver pointed out, tropical countries, which combined have half the world’s population, have been largely unscathed so far. This is very good news, because most of the countries have poorly developed health care systems.
And if you look at state by state data, it’s notable that the warmest states seem to be doing better relative to their population. Most notably, Hawaii seems almost entirely unscathed, even though the high number of people who travel between Hawaii and Asia should have been expected to cause an early outbreak in Hawaii, before the threat was recognized.
Also worth noting is that among China’s neighbors, Southeast Asian countries like Vietnam, Cambodia and Thailand, and South Asian countries like India, have fared much better than Korea and Japan, despite having worse public health systems. Taiwan has also done amazingly well, albeit they also have a great public health system and reacted really quickly in terms of screening travellers.
If the virus is seasonal, you should expect to see countries in the northern hemisphere start doing better than projected over the next two months, while southern hemisphere countries start catching it– albeit not as badly since they’ve had warning.
Also, if it’s seasonal you can expect northern hemisphere countries to suffer a second wave of infections this fall. That’s what happened during the 1918 Spanish flu pandemic, and it’s also something you would expect purely based on countries that have contained the virus getting re-infected from other countries.
If the virus is sensitive to weather conditions, that has practical implications for how to prevent and treat it. More on that later.
How To Stay Healthy While You’re Isolating
The basics of diet, exercise, sleep, and mental health are still more important than anything specifically related to the virus or your immune system.
Diet-wise, eat three small meals a day. Each meal should have the following:
- A lean protein source like meat, eggs, lentils or tofu, about the size of the palm of your hand
- Non-starchy vegetables at least the size of the palm of your hand, maybe even twice as much
- As much fruit as you can cup in one hand
- Optionally, minimally-processed carbohydrates such as potatoes, rice or beans, no greater in size than the palm of your hand
- Between a teaspoon and a tablespoon of added fats, unless one of the other ingredients was something fatty like bacon or avocado
- Note: Vegans should count beans and lentils as both protein and carbs, potentially having up to two palm’s worth while meat eaters should count them only as carbs and limit their intake.
If you’re staying at home, 90% of those meals should be home-cooked. If you’re still working outside the home, at least 60% of them should be.
As for sleep, you need 7-9 hours a night, as always. Maintain an evening routine in which you do the same things for the last two hours before bed every night, and keep going to bed at the same time (within an hour) every night. This should actually be easier now that you can’t go anywhere at night.
Oversleeping should be avoided as long as you’re not sick. If you do get sick, you may need more sleep.
Workouts should be done at home. I recommend a simple upper-lower split routine, performed with a mixture of dumbbells and resistance bands. For cardio, use jump ropes. I’ll recommend specific pieces of equipment at the end of this article.
You will also need to be able to lay on the floor, so may want a yoga mat depending on how soft your floor is.
I’ll provide specific workouts in future articles. For now I’ll provide the general principles. Work out 4-6 days a week, alternating upper and lower body workouts. Yes, that’s a lot– you’re also making up for the lack of lifestyle activity, i.e. walking around.
Oh, also I’ve written a lot about this before, including this resistance band training guide.
Each workout should consist of six to ten movements, with two to three sets of each exercise, for a total of twenty to thirty sets per workout. Exercises should also be performed in circuits of two or three movements that use different muscles. Usually, you want to superset movements that move the same body parts in opposite directions, like chest presses and rows.
Additionally, if you’re self-isolating and not even able or willing to take walks outside, I highly recommend standing up for much of the day. Stand up for as long as you can until you start getting tired or your legs get a little sore, then sit down until you feel able to stand again.
Beyond just exercise, standing up throughout the day like this makes it much, much easier to sleep at night. The lack of exercise is going to be one of your worst enemies here, so every bit counts.
As for mental health, keep in touch with friends and family. Call or text them more than you normally do. Take part in online communities.
Look for ways to take some of your offline hobbies online. For instance, I’m playing a lot of tabletop role-playing games online these days.
A daily meditation practice will reduce stress and help you sleep. Here’s an introductory meditation guide I wrote.
Get kind of obsessive about cleanliness. Throw every shirt in the laundry after one wearing. Wash sheets, towels, blankets, washcloths, pillowcases, twice as often as normal. Clean your floors and countertops 2-3 times a week. Wash your hands 5-10 times a day and your face 2-3 times a day.
Next, remember how I said the virus is likely seasonal? This is speculative, but keeping the thermostat up a bit will likely reduce your odds of infection. And regardless, we do know that higher temperatures protect against a lot of other diseases like the cold and flu and bacterial bronchitis.
Since the worst cases of coronavirus usually involve superinfection with other respiratory illnesses, we don’t really need to know for sure whether Covid-19 favors cold temperatures to know that staying warm is likely to help.
So how warm do you need to be? The areas hardest hit by the virus have mostly been in the 40’s, 50’s or 60’s. The ares I mentioned earlier as doing surprisingly well– like Hawaii, Vietnam, Cambodia, Taiwan and Thailand– have almost always been in the 70’s and 80’s.
Based on that, keeping your thermostat over 70 probably helps, and can’t hurt except in as much as it costs money and might make it hard to sleep. Personally I’m keeping my thermostat in the mid-70’s during the day and around 68 at night (as in it will heat up to 68 but now cool down to 68 if it’s above that), which for me is a good compromise between comfort and virus prevention.
Finally, sinus irrigation with salt water or saline nasal spray helps to clear pathogens out of your system. Incidentally, if the salt water burns your sinuses, that’s a good indication that you do in fact have an infection, since it suggests that your sinuses are a bit raw.
What To Do If You Might Have the Virus
If you develop symptoms consistent the the coronavirus, flu or common cold, do the following.
Keep Staying Healthy But Take It Easy
What I mean is:
Keep eating the same healthy diet, but don’t force yourself to eat if you’re not hungry. You’ll probably lose your appetite if you get sick. The traditional advice of “starve a fever, feed a cold” seems to be correct, but it’s also what you do naturally. So eat as much as you want, just make sure it’s healthy food.
Stop working out, other than really light workouts if you really feel like it.
Stand up only as much as you feel like doing.
Let yourself sleep more than nine hours if you feel the need, but don’t lay in bed for a long time after waking up unless you’re sick enough that you would take the day off work, even when working from home.
Finally, make sure to get plenty of zinc and vitamin C. You’ll likely need to supplement them if you’re losing your appetite. Also vitamin D, which you won’t be getting from the sun.
Heat, Steam and Saline Spray
Get serious about turning up the heat, inhaling steam, and sinus irrigation, as mentioned earlier. Still don’t turn up the heat to the point that it makes it harder to sleep, but otherwise, put up with some discomfort.
When inhaling steam, assuming you’re boiling water on the stove rather than using a steamer of some sort, drape a large washcloth over the back of your head to catch more of the steam and channel it towards your face.
If inhaling steam irritates your airway and makes you cough, you might be inclined to turn down the heat on the stove. In fact you should do the opposite– turn up the heat so more steam comes out of the pot, put hold your face further away. That way you’ll inhale more steam, but it will also be a bit cooler.
As for sinus irrigation, you can use saline nasal spray or mix your own. Either way, studies show sinus irrigation is highly effective against nasal infections. That’s unsurprising since it’s essentially duplicating what your own immune system is trying to do.
That said, COVID-19 mostly concentrates in the lungs and lower airways rather than the nose and throat, so sinus irrigation helps more against other infections. But remember, the worst cases often involve concurrent infection with other things. It’s still worth it
Don’t Unnecessarily Suppress Your Immune Response
Fever, inflammation, coughing and congestion are not directly caused by pathogens. Rather, they’re caused by the body’s own immune system, as they help the body fight infections. Unpleasant as they are, they’re good, up to a point.
As such, you should usually avoid using drugs that suppress the body’s immune response. Specifically:
Avoid acetominophen (aka Tylenol or paracetamol), which is a fever reducer and also bad for your liver. While the exact effect on COVID-19 isn’t known yet, it is known that elevated body temperatures inhibit the reproduction of influenza.
Once a fever gets to 105 Fahrenheit or 40.6 Centigrade, start fighting the fever with medicine and externally applies fans, cold washcloths, and cool baths, but don’t overdo it. Of course, by this point you should probably have sought out medical attention.
Coughing is important for clearing mucus, so you don’t want to suppress coughs. The big exception here might be right before bed, if cough suppressants are the only way you can sleep.
Congestion doesn’t fight the existing infection, but it prevents further infection. So again, don’t fight it unless that’s the only way you can sleep. Also, nasal decongestants like pseudoephedrine and phenylephrine become addictive after 3 days, so there’s that.
Inflammation is vital to the body’s immune and repair signaling in general, and should usually not be suppressed with NSAID’s and the like. However, there is some evidence that COVID-19 causes an excessive inflammatory response, in which cause NSAID’s could be helpful in severe cases.
At the moment, whether anti-inflammatories help or hurt with COVID-19 is still hotly debated, so if you get it, ask your doctor and look up what the latest articles say; maybe there will be a consensus by then. What’s less controversial is that NSAID’s are often counterproductive for other sinus infections. Though again, this comes with the “unless pain is keeping you from sleeping” caveat.
Steam and nasal irrigation, on the other hand, are great as they support rather than opposing the body’s immune response. They’re also not drugs and don’t chemically react with your body; they simply physically remove pathogens from your airways, as does postural drainage.
Diarrhea is usually in the same category as coughing– an unpleasant but necessary way of expelling pathogens. Most people don’t get it, but if you do get diarrhea, it does seem that this indicates the virus is in your intestines, and you need to expel it. So again, avoid Imodium except before bed if you really need it to sleep.
Severe cases of COVID-19 usually involve pneumonia– a buildup of fluid in the lungs. In cases where patients survive but suffer lasting lung damage, this appears to also be caused by fluid in the lungs causing damage.
Again, if you have pneumonia, you’re at the point where you could use medical attention. But there’s also something you can and should do for yourself regardless: let gravity help you cough it up.
Simply put, postural drainage entails doing a (probably partial) handstand and deliberately coughing to drain the lungs. You’re effectively coughing down rather than up. The more upside down you get the better, so have someone hold your ankles if possible.
Otherwise, lay on your belly off the side of the bed, using some pillows to elevate your feet. Incidentally, this also makes clearing mucus from the throat easier as well– however if you have throat congestion rather than dry cough, you probably have a cold.
That said, there is reason to believe that a variety os positions are helpful for draining different regions of the lungs, as the following chart illustrates.
Regardless of position, you’ll want to put a towel under you and cough into it, then immediately wash the towel. Ideally a white towel so you can bleach the hell out of it.
Quarantine For 2+ Weeks
Current evidence suggests that people with COVID-19 are contagious for up to two weeks after onset of symptoms, so quarantine yourself completely for at least that long.
Ordering food by delivery is okay if you really need to, but a) wear a mask or bandana when you go out to get it, and b) have the delivery person set it down and walk away, then pick it up without getting close to them.
When To Test Or Seek Treatment
If you think you might have the virus, call your doctor and ask if they think you should go in to see them. Most people don’t need, and in fact can’t particularly benefit from medical treatment. The ones who do usually have high fever, difficulty breathing, pneumonia, or chest pains.
But again– no reason not to at least talk to a doctor or nurse on the phone. Generally they’ll tell you to self-treat if the symptoms are mild to moderate and you’re young and have no pre-existing conditions. If you’re over 60– don’t hesitate to seek treatment if you feel you need it, but do remember the trade-off, in that going to a hospital full of other sick people isn’t something you want to do if you don’t need to.
As for testing, that really depends on how readily available testing is. Right now in the U.S. it’s by medical referral only since test kits are in short supply, whereas in places like Taiwan and South Korea, my understanding is it’s as easy as walking into a pharmacy or clinic.
The key thing to remember here is that information is only useful if it would affect a decision. If you have a mild case of coronavirus, you’ll treat that the same way you would a cold, so the information isn’t useful. It becomes useful later when you want to know if you’re immune and can stop worrying about the virus, granted.
That said, for the time being, I would only get tested if the symptoms were bad enough to make me think about getting medical attention. Not that there’s any choice when you need a doctor’s referral.
Funny enough, I finished this article late last night and decided to wait until today to publish. Overnight, this piece of advice seems to have become the official policy.
In a couple months when we have a hundred million test kits, I’d say test away. Though maybe that number and timeline is being a bit optimistic.
Stuff to Buy While You Quarantine
I’m going to cover two things here. First, some general rules for stockpiling without being an asshole. Second specific things to buy.
How to Stockpile For the Coronavirus
Two weeks. That’s how long your stockpile needs to last you, more or less. Don’t be that jerk who buys up two months worth of stuff that other people need.
If you get a mild case of the virus, you need to quarantine for two weeks. If you get a more severe case, you’ll likely be hospitalized in less than two weeks.
Let’s break that down:
Keep a two-week supply of cleaning and hygiene supplies, including toothpaste, soap, mouthwash, Lysol, sponges, rags, garbage bags, swiffer pads, toilet paper, paper towels, and enough tissue paper to last you two weeks if you did get sick.
Keep two weeks worth of any medicine you might need, including things both related and unrelated to the coronavirus. This includes the stuff I just warned you to take it easy with. Better to have it than not need it.
Keep two weeks worth of non-perishable food– that is, food that lasts at least a couple months. Half of this should be stuff that needs to be cooked, like frozen meats and vegetables, or canned beans. Half should be stuff that can be eaten straight out of the container or just needs to be microwaves, like canned tuna, microwave dinners, or bags of nuts.
Keep about four to seven days worth of fresh, perishable stuff like fresh fruits, milk, etc. Go grocery shopping once or twice a week, no more.
If you do get sick, try to consume the fresh food first, then the frozen stuff that needs cooking, then the really easy to eat stuff. Of course you might get so sick you can’t be bothered to cook; the point is to save the easy but probably less healthy stuff for that eventuality.
Remember that you’ll lose your appetite if you get the virus, so that two weeks worth of food really becomes three weeks worth.
Specific Stuff to Buy
Full disclosure: these are affiliate links.
Supplements are usually overrated, but between not going out, needing to boost your immune system, and maybe losing your appetite, they become more worthwhile.
A multivitamin, like this one. This gives you all the zinc and vitamin C you need. Note that excessive zinc intake can actually be bad for you, so I don’t recommend an additional zinc supplement on top of this.
Vitamin C. Taking too much vitamin C overall isn’t dangerous, but too much at once causes diarrhea. Take 500 mg once or twice a day, hours apart, ideally with food and also separate from the multi.
Vitamin D. Two to five thousand i.u. a day. Multivitamins have a tiny bit of this, but never as much as you need, especially if you’re not going out at all. Take it with your first meal of the day.
Garlic extract. Garlic enhances immune function, but in another study, more than 500 mg a day seemed to offer little additional benefit, but more digestive side effects. Take one pill a day with food.
Greens powder. Packed full of vitamins, antioxidants and other phytochemicals. Especially helpful if you lose your appetite. I like Barlean’s Chocolate Silk because it tastes like chocolate, whereas every other greens power I’ve tried tasted terrible. Mix with milk or a milk substitute like almond milk; it tastes a bit funny mixed with water, in my opinion anyway.
Adjustable weight dumbbells. These are some of the more expensive ones, albeit convenient and durable. Get cheaper ones if you want, but make sure they go up to at least 50 pounds no matter how weak you think you are. Stronger people will want ones that can go to 80-100 pounds for high-weight movements like deadlifts.
A jumprope. This is going to be your cardio for a while.
A yoga mat. For stretching, planks, maybe other stuff like floor presses. You may not need it depending on how soft your floor is. If you do get one, definitely get one with straps like this.
Flushable wet wipes. These are a great substitute for toilet paper– they actually clean better, and take up less storage space. These seem to be sold out right now. If you can’t find a different brand on Amazon, look up One Wipe Charlie’s from Dollar Shave Club.
There is some concern that while they’re flushable, they can clog plumbing further down. Get a big bottle of drain cleaner just in case.
Bandanas. You can’t find masks anywhere, so wearing bandanas over your mouth like a train robber might be your best option.
Incidentally, if you have a painter’s mask, that will work too, but they’re all sold out everywhere I look. They actually provide a tighter seal and better protection than medical masks; the downside is they’re more expensive and not disposable, so you’ll need to wipe them down between uses.
A thermometer. Obviously.
Pulse Oximeters are probably not worth it. From reading Twitter and reddit threads and the like, I see a lot of people recommending wearable pulse oximeters like the Oura ring to measure blood oxygen for signs of breathing problems. Most of these are worn on a finger, like a ring, and cost one or two hundred bucks.
The thing is, they generally aren’t very accurate. Maybe newer ones are, but I see no proof of it. One study found wrist oximeters to work better. Well, one model anyway, but I can’t find it for sale, and the authors seem to have been associated with the company that makes it.
Also, this should be obvious, but if you’re not breathing enough oxygen, you’ll notice. Measuring blood oxygen may be useful from a performance optimization standpoint, but from a disease monitoring standpoint, I’m pretty sure you’d notice symptoms like coughing, fatigue or shortness of breath before you’d see statistically significant drops in blood oxygen.
Like, buy one if you want, but in my opinion these things are just going to make you freak out over random changes in blood oxygen within the normal range, or worse yet, measurement errors.
An Xbox, maybe, if you don’t have one but think you’d enjoy video games, but also would have some self-control about it. I have one, but I have mixed feelings about recommending this. These things are like little crack vending machines. I’ll probably give it away in September as a birthday present to myself. But for now it’s useful, as it’s hard to fill up my time without it.
Note that if you’re buying one right now, there’s pretty much no reason not to save money by getting the all-digital version that doesn’t have a disc drive, meaning you can only download games.
You might also want the game pass, which is sort of like Netflix in that you pay a flat monthly rate and get unlimited access to a bunch of games. The selection is great and unlike the PS5 version, you can actually download them instead of streaming them. That’s the main reason I recommend Xbox over Playstation, actually.
Kindle Fire TV Stick. For watching TV and movies. There’s also a more expensive Fire TV Cube, but even after reading the description I can’t tell what makes it better. The stick is amazing though.
A Kindle. There are a few different versions, but I think this cheaper one is actually better because is only uses batteries when you changes the page, so the battery lasts days or weeks.
Take this opportunity to read a ton of books. I’m currently finishing up The Remembrance of Earth’s Past trilogy, and it is mind-blowingly good. I’ll probably get back into the Malazan or Black Company series next, unless someone sells me on something else.
Anyway, we live in interesting times right now. I’ll get through this and you almost certainly will too, but we’re going to have to modify our routines quite a bit for the next three to six months. But other than staying at home, the essentials of staying healthy haven’t changed a whole lot. They never do.