How to fight the coronavirus SARS-CoV-2 and its disease, Covid-19 [pdf]

https://drive.google.com/file/d/1DqfSnlaW6N3GBc5YKyBOCGPfdqOsqk1G/view

by dankohn1 • 6 years ago

96 70 6 years ago

drive.google.com

majos3• 6 years ago

Just to check the source, these are the same slides (same Drive doc) tweeted by the listed author on the slides [1], who is a neurobiology and bioengineering professor at Stanford.

If you want an understandable, relatively short but info-dense writeup from a sober expert (there hasn’t been much of this on HN) this is nice.

[1] https://mobile.twitter.com/michaelzlin?lang=en

giglamesh• 6 years ago

Is there a non Twitter source for this? Twitter is not working (for me) today.

majos3• 6 years ago

For verifying the slides’ source? Not that I can think of, unfortunately. The slides themselves are at the featured link.

raphlinus11• 6 years ago

I've added this to my list of resources for my blog audience, which I define as people who are curious about the science and have enough technical background to understand better than simplified popular explanations. My resource list is open source and takes issues and pull requests.

[1] https://raphlinus.github.io/covid/2020/03/14/covid.html

underbluewaters• 6 years ago

I'd like to see more information on what to do if you are sick. Even younger people have gotten serious respiratory complications and it would be great to have information on how to care for yourself or your family short of heading to the hospital and contributing to the overwhelming of their staff.

raphlinus11• 6 years ago

The most authoritative source is (still) the WHO guidelines [1], though the audience for this is health care professionals, not patients. Your national and local public health departments may have more updated and tailored information.

A popular article is "What Will You Do If You Start Coughing?" by James Hamblin [2], though this is heavier on public policy concerns than specific targeted advice.

If anyone can find a really well-communicated set of advice on this, I'll gladly add it to my resource list. The need for such things is urgent, and I'm extremely frustrated about the poor quality and distribution of resources, which is why I'm putting time and energy into curating my own resource list.

[1] https://www.who.int/publications-detail/home-care-for-patien...

[2] https://www.theatlantic.com/health/archive/2020/03/where-do-...

Leary• 6 years ago

Be careful with NSAIDs as they may exacerbate symptoms. [1]

[1] https://www.theguardian.com/world/2020/mar/14/anti-inflammat...

raphlinus11• 6 years ago

Is there an authoritative source for this other than the French public health authorities? I haven't seen references to it at all in epi Twitter.

searine• 6 years ago

This isn't clear yet. It is a reasonable assumption based on the biology but not verified.

yread• 6 years ago

Especially ibuprofen as it can cause water retention exacerbating pneumonia

DoreenMichele2• 6 years ago

1. Onions are good lung support.

2. Watermelon is good kidney support. This is helpful if you are experiencing bloating.

3. Hot peppers are antimicrobial, antiviral, antifungal and open a cell channel that helps you dump fluids.

4. Tea is an astringent. Drinking it can help reduce fluid in the lungs.

5. Spicy foods are medicinal. Some stuff that helps combat infection include: onions, garlic, hot peppers, black pepper, cinnamon, olives. Oregano and oil of oregano are especially helpful for lung infections.

6. Alkalinity helps combat viral infections. Look up alkaline food lists.

7. Stay hydrated and get enough salt. Water and salt are critical components of mucus, an important lung thing.

8. Lysine helps combat viral infections.

9. Lung clearance is a standard means to treat serious lung conditions and keep airways open. A simple means to do this is stand in the shower with your feet about shoulder width apart, bend over as far as you can and cough hard.

10. Caffeine is a stimulant that works very similarly to an inhaler drug. So you can drink coffee or eat very dark chocolate to open up the airways as a drug substitute.

Most likely, this comment will be downvoted to hell and one or more people will promptly jump up to accuse me of nefarious behavior, delusions of grandeur, having no fucking clue what I'm talking about or similar. I get that a lot.

I have a very deadly medical condition that involves the lungs. I'm off all drugs. The above are some of the things I rely upon.

I'm not a doctor. I'm a former homemaker and formerly homeless person.

Do whatever the hell you want with that info.

Edit: if you have lung distress, avoid bacon.

Alex39173• 6 years ago

Onions are good lung support.

Out of curiosity, what in onions is good for the lungs? I know a lot of people have been talking about red onions due to their quercetin content, which in vitro works similarly to chloroquine in terms of helping cells absorb zinc.

throwaway_pdp092• 6 years ago

Have you any clinical evidence that any of this actually works?

Causality1• 6 years ago

Off the top of my head, half of that is utter bullshit. For example, your diet does not affect the pH of your blood or body, so alkaline foods do nothing.

robbiep2• 6 years ago

Medical assistance is ‘supportive’

This means: If you come to hospital, we give you oxygen. Initially through nasal prongs, then progressively through mask and then straight to intubation - ventilator.

If the lungs are completely unable to oxygenate, we will put you on ECMO which can work quite well whilst the lungs recover.... unfortunately not many of them.

We will also take bloods and give IV fluids. If your blood pressure crashes, you may be given inotropes/vasopressors but the case reports about people who make it this far are not good to date (frankly, anyone who needs an ICU bed even today has a 30% mortality rate so there’s always the baseline comparison)

Once ventilated, you will usually be in antibiotics to prevent opportunistic infections.

We have no other ways of helping those who are otherwise able to breathe on their own, besides symptom control (ie fever/aches and pains) however if I were to get this I would ride the fever out (heightened temperature activated immune system, trial in ICU of permissive hyperthermia shows survival benefit, although this is in sepsis patients)

If you have a productive cough (cough usually dry) then chest clearance, breathing exercises may be helpful, but should consider seeking antibiotics for secondary bacterial pneumonia

HashBasher• 6 years ago

Yes, we need more details about how to take care of yourself if you do exhibit those symptoms. Do we just address the symptoms? Anti-fever meds, cough drops?

wahern• 6 years ago

I've had pneumonia several times in my life (mostly as a kid--both my parents were chain smokers), and bronchitis more times than I remember. I'm not asthmatic, though it's possible I'm borderline.

Respiratory illnesses are my achilles heel. One thing I always have on hand is Primatene. The guaifenesin loosens up mucus and the ephedrine opens up your respiratory tract so it's easier to breath--both improving nasal congestion, and also, AFAIU, helping with oxygen uptake in inflamed lungs. I have to be proactive because a simple cold can lead to bronchitis, and bronchitis can lead to pneumonia.

Any doctors, please opine, but I believe that if you have pneumonia (obvious infection, shortness of breath, etc) and are unable to get medical treatment, having some ephedrine on hand might be worthwhile. A quick search through the medical literature shows that ephedrine is apparently used precisely to improve oxygenation for acute respiratory distress (not just for asthmatics, obviously, but sometimes in surgery and in other cases).

The critical question would be counter-indications. The doctors I've run my cold treatment by always remind me that Guaifenesin and ephedrine both increase blood pressure, so that's something to keep in mind. (Fortunately, I don't have high-blood pressure.) But how that would figure into an acute distress situation, I dunno. I'm sure that in any particular context doctors probably know of many other counter-indications.

Primatene, Bronkaid, and similar generics are the only way to get ephedrine OTC, and they always include guaifenesin, so be mindful of dosages for both drugs. I just picked up a box of Primatene just in case as I forgot how much I had left at home. They're usually on the front shelves behind the pharmacist; don't bother hunting for one of the placards in the store aisle.

JamesBarney3• 6 years ago

How do we know the doubling time? That seems like the biggest assumption that we're not sure about. I've seen 1 week, 5 days, and even recently 3 days.

raphlinus11• 6 years ago

Look at the graphs on "our world in data": https://ourworldindata.org/coronavirus#trajectories-since-th...

Based on this, 3 days does indeed look like the doubling time. However, be careful when interpreting this data, as it conflates increases in testing coverage with actual viral spread. If you look at countries with excellent testing, such as South Korea, it was still in the 3 day range, though today they thankfully have transmission comparatively under control.

JamesBarney3• 6 years ago

Thanks for linking to that graph. That's a great resource!

At 3 days that changes both how much we have to slow it down, and how quickly we need to start slowing it down.

Not to mention that if it's 15 days from infection to diagnosis then that's 5 doubling times. So by the time we realize we didn't do enough it's way too late to avoid a complete catastrophe.

tunesmith2• 6 years ago

The doubling time of deaths appears to be much slower than the doubling time of confirmed cases, and is probably a better comparison. It could be slightly faster than reports, if deaths are getting missed, or misattributed to other illnesses. But it still seems more accurate than judging the doubling time of confirmed cases, which is more just a measure of how quickly we are able to increase testing when there's a backlog of "actual cases".

raphlinus11• 6 years ago

There's a much narrower range in reporting rate variation for deaths than for infection->test results, but (a) it lags considerably, and (b) there are many other things that conflate this data as well, including healthcare systems getting better at preventing Covid-19 deaths over time (learning from earlier cases, hopefully starting to see positive results from remdesivir and hydroxychloroquine). I am still comfortable with what I said elsethread, the best way to get your head around doubling time is to look at data from countries with very good test coverage, such as South Korea.

malandrew• 6 years ago

Even doubling times of deaths has issues as a measure. For example, the double time before you're forced to triage is going to be better than when your health system is overwhelmed.

raphlinus11• 6 years ago

Where do you get that the doubling time of deaths is much slower than that of confirmed cases? I looked for data, and this graphic is not reassuring on the question:

https://commons.wikimedia.org/wiki/File:Log-linear_plot_of_c...

bonzini• 6 years ago

2 to 3 days is what we've seen in most countries during the exponential phase. Some countries in Northern Europe have had values down to 2 days or less, but that was when they were ramping up their testing like crazy.

(3 days was also the number I used one week ago to state "at least two of France, Germany, Spain and Switzerland will be in lockdown and with hundreds of deaths one week from now"[1], and boy was I right).

[1] https://news.ycombinator.com/item?id=22528433

Alex39173• 6 years ago

95% don’t need to go to the hospital

Including people who get at asymptomatically, maybe. Of people who get any symptoms, it's 15 - 20%.

And even if you're not in that 15 - 20%, you may still have permanent or long lasting lung and heart damage. Stay inside; your grandparents were asked to go to war for several years, you're just being asked to spend a couple months playing video games.

yovagoyu• 6 years ago

Ehhh... there are more productive ways to spend your time than playing video games.

I agree we should look out for the older generation though. For me, it's my parents (boomers, who fought no wars) I worry about, my grandparents (who fought) have passed already.

Alex39173• 6 years ago

I mean sure. If commit to spending even an hour a day on some sort of self-improvement activity, whether it's getting in shape or teaching yourself some new skill or whatever, you'll come out of this way better than you went in.

patrickbeeson• 6 years ago

I would encourage folks to go outside run, bike, hike, etc. There's plenty of healthy options that won't put you at risk from contracting the virus.

narag• 6 years ago

I don't know where you are, but here in Madrid it's forbidden. Also the gym is closed so it's Netflix + HN.

csomar2• 6 years ago

I would encourage folks to go outside run, bike, hike, etc. There's plenty of healthy options that won't put you at risk from contracting the virus.

Except that most of the world doesn't live in an American suburb where houses are 100 meters apart. For most of the world, going outside means bumping into somebody.

pdonis2• 6 years ago

The comparison of symptoms on slide 26 seems particularly useful.

williamstein• 6 years ago

Especially interesting to me is the entry on "shortness of breath", which is common in COVID-19 but NO for both flu and cold.

pdonis2• 6 years ago

Yes, that seems like a good symptom to focus on for differential diagnosis.

ones_and_zeros• 6 years ago

I'm looking for information for those that provide patient care to covid patients. Infection rate, best practices, transmission to family (I live with a doctor providing care to covid patients...), etc. I've seen some anecdotes and single case reports that are concerning, but anything that is data driven like this will be helpful.

Also, where is non denatured ethanol readily available?

smichel17• 6 years ago

You can use diluted bleach (1:9 bleach:water) for cleaning surfaces. Source is WHO guidelines as linked by raphlinus downthread (hard for me to get a direct link to the comment due to the device I'm reading on, sorry).

raphlinus11• 6 years ago

Here's a review that seems pretty comprehensive and careful with sources:

https://www.uptodate.com/contents/coronavirus-disease-2019-c...

rwmurrayVT• 6 years ago

Everclear is probably your best bet. It depends on where you live. Where I live your only bet is the local Naval Exchange.

DoreenMichele2• 6 years ago

The last slide is a hand sanitizer recipe. It's probably the most useful thing here.

thotypous• 6 years ago

Unfortunately, here in Brazil an old ban exists on selling ethanol, due to concerns of it causing accidents with fire and explosions. The only way for an ordinary person to acquire ethanol is in the form of - take a guess - hand sanitizers (or vehicular ethanol at gas stations, but it is inappropriate for that purpose). So currently hand sanitizers are completely out of stock and soap is the only alternative.

pengaru• 6 years ago

You can't get isopropanol/isopropyl/"rubbing" alcohol as sold in pharmacies usually near the hydrogen peroxide? You can mix this with aloe vera lotion in ~50:50 mix for a diy hand sanitizer.

rebuilder• 6 years ago

If you can get your hands on near-pure ethanol.

devy2• 6 years ago

It's disingenuous to compare COVID-19 death with traffic death in Dr. Lin's presentation.

Here are the facts:

- The 30k U.S. traffic death count is for the ENTIRE YEAR. The 3k death in Wuhun happened in a matter of weeks(6-8 weeks).

- Given that U.S.'s inaction and squandered 2 months of lead time, we could see death count to be in the order of hundreds of thousands in U.S. alone.[1] This is NOT an estimate based on mathematical model, this is the estimate based on clinical data so far and virus's exponential growth rate. There isn't a national lock-down yet although some states are acting quickly, still 2 month late.

- Mass majority of the vehicular deaths are preventable because most of them are due to human error. COVID-19 is NOT preventable RIGHT NOW. Vaccines are at least 1-1.5 years away, no matter how fast track you spin it.

- Asymptomatic and family based clustering transmissions are making the lock-down less effective.

- We will get through this nightmare pandemic outbreak. But the economic depression is real and ongoing. Nobody knows what the long term effect could be.

[1] https://www.businessinsider.com/presentation-us-hospitals-pr...

natalyarostova• 6 years ago

I didn’t get the impression he was comparing them. Just providing reference points. He’s pretty clear that this is bad.

devy2• 6 years ago

The closest outbreak to COVID-19 is probably the 1918 Spanish flu (forward-looking statement). And we are going to have 100% likelihood that this year's COVID-19 death count is going to surpass 30k people globally.

majos3• 6 years ago

This is NOT an estimate based on mathematical model, this is the estimate based on clinical data so far and virus's exponential growth rate.

I’m not saying you’re wrong, but an exponential growth rate is a mathematical model. We’re extrapolating the current curve into the future, that’s a model.

MaupitiBlue• 6 years ago

Why new diseases keep appearing in China

https://m.youtube.com/watch?v=TPpoJGYlW54

azinman2• 6 years ago

I was expecting that to be some racist video, but it was actually very informative.

mcsb4• 6 years ago

There seems to be a second virus in the west: DMTMW - dont mention the M word - M like mask. Purely looking at the data, the doubling of the infection rate in western countries is between 2-3 days.

Looking at Asian countries:

Japan: 8-9 days - many people wearing masks

Thailand: 10+days - most people wearing masks

China: negative values - all people wearing masks (not just in Wuhan) and handsanitizer everywhere

Cost for masks: 0.2$/person per day.

Let's hope that China can ramp up the mask and hand sanitizer production to supply the rest of the world asap, because the west doesn't have the capability.

robbiep2• 6 years ago

Masks don’t help for catching the virus (materially) - better to wash hands. Masks do help with curbing transmission from infected, and are also needed for healthcare workers.

Please don’t waste masks when you could get significantly better benefit by regularly washing your hands and not putting your fingers in your mouth

fma3• 6 years ago

If masks curb transmissions. And everyone wore masks. Wouldn't there be a benefit as a whole?

kjaftaedi2• 6 years ago

The person you are replying to is saying 'if sufficient masks can be supplied in the future'.

Given the distance the virus can travel, the length of time it can live outside the body, how long it can stay in the air after being aerosolized (transmitted via cough). It makes sense to get masks on as many people as possible.. because it's the healthy people who think they are fine, coughing in public places that are the most likely to spread it.

Again, this is assuming supply ramps up and is sufficient to make this a reality, obviously all healthcare worker needs should be met first, but going further to protect the general public should be something to strive for.

blendo• 6 years ago

From p28 of the slide deck:

“Go outside - sunlight is the best disinfectant”

fma3• 6 years ago

FWIW, Open Air Treatment was used to fight the 1918 flu pandemic. But I think culturally, we (Americans at least) love our HVAC.

"A combination of fresh air, sunlight, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff. "

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/

sn92• 6 years ago

This analysis seems largely correct but for one thing, the author assumes that people who contract the virus will develop immunity that lasts long enough to bend the exponential growth curve as herd immunity develops.

(The curve will slow for other reasons as a sufficient number of people get infected such that there just aren't enough people who haven't been infected to be newly infected.)

I didn't see a source for that --- it seemed like an assumption --- and everything I've read suggests that this is a major unknown at the moment.

It's possible the author has a source that was not included. Either way, the author should either include the source or more explicitly take describe the epistemic status of that hypothesis and work through the consequences of it not being true.

chme• 6 years ago

This analysis seems largely correct but for one thing, the author assumes that people who contract the virus will develop immunity that lasts long enough to bend the exponential growth curve as herd immunity develops.

I am not a medical professional, but I would have assumed that the body develops a immunity because otherwise why would they search for a vaccine?

sn92• 6 years ago

I guess I was being overly broad. I'm not an immunologist or anything.

I was thinking more of the kind of immunity one gets for something like chicken pox, where one childhood infection basically protects you for life, vs something like the seasonal flu which you can get again and again.

Now I don't know if the reason you keep getting the flu is because it mutates more rapidly than the chicken pox virus and you still remain immune to the particular strain you got infected with or if that initial immunity weakens over time.

Maybe someone better informed can chime in.

mecit• 6 years ago

Hi, can anyone tell me, if taken Quercetin have negative effects for people who have under funktion of thyroid ?

How to fight the coronavirus SARS-CoV-2 and its disease, Covid-19 [pdf]

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