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Roman7201
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I'm new here. I'm not sure if I posted correctly earlier, please help me know how to put my posts in view of members. the following is a pasted copy of my post. Btw, I'm not selling anything, not looking for investors, simply looking to see if anyone cares to help me open source an answer to Covid 19.

If Facebook can unite people against a common cause I'm hoping for shock and awe with the response from members of an organization like this. I'm new here, I know I have no credentials, no reputation, no previous posts to review (as they were deleted accidentally by moderators). If you can, for but a moment, disregard any skepticism and hear me out. I have been on a search for a man portable air sterilization unit capable for destroying everything but spores and prions. I'm working with a lead member of an infectious disease emergency response unit on a design as nothing man portable exists to date. I'm tired of the nonresponse from all the day drinking engineers during these crazy times.....I'm ready to open source the concept. I'm ready to simply call on folks such as your selves and see what we can do together. I no longer care about even protecting the idea. I've spent months trying to sift through all the conflicting information regarding patents, verification processes, Covid rapid response grants...... I'm over it. I don't care about profits, I don't care about recognition (although it would be pretty cool to make this organization a household name should we pull this off), I care about my friends, my family, my community.... I care about the look in the eyes of the first responder I'm working with when he talks about the limitations of his gear walking into a village in Africa to try and stave off an Ebola outbreak, the true concern he has when expressing his fears pleading that we all stay home in quarantine due to something as simple as Covid 19, I care that if there is anything that I could do to eliminate the possibility of another Spanish flue.... that I did what I could. Many companies are working on this issue. They are failing in one way or another. Either the units are too large, too expensive, to destructive to the air and recipients, to unreliable due to complexity, or too vaporware to ever be practical. I've researched everything from UV light, microwave tech, right down to supersaturation filtration of pneumatic systems. I had lots of motivation. I had a family. I lost them to Covid (I don't care to go into details). Now I have something to volley back at this issue. I'm happy to provide research in detail but, simply put, heat is the answer. Most folks are trying to heat and then cool breathing air. I'll spare details but its impractical save one method using literally ancient tech. I need engineers that are proficient in manufacturing novel designs of screw pumps or in a pinch we can use scroll pumps. My hopes are to create something the size of a Pringles can that is plug and play with current 3m ppe products all agencies are currently provided with. I wish to hear if there is any enthusiasm from this community before I lay out the very simple concept my design uses. I'll actually be dissapointed if no one figures it out simply based on what I said I'd need and the fact it utilizes some of the oldest human tech known. If there is sufficent enthusiasm I would appreciate any input as to the appropriate way to proceed in which we can protect the concept from those who would bury it, manage to open source the idea so as to expedite the chance for its optimization via world input and accessibility, and even make known the association of this organization with it's manifestation from vaporware into something universally shelved. My design does not change the composition of the air it sterilizes, it does not require very much power and could utilize a few small batteries if not be turned by hand worst case, it is versital with its modular design and can be scaled up to commercial capacity with ease. I know this all sounds too good to be true. But, if there is interest from this community in open sourcing the concept, I swear it will take less than a few sentences to convince you its real and why my partner says it is the holy grail they have always wished for in the world of infectious disease response units. This is one of those times you are going to feel stupid for not having thought of it first. Please respond and help me gauge if this is the appropriate platform for this endeavour.
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by eca
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CommunityBiosecurityCOVID-19 pandemic
Frontpage

People have been saying all kinds of wild stuff about the new coronavirus. I work in biosecurity and have been following the outbreak since the beginning. What follows is my best attempt to communicate what we know about the virus, and how to prepare, with my family and friends. I thought I would share in case others have been looking for a similar document.

This is *NOT* intended to be a detailed, rigorous justification of the preparation measures I've outlined, nor an authoritative statement on the best current estimates for epidemiological parameters. Instead, I try to be as straightforward as possible, cite only the action-relevant details, and align with the best recommendations I've heard from the EA biosecurity community as well as experts writ large.

Caveats aside, I'd be interested in feedback on this purpose, including whether I am missing sensible prep measures, have the right tone for sharing widely, or am wrong about the facts. I'm happy to provide more technical justification in comments.

Here is the draft. I'll be updating it as we have more info and I have more time to include sources, so go there for the most recent version. The first draft is included below for convenience.

If you'd like, please feel free to copy, modify, etc and share with your own family.

Coronavirus in brief (work in progress)

Bottom Line.

  • Coronavirus is significantly worse than the flu, but not the zombie apocalypse. No need to panic, but it probably makes sense to prepare.
  • It is going to affect day-to-day-life in western countries, including the U.S.
  • You and your family will probably face personal risk of illness by the end of the year.
  • You can prepare by
    • Stocking ~1 month of nonperishable food and other necessities, and 3 months of medications.
    • Relocating away from dense cities and/or shifting to working from home, if possible.
    • Learning how to properly wash your hands, and practicing not touching your face.
    • Avoiding travel after March of this year, and/or planning with cancellation option.
    • Making plans to care for and protect the elderly from exposure to the virus.
    • Buying and carrying hand sanitizer, and using it frequently (every 30 min outside your home, before you eat or touch your face).
    • Wiping commonly contacted items (phone, keyboard, headphones etc) down with disinfectant regularly.
    • Avoiding crowded places (e.g. concerts, subways, theatres, buses, airports etc) without protection.
    • For essential travel, buying N95 respirators, if you can, and learning how to use them, including shaving facial hair.

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~

What does the virus do?

  • The virus causes coughing, sneezing, fever, pneumonia, and in severe cases kidney failure and death.
  • 80% of cases are relatively mild. The rest look like moderate to severe pneumonia.
  • Approximately 1% of people who catch the virus die.
  • After symptoms show, it takes 3 weeks - 1 month for severe cases to resolve.
  • Risk is much higher for people over 40.
  • Children appear to be relatively unaffected.
  • Men may be twice as susceptible as women, although it is too early to tell with confidence.
  • Immunity may not last long, and no-one has it to start with.

Where is the virus now (Feb 28)?

  • 80,000+ cases worldwide, most in China. 2,800+ deaths.
  • 23 countries have more than 10 cases outside of China.
  • Japan, Iran, Italy, and South Korea all had an exponential growth of cases from 10s to 100s in less than a week.
  • 60 cases in the U.S. 1 case, in Northern California, is likely the first spread without link to China, suggesting the virus is spreading undetected in the United States.

What do we know about the virus?

  • It likely arose from a crossover, or “zoonosis” from animals in China, sometime in late November early december of 2019.
  • It is most closely related to a virus called SARS which caused a small epidemic in 2002. It is also related to viruses that cause the common cold.

How does the virus spread?

  • Probably similarly to the flu. Being within 6 feet of a cough or sneeze, touching a surface that has been coughed on and then touching your face, or eating food that has been coughed on are all ways to spread the virus.
  • Relatively quickly. Approximately doubling the number of infected people every week.
  • The virus can probably survive on many types of surfaces for 2-7 days.
  • Some people who are infectious and can spread the virus do not show visible symptoms.
  • It takes ~5 days for symptoms to develop.

Can we treat it?

  • Not right now. No vaccine or approved medical countermeasure.
  • Supportive care like mechanical ventilation can significantly decrease risk of death if ICU rooms are available.
  • An antiviral, called remdesivir, is in clinical trials and shows some signs of efficacy.
  • Historical timelines for new drug / vaccine rollout suggest mass availability in 2021.

Shouldn’t I be more worried about the flu?

  • No. This is worse.
  • The flu kills 0.1% of infected people. This kills ~1%. That is 10X worse.
  • The coronavirus spreads a little faster than the flu.
  • You have some natural immunity to flu even though each season the strain is different. You probably have no immunity against this coronavirus.
  • We have a reliable vaccine against seasonal flu. We will not have a vaccine or effective treatment for coronavirus for some time.
  • Seasonal flu is very well characterized and understood. This virus is still under intensive study, and all the numbers I give have uncertainty, which means that it may be worse than our best guess. Long-term effects of catching the virus are unknown.

How can I think about my and my family’s risk?

  • Look at these charts for risk of death by age group.
  • Consider risk factors (source) which make the disease more dangerous, such as cardiovascular disease, diabetes, lung conditions + smoking, high blood pressure, and cancer.
  • Think about the population density of places you go to regularly. Ask yourself: “How many people have been here in the last week?”. Avoid places where that number is large, and/or take extra precautions.
  • Think about exponential spread. In the early stages, it will be doubling every week approximately. Really think about that- it means the risk is about 2X higher each week this continues. So it’s twice as safe to travel April 1 than April 7. And twice as safe on April 7 as the 14th. I find that extremely counter intuitive, and chances are you will too.

This all sounds crazy.

  • Yeah, it does. The info I’ve presented above makes this look like probably the worst pandemic since the 1918 Flu.
  • However, what’s presented above is an aggregation of facts and high-quality estimates from the scientific literature and expert recommendations, as best as I could find them.
  • The outlook presented here is largely shared by experts at: the CDC, the World Health Organization, the Harvard School of Public Health, the Johns Hopkins Center for Health Security, a biosecurity summit I recently attended, and by most of my colleagues in the biosecurity space.
  • Unfortunately, I think this is the world we live in.

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ElizabethBarnes21
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A friend pointed me to a study showing a high rate of chronic fatigue in SARS survivors (40%). I did a quick analysis of risk of chronic fatigue from getting COVID-19 (my best guess for young healthy people is ~2 weeks lost in expectation, but could be less than a day or more like 100 days on what seem like reasonable assumptions. ) https://docs.google.com/spreadsheets/d/1z2HTn72fM6saFH42VKs6lEdvooLJ6qaXwCrQ5YZ33Fk/edit?usp=sharing

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eca3
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Thank you for doing this. Has been on my list to look at for a while and am really glad we have numbers to work with.

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ElizabethBarnes6
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Big source of uncertainty is how long the fatigue persists - it wasn't entirely clear from the SARS paper whether that was the fraction of people who still had fatigue at 4 years, or people who'd had it at some point. Numbers are very different if it's a few months of fatigue vs rest of your life. Not sure I've split up the persistent CF vs temporary post-viral fatigue properly

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riceissa21
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Stocking ~1 month of nonperishable food and other necessities

Can you say more about why 1 month, instead of 2 weeks or 3 months or some other length of time?

Also can you say something about how to decide when to start eating from stored food, instead of going out to buy new food or ordering food online?

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eca7
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(Based on feedback I've updated the dock to say "at least 1 month")

This is largely me aggregating numbers from people I respect, and my views are in flux (e.g. above)

That said I think it makes sense on a couple of grounds:

  • if you are below the age of 40 and/or have a mild case, this is ~enough food to ride out a self quarantine after showing symptoms (recovery time estimates vary widely, but I've seen 14-30 days)
  • This is also enough food to self quarantine for the estimated incubation period (5-14 days, with some reports of 20-25 days) if you think you might have been exposed.

My model is that there may be short-term food shocks as well, e.g. runs on grocery stores after more cases are discovered in the U.S. 1 month seems like probably 4x what you need for one of those.

The way I view a food stock is to minimize the number of trips to high-risk places like grocery stores (as a young, healthy person). For people over 40 I don't much more food, say 4 months is crazy because it might make more sense to completely self-isolate with higher mortality risk.

As for when it makes sense to start eating stocks instead of grocery shopping or going out, its really hard to say. I personally plan on evaluating each public trip based on the logic of how many people are infected in my area * adjustment for undertesting * number of people who have been to the location I am visiting in the last week * ppe safety likelihood . A lot of magic is happening in the adjustment for undertesting bit. I expect this to mean that I avoid crowded restaurants and grocery stores at peak hours starting nowish. My guess is I will choose to start eating my food stocks and only making rare large restock trips somewhere in the 100s of cases in U.S. but I'm not sure.

Would welcome any other ways to think about this.

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Kirsten3
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The UK's National Health Service is advising that it's fine to continue accepting grocery deliveries even when you have coronavirus.

If you live somewhere with multiple grocery services and are somewhat flexible with what you eat, I don't predict needing a food stockpile, although it doesn't necessarily seem harmful to buy a few canned goods!

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eca13
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I definitely agree that its not a certainty you will need a food stock.

I think my view is stronger than "it doesn't necessarily seem harmful to", though. Chinese cities under quarantine have managed to continue food delivery, but my impression is that this relies on state-organized supply lines and infection control measures (like measuring temperature of food preparer and deliverer) which are harder to imagine being executed well in the U.S. I've also seen stories of people starving in their homes, but not from credible sources (and anecdotal besides).

I'll point out, as I think I did above, that viruses related to this one can survive on surfaces for a long time (1- 9 days, a source). This suggests that without knowledge that your delivery person and food preppers are healthy and/or correctly using PPE, you are taking a risk with each delivery.

My median case is that most people will be glad to have the amount of food I advised. It opens up a lot of risk-reducing options in an event like this.

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Simon_Jenkins20
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Thanks for taking the time to think and write about how we can reduce the risk of getting ill. I think it's fair to say that this advice is a bit more alarming than what other organizations are saying, like the Centers for Disease Control, the National Health Service, the World Health Organization, and the UK Foreign Office. For example, NHS.uk says that you don't need to self isolate unless you are feeling unwell and have been to one of the listed countries recently, and they also say that even if you are self isolating, it is ok to accept food drop-offs. This contrasts with the advice above.

Could you tell us a little about why you think these organisations aren't giving us the same advice as what you've written above? I'm finding it hard to give credence to this when the official picture is so much more subdued. I would guess that maybe there is a concern about creating hysteria or pressures on supplies of resources, but it would be good to know what you think.

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eca10
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Yeah, its an obvious tension. I'm not sure I can satisfactorily resolve it from the perspective of appealing to authority. My advice is based on first principles and aggregating the thoughts of other people who are primarily thinking from first principles. The first principle argument goes like this:

1. It is very unlikely that this disease will be contained in western countries. The CDC apparently agrees with this for the United States.

2. Medical countermeasures are unlikely to be widely available this year. There is some chance that the virus will struggle to transmit in warm weather but this is not high enough to be comfortable.

3. This means the virus is going to spread. Both models and reference class forecasting against diseases with similar R0 suggest that a large fraction of the population will be infected before treatments arrive, e.g. Harvard School of Public Health's Marc Lipsitch citing 40-70% of population infected.

4. All of this is uncertain, and maybe we are saved by something we haven't thought of, but given both the median and upper tail scenarios, it makes sense to be prepared. This is not only good for you but also a prosocial action which will flatten the case curve, reduce load on the hospital system, and protect elderly and vulnerable people in your contacts.


So why haven't they made recommendations to prepare? Not sure. In the SARS outbreak, I don't believe CDC made recs to prepare, but this Senior CDC official guy reports in his book to have called his wife during the early part of the outbreak (when it looked really bad) to get enough food to stay home for a few months.

The CDC is also really botching testing by all accounts, including both screwing up the reagents so the test is inconclusive and refusing to test people who pretty obviously have the disease. Not to mention the increasing politicization of the virus as well as what appear to be outright gag-orders on US. public health officials.

My model of the world says that when things get bad enough for the CDC to have the political will to announce needed prep measures, it will be well after the time where it made sense to actually prepare (and may lead to runs on grocery stores etc). I don't know how the NHS works so maybe you'd expect them to be right on the money?

I should say that this advice is largely directed at folks in the U.S., so haven't thought through the U.K. situation fully.

That's probably not satisfying. I wonder, though, if anyone could articulate what the (CDC, NHS etcs) first principles argument is for not taking these largely prosocial steps (with exception of N95 which I tried to emphasize is only for extenuating circumstances) to prepare?

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mvolz5
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Re: the UK response, the UK distributed the following guidance to schools to be passed on to parents on February 26th (since updated more extensively). The original guidance was first published on Jan 23:

https://publichealthmatters.blog.gov.uk/2020/01/23/wuhan-novel-coronavirus-what-you-need-to-know

They've also already set up isolation pods in some hospitals (i.e. St. Mary's in London, John Radcliffe in Oxford), and are planning to expand this to every hospital with an A&E: https://metro.co.uk/2020/02/29/coronavirus-isolation-pods-installed-every-ae-unit-uk-sees-confirmed-cases-12325487/

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Jess Kinchen Smith3
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3. This means the virus is going to spread. Both models and reference class forecasting against diseases with similar R0 suggest that a large fraction of the population will be infected before treatments arrive, e.g. Harvard School of Public Health's Marc Lipsitch citing 40-70% of population infected.

Do you have any thoughts on the Metaculus estimate?

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eca1
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I think it is a little low but right order of magnitude (lower when you asked this question).

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Lukas Trötzmüller🔸15
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You mention exponential spread, working from home, and avoiding travelling after March.

But what is the endgame here? How long do we need to stop travelling for? Should we apply these measures, as far as possible, starting in April and keep them up until a vaccine is available in 1-2 years? Will the number of cases level off eventually?

I assume there is no scientific consensus on these questions. If the virus is here to stay, then there might be little value in adopting extreme individual precautions for just one or two months. Afterwards, when you stop taking these extreme measures, there will be an even higher risk of infection. Under these circumstances, it seems better to adopt measures that can plausibly be sustained for one year or even longer.

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saulius14
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I know next to nothing about this stuff, but I was thinking that it would be good to at least avoid the virus in the period when there might not be enough hospital beds and the health system is very overwhelmed. So it might make sense to take more extreme precautions in that time.

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Kirsten6
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Chief Medical Advisor in the UK, Professor Chris Whitty, "told MPs on the health and social care committee that half of all coronavirus cases in the UK are most likely to occur in just a three-week period, with 95% of them over a nine-week period."

https://www.bbc.co.uk/news/uk-51759602

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eca7
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All good questions. I don't have great answers, but here are a few things.

The disease CAN burn itself out:

When the density of susceptible individuals is low enough (either because many are recovered and immune or because of social distancing) the disease is predicted to burn out. Google "SIR model" for more info. It is really hard to guess when this will be, obviously. It does look like the social distancing measures taken by China, even after alleged number fudging and diagnostic shortages, made the disease spread much more slowly (and MAYBE would have burned it out if China was completely isolated from the world- very dubious though)

Re extreme individual precautions and the long game

I don't expect this to blow over in 1-2 months, and I wouldn't advocate that view to anyone else. The recommendations I made are intended to be risk-reducing in the medium- long term as well as the short term. If you have food stock for 1+ month, then you can choose the safest time to go to the grocery store, or leave your food delivery for 10 days to sanitize, and thereby reduce your risk. Likewise, each time you avoid travel or work from home is reduced risk.

You definitely do want to avoid sheltering in place, only to desperately need food or other supplies later when the risk is higher. But as I said above, having food stocks and taken other precautions means you have more options.

It's also not the case that you will always be at higher risk if you wait. While the exponential doubling is a good approximation in the short term (and important IMO for people to wrap their heads around), things like safe delivery infrastructure, overall proficiency treating the disease, and availability of medical countermeasures like remdesivir will probably improve in the medium term.


I'm curious what you're thinking of when you say "adopt measures that can plausibly be sustained for one year or even longer"?

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Lukas Trötzmüller🔸5
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Thanks for the explanation on extreme individual precautions, that made things clearer.

I'm curious what you're thinking of when you say "adopt measures that can plausibly be sustained for one year or even longer"?

I'm thinking of simple, low-cost changes to habits and my living environment that reduce chances of infection with Coronavirus and other illnesses. For example: improving personal hygiene practices (how to handle laundry, when to desinfect hands, how to keep the kitchen super clean, desinfecting electronic devices), changing workout times (to hit the gym at times when it's empty), invite my friends to use hand sanitizer when eating together, going to smaller events instead of mass gatherings, keeping a 1-month food supply at home.

These would be easy to sustain for a year or even longer. On the other hand, "not leaving the house" or "cancel all events" incurs significant cost, so I would not be willing to do that for an entire year unless the risk was very high. (Of course, the risk might become "very high" if >10% of the population becomes infected).

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eca3
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This makes sense. To say the obvious, it is sensible for everyone to judge their risk individually and adjust precautions as we have more info. A particularly large factor is your age and comorbid conditions, as well as those of people who you would have the opportunity to infect (who may have higher risk and lower risk tolerance).

I think it is likely enough that most people will consider the risk "very high" at some point before we get a treatment to recommend preparing for that eventuality.

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Tsunayoshi2
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There will not be a vaccine soon, but anti-viral drugs are currently in an FDA approved Phase 3 trial, and from what I have heard could be both approved and available in May.

There is evidence that higher temperatures will limit the spread: Africa has so far been mostly spared, and warm places like Singapore are doing much better than Japan or South Korea.

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Sean_o_h11
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Too early to have confidence on higher temperatures limiting spread IMO (although some reason to hope, certainly); cases in japan are only <2.5x higher than singapore (234 vs 102 last I saw, and IIRC it got to japan slightly earlier); surveillance and testing in African nations unlikely to be as extensive as e.g. Japan/SK; likely less volume of travel going through african nations than some of the Asian hubs.

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Lukas_Gloor3
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Singapore also ranked lower on lists published in late January on "most at risk countries" compared to Japan and Korea. Thailand (first on that list) would be a better example for a warm location being hit less badly than predicted. It reported a lot of cases initially, but it indeed seems like the virus hasn't spread as much as in some other locations. Warmth could be the decisive factor, but there might also be other reasons.

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Sean_o_h4
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The information Singapore is gathering, collating and making available is fascinating.

https://twitter.com/RyutaroUchiyama/status/1234616723615166465

Singapore is also one of the nations that appears to be dealing most effectively with their coronavirus outbreak (rate of new cases is comparatively low). The country also had a very effective response to SARS in 2003. (Although by Western standards the extent to which they gather information on the population might be uncomfortable).

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Lukas_Gloor4
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I just read (surprisingly to me) that Thailand ranks extremely high in pandemic preparedness and early detection. This makes me downshift the warmth hypothesis a bit.

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holychowder3
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Where did you read this?

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Lukas_Gloor4
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I don't remember the exact source, sorry.

FWIW I now think that warm conditions very likely do slow down transmissions by a lot. Mostly because there are many cold countries where outbreaks became uncontrollable quickly, and this happened nowhere in a hot country so far.

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Steven Byrnes9
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This blog post suggests (based on Google Search Trends) that other coronavirus infections have typically gone down steadily over the course of March and April. (Presumably the data is dominated by the northern hemisphere.)

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Steven Byrnes3
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Update: this blog post is a much better-informed discussion of warm weather.

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Sean_o_h11
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FYI, sequencing from the Snohomish county washington cases suggest there has been cryptic transmission in washington state for the last 3-6 weeks, and potentially a substantial outbreak (a few hundred cases) ongoing in washington state (likely missed because of the focus on travellers returning from China).

https://twitter.com/trvrb/status/1233970271318503426

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eca6
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Troubling indeed. My guess is this will not be the only cryptic seed case we discover over the next few weeks, unfortunately.

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Sean_o_h5
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6 deaths now reported in Washington State is also consistent with the outbreak there being substantially larger than the 14 cases currently recorded.

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ElizabethBarnes6
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Although I believe all the deaths were at a nursing home, where you'd expect a much higher death rate

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otter-man10
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Thank you, your text is very on point and I found it very helpful but couldn't share with my family and most of my friends, since they don't read in english.

So I translated it to russian and made a github repo for people to translate it to other languages.

https://github.com/Otter-man/COVID-19-brief-by-eca-translation

Will keep up with the changes in text if they come.

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Jacob_Hilton10
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Thank you for writing this.

Please could you add to the top of the Google doc:

  • When it was last updated (Edit: I see this is at the bottom of each page but I think the top of the doc might be better)
  • A little about your expertise and your process for aggregating information, like you have included in the post but perhaps with more specific details about your work, if you are comfortable sharing that

This would make it easier for people to judge for themselves how much weight to put on your advice.

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eca3
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Added my bio at the bottom of the doc, want to keep the bottom line first and not disrupt the flow for my family and friends, who this doc is primarily geared towards (and already know who I am).

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matthew.vandermerwe9
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Thanks for writing this!

In the early stages, it will be doubling every week approximately

I’d be interested in pointers on how to interpret all the evidence on this:

  • until Jan 4: (Li et al) find 7.4 days
  • Jan 16–Jan 30: (Cheng & Shan) find ~1.8 days in China, before quarantine measures start kicking in.
  • Jan 20–Feb 6: (Muniz-Rodriguez et al) find 2.5 for Hubei [95%: 2.4–2.7], and other provinces ranging from 1.5 to 3.0 (with much wider error bars).
  • Eyeballing the most recent charts:
  • I’ve also seen it suggested that the outside-China growth might be inflated due to ‘catch up’ from slow roll-out of testing.

Altogether, what is our best guess, and what evidence should we be looking out?

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eca7
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Yeah 7 days was intended to be a reasonable conservative guess. My actual guess is closer to 5.5. As you point out there are testing artifacts that point in both directions. Within china, test shortages, outside of china, slower testing roll out. I'm not an epi expert but I think the gold standard here would be to do something like time-series immune surveillance, where you randomly sample a large group of people from a pop and test them for an antibody reaction and/ or viral RNA, then do the same at intervals later. My guess is this is challenging because of the number of samples required to detect in most places, but maybe if you did this somewhere like italy you could pull it off (you get the population abundance as well).

Its also the case that this isn't a fixed number, and you expect it to vary from population to population based on fraction of asymptomatic cases, social distancing, pop density etc. So I'm not sure we'll get a better number than 2-8 days in the short term, which is disconcerting given how big of a difference it makes to risk forecasts.

I'd love to hear from anyone with more epi expertise!

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[anonymous]7
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I dont know whether this is the right place to post it: But why are we caring about the risk of the coronavirus for us as EAs? Why are people thinking about canceling EAG or other local meetings?

(are we caring for selfish reasons or because this indirectly reduces the extent the virus spreads?

If we believe that a young healthy person has a 0.5 percent of doing from the virus and 5 percent of the world will be infected in expectation and all these actions (cancellation of EA events) reduces my chance of being infected by 5 percent:

(This seems super optimistic as most of the attendees wont change other behavior just because EA events are cancelled. They will just go to other events.)
then we are talking about roughly 10 micromorts. It seems like that the EA events might be worth the cost. If we want to reduce micromorts telling EAs to stop drinking alcohol seems like a better idea (1 micromort =0.5 liter wine) than changing the way we spend our time because of the coronavirus.

I am interested to hear why this argument is wrong

[This comment is no longer endorsed by its author]Reply
Sean_o_h11
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Datapoint (my general considerations/thought processes around this, feeding into case-by case decisions about my own activities rather than a blanket decision): I am (young healthy male) pretty unconcerned personally about risk to myself individually; but quite concerned about becoming a vector for spread (especially to older or less robust people). While I have a higher-than-some-people personal risk tolerance, I don't like the idea of imposing my risk tolerance on others. Particularly when travelling/fatigued/jetlagged, I'm not 100% sure I trust my own attention to detail quite enough on reliably taking all the necessary steps carefully enough, so this makes me a little hesitant to take on long-haul travel to international events (I also work/interact with older colleagues reasonably regularly, and am concerned re: the indirect activities of my actions on them).

I would also like to see society-level actions that reduce disease spread, and I intuitively feel that EA should be a participant in such actions, given it takes such risks seriously as a community.

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eca6
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Yeah, its a good point.

On personal risk: a calculation I am stealing from a friend (who I believe does not want credit) suggests a young person's risk after catching is around 1000 micromorts (based on ~.1% young healthy person's IFR). This is doubling or tripling your risk of dying in a given year. See also Beth's comment about chronic fatigue, and note the unknown immunity period etc. I'm not super psyched about those personal risks (if I were to catch it).

This stands if you take best guess if you take the median parameters for things. It seems like if we were to actually propagate uncertainty over the values of parameters like per-age IFR, long-term follow-on conditions like chronic fatigue, infection risk in location of origin, infection risk in San Francisco, infection risk from domestic and international air travel, the posterior distribution looks pretty different. In particular, I'd guess a mildly risk averse (say 75th percentile) decision point would say that cancelling EAG saves a fair bit more than 10 micromorts per person, given how bad current information is.

Other random things:

-SF seems a likely place for an early outbreak given community transmission was first documented in Nor Cal and east asia travel links

-There might be some signalling benefit

-EAs probably have higher risk of infecting other EAs outside the conference

-Conference attendees are generally young but some may be at much higher personal risk because of age or comorbidities.

I don't know if these points are conclusive. On a meta-level, my doc is really intended for friends and family and is not trying to weigh in on this point.

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Linch6
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In addition to critical medication, I think it's plausibly a good idea to stock up on significantly more than one month of handwashing soap (and maybe other soap too). (Tentatively suggesting 1-2 years).

Reasoning:

1. I'm not particularly worried about large-scale cuts for goods that have widespread availability (eg, food) and more worried about supply chain cuts for things that are relatively specific to coronavirus and other disaster-like scenarios.

2. (In America at least) Facemasks have been sold out for consumer use for several weeks; hand sanitizer has been somewhere between sold out and 10x more expensive in the last week. So some evidence that this will extend to other products.

3. Usage patterns are likely to change. For example I wouldn't be surprised if people (including EAs) use 4-6x less hand soap than they should.

4. If you anticipate increasing usage rates in the coming months, it's more prosocial to buy them now rather than in April/May so markets, factories, etc., have a chance to respond. (I find stockpiling masks much more iffy because 1. I think it's plausible that it'd be hard to repurpose other factories for facemasks, whereas for hand sanitizer and soap it's not hard to imagine relatively fast production changes, and 2. Outside of Asia, normal consumer usage of masks is pretty low so a sudden spike in demand might be harder to prepare for so it's better to leave them for medical service provdiers).

5. Selfishly, the cost of doing this is very low (you can always spend down your soap if this turns out to be a nothing-burger), while the potential benefits are large.

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Will Bradshaw6
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Today I learned that my mother, while largely ignoring my suggestions to stock up on food, has quietly gone and bought lots of hand soap and basic medicines, both of which I didn't think about until very recently. Interesting example of practical rationality at work.

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Liam_Donovan1
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What was her rationale for prioritizing hand soap over food?

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gavintaylor3
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In terms of hand sanitiser - in Brazil I've also found hand sanitiser is sold out or very expensive. However, here it is common to use 70% ethanol for household cleaning at it is possible to buy this in gel form as well, which is still well stocked and at normal prices. I expect this will work just as well for sanitisation. Would it be worth considering as an alternative if proper hand sanitiser is unavailable or for people on a budget (maybe it would leave you hands a bit dryer)?

I don't recall seeing this product while living in Australia or Sweden, so I'm not sure how widely available it is. Here is a link to the last pack I bought, although there are many brands available in Brazil.

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eca3
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This is a good idea. I'll add a recommendation on something to this effect in the doc. Thanks!

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Milan Griffes5
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EA Global SF 2020 won't be held this month: https://www.eaglobal.org/coronavirus (a)


Based on our best understanding of the risks from COVID-19, and after seeking the advice of experts in public health, we have sadly decided not to hold EA Global: San Francisco this month. We will update you as soon as possible about whether the event will be postponed to later in the year, or whether it will be canceled.
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coffeetable5
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I've seen references to - but am having trouble finding concrete research on - the typical lifecycle of flu pandemics. Eyeballing case counts in the UK/US, 1918 and 2009 both had two waves of 4-8 weeks each. Both the relatively short duration of each wave and the likelihood of a second wave seem like Very Important Things To Know, but I'd like something to cite before shooting my mouth off. Have you come across any good resources on this?

The best paper I've found so far is this review of the two 2009 waves in the US , but I'd really like something that compares pandemic lifecycles across time and across countries.

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Pawel Sysiak3
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„Think about the population density of places you go to regularly. Ask yourself: “How many people have been here in the last week?”. Avoid places where that number is large, and, take extra precautions.”

What do you consider a small/moderate/large numbers here? i.e. I go to a small exercises studio with ~200 weekly visitors. When this type of place starts being a high risk place.

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ianps3
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First, thank you very much for this post!

Having a pregnant wife, I am trying to find more about the risks to her and the child, but could only find:

Does anyone have better information about the impacts of Covid-19?

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eca2
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Hey ianps, sorry for the silence (really busy time for me). I just found an article suggesting that in 4 tracked instance of infection in pregnant women, both the mother and baby have been fine, and the virus was not transmitted to the child. https://www.frontiersin.org/articles/10.3389/fped.2020.00104/full.

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ianps1
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Thanks for replying, much appreciated! I have seen a bit more discussion on the topic in the news recently, I saw these two good articles:

(I though there was a very good BBC article as well, but could not find it now).


PS: in general, thank you again for your post. I was able to buy the essentials much before everyone ran to the supermarkets this last week.

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Roman7201
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I'm new here. I'm not sure if I posted correctly earlier, please help me know how to put my posts in view of members. the following is a pasted copy of my post. Btw, I'm not selling anything, not looking for investors, simply looking to see if anyone cares to help me open source an answer to Covid 19.

If Facebook can unite people against a common cause I'm hoping for shock and awe with the response from members of an organization like this. I'm new here, I know I have no credentials, no reputation, no previous posts to review (as they were deleted accidentally by moderators). If you can, for but a moment, disregard any skepticism and hear me out. I have been on a search for a man portable air sterilization unit capable for destroying everything but spores and prions. I'm working with a lead member of an infectious disease emergency response unit on a design as nothing man portable exists to date. I'm tired of the nonresponse from all the day drinking engineers during these crazy times.....I'm ready to open source the concept. I'm ready to simply call on folks such as your selves and see what we can do together. I no longer care about even protecting the idea. I've spent months trying to sift through all the conflicting information regarding patents, verification processes, Covid rapid response grants...... I'm over it. I don't care about profits, I don't care about recognition (although it would be pretty cool to make this organization a household name should we pull this off), I care about my friends, my family, my community.... I care about the look in the eyes of the first responder I'm working with when he talks about the limitations of his gear walking into a village in Africa to try and stave off an Ebola outbreak, the true concern he has when expressing his fears pleading that we all stay home in quarantine due to something as simple as Covid 19, I care that if there is anything that I could do to eliminate the possibility of another Spanish flue.... that I did what I could. Many companies are working on this issue. They are failing in one way or another. Either the units are too large, too expensive, to destructive to the air and recipients, to unreliable due to complexity, or too vaporware to ever be practical. I've researched everything from UV light, microwave tech, right down to supersaturation filtration of pneumatic systems. I had lots of motivation. I had a family. I lost them to Covid (I don't care to go into details). Now I have something to volley back at this issue. I'm happy to provide research in detail but, simply put, heat is the answer. Most folks are trying to heat and then cool breathing air. I'll spare details but its impractical save one method using literally ancient tech. I need engineers that are proficient in manufacturing novel designs of screw pumps or in a pinch we can use scroll pumps. My hopes are to create something the size of a Pringles can that is plug and play with current 3m ppe products all agencies are currently provided with. I wish to hear if there is any enthusiasm from this community before I lay out the very simple concept my design uses. I'll actually be dissapointed if no one figures it out simply based on what I said I'd need and the fact it utilizes some of the oldest human tech known. If there is sufficent enthusiasm I would appreciate any input as to the appropriate way to proceed in which we can protect the concept from those who would bury it, manage to open source the idea so as to expedite the chance for its optimization via world input and accessibility, and even make known the association of this organization with it's manifestation from vaporware into something universally shelved. My design does not change the composition of the air it sterilizes, it does not require very much power and could utilize a few small batteries if not be turned by hand worst case, it is versital with its modular design and can be scaled up to commercial capacity with ease. I know this all sounds too good to be true. But, if there is interest from this community in open sourcing the concept, I swear it will take less than a few sentences to convince you its real and why my partner says it is the holy grail they have always wished for in the world of infectious disease response units. This is one of those times you are going to feel stupid for not having thought of it first. Please respond and help me gauge if this is the appropriate platform for this endeavour.
Personal Blog

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eca1
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As anyone who have checked the google doc recently knows already, I haven't been maintaining it. It is now so out of data I consider it to be doing more harm then good, and have killed the link. I think most people have found better resources by now, anyway.

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RomeoStevens1
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Touchscreen styluses for all those public touchscreens.

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gavintaylor1
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and practicing not touching your face.

How important is it to avoid touching your face if you are also washing your hands regularly?

As a practical point, I think this is somewhat hard to avoid for some people. I feel I touch my face more than wanted and even though this occurs in social situations where it may be mildly unacceptable, I have problems breaking the habit (I do have weak symptoms of body-focussed repetitive behaviour disorder and it's probably related to this). I don't think the somewhat abstract threat of reducing infection risk will be enough to stop me touching my face much as I mostly do this without think about it, although that may change when the virus spreads to my region and I feel under more personal threat.

This made me recall the Pavlok, which is a wrist-band that uses aversion therapy (vibrations and electric shocks) to break bad habits like nail biting. Although I cant find this described as a use case on their website, I suspect it could also be used to break a face touching habit quickly. Alternatively, you can probably get most of the aversion from snapping a rubber band on your wrist whenever you notice you're touching your face.

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gavintaylor3
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I was happy to see that I'm apparently not the only person who touches their face a lot and the BBC noted that many people even touch their face while giving official advice not to:

https://www.bbc.com/news/av/uk-51879695/coronavirus-why-we-touch-our-faces-and-how-to-stop-it

The main tips for how to avoid face touching were:

-Wear glasses on your face so you touch them instead.

-Make an effort to keep your hands clasped most of the time, so that touching your face is more of a conscious act that you'll notice and and can choose to stop.

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eca2
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If you are in public it seems very important? If you touch something that someone infected coughed on in last 2-9 days and then touch your face that's a likely infection event. Washing your hand "resets the clock" on the surfaces you've touched, but doesn't protect you if you touch something new.

Its obviously ok to touch your face right after thorough hand cleaning- I practice hand sanitizing before I feel the need to touch my face. I think it is really worth practicing that habit, keeping hand sanitizer on you at all time etc, if you can.

You could also wear latex gloves as a reminder not to touch your face (works for some people)

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Jess Kinchen Smith11
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your face

To clarify- is it face or mucous membranes? I've seen 'face' everywhere, and I can't really understand how touching my forehead would infect. Thanks!

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eca4
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Face, sort of. The major vector of infection is getting virus into your noes/ mouth/ eyes etc, not really by touching your forehead. But instrumentally, I think full face is what makes sense here. Once you have touched your forehead, your face is not a clean zone anymore; when you go to bed and put your face on your pillow, you'll (possibly) be transferring virus there. Likewise once you thoroughly wash your hands once home and let yourself rub your face, you could be recontaminating your hands and spreading the virus from your forehead to some mucus membranes. Even if this wasn't the case, I think it is also easier to self control a "no-face" rule than make a judgement about exactly where your mucus membranes are every time you have a face itch (that itchy place near my eye is still skin, right?)

My first also implies avoiding touching your hair, but I haven't followed up on this (I avoid it myself and think it would be prudent in general but don't know what standard practice is among e.g. health care workers)

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Max_Carpendale2
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I get frequent muscle pain in my head and face and I normally believe that by massaging them. I've started to use use a part of my shirt or maybe another object as a barrier to let me do this without touching my hands to my face, but I guess my shirt could also pick up some of the virus, and I could be infected that way. Not sure what my other options are.

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eca4
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Carry hand sanitizer and do a quick hand sanitization before you touch your face?

Clothes can pick up virus but are much less likely to come into contact with surfaces then your fingers.

You could also keep a pocket full of latex gloves and either wear all the time then remove (carefully without contaminating your hand) before touching your face, or carefully putting on before touching your face.

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topazann0
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The way that this is a sociopolitical problem is because the virus exposes so many problems that we have today in our society and media. I understand that the media is just trying to inform us, but they are taking it into a whole other level. Many of my family members are extremely worried about it, and this is because they look into unreliable sources. Furthermore, many people believe that the virus has spread to places in which it hasn’t. Secondly, the amount of sheer racism that is being directed towards China is sad. A stereotype in which states that Chinese people follow a certain diet is wrong, and they shouldn’t be judged.

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