Most people will have a mild form of the disease and get better without needing any special care. (ref)

In serious cases (ca. 12-30% of cases), the disease progresses to pneumonia within about a week, with symptoms including shortness of breath, rapid, shallow breathing, and a sharp or stabbing chest pain that gets worse with deep breathing or coughing. (ref)

How to protect yourself and others from being infected

Reducing physical contact

As of late March 2020, many countries are in lockdown, and measures that might have seemed extreme just a few weeks ago are now regarded as crucial. But as a general rule, protecting yourself means avoiding contact with people who are infected, and avoiding infecting yourself after touching contaminated surfaces. The degree of risk is dependent on the number of people infected in your region, and the number of people you have contact with. As infection rates have been climbing, it has become more urgent to take precautions, including avoiding travelling long distances if not essential, and avoiding large crowds. It is safest to avoid physical contact with most other people, even if they do not appear sick, and not to shake hands or kiss. At any gatherings, ensure that everyone washes their hands or uses hand disinfectant at the entrance, and people should keep a distance from one another.

The safest way to avoid infection is to isolate yourself in one place, if feasible. If you are older or with a condition that makes you more vulnerable, and especially if there are cases near you, taking this precaution may be necessary to avoid putting your life at risk. This means stocking up with at least several weeks’ worth of extra food and supplies so that you can comfortably stay at home for an extended period if you need to, until the danger has lessened (e.g. drugs become available or effective measures taken make infections much less prevalent). Supplies should include non-perishable food, medicine (anything you regularly take, paracetamol, other flu remedies), vitamins (especially vitamin D for long periods indoors), soap, toilet paper, alcohol to disinfect, hand cream. Also include items that will make your stay indoors more pleasant, including your favourite food items.

If you live in an apartment building, an additional precaution you could consider taking to prevent airflow that may be contaminated – a factor in the spread of SARS in 2013 – is to seal vents and drains. More information in this slideshow.

The more we keep our distance, and the earlier we choose to do this, the more lives can be saved and the less suffering will be endured by the sick.

Washing hands and disinfecting surfaces

Very important, especially if you are not isolating yourself: wash your hands often, and do it carefully for at least 20 seconds. Hand sanitizer can help if you can’t find water and soap nearby, but it's not as effective. Disposable gloves are even better, but they need to be changed frequently.

Very important: avoid touching your face, especially your mouth, nose and eyes, without washing your hands first. Facial orifices are how the virus gets into the body - not through unbroken skin on your hands. Wearing gloves is useless if you touch your face with them. It’s not easy: a 2015 study found that participants touched their faces 23 times an hour. Some tips from NYT and HuffPost articles: 1. Use tissues, 2. Identify triggers and habits (nervousness, dry eyes) so you can stop them mentally or physically (e.g. keep eyes lubricated, wear glasses instead of contact lenses), 3. Keep your hands busy, touch something else (e.g. a stress ball), 4. Put up reminders, 5. Chill, practice meditation, mindfulness, intentional breathing.

Mobile phones are like a third hand that we hardly ever wash. Keep your phone disinfected by cleaning several times a day! There are a few options:

Wash it with soap and water if it is waterproof (IP67 or IP68). Use wet-wipes, screen cleaning wipes (so long as they are wet with alcohol and haven't dried out), or apply isopropyl alcohol or regular alcohol (ethanol) at a concentration of at least 70%. Use a UV lamp to sterilize it. Keep your phone in a ziplock bag if you need to use it in a contaminated environment (safely dispose of the bag afterwards).

Clean surfaces with a solution of either 70% isopropyl alcohol/ethanol or 0.5% hydrogen peroxide or 0.1% sodium hypochlorite bleach. For example: work surfaces, door handles, light switches, water faucets.

Face masks

There is now a clearer understanding of the effectiveness of surgical face masks and even simple face masks made of cloth in reducing transmission through droplets produced by coughing, sneezing and even talking, thereby protecting both the wearer and others. They are most effective in preventing an infected person transmitting to others, but they also reduce exposure to the wearer, and they can also help keep you from touching your face with your hands. Cloth masks can be disinfected and reused. This video by data scientist Jeremy Howard, explaining the usefulness of simple face masks, is highly recommended. See also these related links:

Jeremy Howard's Twitter thread: https://twitter.com/jeremyphoward/status/1242894378441506816

Link to the Czech story on how face masks have quickly become standard there, with tutorials on making your own mask: https://tiny.cc/masks4all

A list of scientific papers providing the evidence: http://tiny.cc/maskswork

A comparison of materials for effectiveness in blocking particles: https://smartairfilters.com/en/blog/best-materials-make-diy-face-mask-virus/

More detailed reflections on the Slate Star Codex blog: https://slatestarcodex.com/2020/03/23/face-masks-much-more-than-you-wanted-to-know/

Some key points worth noting:

Blocking transmission doesn't need to be perfect to steadily reduce the number of new cases and eventually cause the pandemic to fizzle out.

Infection isn't all or nothing: dose matters, and the body is better able to mount an immune response in time when exposed to less virus.

Large institutions like the WHO and others can be slow in updating their recommendations, including on the use of face masks, in response to new data.

Mask-wearing after lockdowns are relaxed may be the difference between "normal" life and repeated isolation/economic disruption.



See this piece by molecular and cell biologist Sui Huang of the Institute for Systems Biology, that makes a strong argument for the use of homemade masks, as well as this Twitter thread from Yale economics professor Jason Abaluck.

More sophisticated and effective respirators masks such as N95 (FFP2) and N100 (FFP3) create a seal around the mouth and nose. However, they are uncomfortable to wear for long periods. More importantly, highest priority must be given to healthcare workers, and as there are ongoing supply shortages, it is strongly recommended not to purchase them for personal use. More lives can be saved by far by ensuring that healthcare workers have the personal protection they need.

Maintaining a strong immune system

Getting enough sleep is important for keeping your body’s immune system in shape.

Deficiencies in some nutrients may have a negative effect on the immune system. A daily multi-vitamin or supplementation with individual nutrients can protect against this. In particular:

selenium intake due to low quantities in the local soil. There is evidence that selenium deficiency can affect the immune system, and that supplementation can improve immune function. ( Many people have lowintake due to low quantities in the local soil. There is evidence that selenium deficiency can affect the immune system, and that supplementation can improve immune function. ( ref ) In this case, it is recommended to either take a multi-vitamin or a daily selenium supplement or 2 Brazil nuts a day.

vitamin D deficiency can affect the immune system and that supplementation can protect against respiratory tract infections. There is no evidence that high doses provide any additional protection ( There is evidence thatdeficiency can affect the immune system and that supplementation can protect against respiratory tract infections. There is no evidence that high doses provide any additional protection ( ref 1 ref 2 ), though there is evidence that there are other beneficial effects unrelated to the coronavirus.

There is not yet conclusive evidence that high doses of vitamin C can help protect against viral infections, though trials are underway. It is still important to maintain adequate intake to keep the immune system healthy. ( ref

Zinc lozenges taken several times daily might have a prophylactic effect in addition to reducing symptoms - see section below. There is no conclusive evidence, though.

What to do if you become sick

If you suspect that you may have COVID-19, contact a healthcare professional. If you are tested positive for COVID-19 or suspect that you have it but have only mild symptoms (mild fever, cough) you should self-quarantine. If you have more serious symptoms (high fever, weakness, lethargy or shortness of breath) you should seek medical care. (ref) The most serious cases require immediate hospitalisation and mechanical ventilation.

If a person near you is experiencing respiratory distress, it is important while helping them to protect yourself and others nearby from being accidentally infected. Avoid “close contact”, which for healthcare exposures is defined as: a) being within approximately 2 metres of a person with COVID-19 for a prolonged period of time (such as caring for or visiting the patient, or sitting within 2 meters of the patient in a healthcare waiting area or room); or b) having unprotected direct contact with infectious secretions or excretions of the patient (e.g. being coughed on, touching used tissues with a bare hand). If you do not have adequate PPE (personal protective equipment), then if possible, you should remain a few meters away and call for medical help (and warn the first responders it is a potential coronavirus incident so they are adequately protected before approaching the person in need).

Treatments that may reduce symptoms and speed recovery, and that might make a critical difference if medical facilities are unable to care for all patients:

Chloroquine: chloroquine and its close derivative hydroxychloroquine may be helpful in treating the infection. ( There is good in vitro evidence ( ref ) and some evidence from new clinical trials thatand its close derivativemay be helpful in treating the infection. ( ref ) Chinese clinical trials (data not yet available as of 13 March) reported that patients treated showed better indicators on "abatement of fever, improvement of CT images of lungs, the percentage of patients who became negative in viral nucleic acid tests and the time they need to do so." ( ref 1 ref 2, ref 3 ) A report from a French clinical trial that has received a lot of attention (but which has also been criticised for its methodology) stated, "Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin." ( ref ) Clinical trials are currently underway to better determine the effectiveness of these drugs. A study from China reported on 31 March that hydroxychloroquine helped to speed the recovery of a small number of patients who were mildly ill from the coronavirus, and the illness only turned severe in patients in the control group . ref)

The two forms of chloroquine being used in trials are chloroquine phosphate (most common brand name Aralen) and hydroxychloroquine sulfate (most common brand name Plaquenil). The Chinese expert recommendation is a dosage of 2 x 500mg of chloroquine phosphate per day for 10 days. In the French trial mentioned above, all patients were proposed oral hydroxychloroquine sulfate 3 x 200 mg per day for 10 days. In South Korea, there are unconfirmed reports that they are significantly reducing the lethality of the coronavirus by prescribing 500 mg per day of chloroquine + zinc for 10 days (ref 1, ref 2).

These drugs are considered relatively safe. However, they can have toxic effects at levels not much higher than the therapeutic range, and there are rare cases of death when accidentally ingested by children or taken in large amounts by adults. Although they are not specifically approved for treatment of the coronavirus, doctors have been prescribing them off-label, and the FDA issued an emergency-use authorization. It is advisable that these drugs be taken under medical supervision, especially to rule out contraindications such as heart conditions, unless an emergency situation makes medical care unavailable. They are known to have potential serious side effects when used long term, but in the Chinese trials, short-term usage for treatment of coronavirus had no serious adverse effects in over 100 patients. Hydroxychloroquine has been found to be less toxic than chloroquine.

Antiviral drugs: Tamiflu (oseltamivir phosphate) and some other medications (e.g. remdesivir ( ref ) and Kaletra, a combination of the HIV drugs lopinavir and ritonavir) might also be helpful if available.

Zinc lozenges: Zinc inhibits the replication of many viruses, including coronaviruses, and seems to have an effect on some viral symptoms, including reducing the duration of cold symptoms at daily doses >75 mg. It is possible that taking a zinc lozenge (20 mg) several times a day might be helpful. ( ref 1 ref 2, ref 3 )

Zinc inhibits the replication of many viruses, including coronaviruses, and seems to have an effect on some viral symptoms, including It is possible that taking a zinc lozenge (20 mg) several times a day might be helpful. ( Ivermectin: A new study shows that ivermectin, a safe, cheap medicine used since decades to treat parasitic infections, could stop the SARS-CoV-2 virus growing in cell culture. Clinical studies will be needed to demonstrate effectiveness in humans, but there are reasons for optimism.

Resources and current data

Data

World Health Organization page on the COVID-19 outbreak: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Q&A: https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

COVID-19 statistics with daily updates, including country data and graphs: https://www.worldometers.info/coronavirus/

COVID-19 data including zoomable maps (such as the one below): https://ourworldindata.org/coronavirus

Chris Billington: graphs with exponential projections for various countries compared with availability of ICU beds: chrisbillington.net/COVID

Protection and care