COVID is doing the rounds again

This post is mostly a small PSA and some related thoughts and information people might find useful. Please be aware that I am in no way an expert on this subject¹, so take all of this as at most medium confidence.

Specifically the PSA is this: I don’t know if you’ve noticed the same thing, but it seems to me that an unusually large number of people I know are getting COVID at the moment. I’ve noticed this with friends in the UK, US, and Europe.

The UK case data doesn’t support there being a huge wave on at the moment (though cases are significantly elevated, and it’s possible this data is on a bit of a lag), so it’s possible this is something of an illusion, but the same case data also suggests that a big wave began around this time in October last year, so it’s also plausible we’re just at the start of a wave. Either way, I’m personally considering COVID higher risk than usual at the moment, and think you probably should too. [Update from the future: Turns out, I was writing this literally at the point where the UK case data peaked, and it’s dropped right down again, so looks like there was a small wave rather than a big one. I think the rest of the post stands as it wasn’t dependent on there being a wave, but the risk was modestly lower than I believed it to be.]

That being said, I’m personally not at particularly high risk of getting COVID right now, because I’m one of the lots of people who have just had it. It sucked. COVID is no longer, for me at least, the massive fear it was in 2020, but I’ve had it at least three confirmed times,² and they’re all shortlisted for some of the most unpleasant viral illnesses I’ve had. I’m pretty sure I’ve had flu at once which was worse than COVID, but I would not like to repeat any of these experiences.

It’s tempting to just write it off as “just another viral illness these days”, and I think it’s not necessarily egregiously wrong to do that (I remain confused about long COVID and how to reason about the risks of this), but it is a very unpleasant viral illness for many³ people who get it.

Not everyone has it this bad of course - many people have COVID and it just feels like a minor cold - but this is part of the problem, because it makes it much easier to spread. Even if you feel fine, that doesn’t mean the people who catch it from you will.

Given this, it’s worth treating it accordingly as something that it’s worth putting in a bit of effort to avoid getting it or passing it on. Also, it’s coming into winter, so there’s a bunch of other viruses about to peak, and almost everything that helps with COVID helps with those too.

What I think you should do

I’m not going to be super alarmist here. I don’t think you should obviously drop everything to avoid COVID, and even if I thought that, I think anyone who would follow that advice already is. But here are the things I think it’s clearly worth doing.

1. If it is easy and safe for you to get a COVID vaccine, I think you should. Even with my recent bout of COVID I intend to,⁴ though I’m waiting a few weeks. Same applies for flu vaccine even though this post is about COVID, because flu also sucks and most of the same general principles apply.

2. You should have a supply of masks, ideally good masks (more on this in a moment).

3. You should have at least a small supply of at home COVID tests.⁵

And I wish people would follow the following norms at a minimum when interacting with people outside your household:⁶

1. If you are going somewhere while obviously sick, warn people in advance to give them the option to avoid you. I know it’s winter and everyone is a bit sniffly and the like, I’m not going to tell you the exact threshold that makes sense for “obviously sick”, you’ll have to use your judgement, but if you’re coughing and sneezing a lot you’re obviously sick. Also, if when you say this if someone asks you not to go, please handle it gracefully.

2. If you are obviously sick, wear a mask when interacting with people as much as possible,⁷ and try to maintain personal distance, etc. Even at lower levels of sickness it’s polite to offer to mask up, though people will usually say no.⁸

3. All else being equal, prefer to stay in well ventilated spaces while ill. Outside is ideal, but you can also e.g. open windows and doors, prefer large rooms to small rooms, etc. You may not be able to achieve this reliably, hence “all else being equal”.

4. If you develop new illness symptoms, please test for COVID.⁹ I’m not sure what the current best time for testing is. If you’re like me and are somewhere where tests are cheap (and have an income where they still count as cheap), test for a couple days. If you’re somewhere where tests are expensive, my guess is waiting at least 24 hours after symptom onset will get you a more reliable result.

5. If you test positive for COVID, try to minimise interactions with people. If you have to interact with people, absolutely wear a mask no questions, try to keep it outside, and if you have to go inside try to maintain personal distance.

6. Only treat yourself as free from COVID 24 hours after your first negative test. Ideally test again at that point, cost and test availability permitting.

In short: Give people the option to not get infected by you, do your best to make sure that you don’t infect them whether it’s COVID or not, but try extra hard to not infect people with COVID.

These are, I think, extremely relaxed norms - in particular, they don’t tell you not to see people when sick, they try to take into account the fact that you have other priorities and constraints. They don’t tell you should be masking whenever possible. All they do if you don’t currently have COVID is ask you to take some relatively basic steps to try not to get other people sick if you have to interact with them.

But they are significantly stricter than most people follow. I mostly regard this as a failure of our society to figure out how to have good shared norms in general and around this in particular, though in the most extreme cases I do also think this is a failure of individual people to have any sense or decency - e.g. don’t turn up unmasked and without warning to your office job where you can easily work from home or an easily skippable social gathering while spluttering and coughing and not having tested for COVID.

A brief aside for companies

If you run any sort of office, you should make sure that it’s well stocked with COVID tests and good masks. It’s stupid not to.

Offices are great ways of passing on COVID, and as a result the expected cost of having COVID in your office is at the very least several person-days of lost work, potentially much more. Individuals often don’t get around to testing for one reason or another (out of tests, tests are expensive, forgot and now they’re at work…), and making it easy for them to do the thing that helps everyone and saves you money is a no brainer.

You should also have some sort of COVID policy about using these tests. I don’t know what the optimal policy here is, but I think that e.g. asking people to comply with the norms I suggested above¹⁰ in tandem with the free masks and tests is probably sufficient, or at least a very good start.

What I know about masks

Not nearly as much as I feel like I should.

Here are what I think of as basic mask facts:

1. Any mask is better than no mask, but at the low end not by much. If all you have is a cloth or surgical mask, you might as well wear it, but you should try to have better masks than that.

2. You should ideally use FFP3 (UK) or N99 (US) masks. FFP2 or N95 are probably good enough. I am currently using these ones, which I actually thought were N99 but oops on review are actually N95. For more durable masks, I have heard good things about the Cambridge Mask company, but have no information about them beyond that.

3. Ideally use masks that have straps behind your head rather than your ears. If your mask has straps that go round your ears, a mask clip to make them go around the back of your head will make them more comfortable and more effective.

4. If you are trying to avoid getting sick, you should use a valved mask (because it doesn’t lose its seal when you breathe out). If you’re trying to avoid other people getting sick, you should use an unvalved mask (because the point of the valve is that the air coming out is not getting filtered). If you don’t know whether your mask is valved, it’s probably unvalved. The valve is a big lump of plastic on the front. A valved mask probably still protects others - almost certainly better than no mask, probably better than a bad cloth mask or a surgical mask - so if you’re sick and all you have is a valved mask you should probably still wear it.¹¹

5. Wear your mask covering your nose. I really feel like I shouldn’t have to say this, but I feel like a good quarter of the people I see wearing a mask in public don’t.

My recent COVID experience

Here’s a timeline of my recent COVID experience. If you get it, yours will obviously not be exactly the same as mine, but people seem to have found it helpful to hear.

Saturday: Had a little bit of a sore throat in the morning. Nothing bad, but the sort of thing that feels like you might be about to get ill. By Saturday evening, I had a really quite bad sore throat and was starting to feel feverish though not actually running a fever.

Sunday: Was feeling pretty awful in the morning. Tested for COVID and got a bright, thick, red positive line, suggesting that I would probably be testing positive. Over roughly the next 24 hours I got a moderate fever (i.e. a bit over 38C, but it sure didn’t feel moderate).

Monday: By the afternoon I was feeling... not great but sortof OK? But at this point respiratory symptoms started and I started sneezing and developing a really nasty cough.

Tuesday: I was coughing a lot, and my throat was starting to get pretty raw, and was generally very tired but otherwise not too bad.

Wednesday: Coughing less, still quite weak and tired but feeling mostly fine otherwise. My throat was super raw at this point though, and probably the most unpleasant thing was the agony of eating anything remotely acidic.

Thursday: Same

Friday: Finally tested negative and was feeling surprisingly human. Still coughing but worst of the cough was already gone.

At this point I thought I’d got off very lightly, so like an idiot I over-exerted myself over the next couple of days. Went for a long walk on Sunday and felt exhausted and shivery on the Monday, had a super busy day on Tuesday and then an international flight home on Wednesday (I had been stuck in the US - I’d meant to fly back the previous Tuesday when I was still very full of COVID).

I then spent the next week absolutely wrecked. Some of this was definitely jet lag, and some of it was general travel crash, but that’s not enough to explain it. I was constantly exhausted, sleeping huge amounts, and barely functional while I was awake. Fortunately this only lasted a week, but it was really unpleasant.

It’s now a week past that and I’m… mostly fine. My health is never particularly great, and I’ve got a litany of minor complaints, but I don’t know if any of these are related to the COVID. Certainly the terrible fatigue seems entirely gone¹².

Things that helped me while I had COVID

I am not a doctor, but here’s some stuff that helped me, maybe it will help you too.

In the first 36 hours I was sweating buckets, and it was really useful to have ORS salts. I used dioralyte, which is generally good.

If you’re in the UK, check whether your ORS contains artificial sweeteners. If it does, it’s probably not very useful (ORS requires sugar to be useful, but the UK sugar tax means that people are swapping out sugar for artificial sweeteners in lots of products, including ones where they really shouldn’t). You can also easily make classic WHO recommended ORS, which is 8tsp of sugar, 1tsp of salt, 1 litre of water. Boil some of the water first so that the salt and sugar dissolve, and then either let it cool or top it up with cool water.¹³

I’m a big believer in gargling with mouthwash and using saline nasal sprays while ill in order to reduce the amount of virus in the upper respiratory system. It might even work! Certainly I was doing this while ill and the upper respiratory symptoms cleared up remarkable quickly, but that’s only weak evidence.

Strepsils were life saving during this time, what with the cough and the sore throat.

I personally mostly didn’t need much in the way of medication while this was going on. I think I took some ibuprofen occasionally for headaches, but there was nothing particularly severe. Other people I know who have had it recently have had worse fevers, so I’d want to have both ibuprofen and paracetamol on hand to manage that, but I personally didn’t need it.

And, of course, it’s important to have easy to eat food to hand, because you want to minimise interactions with others and also will have zero energy yourself to do any cooking.

COVID guilt

Through a mix of precautions and luck, I managed not to pass on COVID to anyone that I know of. There are a few cases where I might have passed it on to strangers without knowing, but I was careful to minimise those, and they in general had far less exposure than anyone I knew I’d interacted with, who all managed to escape. I still think I was lucky, but I stacked the dice in my favour so this was the most likely outcome. I do think it’s straightforwardly lucky that I didn’t manage to pass COVID on to my aunt (who I was staying with for the first fourish days of this). We did our best to minimise contact, and it worked, but our best was only so good.

I think there is one thing I obviously did wrong and I do feel a bit bad about it: I should have tested Saturday afternoon. I’d tested Friday night, and I didn’t feel particularly bad in the morning, so it’s reasonable that I didn’t test Saturday morning, but on Saturday afternoon I had a window where I was starting to feel worse (developing an obvious sore throat) and could easily have tested before seeing some friends and didn’t.

I think (I’m not sure) I also didn’t adequately warn the friends I was visiting after that that I was starting to get sick. I don’t think we’d have done a single thing differently if I had warned them, but I still should have warned them.

I took one Uber trip while COVID positive and didn’t tell the driver I had COVID. I did tell him I was sick, and I masked up and opened my window and he opened his window so there was a lot of airflow, and I judge that this is probably still safer than a typical day of driving people around right now. I probably still should have told him, but I’ve had bad experiences with Uber drivers being dicks, and I didn’t want the hassle. I still feel a bit bad about it but if I’m honest I probably would do the same again in future.

I mention all of these things, because I think there’s a recurring theme that I run into a lot that if you give someone COVID you shouldn’t feel bad about it.¹⁴ I think this is clearly wrong.

I don’t think you need to be wracked with mortal guilt over it unless you did something so stupid as to cross over into evil (if you go unmasked to visit your immunocompromised but otherwise healthy grandpa in an unventilated room while knowing you have COVID and not warning anyone, I actually do think you should feel wracked with mortal guilt about this. This is thankfully a hypothetical example for me, but I’m sure it’s a real example somewhere), but when you cause a bad thing to happen, intentionally or otherwise, I do think it is important to pause and reflect on whether your actions were appropriate.

Sometimes the answer is that they were! If I had given my aunt COVID, I would feel bad (mostly for her sake), but I wouldn’t feel guilty, because I honestly don’t know what I could have done differently.

In contrast, for the Saturday testing: That was stupid. I was being a bit careless and lazy. It’s very far from unforgivable (if that was the standard for unforgivable, I guess we’re all going to hell), but it’s worth feeling a bit guilty about and resolving to do better in future. This is true even though I got away with it and did not give the friends I was visiting COVID.

Part of why I’ve tried to articulate what I think are reasonable COVID norms is to provide a baseline for this: I think that if you’re following these norms, under normal circumstances (e.g. not interacting with immunocompromised people) if you give someone COVID, that sucks, bad luck. It’s worth thinking about whether you did something wrong, but you probably didn’t do anything terribly wrong.

If, on the other hand, you give someone COVID and easily implementable steps from my suggested norms could have significantly reduced the risk of that… that probably is, at least partly, your fault, and you should maybe think about changing your behaviour to do less of that. Even better, you can change your ways before that happens.

The harder part is of course that you should also be encouraging other people to change their ways,¹⁵ and it’s hard to instil an appropriate sense of guilt in a productive manner. It’s very easy to do this in an unproductive manner by shouting at people, which mostly involves the other party getting defensive and entrenching in their existing position. It’s also easy to cause some people to be wracked with guilt wildly disproportionate to their actions. That doesn’t help much either.

I think the most effective lines are something like “I’d feel more comfortable if…” or “Under circumstances like these I’ve been trying to…”, where you make it clear that there are specific behavioural norms that you yourself have adopted. I don’t know how well this works, but it’s probably a good start.

When I try to rehearse such conversations in my mind I tend to get pretty snippy pretty quickly though, because I imagine the other party going “oh that sounds like far too much hassle”, at which point I respond with “well, if your convenience is worth giving other people COVID…”, at which point it all snowballs from there. I don’t know. Probably these go fine more often than I think, but this sort of aversion is part of why norm change is hard.

Probably the best time to have these conversations is when nobody has violated these norms recently. Rather than say “You gave people COVID, so you should have…”, get ahead of the problem and say “Winter is coming, and as a result I would like us to be extra careful about not giving people infectious diseases including COVID, and here are some things I know help…”

In general, I’m very disappointed in how little norms have changed post COVID. You’d have thought a giant global pandemic was enough to get people to change their behaviour a bit, but instead it politicised and polarised with no ability for anyone who disagreed with each other to have a reasonable conversation, and then we collectively seem to have agreed it was a terrible time best forgotten and as a result have learned nothing from it.

But maybe now that the dust is settled a bit we have another opportunity to try to do better. Do better ourselves, and try to have constructive conversations about what to do wherever we can. Norm change is hard, but it’s impossible if we don’t at least try to make it happen.

1. Although I do find myself thinking that other people are weirdly bad at it a lot.

2. And one or two times where I suspect I had it but didn’t test positive, in one case because it was April 2020 and my flatmate confirmed had it because he had access to tests for his job.

3. I think most, but there’s some sampling bias here - you’re more likely to hear about the people who get it badly.

4. I’ve historically been on the fence about this, because I react very badly to COVID vaccines, but I think I’ve decided it’s worth it. We’ll see if I still think that after this vaccine.

5. This might also be true of flu tests. I’m not sure. Flu tests are a lot more expensive and harder to find, so I think the tradeoff is less clearly good, but I’m leaning towards wanting to take flu tests myself.

6. Household disease control is a whole other topic. I sometimes mask at home in the common areas if I’ve got something bad, and I isolate if I get COVID, but we’ve mostly given up beyond that.

7. I’m not confident whether this is true or not, but I think this is less necessary outside. Certainly if outside and at a reasonable distance from people I will often remove mask in cases where I’d mask indoors. Not if I know I have COVID though.

8. I’m somewhat on the fence of how proactively one should mask in borderline cases when interacting with non immunocompromised people.

9. There are caveats and circumstances where you don’t need to do this. I tested for COVID yesterday out of an overabundance of caution because I was visiting some people and had a bit of a sore throat, but this really was an overabundance of caution given that I’ve literally just had COVID.

10. Although note that “obviously ill” is complicated when applied to other people. Be cautious. e.g. I often end up with a long lingering post-viral cough long after I’m no longer ill.

11. I’m not super confident in this claim, but it does seem to be what the research supports. I previously believed they weren’t helpful for source control, then someone suggested in proof reading this article that they might actually be harmful, so I got Claude to do some research for me and followed its links, and as a result changed my mind on this.

12. And I’m back to my default status of only medium fatigue…

13. There are better formulations than this, but the advantage of this one is that it is easy.

I’ve seen some discussion about how much sugar to add and whether 6tsp or 8tsp is better - something something molarity. I don’t really know. I suspect unless you are suffering from severe diarrhoea it doesn’t actually matter very much, but once again I must remind you that I’m not an expert.

14. I do also run into a recurring theme that if you do not take absolute maximal precautions against COVID at all times you are a monster and a worm. I also disagree with this, but don’t feel the inclination to argue against it at this time.

15. e.g. by writing long newsletter posts about this. But that’s probably not scalable.