Level 1 – Healthy

Don’t Get Infected - And Don’t Infect Others

You might feel fine. But the virus can spread before you show symptoms. Some people can spread it without ever showing symptoms. Some people might have more severe disease after more significant exposures due to increased initial viral load, so it’s worth preventing more exposures even if you think you were already exposed. Overall, follow the instructions from authorities. This includes some of the by-now familiar guidelines for social distancing:

Stay home

• Work and study from home when possible.
• Use alternatives to in-person meetings (e.g., video or voice calls) when possible.
• Avoid crowds and unnecessary travel. If you must go shopping, do it when stores are less likely to be busy. If you must be in a crowd, try to keep your safe distance of at least 1.5 meters (or around five feet) from others. Move away from anyone who seems to be ill (e.g., is coughing or appears feverish).

Use appropriate hygiene

• Change your greetings. Instead of a handshake, hug, or kiss(es), try waving or bowing from a distance, namaskar 🙏 or bumping elbows or feet.
• Your eyes, nose, and mouth are possible places for the virus to enter your body. So wash your hands before touching your face. Don’t touch your face while outside.
• Take care with handwashing hygiene.
  • Wash your hands thoroughly for 20 seconds with soap and water as soon as you come home, before preparing food or eating, and after using the toilet.
  • Use soap and water, not hand sanitizer, when possible: It is more reliable because you can easily cover every wrinkly bit of skin on your entire hand with enough soapy water to get rid of the virus.
  • Watch a video or two on proper handwashing technique just to be sure you are using it.
  • Use moisturizer as needed, too: Keeping skin healthy makes disinfection more effective and reduces the risk of infection from other germs, because dry and damaged skin is more vulnerable to infection.
• Regularly clean doorknobs, light switches, table surfaces, keyboards, cell phones, and other things people frequently touch. If the items or surfaces are dirty, first clean them with soapy water, removing any visible dirt. Then, apply disinfectant (e.g., your favorite household cleaner, diluted bleach or hydrogen peroxide solution). If surfaces are already clean, just apply disinfectant. If you are not ill and no one around you has been ill, weekly cleaning is fine. Otherwise, clean high-touch surfaces daily if possible.
• Cough and sneeze into your elbow, not into your hand or unprotected.

Take care around food

• Instead of going to restaurants, cook and eat at home.
• Instead of having food or groceries delivered or delivering them to another person at home with direct contact, arrange to have them left or to leave them outside the door.
• Instead of meeting friends for lunch or coffee, have a video-chat or coordinate a walk to the grocery store while keeping your safe distance.

Take care going outside

• Wear a mask when you go outside. Make your own using our mask-making template if you cannot find one for purchase. You may also wish to wear disposable gloves, for instance, while buying food or medicines in shops where you will need to touch surfaces many other people may have touched. For more information on personal protective equipment such as this, see this list.
• Wash your hands and change your clothes when you get home. If you’ve been around someone who seemed ill, wash them at 60° Celsius (140° Fahrenheit).
• Instead of taking public transportation, walk or bike wherever you can. If you must take public transport, again, keep your safe distance from others and move away from anyone who is ill.
• Instead of exercising inside, go outside for a walk or run in your neighborhood if weather permits, while keeping your safe distance from other people.

Here you will need up-to-date local information. Walks outside may well be illegal where you are (for a time), while much of this advice may actually be mandatory. You may be asked or required to do other things not on this list, like having your temperature taken before buying groceries. Let up-to-date, local information guide you where there are conflicts between that and this text.

Stay Healthy

On top of this, you can do things to stay as healthy as possible:

• Improve your air quality. Avoid second-hand smoke, mold, and other sources of indoor air pollution, which weakens your lungs and increases your vulnerability to infection. Ventilate your rooms frequently, including especially while cooking.
• Eat well. Avoid ultra-processed foods. Prefer nutrient-rich whole foods (like fruits and vegetables, nuts, legumes, dairy, eggs, meat) with no additives, the fresher the better. Choose whole grain over refined and complex over simple carbohydrates; opt for lower glycemic index alternatives whenever possible. Vitamins D (“the sunshine vitamin”) and C can be especially helpful in preventing or mitigating the effects of respiratory infections.
• Drink enough, mostly water. Your urine should be very light-colored, never dark yellow.
• Get regular exercise. If it is recommended or required to stay indoors, find ways to get moving at home: Dance to favorite songs with friends over video-chat, join online yoga or other exercise classes, or try simple core bodyweight exercises like push-ups, sit-ups, and squats combined with simple stationary aerobic exercises like jumping jacks, hula hooping, and skipping.
• If you smoke, stop smoking! For the longer version of that, read this article which says:

  An article reporting disease outcomes in 1,099 laboratory confirmed cases of covid-19 reported that 12.4% (17/137) of current smokers died, required intensive care unit admission or mechanical ventilation compared with 4.7% (44/927) among never smokers. Smoking prevalence among men in China is approximately 48% but only 3% in women; this is coupled with findings from the WHO-China Joint Mission on Coronavirus Disease 2019, which reports a higher case fatality rate among males compared with females (4.7% vs. 2.8%).

• Avoid heavy drinking and other drug use, as alcohol and other drugs tend to suppress immune function.
• Avoid soft drinks and other high-sugar, ultra-processed, low-nutrient food and drink, as these tend to contribute to inflammation.
• If you want to do more after first covering these essentials, then consider complementary medicine options to improve immunity, prevent and treat upper respiratory and / or viral infections, and the like. There are a number of possibly useful options – but keep in mind that the evidence so far is specific to different (though related) contexts, because this is a new disease. A lot of snake-oil salesmen are going to make a lot of money off of panic here without offering actual help. Don’t fall for them.

Psychological well-being

This is going to be rough on all of us at times, and it is going to affect each and every one of us differently. Isolation in general can make every possible sort of mental health problem worse. Furthermore, this is a situation where it’s completely normal to worry about being or getting sick. Having COVID-19 can also be quite psychologically stressful for some. And then there are special stressors that many will experience, such as the psychological toll of the trauma of an outbreak like this on most healthcare workers, particularly emergency department professionals. Here are a few recommendations and tips for psychological well-being in the context of the COVID-19 pandemic, taken mainly from the Austrian Federal Ministry of Defense (go figure!), summarized and expanded on briefly below. None of this will be right for everyone, but (hopefully) you know you well enough to find what is right for you:

• Remember your choices help others. Every time you take more care to avoid getting sick or spreading the virus, you are helping others. This is true even if you feel well, since you could be asymptomatic and still infect other people – someone else’s mother, father, sister, brother, daughter, son. So celebrate your everyday choices that help other people. That empowerment and altruism may benefit your own mental health.
• Stay informed. Getting regular information from reputable sources establishes a sense of security. Maybe you want to combine these first two hints by finding a way to help combat misinformation, which is a serious part of the public health challenge of the current pandemic. For example, when you see or hear someone you know spreading rumors or falsehoods, suggest reputable sources in a way that lets them know you care (and don’t just want to be right). What we know about this new disease is changing so quickly, everyone needs a little help sometimes keeping current.
• Feelings are fine. It’s normal to experience many emotions – sometimes in quick succession – in crisis situations. Accept what you experience without judgment and wait to make major decisions.
• Focus forward. What do you want to accomplish in this strange window of opportunity? It could be something as simple as writing a diary to express how you are feeling, watching a favorite show on Youtube in a foreign language you want to learn, or reorganizing your kitchen cabinets. Start small and just do something.
• Communicate. Stay in touch with people near and dear to you. You might consider setting aside part of the conversation to talk about the current crisis and your worries – and part of it to talk about other things. Watch and listen to know when you or others are becoming overwhelmed. It’s ok to refocus on brighter spots – what are you enjoying doing lately? What are you excited about doing someday? Cooking, art and crafts, music, reading, watching movies, and writing are examples of sometimes solitary pursuits that might bring you joy.
• Laugh, dammit. Look up your favorite comedians on Youtube or go hunting for new ones. Film a song parody or silly sketch for your friends. Think about your favorite comics as a kid, and see if you can get your hands on a comic book or anthology.
• Move. Whether aerobic or non-aerobic (or both), do some form of exercise that you can enjoy. It’s not only good for your physical health, but also for your psychological well-being.
• Find your routine. Having regular times or orders in which you do things (eat, work, play, sleep) helps some people stay on an even keel.
• Be your own friend (coach, cheerleader). Fear and other negatives are easier to notice and remember than love and other positives – our brains had to evolve this way to help us be alert to predators and survive in different environments than we now find ourselves (like the open savannah). Help your brain adapt to living in the modern world instead by reorienting your attention toward the good things going on. Look for evidence that people are being kind to others. Have faith that you and your dear ones will be able to cope with the situation together. Imagine your future self achieving the best you can, and celebrate that you have had the strength to get through this.
• Talk to your kids. Ask what they know and what they want to know, provide structure and routine, stay calm, and play together.

Prepare

And on top of that, you can prepare so that you are familiar with the things that you will need to do when disease comes knocking. Read the rest of this guide. It is statistically unlikely anyone in your household will develop life-threatening complications, and hopefully there will be plenty of medical care for everyone. But in these times it doesn’t hurt to be a tiny bit more ready for the worst-case scenario.

Remember, at the same time, that there is no reason to panic. Take a deep breath and continue your regular life as much as possible.

Get the things you need

We made a shopping page that lists handy things that may help you care for yourself and others.

Reach out

If you live alone, now is a good time to think who you can ask to check on you regularly if you become ill. If someone you know and love lives alone, now is a good time to be in touch to see how they are doing.

Existing Medical Conditions

If you or your loved ones have existing medical conditions, now is the time to read up on how these conditions could be made worse by COVID-19 / pneumonia. Reputable sources for health information about a wide variety of conditions include the National Institutes of Health, the NHS, and Mayo Clinic. You / they should also make extra sure that you / they have plenty of all of your / their necessary medications. Make sure you have all the information relevant for treatment (contact info of doctors, recent lab results, how much of which drugs the patient is taking). Assume for a moment that your regular doctor isn’t there and you have to explain it all to a new doctor who has very little time. A recent timeline of visits, results, etc. would be nice. What should you not forget? Write it down now!

What sorts of existing medical conditions are especially likely to make you / your loved ones vulnerable to more severe COVID-19 problems?

• Conditions that involve lungs / breathing problems (e.g., asthma, COPD, lung cancer).
• Heart conditions, particularly chronic cardiovascular disease (e.g., hypertension, congestive heart failure, atrial fibrillation).
• Conditions that involve compromised immune function and / or require taking immunosuppressant medications (e.g., lupus, arthritis, organ transplantation, some cancers).
• Other chronic hematologic, hepatic, metabolic, neurologic, neuromuscular, or renal disorders (e.g., sickle cell anemia, diabetes, muscular dystrophy, kidney disease).

Preventive Care

If the news is full of stories of hospitals being overloaded with COVID-19 patients where you are, then ignore the text below and let the doctors and nurses work. Except when local health authorities tell you otherwise, naturally.

If the situation is still somewhat normal where you are, this may be good moment to briefly ask your doctor what (if anything) she/he thinks you should do now, and what you should do if you fall ill. If you have not yet been vaccinated for the seasonal flu, pneumococcal pneumonia, or meningococcal meningitis, now may also be a good time to ask your doctor if you are a candidate for those vaccines. Getting these vaccinations now if your doctor advises it could help prevent another infection from compounding problems that may be caused by COVID-19, should you be infected later.

During pandemics, it is typical for childhood immunizations, maternal healthcare, and healthcare for chronic health conditions to get cancelled or delayed because doctors, nurses, hospitals, and the rest of the healthcare system may be overloaded, and because people may be afraid to go in to doctors’ offices or hospitals for fear (sometimes rational) of being exposed to disease. In case your area is not yet greatly affected by COVID-19: Is there any normal childhood vaccination you want to be sure your child gets while he or she can? Any prenatal care or routine care for a chronic health condition you can get now instead of in a month? What about other conditions that are common ailments for you or your loved ones? Anything you can do to prepare to care for yourselves without normal medical care access in the coming months, in case it becomes harder to get time with doctors and nurses because they are overwhelmed? Do it now.

That said, it is never time to delay needed, urgent medical care. Not even during a pandemic. If you develop symptoms for which you would normally seek urgent medical care, then please find a way to seek that care promptly even if the normal avenues are closed or you are afraid of being exposed to the virus in a healthcare setting. This is especially true if you develop signs of a stroke. Those signs are easy to remember with the acronym FAST: Facial drooping, Arm weakness, Speech difficulty, and Time, as in, it’s time to get help. Sudden strokes of a dangerous kind appear to be much more common in otherwise healthy, young adults due to COVID-19, including in people who are only mildly symptomatic or asymptomatic but positive for COVID-19. Prompt stroke care is essential to prevent more permanent damage. This is a case where getting needed care as soon as possible is a form of preventive care, too.

Life, death, dignity, and choices

Let’s be straight: COVID-19 is potentially lethal, and this is even more true if you are middle-aged or older (because there is a strong age gradient in risk of death from it) and / or have existing medical problems (especially ones affecting the lungs, heart, or immune function). We hate to bring up some potentially depressing things right here in Level 1, when you and your loved ones are not even infected with the virus. But, if at all possible, you want to be level-headed and not rushed when you think about these things.

First, remember not to panic. Of all the people who get infected with the virus, many will show no symptoms. The majority of people who do show symptoms will have a mild or moderate version of the disease. The majority of the people who get sick do not need to go to hospital. Even among risk groups such as the elderly and people with multiple existing medical problems, most will survive. That all being said: the sad reality is that some COVID-19 patients will develop severe respiratory problems, and of those, some will die.

Many people have previously thought about how they would like to die when the time comes. We know most people (ourselves included) hate to think about death, but here are a few things that may guide your thinking:

• There’s no point in not mentioning it, since it’s all over the news: The COVID-19 crisis is already forcing doctors in the most affected areas to make terrible choices to distribute limited resources to the patients with the best prospects for recovery. For patients who are older (and this may mean different ages at different places and times) and / or have existing health problems, the terrible truth is that during the peak in cases in your area, some may simply not qualify for treatment.
• When thinking about the above, it’s important to simultaneously realize than even in the best of times, elderly people (generally defined as 65 years or older) with existing conditions have a low survival rate once they need to be mechanically ventilated.
• You may or may not want to be explicit as to what you want in case you face difficulty breathing. Many countries have “living will” (also known as advance directive) documents that let patients tell doctors what treatments they would not like to receive. Talk to your doctor if still possible and openly discuss different scenarios.
• Death in a hospital is likely to be a heartbreakingly lonely and technical affair that may first involve intubation, all sorts of other tubes and machines – and isolation from home and loved ones, possibly even during the last moments. Many hospitals have already stopped visitation altogether in order to lessen the spread of COVID-19.
• On the other hand, if you decide to stay at home when the time comes, you may need to arrange for palliative care and possibly for spiritual/religious and emotional support to the extent desired and possible. You may also want to pre-arrange access to pallative care medication (such as opiates and sedatives) that is no longer intended to prolong life, but to ease suffering during the dying process. In some countries, doctors can help patients have such medicines at home before the situation is dire, in case the time comes.
• You may want to talk about these things with others close to you if you find these issues difficult to think about on your own.