Ask HN: NYC with autoimmune disease, what should I do?

[BayezLyfe]

I'm 30 years old with an autoimmune disease that puts me at high risk of COVID19. I'm otherwise very healthy -- vegetarian, yoga instructor, runs marathons, sleeps 8 hours, non-smoker. I'm isolating well in my apartment: haven't left in 10 days, and work well as a software eng. My main concern is if I do get infected (which is likely [1]), my immune deficiency suggests I'm very likely to become a critical case and need hospitalization, yet the lack of healthcare resources in NYC is appalling [1].

Should I leave NYC? How? Where should I go?

[1] https://www.businessinsider.com/makeshift-morgue-built-in-nyc-to-deal-with-coronavirus-deaths-2020-3

[ng12]

I'm in the exact same boat. Two weeks ago I thought about leaving to stay with family who live an hour outside Boston. Two things stopped me. The first was my family members are all still going to work (even though Boston is pretty bad and there's a handful of confirmed cases in their local area). The second was I worried about bringing it back from New York with me an infecting my retired parents.

The nice thing about NYC is that I literally don't have to leave my apartment. I get all groceries delivered (perishables from Whole Foods, non-perishables from Walmart). Medication for my condition is delivered as well. I'm blessed enough to have a doorman so the only exposure I have to the outside world is going down to my lobby to pick up the packages which I do late at night to avoid running into anyone else.

My only concern would be if I did get sick and was hundreds of miles away from any of my family members. However as far as risk of getting sick goes I'm pretty confident that bunkering in my apartment is the right call.

[PeterisP]

If you do get seriously sick, your family members would not be able to visit you anyway so it does not matter if they're hundreds of miles away or just across the street.

Unlike in normal circumstances, people who die in this epidemic die alone without seeing their loved ones since the moment of hospitalization.

[edit] Sorry for the morbid implications! The vast majority of people do get better, the risk definitely exists, but even with previous conditions it's not overwhelming, getting it is not a death sentence.

[BayezLyfe]

> if I did get sick and was hundreds of miles away from any of my family members

I'm concerned about this as well.

> I'm pretty confident that bunkering in my apartment is the right call.

Thank you, that's reassuring

[dyingkneepad]

If I were you, I would stay in NYC and try to stay as clean/isolated as possible.

If the theory that people who already got covid19 develop immunity from it and won't catch it again is true, then one thing to realize is that NYC (and Italy and others) will become a "safe" place sooner than other places. Yes, there's the horrible downside that a lot of people are dying, but since so many people already caught it (and so many will catch it in the next days/weeks), after this peak passes you'll reach a point where mostly everybody around you will be immune, so you will benefit from herd immunity. If you move to another city, one where the number of cases is still increasing, it will likely take longer for this stage to be reached.

I should note that I'm not advocating in favor of society pursuing herd immunity strategies: letting people die is never a good strategy. I am just pointing the fact that the since the curve is not very flat in NY, herd immunity will be a thing there sooner than in other places. It's happening whether we like it or not.

I'm not a doctor and I'd love to hear arguments on how this theory could be wrong.

[yboya]

There is evidence coming from China that people who had the virus and recovered became re-infected. Which means there is no certainty at this point on immunity.

[dyingkneepad]

I am aware of that, but there is still doubt in that data. Apparently the tests used in a lot of Chinese people have really bad false positive and false negative rates, so it could lead do conclusions such as apparent reinfection. We'll have to wait and see if it happens with more people, especially in regions with more accurate testing.

[boltzmannbrain]

Do you have data sources?

[avgDev]

Isolate if you can. If you receive packages let them sit somewhere for 2 days before opening and handling them, or open and clean the box inside and clean your hands right away.

If you do go out wear rubber gloves and a mask. Never touch your face when out. Thankfully you got a job that allows WFH and you should be able to ride this out.

[marklacey]

> If you receive packages let them sit somewhere for 2 days before opening

I am curious if you have a source for the two day number.

I have seen various reports ranging from 12-24 hours for how long this particular virus can last on surfaces like cardboard. The longest estimate I have seen for any surface is 72 hours for stainless steel under lab conditions (i.e. not real-world conditions).

So presumably if it takes 2-3 days for a package to arrive, the contents should be okay if you wait another day or so for the exterior surface to become safe.

[impendia]

I think I read somewhere that the virus has a half-life of roughly 6-7 hours on cardboard. I've also read "24 hours" as a guideline for how long the virus can last. Apparently it depends on conditions such as temperature, sunlight, and humidity. (In particular, direct sunlight and warm weather apparently cause the virus to die faster.)

Although I'm not an epidemiologist, I suspect that your probability of catching the disease from a package decays roughly exponentially with time.

Personally, and as someone not immunocompromised, I've been setting my packages aside (in my apartment) and washing my hands thoroughly afterwards. In cases where I'm particularly eager to get the contents, I'll open them after a day and not worry too much. Otherwise, I'll let them sit for two or three days.

[pacman83]

Bleach and peroxide, among other disinfectants, do kill the virus. One could clean the outside of the box before opening it.

Not sure why parent is subtracting the transit time: Who delivered the package? Were they infected? Exactly.

[marklacey]

Assuming you’re referring to my comment:

> wait another day or so for the exterior surface to become safe.

Unless you think that for some reason the exterior of the box is going to have live virus for more than what’s been reported, this seems reasonable.

[saluki]

Sounds like you are setup to ride it out in NYC. I would stay in place, carefully have groceries delivered when possible and ride it out until the healthcare system can support you if needed then revaluate your situation. You are probably safest in your current environment since you don't have to go out and have already been in 10 days.

[DoofusOfDeath]

If you go that route, perhaps have 1-2 months of groceries and toiletries delivered?

That would give the groceries enough time to decontaminate before you touched them, even if later on nobody is able to make deliveries to you.

I don't know about refrigerated / frozen foods though. Not sure how long covid19 remains viable when frozen.

[pmiller2]

Good luck with that. I’m having a hard time getting things delivered at all. None of the services seem capable of finding things like pasta, beans, TP, etc., and I’m not trying to shop in 2 month quantities.

[saluki]

Be creative, seems like most areas have items in stock, maybe not the typical staples, but items are available.

[shadowprofile77]

If you don't mind my asking, what is the autoimmune disease? I have one of my own and with my own worries for the same reason. Data based on China and a few other sources from the Imperial College Covid-19 response team for people below the age of 40, down to 30 shows that of this subset of confirmed infected, only 3.2% are likely to require hospitalization and even of those 2.3% only 5% are likely to require critical care. I assume that quite a few more than that among them have some complicating condition.

[rococode]

> (which is likely [1])

Why do you think it's likely? If you haven't left in 10 days and continue to stay home you're probably safe - safer than if you decided to leave the city now. Is there something preventing you from staying in your room for another couple months? Groceries can be delivered and carefully handled on your end.

[BayezLyfe]

Good points, but a back-of-envelope calculation looks like:

P(failure) = P(infection) * P(critical) * (1-P(icu))

0.1 * 0.8 * 0.9 = 0.072

That infection probability is optimistic, considering what you mention above. That ICU availability probability is the situation we're facing in NYC.

[TheDesolate0]

Stay put. That's your best choice. Your home / apt is the environment over which you have the most control. Order a bunch of water and TP and delicious snacks from amazon and twitch your heart out.

When you have to come into contact with people, wear gloves, a mask (you can make it yourself, and sterilize it too), and eye protection (safety glasses). We call it MEGG, but you probably won't need the gown.

Here is how some of my colleges do it: https://www.youtube.com/watch?v=k-tw-7XRV5w

[marklacey]

> Order a bunch of water and TP

The TP makes sense. I don't understand why you're suggesting to order water, though.

Can you elaborate?

I haven't seen any recommendations that tap water would be unsafe.

If you're in an earthquake prone zone like SF or LA of course having water at home is a very good idea any time of the year.

[throw_this_one]

Do you have any friend that is confirmed negative (spent at least 10 days stationary as far as interactions go) and has a car? They can scoop you up and take you somewhere. Whether that's home to your parents or whatever. Otherwise you need to stay inside for at least the next 3 weeks or go outside with a mask and stay way away from people (just to get sun).

[sloaken]

At this point I think it is a frying pan / fire equation.

Although NY might not be the best place, where would, and can you get there in time, and without risk.

I see how the calculation is that NY ICU will be overwhelmed, not sure that there is anywhere which will not be. I see little difference between a 1% chance of getting an ICU bed and a 0.02% chance. If it was me, I would stay put.

[boltzmannbrain]

Yes, thank you.

My thought experiments have been hand-wavy expected value calculations like this: P(failure) = P(infection) * P(critical) * (1-P(icu))

0.1 * 0.8 * 0.9 = 0.072

and cost of failure is, well, infinite.

That infection probability is optimistic, considering what you mention above. That ICU availability probability is the situation we're facing in NYC.

[pacman83]

Ron Hunninghake, MD, suggests these vitamins and minerals: https://riordanclinic.org/2020/03/covid-19/

Robert Cathcart, MD, prescribed vitamin C, orally to bowel tolerance, for all viral illnesses, including common cold, which is a coronavirus: http://orthomolecular.org/resources/omns/v16n14.shtml

Robert Rowen, MD, suggests IV ozone for coronavirus and explains why: https://scholar.google.com/scholar?cluster=78032311573342346...

A prolific teacher of IV ozone is in NYC, has trained many nearby, and may share a list of doctors he's trained: https://www.ozonedoctor.net/

Dr. Rowen is interviewed by Dave Asprey here: https://blog.daveasprey.com/robert-rowen-352/

An MD-PhD neurologist at Mayo Clinic recommended Rowen to me, said she'd sent patients to him.

I got turned onto the alternative doctors, who got me back to work, after conventional medicine failed me for years. Turns out regulatory capture isn't in the public interest after all. Who knew?

See also the doctors interviewed in https://thatvitaminmovie.com/

[impendia]

I don't have any particular advice for you, but best wishes!

[biolurker1]

Who told you that autoimmunity is a risk factor for covid-19? Maybe you are confused with immunosupression but they are two opposites.

[muzani]

Many deaths are from cytokine storms.

[biolurker1]

I don't think that means anything. Strong immune systems can do that too. Autoimmune means deregulated in a very specific way that may or may not induce or protect vs covid-19 but I am not a doctor. But if you didn't find any study linking it then it's probably random.

[twox2]

Maybe you can add some breathing exercises to your routine to strengthen diaphragm breathing and lung capacity.

[brudgers]

Have you talked with your doctor?

[BayezLyfe]

Yes... He says equal risk of covid here or Chicago (where'd I go stay with family), NYC definitely has more resources, and it's moving west.

[pacman83]

In and near NYC are Robins, the US pioneer of IV ozone therapy ( https://www.ozonedoctor.net/ ) and presumably many doctors Robins has trained.

Of course nothing is known yet to be effective against SARS-CoV-2, but, see paper on IV ozone by Robins and Robert Rowen, MD: https://scholar.google.com/scholar?cluster=78032311573342346...

I got turned onto the alternative doctors, who got me back to work, after conventional medicine failed me for years. Turns out regulatory capture isn't in the public interest after all. Who knew?

Anyway, if there is any upside of being in NYC right now, it may be access to broader variety of treatment options.

[brudgers]

As a random person on the internet, going from one metro to another seems counterproductive.

[Spooky23]

It’s hard to know what to do. Personally, I’d stick it out through April and reassess.

If it were me and I had family out in the country somewhere, I’d consider staying with them. But... you seem to have your stuff together and the devil you know may be better than the one you don’t!

[pyb]

Bad advice, relatives would contaminate the OP with high probability.

[Spooky23]

I agree all things being equal. But they're not. The delivery guy or mailman or building super could infect them too.

It's a hard problem that I struggle with personally. My parents are elderly and not in great health. I live in fear every day that the efforts of my family and their support network (visiting nurses, etc) to help them can kill them.

[WalterSear]

You are way more likely to get it from someone you know than a stranger. 80% of Wuhan infections were in 'familial clusters'.

[snikeris]

This doctor says to get out if you can safely:

https://youtu.be/F2EK-XRBsSo?t=468

[BayezLyfe]

Damn. What is safe though? Is it safe to rent a car? Better to drive across the country and stay with family, where healthcare systems aren't crumbling? Or find a random cabin upstate NY to rent, but risk access to healthcare?

[snikeris]

Yeah, good questions. I'd say if you already have a car, probably reasonably safe to make your way to it and drive somewhere. But renting, hmm not so sure.

Also, staying with family has its risks. Maybe someone is infected but asymptomatic.

Sorry man, I don't have much advice for you. Best of luck.

Whatever you decide to do, think it through, preferably with some other brains involved. Don't rush. As others have said, you're reasonably safe inside where you are now.

[BayezLyfe]

Thank you :)