Comment by sjcs on What should we do once infected with COVID-19? · 2020-03-22T09:14:37.534Z · LW · GW

Hydroxychloroquine is pretty well tolerated from what I've seen (never seen chloroquine given we have a safer alternative). The most common side effect is nausea/vomiting/diarrhoea and this is the only thing I could find a rate on (~10%). There are also a collection of rare, severe side effects.

Some of my concerns are:

  • Most of our safety data would be targeted at use in relatively well patients with rheumatological or dermatological disease, not acutely unwell infective patients (I have no idea about its safety profile in malaria other than it's not really used anymore due to resistance)
  • Unknown dosage - as you suggested a lower dose might be safer but could also be below the therapeutic dose (the studies DO seem to use a fairly high dose)
  • The chloroquines come with a risk of QT prolongation; coronavirus comes with a risk of myocarditis - I would expect one would have much higher rates of arrhythmias. Also worsened by the other QT prolonging medication one would be on by then (azithromycin), and electrolyte abnormalities present in critical illness/from GI side effects of the drugs and infection. Admittedly, myocarditis seems to be a late development and the patient would be in ICU already, rather than early in the disease

Most of this probably comes down to the unknown - this is extremely early days into the investigation of using hydroxychloroquine for COVID19. I don't think we know enough about this to be using it outside of the medical setting. Maybe my risk threshold would be for its earlier use in those over 60 or those with isolated hypertension? I'm unsure. This could all change within 1-2 weeks as I'd expect there'll be significantly more data.

Comment by sjcs on What's the upper bound of how long COVID is contagious? · 2020-03-22T06:34:15.697Z · LW · GW

TL;DR We don't know, it's variable case to case, and could be longer than 25 days from symptom onset if you get sick

In patients admitted to hospital with COVID-19, there are cases (Korea, Singapore) of viral RNA detectable up to 25 days after symptom onset. This is not the same as still being infective, so we don't really know.

In people exposed to SARS-CoV-2, 14 days is an estimation that the vast majority will have developed symptoms by this time (here). However, this doesn't take into account cases that remain asymptomatic throughout their infection (maybe 15-20% from Diamond Princess data)

Comment by sjcs on What should we do once infected with COVID-19? · 2020-03-22T06:09:42.469Z · LW · GW

I think this is unsafe advice, specifically using chloroquine and hydroxychloroquine without medical supervision.

These are not benign drugs (chloroquine being worse) and you are advising people use it while unwell with an emerging and poorly understood disease that could potentially alter its safety and pharmacokinetic/dynamic profile, and without any consideration for potential other health issues people have or medications people are taking (eg many antidepressants and anyone with diabetes).

If you have chloroquine/hydroxychloroquine, you should go see your healthcare provider before taking it do the baseline tests and discuss relevant side effects for your individual situation.

If you have COVID-19 and have chloroquine/hydroxychloroquine, you should not be taking them without medical supervision. If you are young and healthy, you are more likely to have side effects from the drugs than have a severe infection.

If you are unwell enough to be admitted to hospital, bring your drugs with you and ask the doctors to prescribe it while you are an inpatient, with appropriate monitoring, using your own supply (and keep it with you, rather than in the hospital's drug cupboard - lots of theft of hospital supplies happening)

Edit: for formatting

Comment by sjcs on Coronavirus: Justified Practical Advice Thread · 2020-03-22T04:57:52.174Z · LW · GW

1000-2000IU on average per day for an adult, depending on your size. You add this up and take it instead every 2-3 days likely without any issues (e.g. I take 3000-4000IU every 2-3days)

If you have lighter toned skin and get regular sun exposure you may not need any supplementation

Comment by sjcs on What should we do once infected with COVID-19? · 2020-03-22T04:38:00.009Z · LW · GW

Normal blood oxygen saturation is 95% and above; without a history of fairly significant lung disease I'd be surprised if you were persistently under this level - note that an oximeter can give very variable readings due to artefact from all sorts of things including movement, ambient light, temperature (probably a significant one in the context of an infection if you are having a fever/rigoring/very cold fingers), and the number it spits out is the average over the last 3-12s.

If you are short of breath with coronavirus it is worth talking to a healthcare provider. If you are a generally well human and have persistent sats around 90%, go to hospital. If you have oxygen sats of 85% you are severely hypoxic and should consider an ambulance.

(I didn't downvote your post and I applaud that you went to the effort to find out more and make actual thresholds for action)

Comment by sjcs on Sarah Constantin: Oxygen Supplementation 101 · 2020-03-22T04:21:06.642Z · LW · GW

Most potential at-home oxygen supplementation methods will aerosolize the virus and increase contagiousness nearby, and are not allowed in a healthcare setting as a result. Default to assuming this applies.

I don't think this is correct; (almost) all at-home devices will be oxygen concentrators providing supplemental oxygen at low flow rates (majority 1-6L/min) via (low flow) nasal prongs or masks (not the non-rebreather style mask mentioned later). Clinically significant aerosolization of respiratory droplets requires higher flow - like the high flow nasal prongs (30-70L/min flow), CPAP/BiPAP machines (NIV), or high respiratory tract flows (shouting/heavy coughing/puffing from shortness of breath etc).

Part of the problem with this outbreak is that deterioration from requiring supplemental O2 to requiring intubation can be sudden, so while home oxygen would potentially free up a lot of beds/space/workload, lack of monitoring for deterioration and travel time back to the hospital would probably worsen mortality in that subgroup. I'm unsure how this risk/benefit equation would play out overall.

Comment by sjcs on Kenshō · 2018-01-21T01:40:53.450Z · LW · GW
The thing is, I don’t mean “it’s okay” as something to think. I mean it more like an instruction, like “look up” in the cell phone parable. Trying to understand the meaning is analogous to Alex posting a photo of their phone and then scrolling above it in the text chat.
Another way I could try to say the “it’s okay” thing is something like, “The world is real in your immediate experience before you think about it. Set aside your interpretations and just look.” The trouble is, most people’s thinking system can grab statements like this and try to interpret them: if you think something like “Oh, that’s the map/territory distinction”, then all I can say is you are still looking at your phone.

Is this related to non-judgemental observation/awareness that is talked about in the spheres of mindfulness? Ie, the things that are happening just... Are, and we are observing that the Are. While these things may ellicit emotion and judgement in ourselves, we can put that aside to another part of our minds and just observe how they Are. Is this what you are experiencing with Looking, or a precursor to it/part of it?

(I may just be replacing "It's okay" with "It just Is", without the positive conotations of okay)

Comment by sjcs on Bet or update: fixing the will-to-wager assumption · 2017-06-08T12:54:13.843Z · LW · GW

This is one way to make your beliefs pay rent


Puns aside, great post!

Comment by sjcs on Open thread, March 13 - March 19, 2017 · 2017-03-16T09:00:52.591Z · LW · GW

As a bit of a tangent to 2)

Certainly using visualisation as practice has some evidence (especially high-fidelity visualisation increasing performance at comparable rates to actual practice; one course I've been to advocated for the PETLEPP model in the context of medical procedures/simulation) - in this sense it may help achieving an endeavor but 1. It's got nothing (much) to do with positive visualisation and 2. It feels like its moving the goal-posts by interpreting the 'endeavor' as 'performing better'.

I've definitely also heard people discussing positive and negative visualisation as tools for emotional stabilisation and motivation - although the more persuasive (read: not sounding like new age/low brow self help BS) usually favour using both together or just negative visualisation - see gjm's and Unnamed's posts

Comment by sjcs on [Video] The Essential Strategies To Debiasing From Academic Rationality · 2016-03-28T01:19:55.710Z · LW · GW

You could record the audio on a separate device at the same time placed much closer. I'd suggest recording the audio in a lossless format (I used wavpack but only because it was convenient), then converting to WAV format (lossless but no compression so large filesize). In WAV format the audio can be processed by CN Levelator to improve the quality. Then convert to whatever format you want (eg for podcast) or directly replace the video's audio with your improved recording using any video editing software. It's a annoying series of steps but may get you much better audio quality and is free.

Alternative is buying a better microphone. Probably almost any external microphone will get you much better quality, just consider whether you need a directional or omnidirectional microphone (one person talking vs multiple people plus background noise).

Comment by sjcs on Lesswrong 2016 Survey · 2016-03-28T01:01:18.786Z · LW · GW

I have taken the survey.

The only option i think was missing was in the final questions about quantities donated to charities, an option such as "I intend to donate more before the end of the financial year" or similar. (and while likely not feasible, following up on those people in the next survey to see if they actually donated would be interesting)

Comment by sjcs on Open thread, Oct. 19 - Oct. 25, 2015 · 2015-10-20T10:29:35.734Z · LW · GW

Off the top of my head, the most reliable way would be to ask another senior medical professional - senior as they would tend to have been in the same geographic area for a while and know their colleagues, plus have more direct contact with primary care physicians. Also, rather than asking "who should i see as my primary care physician", you could ask "who would you send your family to see?". This might help prevent them from just recommending a friend/someone with whom they have a financial relationship. I note that this would be relatively hard to do unless you already know a senior medical professional.

Another option would be to ask a medical student (if you happen to know any in your area) which primary care physicians teach at their university and they would recommend. Through my medical training I have found that teaching at a medical school to be weak-to-moderate evidence of being above average. Asking a medical student would help add a filter for avoiding some of the less competent ones, strengthening this evidence

I think lay-people's opinions correlate much more strongly with how approachable and nice their doctor is, as opposed to competence. Doctor rating sites could be used just to select for pleasant ones, if you care about that aspect.

(caveats: opinion based; my experience is limited to the country i trained in; I am junior in experience)

Comment by sjcs on Open Thread, Apr. 06 - Apr. 12, 2015 · 2015-04-11T05:38:13.329Z · LW · GW

paracetamol (tylenol) but with muchas caution as it is a liver killer, or ibuprofen (I would say if you have kids, don't even keep paracetamol/tylenol in the house, ibuprofen works just as well and is safer)

This is incorrect. Normal paracetamol dosing is less than half the toxic dose of paracetamol, and it is an incredibly safe drug at these levels. Ibuprofen however has rare but well know side effects of gastric irritation, ulceration and life-threatening haemorrhage

Comment by sjcs on [FINAL CHAPTER] Harry Potter and the Methods of Rationality discussion thread, March 2015, chapter 122 · 2015-03-15T02:43:04.671Z · LW · GW

Why does it being blatant mean it is no longer humorous? Sure, a subtle joke can be more humorous for its subtlety, but not being subtle doesn't necessarily preclude a joke's enjoyment.

There are many forms, and EY is probably trying catering to a range of people's sense of humour.

Comment by sjcs on Harry Potter and the Methods of Rationality discussion thread, March 2015, chapter 116 · 2015-03-04T23:10:08.746Z · LW · GW

Preserving the image of Quirrell also helps in continuing to restore Slytherin, whereas outing him could damn the house to be forever ignoble or be removed completely

Comment by sjcs on Productivity poll: how frequently do you think you *should* check email? · 2015-01-10T23:23:27.840Z · LW · GW

As my email is on my phone, I almost never proactively check my mail - instead I check it in a reactive manner. All my email addresses forward to a central email which is synced to my phone. Once email arrives, I check its contents and either:

  • archive it if I don't need to respond or need it for anything
  • mark it as read if I want to read it later or it requires a response
  • mark it as read and star it if it is really important (assuming I don't deal with it immediately)

Additionally, I have a pebble smartwatch which notifies me when mail arrives so I can keep my phone on silent, and I use the awear pebble app so I can star, mark read and archive emails without looking at my phone.

I also use a custom email domain with google business apps (basically gmail but with a custom email address). I have set it up so that I can put anything before the @ in the email address, and it will still reach my inbox. That way, everything I sign up to can have a personalised email address e.g or If I start getting spam from somewhere, I can often figure out where my email address leaked from, and forward everything to spam from that address.

Comment by sjcs on 2015 Repository Reruns - Boring Advice Repository · 2015-01-09T10:02:28.595Z · LW · GW

Instead of using a nasal decongestant pill such as Sudafed, try using a decongestant nasal spray like Afrin or Anefrin.

It is worth noting that nasal sprays containing oxymetazoline (the active ingredient in Afrin and Anefrin) should not be used for extended period as they cause rebound congestion ie if you use it for more than 3-5 days, when you cease using it you may become congested for a number of days.

I agree that sinus rinses are good. I tend to mix salt with lukewarm water, as it is the least irritating. I have read you are not meant to use tap water as it is not sterile and can put you at risk of infections of the central nervous system, but afaik data related to this is pretty limited. Due to the insufficient amount of evidence and the potentially severe consequences, it is likely safer to buy over the counter saline preparations or boil your water first.

Comment by sjcs on Open thread, Nov. 24 - Nov. 30, 2014 · 2014-11-25T11:33:30.226Z · LW · GW

You could try changing your username. I am not sure whether it would change the username that appears on all your past comments, but I suspect it would. You could email and ask.

Comment by sjcs on Open thread, Nov. 24 - Nov. 30, 2014 · 2014-11-25T11:26:49.727Z · LW · GW

The book On Combat by Dave Grossman discusses some of these things. I haven't read it yet, but have read reviews and listened to a podcast by two people I consider highly evidence-based and reputable (here). In particular, the book discusses a method of physiologically lowering your heart rate he calls "Combat Breathing". This entails 4 phases, each for the durations of a count of 4 (no unit specified, I do approx 4 seconds):

  1. Breathe in

  2. Hold in

  3. Breathe out

  4. Hold out

It sounds very simple, but I have heard multiple recommendations of it from both the armed-forces and medical worlds. I can also add a data point confirming it works well for me (mostly only for reducing heart rate to below 100, not all the way down to resting rate).

Comment by sjcs on Open thread, Nov. 24 - Nov. 30, 2014 · 2014-11-25T10:51:22.714Z · LW · GW

I unfortunately haven't developed a quirrellmort yet (the concept is on my to-do list though, along with a number of other personifications). I do have two loose internal models though, for very specific tasks.

The first is called "The Alien" or just "Alien". I created it in my mid-teens after reading the last samurai (not the movie), although my use of The Alien is not the same as the book's. The Alien is the voice in my head that says the pointlessly stupid or cruel things (generally about people) for no reason other than being able to. They aren't things I actually believe or feel, so I just tell The Alien to shut up. By doing this, I can create a divide between myself and these thoughts, not feel guilty about them occuring, and more quickly put them out of my mind.

The second I created very recently based off this thread. It is for the prevention of ego depletion when it comes to either starting big tasks or taking care of long lists of little tasks. Rather than think "Ok time to (make myself) do this" I defer the choice to an internal, slightly more rational model of myself that doesn't suffer from decision fatigue. The outcome is very predictable ("Do the goddarn task already"), but does seem to work very well for me. It's still quite new, and I probably don't use it as much as I should.

I have plans to make a number of other internal models to create an internal 'parliment' that can discuss and debate major decisions, or act on their own for specific required benefits. Other models that might be included include a cynic/pessimist (to help me be more pessimistic in my planning), an altruist (to consider if my actions are actually beneficial), a highly motivated being (to help renew my resolve), and some kind of quirrellmort. These are probably very liable to change as I try to implement them.

Comment by sjcs on November 2014 Monthly Bragging Thread · 2014-11-02T22:58:19.336Z · LW · GW

This month, I finished medical school, which elicits a complex set of emotions difficult to describe. Maybe relief/fist pumpin' exuberance/trepidation/excitement/tiredness/nostalgia/determination/pride in variable amounts (results aren't out yet, and I guess that adds to some of those emotions). This isn't very LW-related, but is a big transition point and I'm quite proud it's complete.

Possibly my favourite thing about finishing is that I now have 3-or-so months with only a few commitments before I start work, which means I can get started on some of my personal to-do list - I have already read 3 books, am meditating every day, organised catching up with friends/mentors I haven't been able to see in a while, learnt some basics of investing and economics and set myself up to start investing my savings in a more useful way i.e. index funds.

Comment by sjcs on Open thread, Oct. 27 - Nov. 2, 2014 · 2014-10-30T00:41:14.045Z · LW · GW

Put another way, I've been trying to think of the various ways that people outside the memeplex see those inside it as weirdos.

The lurker, who may not be gaining as much utility as they would if they participated. However, they still receive the same (or a degree of) connotations from those outside the memeplex, due to their association with the group. These percepts from the outside may be either good or bad.

Comment by sjcs on 2014 Less Wrong Census/Survey · 2014-10-29T23:07:35.749Z · LW · GW

Took the survey a few days ago, and forgot to even comment! Thanks Yvain and looking forward to seeing what comes out of it

Comment by sjcs on Open thread, Oct. 27 - Nov. 2, 2014 · 2014-10-29T04:02:39.577Z · LW · GW

I have been an on-and-off lurker for ~15 months, and only recently created an account (not because of the survey though). I have participated in both 2013 and 2014's surveys.

Comment by sjcs on LW Supplement use survey · 2014-10-29T00:39:43.405Z · LW · GW

Although I would consider myself as a supplement novice, I generally look into supplements based on other peoples recommendations whenever I stumble upon them, and then look them up on Wikipedia and Examine. I occassionally go looking (via google) specifically for peoples' negative reviews of the supplement to check for significant adverse effects that might not have been made clear.

I realise this is obvious, but if anyone were to experiment with supplements be very aware of placebo effect and confirmation bias.

Comment by sjcs on Podcasts? · 2014-10-26T01:49:00.796Z · LW · GW

I almost exclusively listen to medical podcasts (as I work in the medical field), but have been meaning to break into some non-medical podcasts; this looks like an interesting list to start with, thank you.

If anyone else is interested in medical podcasts, particularly from the emergency/intensive care/anaesthetics/retrieval sphere, there is a flourishing community of #FOAMed (Free Open Access Meducation) that strive to provide quality, evidence based teaching in medicine. It aims to reduce the knowledge translation time, as well as discuss cutting edge topics and portray different styles of work from around the world. I have found it excellent for making me both more passionate and more knowledgeable about my work.

Some of the best from my perspective are EMCrit, the SMACC conference talks from 2014 (or direct download here) and 2013, Life In The Fast Lane, The RAGE Podcast, St.Emlyn's Virtual Hospital podcast, and the Intensive Care Network