Cases as of 2020-03-17 21:00: "53 bestätigte Fälle im Westerwaldkreis."

Start of intervention: "On 16 March, the state of Bavaria declared a state of emergency for 14 days and introduced measures to limit public movement […]. Bavarian minister president Markus Söder ordered closures of all sports and leisure facilities starting on 17 March. […] non-essential shops are to be closed at all times. […] In the evening, Merkel announced measures similar to Bavaria for the entire country, agreed on by all federal states and the ruling coalition. This also includes a prohibition on travelling in coaches, attending religious meetings, visiting playgrounds or engaging in tourism. […] On 22 March, the government and the federal states agreed for at least two weeks to forbid gatherings of more than two people and require a minimum distance of 1.5 metres (4 ft 11 in) between people in public except for families, partners or people living in the same household. Restaurants and services like hairdressers were to be closed." (https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Germany#Reactions)

We can assume 2020-03-22 as the start of measures, given that people were not really following the earlier orders much and there were no distancing rules before. By 2020-03-22, they had however understood the severity of the situation and complied.

Using the example of China, "we can foresee that the cumulative curve of patients who are infected will peak 30 days [after the intervention measures]". ("COVID-19 and Italy: what next?", https://doi.org/10.1016/S0140-6736(20)30627-9 ).

  That article also shows that the maximum number of cumulative cases is about 4 times what it was at the beginning of the measures. For Germany, there were 18610 cases on 2020-03-22. So for the best case scenario, roughly we can expect about 80 000 cases in total for this wave of the pandemic, with new infections coming to a near-standstill around 2020-04-22. That's an infection risk of about 1 in 1000 in Germany. Given that the German measures are less strict than those in China, realistically there could be 100 000 - 120 000 cases.

This is an interesting paper as it argues that "20% effective social protection brings the reproduction number below 1.0 so long as 75% of the symptomatic population is covered by TTI [testing, treatment, isolation] within 12 hours of symptom onset". It accounts for 40% of asymptomatic but still infectious patients. Note that "20% effective social protection" does not mean social distancing but less invasive measures such as facemask usage and hand washing.

From the head of the WHO mission to China: "Is the virus infecting almost everyone, as you would expect a novel flu to? – No. 75 to 80 percent of all clusters are in families. You get the odd ones in hospitals or restaurants or prisons, but the vast majority are in families. And only 5 to 15 percent of your close contacts develop disease. So they try to isolate you from your relatives as quickly as possible, and find everyone you had contact with in 48 hours before that."

(https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html)

"Date: February 24th, 2020 […] Dr. Liang Wannian, Head of Expert Panel of COVID-19 Resposne of China National Health Commission (NHC)[:] […] Good  evening  everyone!  Let  me  begin  with  the  main purposes and the major findings of the WHO-China Joint Mission on COVID-19. […] Familial clustering of COVID-19 has been identified, especially in Guangdong and Sichuan, where up to 78% - 85% of the confirmed cases were from familiar clusters. The familial clustering just reflected that the prevention and control measures in these two provinces are highly effective. Thanks to the these  strict prevention and control measures, only the second-generation cases and  clusters occurred inside families after the occurrence of imported cases. No  continuous community spread was found. Thus, the relatively large number of clustered cases is not too bad." (https://www.who.int/docs/default-source/coronaviruse/transcripts/joint-mission-press-conference-script-english-final.pdf)

"[From an interview with the head of the] World Health Organization (WHO) mission to China, led by the agency’s assistant director general and veteran epidemiologist Bruce Aylward. […] The idea that the spread of this virus is driven mainly by families features prominently in your report. How do we know that? […] You look at the big, long lists of all the cases and identify those where you have clusterings in space and time and try to investigate what kind of clustering happened: Was it in a hospital, an old-age home, theaters, restaurants? We found it was predominantly in families. It’s not a big surprise; China had shut down a lot of the other ways people could gather. And family clusters are the closest, longest exposures [to the virus], and getting the virus is a function of whether someone’s got it, how long they’re exposed, and how much virus they are shedding." (https://www.vox.com/2020/3/2/21161067)

The overall secondary attack rate of a case among its close contacts was 7%, as per https://www.spiegel.de/wissenschaft/medizin/a-72e2a605-5865-4d23-81b1-c1c4f453d659 . This was not yet found in the original study, but conforms to the finding of that study, which says: the secondary attack rate (for cases then developing symptoms) among close contacts of a case was 6-8% for 0-59 years, 15% of 60-69 years, 10% for 70+ years. See: https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1.full.pdf+html , figure 1, page 12 .

"Household contacts and those travelling with a case where at higher risk of infection (ORs 6 and 7) than other close contacts. The household secondary attack rate was 15%" (https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1.full.pdf+html)

  This means: the risk of infection by being a household contact is 600% higher and by being a travel partner 700% higher compared to being any other "close contact" of a case. On average 15% of household members get infected by a COVID-19 case in the household. Which of course can be zero a lot of times. This also means that 15%/6 = 2.5% (1 in 40) of non-household, non-travel-partner close contacts get infected by a case.

  Note that this is from a study with contact tracing and intervention of isolating the infected cases. The proportions would be higher otherwise, as close contacts would be exposed for longer to the source without isolation. It does not change that the rate of transmission among non-close contacts (such as shoppers in the same supermarket etc.) will be way less than 2.5%.

  The same and even lower numbers (2.5% as for non-family close contacts) can be expected in households when practicing isolation of all sick individuals in the household, even those who have simple cold symptoms. Together with social distancing in the household to deal with the 48 hour period of pre-symptomatic infectiousness, this should bring the household secondary attack rate close to zero.

From randomized population screening in Iceland it appears that men are at a 1.66 times higher risk of becoming infected than women. See: "Spread of SARS-CoV-2 in the Icelandic Population", https://www.nejm.org/doi/full/10.1056/NEJMoa2006100

Risk of infection from fomites and non-close contact: from a modeling study based on data from contact tracing it appears that infection risk from non-close contacts is two orders of magnitude smaller than from any close contact (household or not). A close contact was defined as follows: "A close contact  is defined as an individual  who had  unprotected  close contact (within 1 meter) with a confirmed case or an asymptomatic infection within 2 days before their symptom onset or sample collection".

  See: "Household Secondary Attack Rate of COVID-19 and Associated Determinants",

https://doi.org/10.1101/2020.04.11.20056010 , published 2020-04-15

  Specifically:

• Table 3, https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v1.full.pdf#page=18
• p. 4, for the definition of close contact, https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v1.full.pdf#page=4

Best summary of studies about transmission modes:

https://www.worldometers.info/coronavirus/transmission/

So far, in Germany there have been no confirmed transmissions during shopping or when using public transport. There may of course be some, but it means that the risk of these activities (esp. with proper social distancing) are very limited. Transmission rather happens during prolonged, close personal contact. Not when passing somebody for a few seconds in a supermarket.

  Source: "Und Sie sitzen kürzlich bei Markus Lanz und sagen, bisher seien keine Infektionen beim Friseur, beim Busfahren oder beim Einkaufen nachgewiesen worden. Sind die Maßnahmen etwa zu hart? […] Wenn es noch einzelne Übertragungen beispielsweise im Supermarkt oder beim Friseur gibt, ist das nicht gut, aber auch kein großes Problem. Es wurde immer gesagt, dass unser Ziel nicht die restlose Eindämmung des Virus ist, sondern, dass wir unter der Kapazitätsgrenze der Krankenhäuser bleiben. […] Unsere vorläufigen Daten geben ja zumindest Hinweise darauf, dass das Virus eher nicht über Oberflächen, sondern bei engem Kontakt übertragen wird. Und der Fall bei München, also der deutschlandweit erste, deutet in eine ähnliche Richtung. Die Mitarbeiterin des Autozulieferers aus China hat bei ihrem Besuch nur Kollegen angesteckt, mit denen sie recht eng zusammengearbeitet hat. Es gab keine Übertragung im Restaurant, der Taxifahrer hat sich nicht infiziert und niemand in öffentlichen Verkehrsmitteln. Und das, obwohl diese Frau hochinfektiös gewesen zu sein scheint.   " (https://www.zeit.de/wissen/gesundheit/2020-04/hendrik-streeck-covid-19-heinsberg-symptome-infektionsschutz-massnahmen-studie/seite-3)

After implementation of public health measures, the type of exposure leading to infection in Iceland was roughly as follows: household 80%, work 15%, social 5%. Infecting during shopping is not even included, so that risk seems very low indeed. This was derived from contact tracing information. See: "Spread of SARS-CoV-2 in the Icelandic Population", https://www.nejm.org/doi/full/10.1056/NEJMoa2006100

"Der Hauptübertragungsweg scheint die Tröpfcheninfektion zu sein. Theoretisch möglich sind auch Schmierinfektion […].

Tröpfcheninfektion: Es kann davon ausgegangen werden, dass die hauptsächliche Übertragung über Tröpfchen erfolgt. Epidemiologische Studien, die dies untermauern, konnten noch nicht identifiziert werden.

Aerosol: keine Evidenz

Schmierinfektion: Eine Übertragung durch Schmierinfektion ist prinzipiell nicht ausgeschlossen, vermutlich spielt dies jedoch nur eine untergeordnete Rolle, da häufig Infektionsketten identifiziert werden konnten, die eher für eine direkte Übertragung, z. B. durch Tröpfchen, sprechen."

(https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html)

There is relatively good evidence from the first cluster of cases in Germany that even brief close contact can pass the virus. In this case, two colleagues were sitting back-to-back in the canteen until one asked for the salt. This may have been either droplet infection or fomites (due to both touching the salt shaker), but in both cases, it was just a brief, passing contact. Source: https://www.reuters.com/article/idUSKCN21R1DB

There is no evidence of fecal-oral transmission. From a detailed study of nine patients: "Infectious virus was readily isolated from throat- and lung-derived samples, but not from stool samples in  spite of high virus RNA concentration. […] Further studies should therefore address whether SARS-CoV-2 shed in stool is rendered non-infectious through contact with the gut environment. Our initial results suggest that measures to contain viral spread should aim at droplet-, rather than fomite-based transmission.", https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1

"[T]he method adopted in  China  [… included] basic hygiene measures, including constant emphasis on the importance of frequent hand washing to the public. As we all know in hygiene, 30% of infectious diseases of the  respiratory  tract  are  caused  by  hands  touching  the  mucosa  of the respiratory tract." (https://www.who.int/docs/default-source/coronaviruse/transcripts/joint-mission-press-conference-script-english-final.pdf)

Discussion of other possibilities how the virus might spread: "How does the new coronavirus spread? These new studies offer clues.", https://www.vox.com/2020/2/20/21143785

In buses with A/C and other actively ventilated closed spaces, the virus can infect people up to 4.5 m away by droplets. Masks seem to prevent such infections. Source: a study from China, shown in "Coronavirus can travel twice as far as official ‘safe distance’ and stay in air for 30 minutes, Chinese study finds", https://www.scmp.com/news/china/science/article/3074351/coronavirus-can-travel-twice-far-official-safe-distance-and-stay

"So the main way of disease transmission is by respiratory droplet. But the fact that health workers, NYPD officers (currently over 500) and others are getting infected wearing masks points to surface contamination as the second main mode of infection, or, possibly lack of training in wearing the masks and/or poor hand washing, or, that aerosol transmission is indeed important." ("What is the main way COVID-19 spreads?", https://medicalsciences.stackexchange.com/q/22796)

"Experts tell White House coronavirus can spread through talking or even just breathing", https://edition.cnn.com/2020/04/02/health/aerosol-coronavirus-spread-white-house-letter/index.html . Does not provide definitive evidence, so to be researched more.

"Although the virus titer was greatly reduced, viable SARS-CoV-2 was measured for this length of time:

• Plastic: up to 2-3 days
• Stainless Steel: up to 2-3 days
• Cardboard: up to 1 day
• Copper: up to 4 hours

"

https://www.worldometers.info/coronavirus/transmission/

Quoted from a study at https://wwwnc.cdc.gov/eid/article/26/7/20-0885_article

"Durch Einhalten von stringenten Hygienemaßnahmen ist zu erwarten, dass die Viruskonzentration bei einem Infektionsereignis einer Person so weit reduziert werden kann, dass es zu einem geringeren Schweregrad der Erkrankung kommt, bei gleichzeitiger Ausbildung einer Immunität. Diese günstigen Voraussetzungen sind bei einem außergewöhnlichen Ausbruchsereignis (superspreading event, z.B. Karnevals-Sitzung, Apres-Ski-Bar Ischgl) nicht gegeben. Mit Hygienemaßnahmen sind dadurch auch günstige Effekte hinsichtlich der Gesamtmortalität zu erwarten."

  Source: "Vorläufiges Ergebnis und Schlussfolgerungen der COVID-19 Case-Cluster-Study (Gemeinde Gangelt)", https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt_0.pdf

"We estimated that 44% (95% confidence interval, 25–69%) of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission."

  Source: "Temporal dynamics in viral shedding and transmissibility of COVID-19", https://www.nature.com/articles/s41591-020-0869-5

Good overview article about pre-symptomatic and asymptomatic transmission, with many links to studies: "It's Estimated 1 in 4 Coronavirus Carriers Could Be Asymptomatic. Here's What We Know", https://www.sciencealert.com/here-s-what-we-know-so-far-about-those-who-can-pass-corona-without-symptoms

"In addition to case reports, pre-symptomatic transmission has been inferred through modelling, and the proportion of pre-symptomatic transmission was estimated to be around 48% and 62%. Pre-symptomatic transmission was deemed likely based on a shorter serial interval of COVID-19 (4.0 to 4.6 days) than the mean incubation period (five days) with the authors indicating that many secondary transmissions would have already occurred at the time when symptomatic cases are detected and isolated. Major uncertainties remain in assessing the influence of pre-symptomatic transmission on the overall transmission dynamics of the pandemic."

Source: "Novel coronavirus disease 2019 (COVID-19)pandemic: increased transmission in the EU/EEAand the UK–sixth update", 2020-03-12, https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf

"Further, transmission in the first 3-5 days of illness, or potentially pre-symptomatic transmission –transmission of the virus before the appearance of symptoms –is a major driver of transmission for influenza. In contrast, while we are learning that there are people who can shed COVID-19 virus 24-48 hours prior to symptom onset, at present, this does not appear to be a major driver of transmission." (https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf#page=2)

"Mit der Entscheidung […] berufen sich Mediziner und Landkreis nach eigenen Angaben auf die Richtlinien des Robert Koch-Instituts, wonach eine Ansteckungsgefahr ab zwei Tage vor den ersten Symptomen bestehe." (https://www.morgenpost.de/vermischtes/article228605257/Coronavirus-Corona-News-Ticker-Lufthansa-streicht-Haelfte-Fluege-Suedtirol-Risikogebiet.html)

"There’s this big panic in the West over asymptomatic cases. Many people are asymptomatic when tested, but develop symptoms within a day or two.

In Guangdong, they went back and retested 320,000 samples originally taken for influenza surveillance and other screening. Less than 0.5 percent came up positive, which is about the same number as the 1,500 known Covid cases in the province. […]

There is no evidence that we’re seeing only the tip of a grand iceberg, with nine-tenths of it made up of hidden zombies shedding virus. What we’re seeing is a pyramid: most of it is aboveground."

(https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html)

There are several reports about pre-symptomatic transmission, such as this: " 15.46 Uhr: Auf einem Kreuzfahrtschiff auf dem Nil sind nach offiziellen Angaben zwölf Menschen positiv auf das Coronavirus getestet worden. Es handele sich um Ägypter, die auf dem Schiff arbeiteten, teilte das Gesundheitsministerium mit. Sie seien zwar positiv getestet worden, zeigten aber keine Symptome. Die Behörden hätten die Tests angeordnet, nachdem das Virus bei einer Touristin aus Taiwan nach ihrer Rückkehr festgestellt worden sei." (https://www.morgenpost.de/vermischtes/article228605257/Coronavirus-Corona-News-Ticker-Lufthansa-streicht-Haelfte-Fluege-Suedtirol-Risikogebiet.html)

The best estimate of the proportion of true asymptomatic cases (as opposed to pre-symptomatic) is 17.9% of all cases, with a 95% credible interval of 15.5–20.2%.

  Source: "Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020", https://dx.doi.org/10.2807%2F1560-7917.ES.2020.25.10.2000180

There are rumors citing leaked documents that 18-33% of all cases (40,000 in the case of China) are true asymptomatic cases: https://www.reuters.com/article/idUSKBN21C0P2

"Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China.", https://www.ncbi.nlm.nih.gov/pubmed/32146694 . Shows that completely asymptomatic carriers (who never develop symptoms) are young, with a median age of 14.0 years.

"We monitored SARS-CoV-2 viral loads in upper respiratory specimens obtained from 18 patients […] in Zhuhai, Guangdong, China, including 4 patients with secondary infections (1 of whom never had symptoms) within two family clusters […] The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients."

  Source: "SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients", https://www.nejm.org/doi/full/10.1056/NEJMc2001737

Children get infected as often as adults, but show no or little symptoms. They shed the virus longer than adults, though. This makes it possible that the virus spreads in schools without being detected, and that children could be multipliers of the disease. See: https://www.spiegel.de/wissenschaft/medizin/a-72e2a605-5865-4d23-81b1-c1c4f453d659

"Dauer der Infektiosität: Es liegen bislang keine publizierten Daten dazu vor, bis zu welchem Zeitpunkt nach Erkrankungsbeginn vermehrungsfähige Viren im oberen Atemwegstrakt gefunden werden. […] Eine Studie mit 17 Patienten hat die Ausscheidungsdynamik in den oberen Atemwegen untersucht. […] Ein Nachweis von Virus-RNA war etwa bis zum Tag 7–9 nach Erkrankungsbeginn möglich. In einer weiteren Studie wurde die Dauer von Erkrankungsbeginn bis zu dem Zeitpunkt, bis keine virale RNA mehr nachweisbar war – abhängig vom Schweregrad der Erkrankung – auf 13–18 Tage angegeben." (https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html)

"Why Do Italians Test Positive After Symptoms Are Long Gone?", https://www.thedailybeast.com/why-do-italians-test-positive-after-symptoms-are-long-gone

  Italy mandated 28 days of self-isolation for people who tested positive or who have symptoms (but cannot be tested). Because it was found that asymptomatic and near-asymptomatic carriers can shed the virus for more than the previously mandated 14 days of self-isolation.

"Das Land Rheinland-Pfalz richtet ab heute [2020-03-24] eine zentrale Telefonhotline für Patienten ein, die vermuten, sich mit dem Coronavirus infiziert zu haben. Die Federführung wird vom Deutschen Roten Kreuz getragen. Bevor Bürgerinnen und Bürger eine der in Rheinland-Pfalz eingerichteten Fieberambulanzen aufsuchen, sollte sie sich unter dieser Hotline melden. Die Hotline lautet: 0800 990 04 00." (https://www.westerwaldkreis.de/aktuelles-detailansicht/gesundheitsamt-informiert.html)

"Generell gilt: Wenn Sie direkten Kontakt zu Corona-Erkrankten hatten oder in den letzten 14 Tagen in einem der nach RKI aktuell benannten Risikogebiete waren, besteht ein relevantes Ansteckungsrisiko. In diesem Fall melden Sie sich bitte telefonisch beim Bürgertelefon des Kreisgesundheitsamtes, auch wenn Sie keine Krankheitssymptome haben. Aktuell (11.03.2020, 18:00 Uhr) nach RKI benannte Risikogebiete: […] Italien" (https://www.westerwaldkreis.de/aktuelles-detailansicht/gesundheitsamt-informiert.html)

As of 2020-03-12 09:00, it is exactly 14 days since I left the bus with the travel group from Genoa, Italy. So that's no longer applicable to me, as I have no symptoms and did not have any symptoms. The note about "not having symptoms" means "not yet having symptoms", as more or less all asymptomatic COVID-19 carriers develop symptoms within 1-2 days. Whoever did not develop symptoms within the full incubation period of 14 days is not infected, as far as anyone knows.

Strict hygiene measures are needed even in households because of the danger of pre-symptomatic transmission (up to 48 hours before symptom onset). So the person doing the shopping could infect others if strict measures are not taken.

"How can I protect myself? The WHO says:

• Wash your hands - soap or hand gel can kill the virus
• Cover your mouth and nose when coughing or sneezing - ideally with a tissue - and wash your hands afterwards, to prevent the virus spreading
• Avoid touching your eyes, nose and mouth - if your hands touch a surface contaminated by the virus, this could transfer it into your body

Don't get too close to people coughing, sneezing or with a fever - they can propel small droplets containing the virus into the air - ideally, keep 1m (3ft) away" (https://www.bbc.com/news/health-51048366)

"Im stark von Corona-Fällen betroffenen Kreis Heinsberg haben Prof. Streeck und sein Team diverse Oberflächen getestet und kein aktives Virus nachweisen können […] Die bisherige Forschung zeige: Vor allem große Menschenmengen mit viel Kontakt seien eine Gefahr, also beispielsweise Partys und Fußballspiele." (https://www.youtube.com/watch?v=VP7La2bkOMo)

"COVID-19: Optionen für Maßnahmen zur Kontaktreduzierung in Gebieten, in denen vermehrt Fälle bekannt wurden", https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Kontaktreduzierung.html

Shutting down public gatherings was enough in many Chinese cities to suppress the case levels to the low daily counts (~40) we're seeing as of 2020-03-10. So it may not be needed to enforce complete lockdowns in Europe, if other measures are taken early enough.

From the head of the WHO mission to China: "You said different cities responded differently. How?

It depended on whether they had zero cases, sporadic ones, clusters or widespread transmission.

First, you have to make sure everyone knows the basics: hand-washing, masks, not shaking hands, what the symptoms are. Then, to find sporadic cases, they do fever checks everywhere, even stopping cars on highways to check everyone.

As soon as you find clusters, you shut schools, theaters, restaurants. Only Wuhan and the cities near it went into total lockdown.

[…]

In Wuhan, in the beginning, it was 15 days from getting sick to hospitalization. They got it down to two days from symptoms to isolation. That meant a lot fewer infected."

(https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html)

"On the basis of these results the scientist advises that for walking the distance of people moving in the same direction in 1 line should be at least 4–5 meter, for running and slow biking it should be 10 meters and for hard biking at least 20 meters. Also, when passing someone it is advised to already be in different lane at a considerable distance e.g. 20 meters for biking."

  Source: "Belgian-Dutch Study: Why in times of COVID-19 you can not walk/run/bike close to each other.", https://medium.com/@jurgenthoelen/a5df19c77d08

  This is however not to be applied verbatim, as it is mostly about particles landing on the clothing of others, where they pose little to no infection risk as fomites based infection seems to be not much of a concern for COVID-19.

"Respiratory Pathogen Emission Dynamics"

video: https://edhub.ama-assn.org/jn-learning/video-player/18357411

article: https://edhub.ama-assn.org/jn-learning/module/2763852

  This argues that sneezes can transport pathogens for 7-8 m away. So keeping a distance of 1.5 m would not be enough in that case. However, it is not relevant in practice as violent sneezes into ones exact direction basically never happen.

How to wash your hands: https://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf

How to produce hand disinfectant:

• https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf
• https://blog.fefe.de/?ts=a0a61741
• https://www.wired.com/story/how-to-make-hand-sanitizer (also includes a recipe for a gel)

The facts are not too clear, but exercise is beneficial anyway and it won't make anything worse.

"Exercise may protect against a deadly coronavirus complication. One expert thinks it should be recommended just like social distancing.", https://www.businessinsider.com/exercise-may-help-prevent-a-deadly-coronavirus-complication-2020-4

"Online-Supermärkte in der Übersicht: Wer jetzt noch zeitnah liefert", https://t3n.de/news/a-1264762/

"Aktualisierte Fragen und Antworten des BfR vom 30. März 2020 […] Ist es in der gegenwärtigen Situation sinnvoll, Desinfektionsmittel auch im Privathaushalt einzusetzen? Das BfR sieht auch in der aktuellen Situation keine Notwendigkeit für gesunde Menschen, im Alltag Desinfektionsmittel anzuwenden. Die Empfehlungen zum Einsatz von bioziden Stoffen im Privathaushalt sind in FAQs zum Thema dargelegt (https://www.bfr.bund.de/de/fragen_und_antworten_zu_nutzen_und_risiken_von_desinfektionsmitteln_im_privathaushalt-190275.html). Welche Desinfektionsmaßnahmen durchzuführen sind, wenn ein Infizierter unter Quarantäne im Haushalt lebt, ist mit dem zuständigen Gesundheitsamt oder dem betreuenden Arzt bzw. der betreuenden Ärztin abzusprechen." (https://www.bfr.bund.de/de/-244062.html)

"Im stark von Corona-Fällen betroffenen Kreis Heinsberg haben Prof. Streeck und sein Team diverse Oberflächen getestet und kein aktives Virus nachweisen können: Weder auf Handys, Türklinken, Waschbecken noch Katzen, selbst bei hoch infektiösen Familien. Er betont daher, es gebe stand jetzt keine Gefahr, beim Einkaufen, jemand anderen zu infizieren. Die bisherige Forschung zeige: Vor allem große Menschenmengen mit viel Kontakt seien eine Gefahr, also beispielsweise Partys und Fußballspiele. Prof. Hendrik Streeck ist Direktor des Instituts für Virologie und HIV-Forschung an der Universität Bonn." (https://www.youtube.com/watch?v=VP7La2bkOMo)

"Aktualisierte Fragen und Antworten des BfR vom 30. März 2020 […] Können Coronaviren außerhalb menschlicher oder tierischer Organismen auf festen und trockenen Oberflächen überleben und infektiös bleiben? Die Stabilität von Coronaviren in der Umwelt hängt von vielen Faktoren wie Temperatur, Luftfeuchtigkeit und Beschaffenheit der Oberfläche sowie vom speziellen Virusstamm und der Virusmenge ab. Im Allgemeinen sind humane Coronaviren nicht besonders stabil auf trockenen Oberflächen. In der Regel erfolgt die Inaktivierung in getrocknetem Zustand innerhalb von Stunden bis einigen Tagen. Für das neuartige Coronavirus SARS-CoV-2 zeigen erste Laboruntersuchungen einer amerikanischen Arbeitsgruppe, dass es nach starker Kontamination bis zu 3 Stunden als Aerosol, bis zu 4 Stunden auf Kupferoberflächen, bis zu 24 Stunden auf Karton und bis zu 2-3 Tagen auf Edelstahl und Plastik infektiös bleiben kann.

https://www.nejm.org/doi/full/10.1056/NEJMc2004973?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

"

(https://www.bfr.bund.de/de/-244062.html)

"SARS-CoV-2: Wie lange das Virus in der Luft und auf Oberflächen nachweisbar bleibt", https://www.aerzteblatt.de/nachrichten/111039 . The interesting point here is that the decay of the virus particles is exponential, i.e. it has a half-life (https://en.wikipedia.org/wiki/Exponential_decay).

"Kann das neuartige Coronavirus über Lebensmittel und Gegenstände übertragen werden?", https://www.bfr.bund.de/de/-244062.html

"How to Clean and Disinfect Yourself, Your Home, and Your Stuff", https://www.wired.com/story/coronavirus-disinfectant-cleaning-guide . Among others, it includes the following tips:

• No need for special precautions about disinfecting food or food packaging. Just follow the usual kitchen hygiene procedures.

"Daily clean and disinfect surfaces that are frequently touched in the room where the [COVID19] patient is being cared for, such as bedside tables, bedframes, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite (i.e. equivalent to 1000 ppm) should be applied."

  Source: "Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts", https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

"Surfaces that may become damaged by sodium hypochlorite may be cleaned with a neutral detergent followed by a 70% concentration of ethanol" (https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf)

"Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.1% sodium hypochlorite solution. Single-use gloves (e.g. nitrile or latex) should be discarded after each use. Perform hand hygiene before putting on and after removing gloves."

  (So this shows that it is not necessary to wear a mask when cleaning surfaces, or a respirator mask for that matter, as there will be no infectious levels of airborne viruses.)

  Source: "Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts", https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

"ACE2 and HYPERTENSION", http://www.nephjc.com/news/covidace2 . The article gives a lot of background. To be studied in more detail.

This is mostly derived from "The Open-Air Treatment of Pandemic Influenza", https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/ . There, they argue that the open air hospitals had a very low infection rate of healthcare workers because the breeze quickly dispersed pathogens. So any environment with high air exchange, esp. outdoors, will help to prevent transmission.

Review of experimental drugs against SARS-CoV-2: "Coronavirus SARS-CoV-2: Antivirale Wirkstoffe auf dem Prüfstand", https://www.aerzteblatt.de/archiv/213027

"Global Virus Network: SARS-CoV-2 Updates – Therapeutics", https://gvn.org/sars-cov-2-response-efforts/other-sars-cov-2-updates-therapeutics/

As of 2020-04-16, this seems to be clearly the most effective drug so far.

"Gilead says it expects to share preliminary data from a study of remdesivir in severe patients at the end of April, and will work quickly to interpret the findings. Come May, initial data from a placebo-controlled NIAID trial, as well as data from a Gilead study of patients with moderate symptoms of COVID-19, will also be available." (https://www.laboratoryequipment.com/563201-COVID-19-Treatment-Update-Remdesivir-Hydroxychloroquine-Leronlimab-Ivermectin-and-More/)

Of 113 severely ill patients on remdesivir therapy, only two died. See:

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

It is allowed to use it in Germany on a compassionate use basis: "Aufgrund erster Forschungsergebnisse hatte die europäische Arzneimittelbehörde Ema bereits Anfang April empfohlen, Remdesivir als Behandlungsalternative für Schwerkranke einzusetzen. Das Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) erlaubte wenige Tage später, die Arznei bei schwer kranken Corona-Patienten in Deutschland zu testen. Offiziell ist die Wirksamkeit bislang aber noch nicht bestätigt." (https://www.spiegel.de/wissenschaft/medizin/a-a-52c07b75-4594-4b84-bfa9-877bfdf6dcbe)

"Ein Team des University of Queensland Centre for Clinical Research verkündete […] man habe vielleicht eine Therapie gegen das neue Coronavirus gefunden: Ende März soll ein landesweiter Test anlaufen. […] Offenbar setzen die Infektiologen aus Queensland eine Kombination ein – erstens Remdesivir […]; zweitens Resochin (Chloroquin) […].

Die ersten Einsätze bei Covid-19-Patienten in Australien hätten bereits zur vollständigen Erholung und zum «Verschwinden des Virus» geführt, sagte Paterson […].

[…]

Nun beginnt ein grosser Test, an dem sich 50 Spitäler in ganz Australien beteiligen: Geprüft wird, in welcher Mischung die beiden Heilmittel die stärkste Kraft gegen das tückische Virus entfalten."

(https://www.handelszeitung.ch/panorama/forscher-gegen-das-coronavirus-spannende-entwicklungen-des-tages)

"[Quoting prof. Raoult, who did the study about chloroquine use in Europe:] the IHU Méditerrannée-Infection (like others) has long been advising that antibiotics be prescribed concomitantly for respiratory viral infections "because they are mainly complicated by lung disease. So all people who had clinical signs susceptible of evolving into a bacterial complication of pulmonary disease were given Azithromycin. There is proof that this lowers risk in people with viral infections. The other reason is that laboratory testing shows Azithromycin to be effective against a great many viruses, although it is an antibiotic. So if we were to choose an antibiotic, it was preferable to administer one that was effective against viruses. And when you look at the comparative percentage of positive carriers with the combination of hydroxychloroquine and Azithromycin, you find an absolutely dramatic decrease in the number of positive carriers."

( "Covid-19: The game is over?!", http://jdmichel.blog.tdg.ch/archive/2020/03/24/covid-19-the-game-is-over-305275.html )

"treatment with a combination of hydroxychloroquine (200 mg x 3 per day for 10 days) + Azithromycin (500 mg on the first day then 250 mg per day for 5 more days), as part of the precautions for use of this combination (with in particular an electrocardiogram on D0 and D2), and outside the MA. In cases of severe pneumonia, a broad-spectrum antibiotic is also associated." (http://jdmichel.blog.tdg.ch/archive/2020/03/24/covid-19-the-game-is-over-305275.html)

The reason why an antibiotic treatment helps is: "many people who are now infected with corona (sars-cov-2) in Italy probably do not die from the virus itself, but rather from secondary bacterial infections caused by resistant microbes. It is a known case that respiratory infections of viruses generally weaken the immune system, allowing bacteria to attack more easily. This is also common for viruses that cause flu or colds. Between 10 and 30 per cent of patients admitted to hospitals with a virus-based respiratory infection subsequently receive a secondary bacterial infection, figures from the UK Antibiotic Center show. […] In a study published in acclaimed The Lancet this month, researchers found that over half of patients who died of the Wuhan virus in China had sustained a secondary bacterial infection before they died." (English translation of "Derfor tar koronaviruset så mange liv i Italia", https://www.aftenposten.no/meninger/kronikk/i/awEP27/a )

Since infection with antibiotics resistant bacteria happen often in hospitals, it would make sense to do the COVID-19 therapy at home if at all possible. That should work well using HCQ and azithromycin, as the antibiotics can do their job if no resistant bacteria are present.

This has not been studied yet, but it makes complete sense as CQ and HCQ are basically interchangeable and the combination is safe.

Study about the safety of chloroquine, also in combination with azithromycin: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Chico-2011.-Azithromycin-plus-chloroquine-combination-therapy-for-protection-against-malaria-and-STD-infections-in-pregnancy.pdf

"Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial", https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v3 . Published 2020-04-10.

  From there: "31 patients were assigned to receive an additional 5-day HCQ (400 mg/d) treatment […] But for TTCR [time to clinical recovery], the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 31) compared with the control group (54.8%, 17 of 31). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia."

  This seems to indicate that HCQ helps if given early as it prevents progressing to severe disease – which is not surprising for antivirals, they work best when given early.

"Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro", https://www.nature.com/articles/s41421-020-0156-0

"600 mg HCQ per day after 6 days, 90% of patients tested COVID-19 negative.  96% of control group tested positive after 6 days." (https://twitter.com/RiganoESQ/status/1239780304082124800)

There is also this ongoing study evaluating the effectiveness of hydroxychloroquine for prophylaxis: https://www.covidtrial.io/

"On the contrary, initial results from a placebo-controlled trial of hydroxychloroquine at Renmin Hospital of Wuhan University in Wuhan, China indicate that patients hospitalized with mild COVID-19 recovered more quickly with addition of the drug than with placebo at the start of a standard treatment. In this trial, 62 patients at the hospital were randomized to receive either a placebo or 200 mg of hydroxychloroquine twice daily for five days, in addition to standard care for both groups. According to the results, the 31 patients given hydroxychloroquine reported a normal body temperature and cessation of cough much quicker when compared with the 31 patients given the placebo.  A larger proportion of patients on hydroxychloroquine also demonstrated an improved chest CT, with 61% showing “significant improvement." (https://www.laboratoryequipment.com/563201-COVID-19-Treatment-Update-Remdesivir-Hydroxychloroquine-Leronlimab-Ivermectin-and-More/)

HCQ is used by Dr. Cavanna, an Italian "country doctor" who pioneered treating people at home early with antivirals rather than waiting until they turn up in the emergency room later. He says "it's the most effective drug so far", obviously only from his own experience. See: https://time.com/5816874

Chloroquine treatment information by WHO, including about overdose: https://apps.who.int/medicinedocs/en/d/Jh2922e/2.5.1.html

Chloroquine is also used for treatment of fish, and might be possible to purchase via that route if necessary. See: https://www.reef2reef.com/threads/chloroquine-phosphate.192309/

"It is available as a generic medication.[1] The wholesale cost in the developing world is about US$0.04 [per dose.]" (https://en.wikipedia.org/wiki/Chloroquine)

When ordering Chloroquine, tell that it's needed for traveling to India, Central America or the Caribbean, because:

• "However, Chloroquine and/or Proguanil will still be recommended in such areas where the plasmodium falciparum is less common. These areas include India and Sri Lanka." (https://www.theindependentpharmacy.co.uk/malaria-prevention)
• "Chloroquine (Avloclor) is only effective in a small number of countries, mainly in Central America, and should never be taken to prevent malaria in Africa, South East Asia or South America where the malaria parasite has developed resistance to Chloroquine (Avloclor)." (https://www.nomadtravel.co.uk/blog/travel-health/which-malaria-tablets-should-i-take)
• "[Chloroquine] may still be used effectively, however, in areas where low-grade P. falciparum resistance is reported, especially in persons likely to have acquired a significant degree of immunity, and also wherever P. vivax is the predominant parasite." (https://apps.who.int/medicinedocs/en/d/Jh2922e/2.5.1.html)

The uncertainty about the use of chloroquine but its established safety for preventative treatment (over weeks and months) might mean that it's best to use chloroquine for prevention of COVID-19 infection. That is, get a larger stockpile of it and use it once the pandemic has spread enough to present a real danger. Only one person per household would use it and be the one to go shopping when needed, while the others would all just stay home.

  But note that for prophylaxis, hydroxychloroquine seems to be superior (see https://twitter.com/elonmusk/status/1239776019856461824 ; link to the original source needed). Also note, there is a certain lifetime dose of chloroquine that should not be exceeded or one might suffer eye damage.

On 2020-02-14, chloroquine phosphate did cost about 50 EUR for 20 tablets of 250 mg each. On 2020-03-07, it did cost 74-79 EUR for the same amount, at the same sources (namely dokteronline.com).

There are two equivalent variants of chloroquine available in medications: chloroquine phosphate and chloroquine sulphate. See: "tablet 100 mg, 150 mg, 300 mg base (as phosphate or sulfate) […] chloroquine base 150 mg is equivalent to chloroquine sulfate 200 mg or Chloroquine phosphate 250 mg" (https://apps.who.int/medicinedocs/en/d/Jh2922e/2.5.1.html).

  Both are used against malaria, just the dosage is different (malaria prophylaxis: for phosphate, 1 × 250 mg once weekly, for sulphate 2 × 400 mg once weekly). Only the phosphate variant increased in price in 2020-02 / -03, probably because it was the easiest to find and buy online. At 2020-03-07, the sulphate variant was three times cheaper!

Interest in chloroquine spiked a lot compared to the baseline: https://trends.google.com/trends/explore?date=today%205-y&q=chloroquine,remdesivir

Used to treat cytokine storms, an immune system overreaction. In cases where this happens, the cytokine storm and not the coronavirus would be the cause of death.

This does not treat COVID-19 but prevents potential complications. To be started when showing the first symptoms, and perhaps also when somebody in the household gets sick (as one might also become infected but not show symptoms).

To be used as a blood thinner, because it seems that stroke due to blood clotting is a possible complication of COVID-19, even in young adults. See: https://edition.cnn.com/2020/04/22/health/strokes-coronavirus-young-adults

"Die Forscher identifizierten ein zelluläres Protein, das für das Eindringen des neuartigen Coronavirus` in Zellen wichtig ist. „Unsere Ergebnisse zeigen, dass SARS-CoV-2 die im menschlichen Körper vorhandene Protease TMPRSS2 benötigt, um in die Wirtszelle einzudringen“, sagte Stefan Pöhlmann, Leiter der Abteilung Infektionsbiologie am Deutschen Primatenzentrum laut Mitteilung. „Damit haben wir einen Ansatzpunkt zur Bekämpfung des Virus gefunden.“

Coronavirus: Forscher wollen Medikament testen

Sie verweisen auch auf ein bereits existierendes Medikament, das diese Funktion erfüllen könnte: Camostat Mesilate ist ein in Japan zugelassenes Medikament, das bei Entzündungen der Bauchspeicheldrüse eingesetzt wird.

„Unsere Ergebnisse legen nahe, dass Camostat Mesilate auch vor der Krankheit Covid-19 schützen könnte“, sagte der Infektionsforscher Markus Hoffmann." (https://www.morgenpost.de/vermischtes/article228625595/Coronavirus-Deutsche-Forscher-wollen-Medikament-testen.html)

https://m.jpost.com/HEALTH-SCIENCE/Israeli-COVID-19-treatment-shows-100-percent-survival-rate-preliminary-data-624058

Documentary about traditional Chinese medicine aplied to COVID-19 patients: https://www.youtube.com/watch?v=PbkrNAGu3dk

Makes the following claim, but without giving any source: "Of the 16 makeshift hospitals in Wuhan, the one staffed entirely by TCM doctors reported no death."

Quinine is the natural precursor of chloroquine and hydroxychloroquine, and was the world's first anti-malarial. However, it comes with heavy side effects. And its potential against COVID-19 is so far unexplored.

A quite funny article exploring why tonic water (which contains quinine) is not a suitable treatment. Includes calculations! https://www.lifesavvy.com/21618

"Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts", https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

"Intensivmediziner veröffentlichen Empfehlungen zur Therapie von COVID-19-Patienten", https://www.aerzteblatt.de/nachrichten/111046

"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)", 2020-02-06, https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-020-0233-6

"What Doctors on the Front Lines Wish They’d Known a Month Ago", https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus.html

  Excerpts: "At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators.

  Proning does not seem to work as well in older patients, a number of doctors said. No one knows yet if this will be a lasting remedy, Dr. Caputo said, but if he could go back to early March, he would advise himself and others: “Don’t jump to intubation.” […]

  For heavier patients, Dr. Levitan advocates combining breathing support from a CPAP machine or regular oxygen with comfortable positioning on a pregnancy massage mattress. He had one shipped to the hotel where he was staying in New York and brought it to Bellevue.

  The first patient to rest on it arrived with oxygen saturation in the 40s, breathing rapidly and with an abnormally fast heartbeat, he said. After the patient was given oxygen through a nasal cannula — clear plastic tubes that fit into the nostrils — Dr. Levitan helped her to lie face down on the massage table. The oxygen level in her blood climbed to the mid-90s, he said, her pulse slowed to under 100 and she was breathing at a more normal pace. “She slept for two hours,” he said. […]

  “We have to see how it pans out, but it makes a lot of sense,” Dr. Swaminathan said. “Obesity is clearly a critical risk factor.”"

Twitter thread with multiple links, first-hand experience reports and breathing technique instructions for prone positioning to improve breathing and oxygen saturation: https://twitter.com/paulg/status/1250205685868122115

Prone positioning was recommended since 2018 as the standard care for severe ARDS since 2018: https://pulmccm.org/ards-review/prone-positioning-ards-ats-sccm/ . The news with COVID-19 is that this is often good on its own, not needing mechanical ventilation.

"The Open-Air Treatment of PANDEMIC INFLUENZA", https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/

"With ventilators running out, doctors say the machines are overused for Covid-19", https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/

AmboVent, a "medically tested" open source ventilator developed by an Israeli team, using the same principle as the MIT mechanical ambu bag ventilator: https://github.com/AmboVent/AmboVent

"MIT-based team works on rapid deployment of open-source, low-cost ventilator", http://news.mit.edu/2020/ventilator-covid-deployment-open-source-low-cost-0326 . This is the device to manufacture, if any. All information about it is available open source at https://e-vent.mit.edu/ .

Ininnova non-invasive respirator mask made from scuba-diving gear, see https://www.isinnova.it/easy-covid19-eng/

To be researched further.

The original source is just some text that was copied&pasted around in Facebook: "POTENTIALLY LIFESAVING ADVICE by Lauren Hebert your local Dr’s of Physical Therapy

If you end up with pulmonary symptoms of corona virus pneumonia... there can be lethal damage from effusion (mucous filling lungs) or cytokine storm (body over-reacts with more effusion.)

This kills people... ESPECIALLY when the number of patients is greater than the number of ICU beds or ventilators. You will be left to drown in your mucous. That mucous can also be infected by other germs during your struggle. That is happening in Italy where there are 5x more patients than they have hospital beds. And the USA has far FEWER beds per population than does Italy.

Many years ago, physical therapists have successfully treated this with POSTURAL DRAINAGE... where the patient is tipped over a wedge to tilt the lungs and bronchial tubes upside down... to allow the mucous to flow out, where it can be coughed out.

Google it. It is EASY to do for yourself and family members. Simply get in position and let it flow, helping it along with breathing techniques that emphasize full, prolonged exhale, while puffing your cheeks and you blow out long and steady.

Start as soon as you feel lungs getting filled. Don’t wait until you are too sick to bother. 3-5 minutes several times per day.

I did this inside a nursing home in VT during the 1976 flu epidemic for resident patients. We did not lose anyone, while other nursing homes lost dozens. It is an old PT technique that has faded away since we have ventilators and related machines. BUT this time, we will NOT have nearly enough ventilators, not the ICU beds where they are provided.

One easy way to get into position is to lie over an EXERCISE BALL."

( https://www.facebook.com/prwithlipqin/photos/a.745823322124203/3017284738311372 )

There is substance to it, though: https://en.wikipedia.org/wiki/Postural_drainage . And there are some studies that show it helps with pneumonia.

There is evidence that "a sticky yellow liquid" is what prevents oxygen uptake in COVID-19 patients who then require a ventilator. That might mean that removing this liquid with postural drainage would help.

  See: "But one of the most severe consequences of Covid-19 suggests another reason the ventilators aren’t more beneficial. In acute respiratory distress syndrome, which results from immune cells ravaging the lungs and kills many Covid-19 patients, the air sacs of the lungs become filled with a gummy yellow fluid. “That limits oxygen transfer from the lungs to the blood even when a machine pumps in oxygen,” Gillick said. As patients go downhill, protocols developed for other respiratory conditions call for increasing the force with which a ventilator delivers oxygen, the amount of oxygen, or the rate of delivery, she explained. But if oxygen can’t cross into the blood from the lungs in the first place, those measures, especially greater force, may prove harmful. High levels of oxygen impair the lung’s air sacs, while high pressure to force in more oxygen damages the lungs." (source: "With ventilators running out, doctors say the machines are overused for Covid-19", https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/ )