An alternate zinc ionophore with less side effects is Quercetin [1] [2] which some people here already take for other reasons, myself included. It is most beneficial if being taken prior to infection to slow the RNA transcoding process by getting more zinc into the cells, assuming one is not deficient in zinc to begin with. I mention this because by the time someone is talking to a doctor, the virus has likely already replicated in vast amounts. Chloroquine currently requires a prescription, at least in the U.S. I am neither a doctor or a scientist, as per my profile. Very few doctors study molecular biology as a hobby or as part of their career.
[Edit] To be clear, I am not a doctor and this is not medical advise. Please research this topic yourself. There are many studies on nih.gov on zinc ioniphores. Here is a video discussing both compounds by a doctor. [3] They are also not giving medical advise.
I wouldn't blindly trust it _just because_ a doctor said it, but I would definitely put more trust in a doctor giving medical advice than someone who is not a doctor or similar. Isn't the whole thing with medical advice and doctors that doctors are being trusted and believed in, meaning they have credibility.
> In conclusion, our study strongly suggests co administration of antioxidant flavonoid like quercetin along with CQ for antimalarial therapy. This is particularly important when CQ is administered as long-term prophylactic treatment for malaria as chronic exposure has shown to be resulting in higher dose level of drug in the body.
Bioavailability of quercetin is low. That doesn't prevent the supplement industry from profiting from it, unfortunately. The upside is, since it's poorly absorbed from the gut, you probably won't die from it.
Quercetin has an EC50 value of 84 uM in vitro against SARS-CoV, Chloroquine around 6 uM vs SARS-CoV-2 and it's a lot better absorbed - so to get any antiviral effect from quercetin you'd probably need at least 10 grams pr day.
I can't find the thread right now, but someone did a back of the napkin calculation that you'd need to have 200 gin tonics a day to reach any kind of a reasonable level.
I will say that on a number of people I am calling to do orders or follow-up before we close, that I have heard a large amount of children in the backgrounds. Lot of apologizing which isn't really needed, but I guess it is a bit different for folks and some of them might be ready to do gin experiments soon.
I do answer their survey that they all are very professional.
Wikipedia: In the United States, the US Food and Drug Administration (FDA) limits the quinine content in tonic water to 83 ppm[3] (83 mg per liter if calculated by mass), while the daily therapeutic dose of quinine is in the range of 500–1000 mg,[4] and 10 mg/kg every eight hours for effective malaria prevention (2100 mg daily for a 70 kg adult).
How much less than 83mg/litre is unclear. You would do yourself damage with the sugar should you try to drink enough for a dose. Also it is unclear how effective quinine is compared with hydroxychloroquine.
Finally, quinine can have serious side effects, take care.
This is anecdata, so beware. For a full story, email me.
I have minor symptoms, and have been self-isolating since Wednesday (18) because many people around me were coughing on Monday (16) & Tuesday (17). The government here in NZ has not issued any lockdown instructions.
Due to comments here on HN, I decided to buy 4x 1.5 litres of ordinary Schweppes tonic water. Panic buying had not yet struck (it has now, but mostly bread, pasta, and toilet roll). I shared one bottle around the office, and gave one to my homestay family.
I've been drinking about 3 glasses per day, a litre at most. It's a sub-clinical dose for sub-clinical symptoms. The bitterness causes immediate sputum production in my mouth. Despite feeling a sore throat yesterday, I haven't yet started coughing.
I'm advocating for it in direct messages to friends: not because it's some miracle cure for the virus, but because it eases the coughing symptoms and thus might slow the spread. The placebo effect is probably also very real: I feel like I'm doing something, and that calms me down.
You didn't read it. He's giving people this advice. It's dangerous advice. I am not overreacting. This is a time for solid, real medical information and not anecdotal folklore.
It's as if nobody here has considered that Tonic Syrup is widely available (see any Sodastream aisle at a store) for concentrated quinine https://theginisin.com/tonic-tags/tonic-syrup/
No, you would need to drink 25-30L of tonic water for a preventative dose. For malaria. Coronavirus dose for an acute infection will probably be even higher.
Quinine is super bitter, it doesn't take much for flavor use, and the stuff on the shelf is nowhere near the strength that would have been given for brits in tropical posts during those days.
A word of warning to all who consider stocking up on and self-medicating with Chloroquine: while this is a well-studied medicine, it can have severe side effects, particularly in the eyes (including blindness).
That said, let's hope it has some effect as current anecdata suggests.
I wonder if there is a point where literally everyone just gets a dose of chloroquine. My understanding is it stops the virus replicating and so is almost a preventative rather than a treatment.
I can only speak from my own experience, taking it prophylactically while traveling overseas in a malaria prone area. I had to discontinue it after 5 days because it was keeping me from my work: profound, irrational depression, constant cold sweats, painful tinnitus, nausea and disabling fatigue. Perhaps these side effects would have gone away over the long term.
Autoimmune diseases, can be way, way worse, particularly arthropathies, since, if unchecked, they cause permanent damage. Also IME, as a rule disease modifying drugs have really nasty side effects. You take them anyway, because you have no better alternative :(
Someone else in this thread said that chloroquine experiments started because Chinese doctors noticed that none of the covid-19 patients had lupus (and basically everyone there with lupus takes chloroquine). If that's true, maybe it could be prophylactic. /IANAD
They have actually done that in times past with chloroquine for malaria. It actually worked sort of ok but overuse tended to create resistance.
I'm pondered if a mass use for covid would work. I think it's probably too unproven and covid to small a percentage of the population to make dosing everyone a good idea. What I would try if I were running things is bulk testing and giving people a chloroquine type med straight off if they were positive.
Does anyone know how quickly the production of Chloroquine Phosphate and Hydroxychloroquine can be ramped up (say, to the tune of 500M people * 7g per "course" = 3.5 million kilograms?
I tried finding out how much chloroquine is prescribed world wide per year, but couldn't find it. It may give us a clue into how much is already being used.
I know that it isn't used except for pregnant women as a malaria treatement because the first line antimalarials aren't proven save in pregnancy, but also that the malaria protozoa has some resistence to Chloroquine in many countries (Ecuador, among others)
From this, it doesn't look like there are any major hurdles in the necessary precursors. E.g. chloroaniline is very commonly used for making many drugs (incl. chlorhexidine), methyl acrylate is similarly in the six-figure-tonnes-per-year category, and that diamine also looks to have a nice synthesis route.
From what I understand, it is a very cheap and easy drug to manufacture, having been designed for mass production in a previous era, as well as being a relatively simple chemical formula (some hydrocarbons, amines, a chloride?).
To those who aren't aware of it, there was a recently completed (small) clinical study of hydroxychloroquine (and in some cases HCQ plus z-pack) just completed in France. The results are here: https://www.mediterranee-infection.com/wp-content/uploads/20...
They're miraculous. This is a well-studied, mass-produced drug which has been around for 70 years and appears to be highly effective at treating this virus.
Yeah, you’ll need some serious source to backup this claim. Having a deal with a lab from the same country, that produces a drug you’ve been studying for decades in your lab and hospital isn’t something that justifies dumping on someone’s reputation. Especially if the person in question looks like he has enough papers published to justify his claims.
Ps: i do agree that his tone and style looks unorthodox. But results is the only thing we should care about.
Where are you seeing that? Because what I see is a very non-rigorous, non-randomized study. Also, what about this part:
>A total of 26 patients received hydroxychloroquine and 16 were control patients. Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCRpositive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3.
Really easy to have "miraculous" results when 20+% of your treatment group were excluded and also happened to be the ones with the most severe symptoms.
I don't mean and disrespect to you as a physician, but there appear to be many experts who disagree with you to the point of acting out their disagreement at scale. Chloroquine has become a standard part of treatment for this disease in several countries, and its continued use seems to imply its efficacy.
Miracle (noun): an extraordinary and welcome event that is not explicable by natural or scientific laws and is therefore attributed to a divine agency.
>there appear to be many experts who disagree with you to the point of acting out their disagreement at scale. Chloroquine has become a standard part of treatment for this disease in several countries, and its continued use seems to imply its efficacy.
The fact that experts agree that this drug should be used doesn't mean they agree that it is miraculous. And this certainly doesn't suggest they disagree with the parent MD/statistician.
It seems like such a strange nit to pick here over my use of the term miraculous. I don’t know what else you would call the results of the study I linked (supported by the reaction of many national health orgs). Yeah, maybe this isn’t the cure to this disease, and of course we need more testing, but the result as reported are incredibly hopeful. It seems to have hit a nerve with some people that I used the term “miraculous”, but I will continue to defend that term. We are looking at a virus that has disrupted the global order. Here is a study claiming incredible efficacy. That isn’t a miracle in the divine sense, but if definitely reports as being extremely helpful during a dire need.
If doctors are using this, and not seeing an effect, why do they continue using it? Doctors are humans, and prone to irrationality of course, but they're also scientists.
Maybe my faith in the collective ability of the world medical professionals to evaluate their treatment techniques is misplaced, but I still have faith that these people are acting in accordance with their scientific training.
Maybe that's wrong, and I shouldn't be trusting these people. But if I'm not trusting doctors (and especially infectious disease experts who are writing papers about their findings), then who should I trust?
I think a lot of this distrust in institutions and doctors is going to get us into a lot of trouble. I wish people would start listening to these orgs.
Your post does not address my point. That's okay, if you simply wanted to say the things you said. There are things you've said that I agree with, and things which I strongly disagree with. In a conversation, I like to be careful about going down too many side tangents if certain fundamentals are not already mutually understood.
It seems like you disagree with my implication that use of something (in this case, chloroquine to treat covid-19, the use of which seems to be increasing daily) implies its efficacy.
Why? I'm modeling the doctors and health officials who are making these decisions as agents which are presumably continuously evaluating their decisions. So basically:
A lot of experts are taking this action -> assume the action has a desirable outcome -> believe what the experts are saying (in this case both their words and their actions seem to agree with each other, and point to the idea that chloroquine is an effective treatment of covid-19).
I am genuinely at a loss as to why this stance (my stance) is anything other than completely obvious.
No. Here, as in several places, you make unwarranted assumptions about other's thought processes. Remember that "efficacy" is a matter of degree. I try not to spend too much time and effort on strawmen.
I'm trying to understand you here. Is the assumption that doctors are taking actions based on previous experience with those sorts of actions unwarranted in your opinion? Or a strawman?
I'm sorry if but I'm having a difficult time figuring out what I have said that you disagreed with.
You seem sincere, and unlike prior comments to be approaching this in good faith. Maybe you even welcome criticism as a means of improving your thought process. I don't mean to be cryptic, and certainly don't mean to be rude, I just try to conserve energy and not get caught up in non-constructive arguments.
You don't seem to be taking people's statements at face value, but rather projecting additional meaning onto them, almost as if you conceive of fewer possible positions than there actually are, and pigeonhole us.
Consider my prior two statements in this thread which start with "the fact" and "you were". Do you agree that these statements were correct, on their own terms, in their own context, and independent of additional complexities involving degree if efficacy or various arguments for or against use, testing, or hopefulness?
Also, do you see that the people who disagree with your framing are not 'picking nits' nor are they having 'struck nerves'? Can you see other reasons why they might respond as they did?
Its use in the presence of a plausible mechanism, and in the absence of any good supporting data, does not indicate efficacy. It indicates that when a patient is circling the drain you throw things at the wall that could plausibly have some benefit.
If the control group still is positive for corona after 7 days in 90% of cases and we anticipate the intervention to get that number to 50%, with an alpha of 0.05 and a size of 24 in the intervention group, the study has a power of 0.957 and answers the question whether chloroquine stops viral shedding by day 7. This isn't cardiology where we need 50000 patients to find the significance.
Oh come on that isn't fair. Just do a simple google search for countries which have made chloroquine part of their standard treatment. The reference you're making here is to a person trying to exploit people during a pandemic with what was an obvious lie.
A country using an unproven treatment to quell panic is hardly unprecedented nor out of the realm of many governments and sorry for me to say the US as well.
I wonder if anyone has tried forsythia against covid? I’m just saying... we’d all feel pretty foolish if we find out in a couple years that it is effective.
Edit: yeah, yeah... you downvote me, but I bet you secretly wiki'd forsythia to see if it's a real thing.
This one study is weak, agreed. However, some form of chloroquine+iodine has been used successfully in South Korea. I don't agree with the "miracle" hyperbole, but there is reason to be hopeful.
The findings they're claiming are nothing short of miraculous, and I think the people who were behind the trial, as well as everybody else even remotely interested in this (the entire world, I would say) should and likely does support a broader trial.
Worth mentioning that, with China/Korea, now France deploys this drug to frontlines, in the best case scenario, which is the South Korea case, the death rate still sets at 1%, so still 10 times more lethal than flu.
We all want a miracle, but we need to be cautious about it.
I am more curious right now as whether this drug can work as a preventative medication for high risk individual to lower the chance for getting infected, TBH. That will help the medical stuff greatly.
To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years. But to date it has never really panned out in clinical trials. (If it had, we would all be taking chloroquine every time we caught a serious virus like the flu).
Doesn't mean it can't be beneficial this time for this particular virus; we should always keep trying. I'm just saying it's probably a bit early to be calling miracles based on one small study.
> To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years.
No, the actual reason is that Chinese doctors noted a statistical abberation in their coronavirus patients: none of the patients had lupus. They called around and confirmed it, none of the hospitals had any patients with lupus. And the standard chinese treatment for lupus is... chloroquine.
Chloroquine has proceeded from statistical anomaly, to successful case studies, to successful non-random trials, and now is in random trials. I'm not a doctor but I think there's a pretty good chance it'll be effective.
Yes, it is not officially approved yet, but it is being deployed in China, Korea, and other countries off-label. Right now there are no other options. I'd take chloroquine over nothing. Overall it is not pleasant but there are few dangerous side effects in the short term (retinopathy is a possible side effect if duration of treatment is on the order of months to years). It is an over-the-counter medication in a lot of the world, it is behind the counter in a lot of other places (including the UK).
(the US just likes making sure doctors get paid even if a medication is quite safe. There are a lot of medications like oral contraceptives that are routinely done over-the-counter in most other places that we insist are so wildly dangerous you couldn't begin and discontinue them if you noticed side effects. And on the flip side, there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway, or even in "abuse resistant" combination products. Chloroquine is a pretty standard antimalarial and places that have malaria don't think it's a big enough deal that you need a doctor to get it.)
Given the lack of other options, given the known nature of the drug, if I was in a hospital dying of COVID would I want to give it a shot? Yes. Same principle as experimental cancer drugs. Some chance is better than no chance.
Anyone we can treat with pharmaceutical interventions instead of ventilators frees up those ventilators for more critical patients. Even if they still have to remain under some degree of medical supervision, it frees up ICU beds.
chloroquine and remdesivir, have been designated for Expanded Access, or “compassionate use,” by the FDA. Hopefully to be FDA approved for the gp soon.
I would give it a shot too if I was sick, but that is a far cry from calling it a miracle.
It shows promise and should be pursued—and it is. Let’s not oversell it though.
> there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway
Interestingly, one of the other therapeutic leads that doctors are following up on is whether Tylenol is safer than ibuprofen for Covid patients. It got reported that it was, but it’s not yet clear how true that is.
This is not a rigorous study and doesn't pretend to be but those are sufficiently impressive results that it is still a cause for hope.
You need meticulous study design when you're looking for small effect sizes, with a large enough effect you can extract useful information even from flawed data.
No, he doesn't. Derek has a favourable opinion of favipiravir and in the footnote he calls the French trial "messy". That's very polite, considering the shape of the data.
Boy, "messy" data when performing initial experimental administration of a drug, during an outbreak with no officially approved treatment, with limited testing capacity.which is piling up bodies faster than mortuaries can cremate them. How shameful.
People are nitpicking. Yes, "we need further studies", that's at the end of literally every research paper ever, but the longer you delay the more people die.
It's no different than signing up for an experimental cancer drug. There are no alternatives that are known to work. You take the best shot with the possibility that looks promising right now. The alternative is dying without trying.
It's kind of a weirdly US-centric position, both from science fetishism and the fact that we're the the country with the fewest deaths so far. Oh golly gee I guess we better wait 18 months for a double-blind clinical trial and FDA approval and a Nature article. Other countries have the bodies piling up and they are pushing ahead, because a chance is better than no chance. Just like with cancer.
It's not that you didn't have a supply of patients for clinical trials. You have to make sure that your proposed therapy works, else you waste money and lives. If your wonder drug is so great you'd notice immediately in the data and would cut the trial short. What is concerning that the Chinese didn't notice a great effect, else they would have told the rest of the world.
South Korea and Japan used the very same plan in their ICU's.
Maybe it's the crackdown of Western media on China, but right now italian doctors trust chinese experience more than western experts. Western experts still preach lockdown, whilst Italian officials in the meantime also found out that the asian recommendation of mass testing everybody is better. Without drastic lockdowns. Test everybody, wear masks, be responsible.
> else you waste money and lives. If your wonder drug is so great you'd notice immediately in the data and would cut the trial short.
The problem is that it was chinese and south korean data only. Trials are not cut short, western buerocracy still rule the hospitals. Many doctors do get their younger patients on those trials. But in the overloaded case, such as Italy and Spain it's too late. You need to apply virostatica early on for 10 days, not when it's too late. But those people are advised to stay at home and wait for the fever to go down. Without effective treatment plan, as outlined by the chinese.
> It's not that you didn't have a supply of patients for clinical trials.
No, it's that you couldn't guarantee that every patient could be tested every day in order to measure whether the drug is effective. That is what people are complaining about, and it won't be fixed until testing capacity is reliably there.
WARNING: To all those who are reading threads like these and intend to self medicate: you should not do this unless you are medically qualified or have a doctor prescribe you whatever medication might help. The risk of side effects is substantial and there is a reason many countries keep quack laws on the book to go after those who practice medicine without a license.
Medical advice should be given by doctors and what works for someone else may not work for you (be ineffective), cause side effects of all degrees of severity. Note that the original title includes the word 'potential'.
I know. It might even work. But until there is really hard proof and the side effects are well documented saying it's out there is tantamount to telling people to self-experiment, prescriptions or not. Illegal drugs are a thing.
He didn't "say it's out there". Bayer did, who apparently think there's merit to this enough to issue a press release of their own and donate 3M pills. Bayer probably knows more about this than you.
Also, reuters, cnn, msnbc, etc. covered it.
Making the info available here in HN is not tantamount to telling people to self-experiment. that is laughable.
I don't totally buy the never take medicine without a doctor bit. I mean lots of people do with paracetamol and the like. Some common sense is required.
Warning: chloroquine has strong side-effects, and very high toxicity, unfortunately pretty close to therapeutic doses, that may cause serious arrhythmia, and even heart attacks. Don't ever try to self-medicate with chloroquine.
You needn't use your real name, of course, but for HN to be a community, users need some identity for others to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
WARNING: the above is almost certainly wrong. Citation should be provided.
The preponderance of the evidence suggests that it's a well-understood drug that has been around for decades, used by 10s of millions for not only malaria but also arthritis. In fact it is safe enough that it is available over the counter in some countries. [1]
Hydroxychloroquine has lower toxicity and while it has side effects including sight loss these tend to only occur with long use (years to decades) and are mostly accumulative.
The current HCQ protocol for COVID-19 is a 600mg dose daily (within about the safe limits for a grown adult, however can be a bit high) for 10 days.
This isn’t a recommendation of any sorts however the side effects are likely to be mild and reversible for this type of usage.
I see that the CDC bans blood donations for 3 years after being diagnosed with malaria [1], but can't find any citation that blood donations are banned for taking chloroquine itself... do you have a citation to that effect?
I wouldn't say 'take this with a grain of salt', but I also wouldn't brush it off as fake either. Yes, the french study wasn't structured perfectly. But such a trial isn't possible in the timeframe we're looking at.
If enough respected virologists (like Didier Raoult) and doctors in China/South Korea see some positive signals, it makes sense to prepare for the event that it does indeed help. Keep in mind, this is already being used as a treatment in the US today. They likely have even better data than we do. Or if they don't, they still feel like it's worth taking a calculated risk on.
Starting back in the 60's, hundreds of thousands of Americans serving in the military and peace corps in areas with malaria were given daily chloroquine for extented periods of time. Think Vietnam. How long does it take to evaluate safety?
It’s prescribed here in Canada, but at least in Alberta, the prescription goes along with annual in-depth retina screening to catch retinal toxicity before there’s permanent vision loss. It’s ok, but there’s a reason it’s not available over the counter.
133 comments
[ 3.8 ms ] story [ 146 ms ] thread[Edit] To be clear, I am not a doctor and this is not medical advise. Please research this topic yourself. There are many studies on nih.gov on zinc ioniphores. Here is a video discussing both compounds by a doctor. [3] They are also not giving medical advise.
[1] - https://examine.com/supplements/quercetin/
[2] - https://www.ncbi.nlm.nih.gov/pubmed/25050823
[3] - https://www.youtube.com/watch?v=vE4_LsftNKM
[I have now edited... but please don't say "I see that you added something in brackets"]
> In conclusion, our study strongly suggests co administration of antioxidant flavonoid like quercetin along with CQ for antimalarial therapy. This is particularly important when CQ is administered as long-term prophylactic treatment for malaria as chronic exposure has shown to be resulting in higher dose level of drug in the body.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625570/
I do answer their survey that they all are very professional.
you can buy the cinchona bark on amazon, recipe is very good.
How much less than 83mg/litre is unclear. You would do yourself damage with the sugar should you try to drink enough for a dose. Also it is unclear how effective quinine is compared with hydroxychloroquine.
Finally, quinine can have serious side effects, take care.
I have minor symptoms, and have been self-isolating since Wednesday (18) because many people around me were coughing on Monday (16) & Tuesday (17). The government here in NZ has not issued any lockdown instructions.
Due to comments here on HN, I decided to buy 4x 1.5 litres of ordinary Schweppes tonic water. Panic buying had not yet struck (it has now, but mostly bread, pasta, and toilet roll). I shared one bottle around the office, and gave one to my homestay family.
I've been drinking about 3 glasses per day, a litre at most. It's a sub-clinical dose for sub-clinical symptoms. The bitterness causes immediate sputum production in my mouth. Despite feeling a sore throat yesterday, I haven't yet started coughing.
I'm advocating for it in direct messages to friends: not because it's some miracle cure for the virus, but because it eases the coughing symptoms and thus might slow the spread. The placebo effect is probably also very real: I feel like I'm doing something, and that calms me down.
If people listen to you they're truly ill informed.
He is suggesting drinking a few glasses of tonic water, saying why it is helping him, and prefixed a warning.
There is nothing dangerous in his suggestion, and it is obviously not given as a complete medical solution to the epidemic to use for your family.
No one should mistake this as an alternative to proper treatment.
Quinine is super bitter, it doesn't take much for flavor use, and the stuff on the shelf is nowhere near the strength that would have been given for brits in tropical posts during those days.
https://www.mediterranee-infection.com/wp-content/uploads/20...
It's also important to understand the medication interactions, which can be quite serious.
But it would make sense for medical staff and other people in high risk occupations.
Autoimmune diseases, can be way, way worse, particularly arthropathies, since, if unchecked, they cause permanent damage. Also IME, as a rule disease modifying drugs have really nasty side effects. You take them anyway, because you have no better alternative :(
For example, it enhances influenza: https://www.ncbi.nlm.nih.gov/pubmed/25715935
I'm pondered if a mass use for covid would work. I think it's probably too unproven and covid to small a percentage of the population to make dosing everyone a good idea. What I would try if I were running things is bulk testing and giving people a chloroquine type med straight off if they were positive.
I tried finding out how much chloroquine is prescribed world wide per year, but couldn't find it. It may give us a clue into how much is already being used.
I know that it isn't used except for pregnant women as a malaria treatement because the first line antimalarials aren't proven save in pregnancy, but also that the malaria protozoa has some resistence to Chloroquine in many countries (Ecuador, among others)
https://www.sciencedirect.com/topics/chemistry/chloroquine
From this, it doesn't look like there are any major hurdles in the necessary precursors. E.g. chloroaniline is very commonly used for making many drugs (incl. chlorhexidine), methyl acrylate is similarly in the six-figure-tonnes-per-year category, and that diamine also looks to have a nice synthesis route.
Fingers and toes crossed for this one.
https://www.fiercepharma.com/pharma/bayer-preps-u-s-donation...
They're miraculous. This is a well-studied, mass-produced drug which has been around for 70 years and appears to be highly effective at treating this virus.
Ps: i do agree that his tone and style looks unorthodox. But results is the only thing we should care about.
Where are you seeing that? Because what I see is a very non-rigorous, non-randomized study. Also, what about this part:
>A total of 26 patients received hydroxychloroquine and 16 were control patients. Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCRpositive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3.
Really easy to have "miraculous" results when 20+% of your treatment group were excluded and also happened to be the ones with the most severe symptoms.
I think we could have a whole website of things that were continued to be used without a shred of evidence of effectiveness.
The fact that experts agree that this drug should be used doesn't mean they agree that it is miraculous. And this certainly doesn't suggest they disagree with the parent MD/statistician.
Maybe my faith in the collective ability of the world medical professionals to evaluate their treatment techniques is misplaced, but I still have faith that these people are acting in accordance with their scientific training.
Maybe that's wrong, and I shouldn't be trusting these people. But if I'm not trusting doctors (and especially infectious disease experts who are writing papers about their findings), then who should I trust?
I think a lot of this distrust in institutions and doctors is going to get us into a lot of trouble. I wish people would start listening to these orgs.
Why? I'm modeling the doctors and health officials who are making these decisions as agents which are presumably continuously evaluating their decisions. So basically:
A lot of experts are taking this action -> assume the action has a desirable outcome -> believe what the experts are saying (in this case both their words and their actions seem to agree with each other, and point to the idea that chloroquine is an effective treatment of covid-19).
I am genuinely at a loss as to why this stance (my stance) is anything other than completely obvious.
I'm sorry if but I'm having a difficult time figuring out what I have said that you disagreed with.
You don't seem to be taking people's statements at face value, but rather projecting additional meaning onto them, almost as if you conceive of fewer possible positions than there actually are, and pigeonhole us.
Consider my prior two statements in this thread which start with "the fact" and "you were". Do you agree that these statements were correct, on their own terms, in their own context, and independent of additional complexities involving degree if efficacy or various arguments for or against use, testing, or hopefulness?
Also, do you see that the people who disagree with your framing are not 'picking nits' nor are they having 'struck nerves'? Can you see other reasons why they might respond as they did?
For those that don't get the reference: https://en.wikipedia.org/wiki/Contagion_(2011_film)
And that's exactly what it is.
This is not that.
"Lets all pray for God to cure us" comes to mind.
Edit: yeah, yeah... you downvote me, but I bet you secretly wiki'd forsythia to see if it's a real thing.
We all want a miracle, but we need to be cautious about it.
I am more curious right now as whether this drug can work as a preventative medication for high risk individual to lower the chance for getting infected, TBH. That will help the medical stuff greatly.
South Korea will max end up with a IFR of 0.2-0.5%, 2 to 5 times worse than the flu.
Doesn't mean it can't be beneficial this time for this particular virus; we should always keep trying. I'm just saying it's probably a bit early to be calling miracles based on one small study.
No, the actual reason is that Chinese doctors noted a statistical abberation in their coronavirus patients: none of the patients had lupus. They called around and confirmed it, none of the hospitals had any patients with lupus. And the standard chinese treatment for lupus is... chloroquine.
https://www.jqknews.com/news/388543-The_novel_coronavirus_pn...
Chloroquine has proceeded from statistical anomaly, to successful case studies, to successful non-random trials, and now is in random trials. I'm not a doctor but I think there's a pretty good chance it'll be effective.
Yes, it is not officially approved yet, but it is being deployed in China, Korea, and other countries off-label. Right now there are no other options. I'd take chloroquine over nothing. Overall it is not pleasant but there are few dangerous side effects in the short term (retinopathy is a possible side effect if duration of treatment is on the order of months to years). It is an over-the-counter medication in a lot of the world, it is behind the counter in a lot of other places (including the UK).
(the US just likes making sure doctors get paid even if a medication is quite safe. There are a lot of medications like oral contraceptives that are routinely done over-the-counter in most other places that we insist are so wildly dangerous you couldn't begin and discontinue them if you noticed side effects. And on the flip side, there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway, or even in "abuse resistant" combination products. Chloroquine is a pretty standard antimalarial and places that have malaria don't think it's a big enough deal that you need a doctor to get it.)
Given the lack of other options, given the known nature of the drug, if I was in a hospital dying of COVID would I want to give it a shot? Yes. Same principle as experimental cancer drugs. Some chance is better than no chance.
Anyone we can treat with pharmaceutical interventions instead of ventilators frees up those ventilators for more critical patients. Even if they still have to remain under some degree of medical supervision, it frees up ICU beds.
It shows promise and should be pursued—and it is. Let’s not oversell it though.
> there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway
Interestingly, one of the other therapeutic leads that doctors are following up on is whether Tylenol is safer than ibuprofen for Covid patients. It got reported that it was, but it’s not yet clear how true that is.
You need meticulous study design when you're looking for small effect sizes, with a large enough effect you can extract useful information even from flawed data.
Derek lowe reviews the evidence here and has far more of a positive take on it than i'd expected. (as in , "not obvious nonsense!")
check my post history if you like, i’m skeptical too.
People are nitpicking. Yes, "we need further studies", that's at the end of literally every research paper ever, but the longer you delay the more people die.
It's no different than signing up for an experimental cancer drug. There are no alternatives that are known to work. You take the best shot with the possibility that looks promising right now. The alternative is dying without trying.
It's kind of a weirdly US-centric position, both from science fetishism and the fact that we're the the country with the fewest deaths so far. Oh golly gee I guess we better wait 18 months for a double-blind clinical trial and FDA approval and a Nature article. Other countries have the bodies piling up and they are pushing ahead, because a chance is better than no chance. Just like with cancer.
* https://www.chinalawtranslate.com/en/standards-of-care-for-s...
* Or https://www.reddit.com/r/Coronavirus/comments/fd15kg/preprin...
South Korea and Japan used the very same plan in their ICU's.
Maybe it's the crackdown of Western media on China, but right now italian doctors trust chinese experience more than western experts. Western experts still preach lockdown, whilst Italian officials in the meantime also found out that the asian recommendation of mass testing everybody is better. Without drastic lockdowns. Test everybody, wear masks, be responsible.
> else you waste money and lives. If your wonder drug is so great you'd notice immediately in the data and would cut the trial short.
The problem is that it was chinese and south korean data only. Trials are not cut short, western buerocracy still rule the hospitals. Many doctors do get their younger patients on those trials. But in the overloaded case, such as Italy and Spain it's too late. You need to apply virostatica early on for 10 days, not when it's too late. But those people are advised to stay at home and wait for the fever to go down. Without effective treatment plan, as outlined by the chinese.
No, it's that you couldn't guarantee that every patient could be tested every day in order to measure whether the drug is effective. That is what people are complaining about, and it won't be fixed until testing capacity is reliably there.
Bigger trials would only make that worse.
Medical advice should be given by doctors and what works for someone else may not work for you (be ineffective), cause side effects of all degrees of severity. Note that the original title includes the word 'potential'.
Also, reuters, cnn, msnbc, etc. covered it.
Making the info available here in HN is not tantamount to telling people to self-experiment. that is laughable.
You needn't use your real name, of course, but for HN to be a community, users need some identity for others to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
The preponderance of the evidence suggests that it's a well-understood drug that has been around for decades, used by 10s of millions for not only malaria but also arthritis. In fact it is safe enough that it is available over the counter in some countries. [1]
1: https://en.wikipedia.org/wiki/Chloroquine
Please read what you're posting, at least.
The current HCQ protocol for COVID-19 is a 600mg dose daily (within about the safe limits for a grown adult, however can be a bit high) for 10 days.
This isn’t a recommendation of any sorts however the side effects are likely to be mild and reversible for this type of usage.
Many substances that have been ingested by humans are well understood, but if it comes to drinking a thimble of cyanide, well ... after you.
[1] https://www.cdc.gov/malaria/blood_banks.html
If enough respected virologists (like Didier Raoult) and doctors in China/South Korea see some positive signals, it makes sense to prepare for the event that it does indeed help. Keep in mind, this is already being used as a treatment in the US today. They likely have even better data than we do. Or if they don't, they still feel like it's worth taking a calculated risk on.