4 ms·

Drugs are a solution for mitigation. They already have a preliminary trial result in China that says Chloroquine works. South Korea agrees and I believe is co

Drugs are a solution for mitigation. They already have a preliminary trial result in China that says Chloroquine works. South Korea agrees and I believe is combining it with Zinc. South Korea has the lowest fatality rate of any country.

graeme 7y ago
This has a lot to do with their age distribution. Their fatality rate by age is similar to elsewhere. A large fraction of the infected cult members were young. Korea also hasn’t had any hospital breakdown related increase in the death rate. Chloroquine may indeed work, but the Korean stats are misleading if you don’t adjust for ages.
- cameldrv 7y ago
  China’s fatality rate is also way down. Partly of course from less stress on the medical system, but they’ve also just learned a lot about how to treat it, particularly what drugs to use. I believe Chloroquine + Liponavir/Ritanovir + Interferon or Ribavirin is state of the art.
  - ImprovedSilence 7y ago
    I thought that remdesivir was the drug showing the most promise? What happened with that one? And my big questions are how soon can they spool up world supplying levels of batches?
    - lbeltrame 7y ago
      It's being tested in a few trials, the earliest one should have data in April, IIRC.
  - copperx 7y ago
    Chloroquine + Liponavir/Ritanovir may cause fatal arrithmias, in the case anyone out there is self medicating. It's one or the other.
    - cameldrv 7y ago
      Can you cite a source? Current Chinese treatment guidelines allow it. Also very important to quantify side effect risks, even if it's a rough estimate. For example, if a 70 year old patient has already progressed to dyspena, they might have something like a 20% mortality rate from COVID. Even if there is a side effect profile for the treatment that normally would be considered very dangerous, it may be well worth it to administer it. We see the same thing with chemotherapy or radiation treatment. The side effects are terrible and fairly often fatal, but they are safer than the disease. This is the situation in which we find ourselves.
      - copperx 7y ago
        I can't find the original source, but you can easily verify that both drugs increase the QT/QTC and PR interval, which is a high-risk interaction AFAIK (I'm not a doctor). Some doctors recommend doing an EKG before administering Chloroquine. https://www.sciencedirect.com/science/article/pii/S0883944120303907?dgcid=rss_sd_all https://www.sciencedirect.com/science/article/pii/S088394412... What you're saying is true, but you're assuming that Chloroquine + Kaletra is better than Chloroquine by itself, and we don't have the data for that yet. Do you have a source for the Chinese recommendations?
        cameldrv 7y ago
        Thanks for the link. Current Chinese treatment guidelines are: https://www.chinalawtranslate.com/en/coronavirus-treatment-plan-7/ https://www.chinalawtranslate.com/en/coronavirus-treatment-p... They state: 4. Antiviral therapies: Interferon-alpha (adult: 5 million units or equivalent can be added to 2ml sterile injection water and delivered with a nebulizer twice daily), lopinavir/ritonavir (adult: 200mg/50mg/tablet, 2 tablets twice daily; the length of treatment should not exceed 10 days), ribavirin (recommended in combination with interferon or lopinavir/ritonavir, adult: 500mg twice or three times daily via IV, the length of treatment should not exceed 10 days), chloroquine phosphate (adult 18-65 years old weighing more than 50kg: 500mg twice daily for 7 days; bodyweight less than 50kg: 500mg twice daily for day 1 and 2, 500mg once daily for day 3 through 7); umifenovir (adult: 200mg three times daily; the length of treatment should not exceed 10 days). Pay attention to issues such as adverse drug reactions, contraindications (for example, chloroquine should not be given to patients with heart diseases), and drug interactions. Further evaluate the efficacy of current treatment regimens in clinical applications. Using 3 or more antiviral drugs is not recommended. Corresponding medication should be discontinued should intolerable side effects appear.
bsder 7y ago
> They already have a preliminary trial result in China that says Chloroquine works Chloroquine has a long history with many diseases of "sorta, but not really" working when subjected to actual test. Please don't spread unsubstantiated info.
- cameldrv 7y ago
  This is not unsubstantiated. It is proven in vitro, and this came out the other day: http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/content_190536632.htm http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con... I haven’t found the source paper if there is one yet — I can’t read Chinese except with google translate
  - irq11 7y ago
    Drugs shown to be effective in vitro routinely fail to show similar effects in vivo. Chloroquines have a long history of this in viral studies.
    - cameldrv 7y ago
      The point is that according to what the official Chinese medical line is, it works in vivo. This is apparently confirmed by Korean experience. I understand the skepticism, but you go to war with the data you have, and the data we have indicates Chloroquine works.
      - irq11 7y ago
        The “data” is anecdotal, not even close to the standards of an effectiveness trial. That said, it’s an approved drug, so it will be applied and we’ll see how it goes. But don’t spread rumors about its effectiveness, because the truth is, we don’t know.
  - bsder 7y ago
    Bleach or a handgun also work "in vitro". Relevant XKCD: https://www.xkcd.com/1217/ https://www.xkcd.com/1217/ Chloroquines will be tried since they already pass the "safe" bar. However, I suspect that if they worked "in vivo", we would have compelling data on that from China already. The fact that we don't have such data suggests that they don't. We seem to have much better data about the effectiveness of standard anti-virals already.

graeme 7y ago

This has a lot to do with their age distribution. Their fatality rate by age is similar to elsewhere. A large fraction of the infected cult members were young. Korea also hasn’t had any hospital breakdown related increase in the death rate. Chloroquine may indeed work, but the Korean stats are misleading if you don’t adjust for ages.

cameldrv 7y ago
China’s fatality rate is also way down. Partly of course from less stress on the medical system, but they’ve also just learned a lot about how to treat it, particularly what drugs to use. I believe Chloroquine + Liponavir/Ritanovir + Interferon or Ribavirin is state of the art.
- ImprovedSilence 7y ago
  I thought that remdesivir was the drug showing the most promise? What happened with that one? And my big questions are how soon can they spool up world supplying levels of batches?
  - lbeltrame 7y ago
    It's being tested in a few trials, the earliest one should have data in April, IIRC.
- copperx 7y ago
  Chloroquine + Liponavir/Ritanovir may cause fatal arrithmias, in the case anyone out there is self medicating. It's one or the other.
  - cameldrv 7y ago
    Can you cite a source? Current Chinese treatment guidelines allow it. Also very important to quantify side effect risks, even if it's a rough estimate. For example, if a 70 year old patient has already progressed to dyspena, they might have something like a 20% mortality rate from COVID. Even if there is a side effect profile for the treatment that normally would be considered very dangerous, it may be well worth it to administer it. We see the same thing with chemotherapy or radiation treatment. The side effects are terrible and fairly often fatal, but they are safer than the disease. This is the situation in which we find ourselves.
    - copperx 7y ago
      I can't find the original source, but you can easily verify that both drugs increase the QT/QTC and PR interval, which is a high-risk interaction AFAIK (I'm not a doctor). Some doctors recommend doing an EKG before administering Chloroquine. https://www.sciencedirect.com/science/article/pii/S0883944120303907?dgcid=rss_sd_all https://www.sciencedirect.com/science/article/pii/S088394412... What you're saying is true, but you're assuming that Chloroquine + Kaletra is better than Chloroquine by itself, and we don't have the data for that yet. Do you have a source for the Chinese recommendations?
      - cameldrv 7y ago
        Thanks for the link. Current Chinese treatment guidelines are: https://www.chinalawtranslate.com/en/coronavirus-treatment-plan-7/ https://www.chinalawtranslate.com/en/coronavirus-treatment-p... They state: 4. Antiviral therapies: Interferon-alpha (adult: 5 million units or equivalent can be added to 2ml sterile injection water and delivered with a nebulizer twice daily), lopinavir/ritonavir (adult: 200mg/50mg/tablet, 2 tablets twice daily; the length of treatment should not exceed 10 days), ribavirin (recommended in combination with interferon or lopinavir/ritonavir, adult: 500mg twice or three times daily via IV, the length of treatment should not exceed 10 days), chloroquine phosphate (adult 18-65 years old weighing more than 50kg: 500mg twice daily for 7 days; bodyweight less than 50kg: 500mg twice daily for day 1 and 2, 500mg once daily for day 3 through 7); umifenovir (adult: 200mg three times daily; the length of treatment should not exceed 10 days). Pay attention to issues such as adverse drug reactions, contraindications (for example, chloroquine should not be given to patients with heart diseases), and drug interactions. Further evaluate the efficacy of current treatment regimens in clinical applications. Using 3 or more antiviral drugs is not recommended. Corresponding medication should be discontinued should intolerable side effects appear.

bsder 7y ago

> They already have a preliminary trial result in China that says Chloroquine works Chloroquine has a long history with many diseases of "sorta, but not really" working when subjected to actual test. Please don't spread unsubstantiated info.

cameldrv 7y ago
This is not unsubstantiated. It is proven in vitro, and this came out the other day: http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/content_190536632.htm http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con... I haven’t found the source paper if there is one yet — I can’t read Chinese except with google translate
- irq11 7y ago
  Drugs shown to be effective in vitro routinely fail to show similar effects in vivo. Chloroquines have a long history of this in viral studies.
  - cameldrv 7y ago
    The point is that according to what the official Chinese medical line is, it works in vivo. This is apparently confirmed by Korean experience. I understand the skepticism, but you go to war with the data you have, and the data we have indicates Chloroquine works.
    - irq11 7y ago
      The “data” is anecdotal, not even close to the standards of an effectiveness trial. That said, it’s an approved drug, so it will be applied and we’ll see how it goes. But don’t spread rumors about its effectiveness, because the truth is, we don’t know.
- bsder 7y ago
  Bleach or a handgun also work "in vitro". Relevant XKCD: https://www.xkcd.com/1217/ https://www.xkcd.com/1217/ Chloroquines will be tried since they already pass the "safe" bar. However, I suspect that if they worked "in vivo", we would have compelling data on that from China already. The fact that we don't have such data suggests that they don't. We seem to have much better data about the effectiveness of standard anti-virals already.