19 ms·

Chloroquine has shown apparent efficacy in treatment of Covid-19

462 points by robomartin 7y ago

WilsonPaige 7y ago
Then we have a treatment (i.e., zinc gluconate + chloroquine): A zinc tablet (10-80 mg) dissolved slowly in the mouth, lavaging the throat and nose, while lying down will cease coronaviral replication on most of the surfaces of the upper respiratory system. Zinc sprays also work. This must be done within the first 3-4 days of infection with covid-19. The covid-19 virus' usual course is to first infect the eye, nose and/or throat and then, after ~3 days, move down into the lungs. If chloroquine (mg) stops the virus in the bloodstream then the combination of (dissolved zinc in mouth + chloroquine pill (up to 500 mg of chloroquine per day) should slow (if not stop completely) the virus, allowing time to clear the virus from the body without raising an excessive immune response ("cytokine storm"). But this treatment must be done within 3-4 days of contracting covid-19. These medicines are cheaply available now.
- solotronics 7y ago
  where do I get chloroquine? is this something I can ask my general practitioner for?
  - WilsonPaige 7y ago
    A doctor can prescribe it. Best to take it under the supervision of a doctor.
  - toomanybeersies 7y ago
    GPs won't prescribe on the basis that you might get sick and require a particular medication. You can't walk into your GP's office and ask for antibiotics, for instance.
    - inferiorhuman 7y ago
      That's pretty much the exact set of circumstances that chloroquine is usually prescribed under.
      - cbhl 7y ago
        Under normal times, if you tell your doctor that you're planning on traveling, sometimes they'll ask if you want anti-malaria medication, and I believe chloroquine is one of the options they give you.
        jcims 7y ago
        Yes my daughter got it on a trip to Tanzania last year.
        Khelavaster 7y ago
        Then you should go after the doctor for malpractice because malaria in East Africa is hydrochloroquine-resistant.
        jcims 7y ago
        That’s the least bit of malpractice I’ve seen in the past year.
      - toomanybeersies 7y ago
        My mistake, I didn't realise chloroquine was a malaria prophylactic (I've always been given other anti-malarials), I thought it was only a treatment for when you were actually diagnosed with malaria.
  - petecox 7y ago
    It's commonly used for malaria. A related '-quine' is the active ingredient of Gin and Tonic.
    - Udik 7y ago
      The active ingredient of gin & tonic is definitely alcohol :)
      - IAmEveryone 7y ago
        Tonic was invented to make quinine palatable to British soldiers in India. About three minutes into the scheme, someone added gin. So quinine is indeed arguably the original “active” ingredient, sugar was second (to mask the flavor), and alcohol “let’s just pretend this isn’t happening” was third.
    - elric 7y ago
      Is this the same malaria drug that can cause depression and lead to suicidal thoughts?
  - jandrewrogers 7y ago
    This class of drug is a prophylactic for malaria. It, or one of its equivalents, is commonly given to you if you tell your doctor that you are traveling to a part of the world where malaria is currently endemic. It isn't the kind of drug where they worry much about abuse or misuse, as it is cheap and ubiquitous in the developing world.
- hnick 7y ago
  That is good news. But why 3-4 days? Because once it settles in the lungs it's out of reach for both treatments? And do you mean 3-4 days from the appearance of symptoms or from the initial infection? From what I read, 3-4 days is not always long enough for someone to even know they have it.
- ethbro 7y ago
  > allowing time to clear the virus from the body without raising an excessive immune response ("cytokine storm") Citation requested, that cytokine storms are a common pathology associated with Covid-19. Because (a) I haven't seen that in the literature, & (b) it's at odds with the published age-banded mortality rates.
  - tlb 7y ago
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Not common but very serious.
  - WilsonPaige 7y ago
    Heard of Google, bro? It's settled fact that the covid-19 pneumonia is a result of a "cytochine storm". Always like to lead off with a lancet article, to lance the boil: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://link.springer.com/article/10.1007/s00134-020-05991-x https://link.springer.com/article/10.1007/s00134-020-05991-x https://www.cusabio.com/COVID-19-Cytokine-Storm https://www.cusabio.com/COVID-19-Cytokine-Storm https://lab-a-porter.com/2020/02/wuhan-coronavirus-and-cytokine-storm/ https://lab-a-porter.com/2020/02/wuhan-coronavirus-and-cytok... The age-banded mortality rates aren't all they're bandied up to be, eh? Heh, heh!
    - nl 7y ago
      It's settled fact that the covid-19 pneumonia is a result of a "cytochine storm". This just isn't true. It maybe true for a subset of patients in some circumstances. To quote your first link: Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome.
      - WilsonPaige 7y ago
        Explained by espiratory physician John Wilson in the article "Coronavirus: what happens to people's lungs when they get Covid-19?" https://www.theguardian.com/world/2020/mar/20/coronavirus-what-happens-to-peoples-lungs-when-they-get-covid-19 https://www.theguardian.com/world/2020/mar/20/coronavirus-wh... "How does the pneumonia develop? When people with Covid-19 develop a cough and fever, Wilson says this is a result of the infection reaching the respiratory tree – the air passages that conduct air between the lungs and the outside. He says: “The lining of the respiratory tree becomes injured, causing inflammation. This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough. “But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages. “If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.” If the air sacs then become inflamed, Wilson says this causes an “outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia.” He says lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the body’s ability to take on oxygen and get rid of carbon dioxide. “That’s the usual cause of death with severe pneumonia,” he says. " The last 3 paragraphs are a description of the "cytokine storm".
- jimmyswimmy 7y ago
  So, I'm no medical professional, just an avid reader of such news. But I believe that most of this post is incorrect. I've seen no studies backing up the use of zinc for anything related to COVID-19. A search of pubmed for the terms 'covid zinc' or 'coronavirus zinc' show no papers referencing treatments. Same goes for medrxiv. There are a lot of cold "treatments" involving the use of zinc in the way you suggest. I have even seen studies which support its use as a prophylactic to the common cold (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/) though that one makes no reference to a common side effect, particularly the way you recommend its use, which is loss of sense of smell. Further, I haven't read anywhere about the mechanism of infection you propose for this disease. It is said to attack the lungs, liver and small intestine due to its furin cleavage site (https://www.biorxiv.org/content/10.1101/2020.02.10.942185v1 https://www.biorxiv.org/content/10.1101/2020.02.10.942185v1). Finally, I am nearly certain you are spreading bad information about how this treatment works. Chloroquine is provided after active symptoms present. The first few days of infection are asymptomatic for most patients, certainly the first 4-7 days, if not longer. There is no medical call for treatment until a patient presents symptoms, and your advice risks leading people to attempt to hoard this medication. We agree that chloroquine is indeed cheap.
  - ComputerGuru 7y ago
    Not vouching for the suggested treatment but chloroquine acts as a zinc ionophere enabling increased zinc binding/intake in cells, inhibiting RNA-dependent RNA polymerase, which would theoretically ultimately encumber the replication of the virus.
    - dboreham 7y ago
      Right. The Zinc is already present intercellular, unless the patient is Zinc deficient.
  - WilsonPaige 7y ago
    jimmyswimmy says "I've seen no studies backing up the use of zinc for anything related to COVID-19." It would be very early for posts specific to Covid-19. However that was not the claim: the claim was, verbatim, "A zinc tablet (10-80 mg) dissolved slowly in the mouth, lavaging the throat and nose, while lying down will cease coronaviral replication on most of the surfaces of the upper respiratory system. Zinc sprays also work. This must be done within the first 3-4 days of infection with covid-19." Covid-19 is a corona virus and, like all corona viruses, ceases to replicate in the presence of high zinc levels on the epitheleal surfaces. There are many studies re zinc and the way it halts viral replication: https://www.bing.com/search?q=zinc+halts+viruses+in+vitro&form=OPRTSD&pc=OPER https://www.bing.com/search?q=zinc+halts+viruses+in+vitro&fo... As I believe I stated ealier, I made no claims as to mechanism. I wish to point out that probably most of your information about chloroquine is based on the treatment of other diseases, and likely specifically malaria. It is by no means clear that the dose required for malaria is the same as the dose required for Covid-19, which indeed may be an order of magnitude or more less. Time will tell. As for presenting symptoms, once again I believe this to be take from the malaria playbook. Researchers right now are testing chloroquine for prophylaxis (prevention) as well as treatment, _before_ symptoms present (certainly before serious symptoms present). What I'm saying is that it is a different ailment and the protocols (and restrictions as to timing) for malaria may, indeed, probably do not apply.
r6203 7y ago
The publication is from 02/18/20 (as stated in the footer). Why didn’t gain it more traction?
- droithomme 7y ago
  > Why didn’t gain it more traction? It did. Since then they've done more studies, have started even more studies, and have deployed it en masse as a treatment. It's part of the official treatment recommendations in China, South Korea, Poland, and Italy. It's been described as a "cure" where it was used in Australia after Chinese patients demanded they be treated with it, and Australia is starting a nationwide trial. Pakistan had Bayer start up the closed production line and deliver 300,000 doses.
  - john_minsk 7y ago
    But Italy is a mess... So it is not an actual cure?
    - droithomme 7y ago
      The guidance was adopted far too late but may slow the spread and reduce deaths. You have to catch things early. In Australia, Chinese immigrants came to their doctors and said "I have a symptom and I demand this prescription and here is the research and I won't take no for an answer." Chloroquine seems to work best if you start it within the first few days of infection. So if you are say the US and have widespread BS regarding testing and prevent people from getting it, by the time they are tested and their results back it's too late. There's no chance the US will come to their senses and start using or even producing this drug in time to help stop mass deaths. Some people bought animal grade chloroquine and are self treating, but all that supply is gone now for purchase. Doctors won't prescribe it in the US either, for their own reasons. In China and South Korea you can get tested if you have symptoms and you can start treatment if you have symptoms. So we are seeing things turn around in both places because of this and other actions.
    - stjohnswarts 7y ago
      No but preliminary evidence is that it might speed up recovery. I'm not sure if that applies in elderly if they're already getting sever lung issues though. At that point maybe the damage is already done?
simpsond 7y ago
I just recently watched an interesting video about COVID-19, Zinc and Clororquine. It explains some of the fundamentals: https://www.youtube.com/watch?v=U7F1cnWup9M https://www.youtube.com/watch?v=U7F1cnWup9M
- sliken 7y ago
  Medcram (which is the video linked) has had some great coverage of COV19. Numbers, trends, and conclusions all backed by the original published papers. Awesome.
- molmalo 7y ago
  Great video, thanks for sharing!
- jamesblonde 7y ago
  This is a good video describing the hypothesized method of action of Chloroquine. Chloroquine opens up receptors on the cell membrane to allow Zinc to enter cells - Zinc interfers with the replication of sars-cov-2. So, take Zinc supplements to increase general Zinc levels in plasma/tissue and let in Zinc with Chloroquine. An alternative proposed method of action for Chloroquine is that it binds to proteins created by sars-cov-2 (ORF3a, ORF10, ORF8). Those ORF proteins bind to heme (red in red blood cells), preventing oxygen from being transported - https://twitter.com/davidasinclair/status/1238972082756648960 https://twitter.com/davidasinclair/status/123897208275664896... David Sinclair based his tweets on this paper: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf... But most organizations are going with the Zinc theory of Chloroquine. So take Chloroquine with Zinc supplements (France, South Korea, China are doing clinical trials). Here is a translation of a Chinese study intermediate results - no data was released, which makes some people sceptical: https://twitter.com/jim_dowling/status/1239255793171660800 https://twitter.com/jim_dowling/status/1239255793171660800 Here is a great summary of available treatments used in different countries https://epidemio.wiv-isp.be/ID/Documents/Covid19/COVID-19_InterimGuidelines_Treatment_ENG.pdf https://epidemio.wiv-isp.be/ID/Documents/Covid19/COVID-19_In... Although untested in-vivo, many clinicians prefer hydroxycholorquine due to its superior safety profile - and 4X better efficacy in-vivo (not in humans, in cells). I tried ordering that last week when the paper came out, not sure if i will get it, though. Chloroquine is kind of old news. There has been a lot of talk around Chloroquine, starting around 6 weeks or so ago - the UK banned export of it nearly 4 weeks ago https://www.pharmaceutical-technology.com/comment/parallel-export-covid-19/ https://www.pharmaceutical-technology.com/comment/parallel-e.... I managed to order some before that. References: "Chloroquine Is a Zinc Ionophore" https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109180 https://journals.plos.org/plosone/article?id=10.1371/journal...
nl 7y ago
Previous discussion. I'll repost the paper posted as a top response then: https://www.sciencedirect.com/science/article/pii/S0166354220301145 https://www.sciencedirect.com/science/article/pii/S016635422... I'll also note that chloroquine is very dosage sensitive and lethal when overdosed.
turdnagel 7y ago
Does this mean you can treat coronavirus with tonic water?
- MatthiasP 7y ago
  Yeah, 10 litres per day.
  - jcims 7y ago
    That's going to require a lot of gin.
    - sweetbacon 7y ago
      I volunteer.
  - Robotbeat 7y ago
    83 milligrams per liter for tonic water, so about 6 liters to get a 500mg therapeutic dose.
    - fiddlerwoaroof 7y ago
      Sign me up. I’ll also need about 13 liters of gin and a bag of ice.
      - strictnein 7y ago
        Don't forget the limes.
        matwood 7y ago
        I'm an NFL person...
    - hinkley 7y ago
      But who can drink that much gin a day?
fareesh 7y ago
400M+ people have G6PD deficiency which is a condition that has severely adverse reactions to chloroquine
- jcims 7y ago
  Whoa didn't realize it was that prevalent. I looked into it for vitamin c infusions (long story), seemed to be an easy test to find. Something they could look at while looking for covid if there is an intent to treat it?
- checker659 7y ago
  Yes, but hydroxycholoroquine is a safer alternative. https://www.ncbi.nlm.nih.gov/pubmed/28556555 https://www.ncbi.nlm.nih.gov/pubmed/28556555 https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23296 https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23296
nhebb 7y ago
Previous discussion: https://news.ycombinator.com/item?id=22565107 https://news.ycombinator.com/item?id=22565107
raphlinus 7y ago
It should go without saying that we can cheerlead for the emergence of effective treatments, but actual treatment decisions should be made by a doctor.
- jMyles 7y ago
  > actual treatment decisions should be made by a doctor. Medical advice is given by doctors and other health professionals. Treatment decisions are made by patients, those entrusted by patients to make decisions, or parents, guardians, or custodians who make decisions on behalf of patients.
  - IAmEveryone 7y ago
    For everything but OTC meds, it takes both a doctor’s and a patient’s consent.
  - raphlinus 7y ago
    I take your point, but prescriptions need to be made by doctors, and that is the main point here. I actually have more nuanced views on this. Doctors are not gods, and there are situations where patients have better medical knowledge than the doctor on an important issue. But based on what I've seen so far (including confidently spread misinformation on HN) I strongly suspect that numerically these cases are far outweighed by people with just enough knowledge to be dangerous. That's all am cautioning here.
r6203 7y ago
Here’s an article (without much information...) about an upcoming trial for Chloroquine in Australia. https://www.news.com.au/lifestyle/health/health-problems/coronavirus-australia-queensland-researchers-find-cure-want-drug-trial/news-story/93e7656da0cff4fc4d2c5e51706accb5 https://www.news.com.au/lifestyle/health/health-problems/cor...
filleduchaos 7y ago
I have a fairly tame quinine allergy (and subsequently was incredibly relieved when artemisinin-based treatments became a thing) - this is interesting but also mildly horrifying news.
- barbs 7y ago
  There's also an anti-HIV medication that seems to be effective, though I don't know too much about it. https://www.news.com.au/lifestyle/health/health-problems/coronavirus-australia-queensland-researchers-find-cure-want-drug-trial/news-story/93e7656da0cff4fc4d2c5e51706accb5 https://www.news.com.au/lifestyle/health/health-problems/cor...
monkeygus 7y ago
i currently take Plaquenil (Hydroxychloroquine) for rheumatoid arthritis, and my doctor did indicate it may be helpful against Covid but not enough tests to confirm. Is it close enough to chloroquine to be the same ?
- ridgeguy 7y ago
  The paper says clinical tests used both chloroquine and hydroxychloroquine. In discussing the results, they don't seem to differentiate between the two, unless I missed it.
  - mirimir 7y ago
    Damn, another hydroxychloroquine user here. Maybe that'd ameliorate the <70 factor.
  - forkexec 7y ago
    When administering chloroquine, the hydroxy- form is a very long-lasting metabolite.
    - M_bara 7y ago
      Yes. I think the half-life is ~ 1-2 months
  - drewmol 7y ago
    "The pharmacological activity of chloroquine and hydroxychloroquine was tested using SARS-CoV-2 infected Vero cells." https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa237/5801998 https://academic.oup.com/cid/advance-article/doi/10.1093/cid...
  - deleted 7y ago
    [deleted]
- tanilama 7y ago
  Hydroxychloroquine is currently used by the Korean CDC for treating COVID-19
beager 7y ago
I've seen chloroquine come up a ton and am hopeful for the efficacy of its use in treatment of COVID-19. It's surreal to be observing the global impact of a novel pandemic, and anything that can save lives or blunt the propagation of the virus feels like a gasp of hope. Of course, chloroquine is not a vaccine, it's not a tool to contain the spread of SARS-CoV-2. We need massive and rapid propagation of testing, and meaningful progress toward a vaccine.
- dboreham 7y ago
  Except a vaccine won't be ready until long after everyone is either dead or recovered.
- jackthehammer 7y ago
  But if chloroquin , with or without zinc, halts viral replication as is proposed " Chloroquine Is a Zinc Ionophore" https://www.ncbi.nlm.nih.gov/pubmed/25271834 https://www.ncbi.nlm.nih.gov/pubmed/25271834 then it _is_ a tool to contain the spread of SARS-CoV-2 b/c it could also be used prophylactically. i.e., the virus can't replicate in the human cell if the cell already has adequate chloroquin + Zn++ present.
ggm 7y ago
This is an increadibly potent drug with serious side effects according to anything I read, its not first-line treatment its last-line, when everything else fails. You can go blind, irreversibly. Please people, speak to trained medical people before reaching to the drug cabinet. I am not a doctor. This advice is not meant to contradict the rule of only taking medical advice from medical professionals.
- checker659 7y ago
  The retinopathy happens only after years of use (like a decade). Also, as an immunosuppressant, it is pretty slow acting in that it takes two three months to even start working. The currently prescribed dosage for the viral infection is for 5-10 days (albeit at slightly higher dosage than used for malaria/lupus etc.).
- tiredofit 7y ago
  From wikipedia. One of the most serious side effects is a toxicity in the eye (generally with chronic use).[11] People taking 400 mg of hydroxychloroquine or less per day generally have a negligible risk of macular toxicity, whereas the risk begins to go up when a person takes the medication over 5 years or has a cumulative dose of more than 1000 grams. The daily safe maximum dose for eye toxicity can be computed from one's height and weight using this calculator. Cumulative doses can also be calculated from this calculator. Macular toxicity is related to the total cumulative dose rather than the daily dose. Regular eye screening, even in the absence of visual symptoms, is recommended to begin when either of these risk factors occurs.[12]
  - signa11 7y ago
    > ... has a cumulative dose of more than 1000 grams. ... woowza a Kg worth of drug !!! this doesn't look correct to me !
    - Johnny555 7y ago
      People taking 400 mg of hydroxychloroquine or less per day generally have a negligible risk of macular toxicity 400mg/day for 5 years is 730 grams.
forkexec 7y ago
Watch out for Chloroquine retinopathy
- mirimir 7y ago
  Yeah, they check my retinas at six month interval.
- checker659 7y ago
  Usually takes years to develop. This is really a non issue for the 5-10 days use in this case.
random314 7y ago
They haven't mentioned effect sizes or confidence intervals. Hopefully it is statistically significant - in which case the effect size has to be large to achieve statistical significance. I hope that is the case!
checker659 7y ago
This is an old paper, FYI. Published on Feb 20, which is eons ago given the state of things.
spitfire 7y ago
So I’m not seeing mention of this anywhere else chloroquine is being talked about. Chloroquine used to be taken daily in many of the tropical Britain colonies suffering from malaria. chloroquine in the form of quinine is where the gin and tonic drink came from. Quinine mixed with carbonated water was drunk as a prophylactic. The quinine tasted so terrible it had to be cut with something to make it tolerable - gin! That’s where gin and tonic came from - anti malaria treatment in the British colonies. If you look at tonic water even today you’ll find quinine listed as an ingredient. As a cheap, safe bet it’s not unreasonable to start having a g&t each day along with a zinc pill. The more you know.
- grecy 7y ago
  I recently spent three years driving around Africa. Chloroquine is still a very common anti-malarial in many parts of the continent.
  - vezycash 7y ago
    Name specific countries, to the best of my knowledge, it's no longer in use because malaria has become resistant to Chloroquine. And I was glad to see it go out of use cos it caused crazy itching in many people. Touching water was like pouring fuel on fire. Anyway, even though I hated it, Chloroquine really worked while it worked.
- JamesBarney 7y ago
  From 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).[5] It is often recommended as a relief for leg cramps, but medical research suggests some care is needed in monitoring doses.[6] Because of quinine's risks, the FDA cautions consumers against using "off-label" quinine drugs to treat leg cramps.[7] For malaria prevention that's 25 liters of tonic or about about 200 gin and tonics per day.
1_over_n 7y ago
As far as I read over the past week or so this is in vitro, and not yet shown in vivo or humans.
phreeza 7y ago
Given the dynamic nature of this situation, maybe this needs a [Feb 18th] tag.
jamesblonde 7y ago
I posted this a week ago. I guess a week is a long time in politics... https://news.ycombinator.com/item?id=22523530 https://news.ycombinator.com/item?id=22523530
nikkwong 7y ago
Why haven't the markets reacted positively to this news?
- ailideex 7y ago
  You know, I read this, and then I read other things implying we will fix climate change from this crisis, and I wonder ... The markets has not reacted positively to this news because something possibly helping makes no difference. Actually making a difference to the situation makes a difference. Until the point where there clearly is something that makes a difference the outlook is really bleak.
  - nikkwong 7y ago
    I suppose that may be the case. But let me play devil's advocate against it. Markets are supposed to price in values from expected future returns. Since this is "a cure", there should be positive sentiment for the future economic environment rather than the current negative sentiment. The paper says that people are being successfully treated with this medication. It sounds like a slam dunk and a definite end to all the uncertainty we're experiencing. It's somewhat akin to magically having a vaccine available today, no? A situation in which we'd expect markets to react positively. Maybe, this information has not disseminated widely enough in the media, and the markets are acting as a trailing, not leading, indicator.
    - nikkwong 7y ago
      After reading a bit more, maybe it's not such a panacea. Seems like it's standard of care, but may not help patients who have advanced symptoms; and, obviously, does not prevent infection. Therefore it may not stop us from imposing the preventative measures (quarantine, travel restrictions, the like) which are causing all the economic catastrophe. Still, seems like it would push a bit of a positive spin on things rather than allowing the economic free-fall we've witnessed.
- cm2187 7y ago
  Guessing why the markets do something is like reading the future in the guts of a chicken! But I think the market is reacting not to the virus, which by itself would have a limited economic impact (and if you think that it affects mostly the elderly, from a pure, cold economic point of view, would rather reduce the long term burden on healthcare, so would be a net economic benefit). I think the market instead reacts to the actions taken to contain the virus, which will likely severely supress the economic activity. Until there is any sign of these actions being reversed (and everything is pointing to the opposite, with France and the EU hinting at more restrictions yesterday), it is rational for the market to be bearish. Then as always there are other considerations, stocks were overly expensive, economic cycles, over leverage, etc.
ltbarcly3 7y ago
I think this is a red herring, everyone knows the only treatment is Forsythia.
adv0r 7y ago
There are at least several other sources talking about this, from more than 20 days ago. Try to google the spanish word: Cloroquina https://www.ncbi.nlm.nih.gov/pubmed/32147496 https://www.ncbi.nlm.nih.gov/pubmed/32147496 https://gacetamedica.com/investigacion/covid-19-el-fosfato-de-cloroquina-podria-tratar-la-neumonia/ https://gacetamedica.com/investigacion/covid-19-el-fosfato-d... https://www.sadi.org.ar/novedades/item/931-covid-19-uso-de-cloroquina-hidroxicloroqina-en-pacientes-con-neumonia-por-coronavirus https://www.sadi.org.ar/novedades/item/931-covid-19-uso-de-c...
cm2187 7y ago
For French speakers, a talk yesterday from Didier Raoult who is also testing Chloroquine in France [1] (and I believe who originally discovered the anti-viral benefits of that molecule on certain viruses). He finds that it reduces significantly the viral charge. He made an interesting point. It appears infected people remain contagious for 3 weeks. Taking this drug allows to significantly reduce this period. The current advice for people who are sick is stay at home and only show up at an hospital if you start having respiratory problems. He thinks a better approach is to get them to get tested quickly, and take a combination of anti-viral drugs. This will likely result in less contagions. [1] https://www.youtube.com/watch?v=n4J8kydOvbc https://www.youtube.com/watch?v=n4J8kydOvbc [edit] Adding slides link posted by chmike on this page: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-19.pdf https://www.mediterranee-infection.com/wp-content/uploads/20... [edit] corrected contagiousness from 4 weeks to 3 weeks.
- nico_h 7y ago
  that would make sense: test everybody, if positive take the drug for 5 days, rest for 2 more and back to work you go. a win for everybody!
  - ianbooker 7y ago
    Because testing everybody is no big deal.
    - cm2187 7y ago
      According to Raoult, it doesn’t seem to be a technical limitation, the test is a standard procedure that labs around the country already do routinely for other viruses.
      - gordeh 7y ago
        It's the capacity that is the issue. Testing labs all over the world, are running far above capacity already. It's not something that can be scaled up overnight either.
j-james 7y ago
> It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system ... The wholesale cost in the developing world is about US$0.04. In the United States, it costs about US$5.30 per dose. [1] That's a little over 132x more expensive. Compared to other common medicines like ibuprofen ($0.04 in the developing world, $0.05 in the USA [2]), what makes chloroquine so uniquely pricey in the USA? (or, I suppose, ibuprofen so uniquely cheap?) [1] https://en.wikipedia.org/wiki/Chloroquine https://en.wikipedia.org/wiki/Chloroquine [2] https://en.wikipedia.org/wiki/Ibuprofen https://en.wikipedia.org/wiki/Ibuprofen
- NullPrefix 7y ago
  Ibuprofen can be sold on somewhat recurring cycle.
- baybal2 7y ago
  Not uniquely. USA is famous for very high prices of essential medicines, and being an expensive country in general.
  - vinay427 7y ago
    This was already implied in the question. They're asking why something like ibuprofen is different.
    - baybal2 7y ago
      Maybe because it's one of few medicines being sold by foreign companies in USA? America doesn't have a lot of opportunities for foreign players, let alone in such militantly overregulated sector like medicines.
    - shermozle 7y ago
      I'm assuming because ibuprofen is OTC and chloroquin is prescription.
    - projektfu 7y ago
andybak 7y ago
When I first went backpacking in the 90s I remember people were sharing stories about really disturbing nightmares from taking Chloroquine and generally complaining about mental and emotional side-effects. Google returns a bit of corroboration but that isn't mentioned on the Wikipedia page.
- CPLX 7y ago
  Are you sure you’re not talking about Malarone? That’s the other anti-malaria drug which has very intense and emotional dreams as a side effect.
  - arusahni 7y ago
    Lariam (Mefloquine) was the one I took in the 90s that had the psychological warnings attached. IIRC, Malarone is newer, and may not align with the OP's timeline.
    - CPLX 7y ago
      Whoops. You are correct. We were both wrong, Lariam is what I was thinking of.
      - andybak 7y ago
        Yep. It was Lariam I was thinking of.
chmike 7y ago
Dr Raoult has announced yesterday that the test of hydroxychloroquine on 24 patients showed positive results, especially when combined with an antibiotic against pneumonia. Slides of the presentation are here: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-19.pdf https://www.mediterranee-infection.com/wp-content/uploads/20..., results are on the last slide.
iamgopal 7y ago
Is this the same drug that was given to Harbert in Jule Verne's The Mysterious Island ?
- philipkglass 7y ago
  No. The Mysterious Island was written in 1874. Chloroquine was discovered in 1934: https://www.mmv.org/malaria-medicines/history-antimalarials https://www.mmv.org/malaria-medicines/history-antimalarials
deleted 7y ago
[deleted]
bryanrasmussen 7y ago
so when it says: "In the early in vitro studies, chloroquine was found to block COVID-19 infection at low-micromolar concentration," does this mean it might be a good idea to be taking it regularly to keep from getting covid-19 from contact with surfaces with low concentration of the virus?
shanth 7y ago
ELI5: Neem leaf will cure corona.
hydroreadsstuff 7y ago
Quercetin is over-the-counter and has similar properties Studies according to the video below on Ebola and Zikka used 50-100mg/KG - a lot lot. This Medcram video talks about Chloroquine and the others: https://www.youtube.com/watch?v=vE4_LsftNKM https://www.youtube.com/watch?v=vE4_LsftNKM
- khafra 7y ago
  > Quercetin is over-the-counter and has similar properties Source for the similarities between chloroquine and quercetin?
lokl 7y ago
Can anyone point to data about chloroquine use by people with quinine allergies? I am allergic to tonic water, perhaps to the quinine in it. Thanks.
IXxXI 7y ago
Previous previous discussion: https://news.ycombinator.com/item?id=22500063 https://news.ycombinator.com/item?id=22500063
zilian 7y ago
could there be interactions with anti IL-17a treatments such as cosentyx ?
QuantumGood 7y ago
Poland has formally registered Chloroquine as a drug for COVID-19 and will treat all patients with it. Chloroquine phosphate is a generic antimalarial drug derived from quinolone, in 10 trials for Covid-19 in China, including one in combination with Kaletra, as chloroquine phosphate is believed to have broad-spectrum antiviral activities. Basically the goal is to allow zinc to get into a cell, it needs a helper to get inside the cell (a Zinc Ionophore). Apparently Hydroxychloroquine / Plaquenil (which you can buy here: InHousePharmacy.vu/p-1106-plaquenil-tablets-200mg.aspx or here easyshopping4health.com/buy-plaquenil-usa.html) is even more effective than Chloroquine. Also see Medscape.com/viewarticle/736439 and https://www.ncbi.nlm.nih.gov/pubmed/32074550/ https://www.ncbi.nlm.nih.gov/pubmed/32074550/ title: "Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies" Quinolones like Chloroquine were used in malaria prevention for many, many years. they aren't used specifically against malaria anymore, because malaria adapted. But I always prefer a compound that can be manufactured easily and has been used by many many people over years. Regarding Zinc Ionophores, the flavonoid Quercetin (which you can buy in many places) has been shown to rapidly increase labile zinc in mouse cells as well as in liposomes. Source: https://pubs.acs.org/doi/abs/10.1021/jf5014633 https://pubs.acs.org/doi/abs/10.1021/jf5014633
Gajogo 7y ago
Do other malaria drugs also have potential for attacking COVID-19; ie Malarone (Atovaquone + Proquanil 250/100mm tab)? If also supplemented with Zinc?
Gajogo 7y ago
Do other malaria drugs such as Atovaquone/Proquanil (250/100 mg aka Malarone), or Mefloquine have any promise in combating Coronavirus COVID-19.

462 points by robomartin 7y ago

Then we have a treatment (i.e., zinc gluconate + chloroquine): A zinc tablet (10-80 mg) dissolved slowly in the mouth, lavaging the throat and nose, while lying down will cease coronaviral replication on most of the surfaces of the upper respiratory system. Zinc sprays also work. This must be done within the first 3-4 days of infection with covid-19. The covid-19 virus' usual course is to first infect the eye, nose and/or throat and then, after ~3 days, move down into the lungs. If chloroquine (mg) stops the virus in the bloodstream then the combination of (dissolved zinc in mouth + chloroquine pill (up to 500 mg of chloroquine per day) should slow (if not stop completely) the virus, allowing time to clear the virus from the body without raising an excessive immune response ("cytokine storm"). But this treatment must be done within 3-4 days of contracting covid-19. These medicines are cheaply available now.

solotronics 7y ago
where do I get chloroquine? is this something I can ask my general practitioner for?
- WilsonPaige 7y ago
  A doctor can prescribe it. Best to take it under the supervision of a doctor.
- toomanybeersies 7y ago
  GPs won't prescribe on the basis that you might get sick and require a particular medication. You can't walk into your GP's office and ask for antibiotics, for instance.
  - inferiorhuman 7y ago
    That's pretty much the exact set of circumstances that chloroquine is usually prescribed under.
    - cbhl 7y ago
      Under normal times, if you tell your doctor that you're planning on traveling, sometimes they'll ask if you want anti-malaria medication, and I believe chloroquine is one of the options they give you.
      - jcims 7y ago
        Yes my daughter got it on a trip to Tanzania last year.
        Khelavaster 7y ago
        Then you should go after the doctor for malpractice because malaria in East Africa is hydrochloroquine-resistant.
        jcims 7y ago
        That’s the least bit of malpractice I’ve seen in the past year.
    - toomanybeersies 7y ago
      My mistake, I didn't realise chloroquine was a malaria prophylactic (I've always been given other anti-malarials), I thought it was only a treatment for when you were actually diagnosed with malaria.
- petecox 7y ago
  It's commonly used for malaria. A related '-quine' is the active ingredient of Gin and Tonic.
  - Udik 7y ago
    The active ingredient of gin & tonic is definitely alcohol :)
    - IAmEveryone 7y ago
      Tonic was invented to make quinine palatable to British soldiers in India. About three minutes into the scheme, someone added gin. So quinine is indeed arguably the original “active” ingredient, sugar was second (to mask the flavor), and alcohol “let’s just pretend this isn’t happening” was third.
  - elric 7y ago
    Is this the same malaria drug that can cause depression and lead to suicidal thoughts?
- jandrewrogers 7y ago
  This class of drug is a prophylactic for malaria. It, or one of its equivalents, is commonly given to you if you tell your doctor that you are traveling to a part of the world where malaria is currently endemic. It isn't the kind of drug where they worry much about abuse or misuse, as it is cheap and ubiquitous in the developing world.
hnick 7y ago
That is good news. But why 3-4 days? Because once it settles in the lungs it's out of reach for both treatments? And do you mean 3-4 days from the appearance of symptoms or from the initial infection? From what I read, 3-4 days is not always long enough for someone to even know they have it.
ethbro 7y ago
> allowing time to clear the virus from the body without raising an excessive immune response ("cytokine storm") Citation requested, that cytokine storms are a common pathology associated with Covid-19. Because (a) I haven't seen that in the literature, & (b) it's at odds with the published age-banded mortality rates.
- tlb 7y ago
  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Not common but very serious.
- WilsonPaige 7y ago
  Heard of Google, bro? It's settled fact that the covid-19 pneumonia is a result of a "cytochine storm". Always like to lead off with a lancet article, to lance the boil: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://link.springer.com/article/10.1007/s00134-020-05991-x https://link.springer.com/article/10.1007/s00134-020-05991-x https://www.cusabio.com/COVID-19-Cytokine-Storm https://www.cusabio.com/COVID-19-Cytokine-Storm https://lab-a-porter.com/2020/02/wuhan-coronavirus-and-cytokine-storm/ https://lab-a-porter.com/2020/02/wuhan-coronavirus-and-cytok... The age-banded mortality rates aren't all they're bandied up to be, eh? Heh, heh!
  - nl 7y ago
    It's settled fact that the covid-19 pneumonia is a result of a "cytochine storm". This just isn't true. It maybe true for a subset of patients in some circumstances. To quote your first link: Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome.
    - WilsonPaige 7y ago
      Explained by espiratory physician John Wilson in the article "Coronavirus: what happens to people's lungs when they get Covid-19?" https://www.theguardian.com/world/2020/mar/20/coronavirus-what-happens-to-peoples-lungs-when-they-get-covid-19 https://www.theguardian.com/world/2020/mar/20/coronavirus-wh... "How does the pneumonia develop? When people with Covid-19 develop a cough and fever, Wilson says this is a result of the infection reaching the respiratory tree – the air passages that conduct air between the lungs and the outside. He says: “The lining of the respiratory tree becomes injured, causing inflammation. This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough. “But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages. “If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.” If the air sacs then become inflamed, Wilson says this causes an “outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia.” He says lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the body’s ability to take on oxygen and get rid of carbon dioxide. “That’s the usual cause of death with severe pneumonia,” he says. " The last 3 paragraphs are a description of the "cytokine storm".
jimmyswimmy 7y ago
So, I'm no medical professional, just an avid reader of such news. But I believe that most of this post is incorrect. I've seen no studies backing up the use of zinc for anything related to COVID-19. A search of pubmed for the terms 'covid zinc' or 'coronavirus zinc' show no papers referencing treatments. Same goes for medrxiv. There are a lot of cold "treatments" involving the use of zinc in the way you suggest. I have even seen studies which support its use as a prophylactic to the common cold (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/) though that one makes no reference to a common side effect, particularly the way you recommend its use, which is loss of sense of smell. Further, I haven't read anywhere about the mechanism of infection you propose for this disease. It is said to attack the lungs, liver and small intestine due to its furin cleavage site (https://www.biorxiv.org/content/10.1101/2020.02.10.942185v1 https://www.biorxiv.org/content/10.1101/2020.02.10.942185v1). Finally, I am nearly certain you are spreading bad information about how this treatment works. Chloroquine is provided after active symptoms present. The first few days of infection are asymptomatic for most patients, certainly the first 4-7 days, if not longer. There is no medical call for treatment until a patient presents symptoms, and your advice risks leading people to attempt to hoard this medication. We agree that chloroquine is indeed cheap.
- ComputerGuru 7y ago
  Not vouching for the suggested treatment but chloroquine acts as a zinc ionophere enabling increased zinc binding/intake in cells, inhibiting RNA-dependent RNA polymerase, which would theoretically ultimately encumber the replication of the virus.
  - dboreham 7y ago
    Right. The Zinc is already present intercellular, unless the patient is Zinc deficient.
- WilsonPaige 7y ago
  jimmyswimmy says "I've seen no studies backing up the use of zinc for anything related to COVID-19." It would be very early for posts specific to Covid-19. However that was not the claim: the claim was, verbatim, "A zinc tablet (10-80 mg) dissolved slowly in the mouth, lavaging the throat and nose, while lying down will cease coronaviral replication on most of the surfaces of the upper respiratory system. Zinc sprays also work. This must be done within the first 3-4 days of infection with covid-19." Covid-19 is a corona virus and, like all corona viruses, ceases to replicate in the presence of high zinc levels on the epitheleal surfaces. There are many studies re zinc and the way it halts viral replication: https://www.bing.com/search?q=zinc+halts+viruses+in+vitro&form=OPRTSD&pc=OPER https://www.bing.com/search?q=zinc+halts+viruses+in+vitro&fo... As I believe I stated ealier, I made no claims as to mechanism. I wish to point out that probably most of your information about chloroquine is based on the treatment of other diseases, and likely specifically malaria. It is by no means clear that the dose required for malaria is the same as the dose required for Covid-19, which indeed may be an order of magnitude or more less. Time will tell. As for presenting symptoms, once again I believe this to be take from the malaria playbook. Researchers right now are testing chloroquine for prophylaxis (prevention) as well as treatment, _before_ symptoms present (certainly before serious symptoms present). What I'm saying is that it is a different ailment and the protocols (and restrictions as to timing) for malaria may, indeed, probably do not apply.

r6203 7y ago

The publication is from 02/18/20 (as stated in the footer). Why didn’t gain it more traction?

droithomme 7y ago
> Why didn’t gain it more traction? It did. Since then they've done more studies, have started even more studies, and have deployed it en masse as a treatment. It's part of the official treatment recommendations in China, South Korea, Poland, and Italy. It's been described as a "cure" where it was used in Australia after Chinese patients demanded they be treated with it, and Australia is starting a nationwide trial. Pakistan had Bayer start up the closed production line and deliver 300,000 doses.
- john_minsk 7y ago
  But Italy is a mess... So it is not an actual cure?
  - droithomme 7y ago
    The guidance was adopted far too late but may slow the spread and reduce deaths. You have to catch things early. In Australia, Chinese immigrants came to their doctors and said "I have a symptom and I demand this prescription and here is the research and I won't take no for an answer." Chloroquine seems to work best if you start it within the first few days of infection. So if you are say the US and have widespread BS regarding testing and prevent people from getting it, by the time they are tested and their results back it's too late. There's no chance the US will come to their senses and start using or even producing this drug in time to help stop mass deaths. Some people bought animal grade chloroquine and are self treating, but all that supply is gone now for purchase. Doctors won't prescribe it in the US either, for their own reasons. In China and South Korea you can get tested if you have symptoms and you can start treatment if you have symptoms. So we are seeing things turn around in both places because of this and other actions.
  - stjohnswarts 7y ago
    No but preliminary evidence is that it might speed up recovery. I'm not sure if that applies in elderly if they're already getting sever lung issues though. At that point maybe the damage is already done?

simpsond 7y ago

I just recently watched an interesting video about COVID-19, Zinc and Clororquine. It explains some of the fundamentals: https://www.youtube.com/watch?v=U7F1cnWup9M https://www.youtube.com/watch?v=U7F1cnWup9M

sliken 7y ago
Medcram (which is the video linked) has had some great coverage of COV19. Numbers, trends, and conclusions all backed by the original published papers. Awesome.
molmalo 7y ago
Great video, thanks for sharing!
jamesblonde 7y ago
This is a good video describing the hypothesized method of action of Chloroquine. Chloroquine opens up receptors on the cell membrane to allow Zinc to enter cells - Zinc interfers with the replication of sars-cov-2. So, take Zinc supplements to increase general Zinc levels in plasma/tissue and let in Zinc with Chloroquine. An alternative proposed method of action for Chloroquine is that it binds to proteins created by sars-cov-2 (ORF3a, ORF10, ORF8). Those ORF proteins bind to heme (red in red blood cells), preventing oxygen from being transported - https://twitter.com/davidasinclair/status/1238972082756648960 https://twitter.com/davidasinclair/status/123897208275664896... David Sinclair based his tweets on this paper: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf... But most organizations are going with the Zinc theory of Chloroquine. So take Chloroquine with Zinc supplements (France, South Korea, China are doing clinical trials). Here is a translation of a Chinese study intermediate results - no data was released, which makes some people sceptical: https://twitter.com/jim_dowling/status/1239255793171660800 https://twitter.com/jim_dowling/status/1239255793171660800 Here is a great summary of available treatments used in different countries https://epidemio.wiv-isp.be/ID/Documents/Covid19/COVID-19_InterimGuidelines_Treatment_ENG.pdf https://epidemio.wiv-isp.be/ID/Documents/Covid19/COVID-19_In... Although untested in-vivo, many clinicians prefer hydroxycholorquine due to its superior safety profile - and 4X better efficacy in-vivo (not in humans, in cells). I tried ordering that last week when the paper came out, not sure if i will get it, though. Chloroquine is kind of old news. There has been a lot of talk around Chloroquine, starting around 6 weeks or so ago - the UK banned export of it nearly 4 weeks ago https://www.pharmaceutical-technology.com/comment/parallel-export-covid-19/ https://www.pharmaceutical-technology.com/comment/parallel-e.... I managed to order some before that. References: "Chloroquine Is a Zinc Ionophore" https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109180 https://journals.plos.org/plosone/article?id=10.1371/journal...

nl 7y ago

Previous discussion. I'll repost the paper posted as a top response then: https://www.sciencedirect.com/science/article/pii/S0166354220301145 https://www.sciencedirect.com/science/article/pii/S016635422... I'll also note that chloroquine is very dosage sensitive and lethal when overdosed.

turdnagel 7y ago

Does this mean you can treat coronavirus with tonic water?

MatthiasP 7y ago
Yeah, 10 litres per day.
- jcims 7y ago
  That's going to require a lot of gin.
  - sweetbacon 7y ago
    I volunteer.
- Robotbeat 7y ago
  83 milligrams per liter for tonic water, so about 6 liters to get a 500mg therapeutic dose.
  - fiddlerwoaroof 7y ago
    Sign me up. I’ll also need about 13 liters of gin and a bag of ice.
    - strictnein 7y ago
      Don't forget the limes.
      - matwood 7y ago
        I'm an NFL person...
  - hinkley 7y ago
    But who can drink that much gin a day?

fareesh 7y ago

400M+ people have G6PD deficiency which is a condition that has severely adverse reactions to chloroquine

jcims 7y ago
Whoa didn't realize it was that prevalent. I looked into it for vitamin c infusions (long story), seemed to be an easy test to find. Something they could look at while looking for covid if there is an intent to treat it?
checker659 7y ago
Yes, but hydroxycholoroquine is a safer alternative. https://www.ncbi.nlm.nih.gov/pubmed/28556555 https://www.ncbi.nlm.nih.gov/pubmed/28556555 https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23296 https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23296

nhebb 7y ago

Previous discussion: https://news.ycombinator.com/item?id=22565107 https://news.ycombinator.com/item?id=22565107

raphlinus 7y ago

It should go without saying that we can cheerlead for the emergence of effective treatments, but actual treatment decisions should be made by a doctor.

jMyles 7y ago
> actual treatment decisions should be made by a doctor. Medical advice is given by doctors and other health professionals. Treatment decisions are made by patients, those entrusted by patients to make decisions, or parents, guardians, or custodians who make decisions on behalf of patients.
- IAmEveryone 7y ago
  For everything but OTC meds, it takes both a doctor’s and a patient’s consent.
- raphlinus 7y ago
  I take your point, but prescriptions need to be made by doctors, and that is the main point here. I actually have more nuanced views on this. Doctors are not gods, and there are situations where patients have better medical knowledge than the doctor on an important issue. But based on what I've seen so far (including confidently spread misinformation on HN) I strongly suspect that numerically these cases are far outweighed by people with just enough knowledge to be dangerous. That's all am cautioning here.

r6203 7y ago

Here’s an article (without much information...) about an upcoming trial for Chloroquine in Australia. https://www.news.com.au/lifestyle/health/health-problems/coronavirus-australia-queensland-researchers-find-cure-want-drug-trial/news-story/93e7656da0cff4fc4d2c5e51706accb5 https://www.news.com.au/lifestyle/health/health-problems/cor...

filleduchaos 7y ago

I have a fairly tame quinine allergy (and subsequently was incredibly relieved when artemisinin-based treatments became a thing) - this is interesting but also mildly horrifying news.

barbs 7y ago
There's also an anti-HIV medication that seems to be effective, though I don't know too much about it. https://www.news.com.au/lifestyle/health/health-problems/coronavirus-australia-queensland-researchers-find-cure-want-drug-trial/news-story/93e7656da0cff4fc4d2c5e51706accb5 https://www.news.com.au/lifestyle/health/health-problems/cor...

monkeygus 7y ago

i currently take Plaquenil (Hydroxychloroquine) for rheumatoid arthritis, and my doctor did indicate it may be helpful against Covid but not enough tests to confirm. Is it close enough to chloroquine to be the same ?

ridgeguy 7y ago
The paper says clinical tests used both chloroquine and hydroxychloroquine. In discussing the results, they don't seem to differentiate between the two, unless I missed it.
- mirimir 7y ago
  Damn, another hydroxychloroquine user here. Maybe that'd ameliorate the <70 factor.
- forkexec 7y ago
  When administering chloroquine, the hydroxy- form is a very long-lasting metabolite.
  - M_bara 7y ago
    Yes. I think the half-life is ~ 1-2 months
- drewmol 7y ago
  "The pharmacological activity of chloroquine and hydroxychloroquine was tested using SARS-CoV-2 infected Vero cells." https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa237/5801998 https://academic.oup.com/cid/advance-article/doi/10.1093/cid...
- deleted 7y ago
  [deleted]
tanilama 7y ago
Hydroxychloroquine is currently used by the Korean CDC for treating COVID-19

beager 7y ago

I've seen chloroquine come up a ton and am hopeful for the efficacy of its use in treatment of COVID-19. It's surreal to be observing the global impact of a novel pandemic, and anything that can save lives or blunt the propagation of the virus feels like a gasp of hope. Of course, chloroquine is not a vaccine, it's not a tool to contain the spread of SARS-CoV-2. We need massive and rapid propagation of testing, and meaningful progress toward a vaccine.

dboreham 7y ago
Except a vaccine won't be ready until long after everyone is either dead or recovered.
jackthehammer 7y ago
But if chloroquin , with or without zinc, halts viral replication as is proposed " Chloroquine Is a Zinc Ionophore" https://www.ncbi.nlm.nih.gov/pubmed/25271834 https://www.ncbi.nlm.nih.gov/pubmed/25271834 then it _is_ a tool to contain the spread of SARS-CoV-2 b/c it could also be used prophylactically. i.e., the virus can't replicate in the human cell if the cell already has adequate chloroquin + Zn++ present.

ggm 7y ago

This is an increadibly potent drug with serious side effects according to anything I read, its not first-line treatment its last-line, when everything else fails. You can go blind, irreversibly. Please people, speak to trained medical people before reaching to the drug cabinet. I am not a doctor. This advice is not meant to contradict the rule of only taking medical advice from medical professionals.

checker659 7y ago
The retinopathy happens only after years of use (like a decade). Also, as an immunosuppressant, it is pretty slow acting in that it takes two three months to even start working. The currently prescribed dosage for the viral infection is for 5-10 days (albeit at slightly higher dosage than used for malaria/lupus etc.).
tiredofit 7y ago
From wikipedia. One of the most serious side effects is a toxicity in the eye (generally with chronic use).[11] People taking 400 mg of hydroxychloroquine or less per day generally have a negligible risk of macular toxicity, whereas the risk begins to go up when a person takes the medication over 5 years or has a cumulative dose of more than 1000 grams. The daily safe maximum dose for eye toxicity can be computed from one's height and weight using this calculator. Cumulative doses can also be calculated from this calculator. Macular toxicity is related to the total cumulative dose rather than the daily dose. Regular eye screening, even in the absence of visual symptoms, is recommended to begin when either of these risk factors occurs.[12]
- signa11 7y ago
  > ... has a cumulative dose of more than 1000 grams. ... woowza a Kg worth of drug !!! this doesn't look correct to me !
  - Johnny555 7y ago
    People taking 400 mg of hydroxychloroquine or less per day generally have a negligible risk of macular toxicity 400mg/day for 5 years is 730 grams.

forkexec 7y ago

Watch out for Chloroquine retinopathy

mirimir 7y ago
Yeah, they check my retinas at six month interval.
checker659 7y ago
Usually takes years to develop. This is really a non issue for the 5-10 days use in this case.

random314 7y ago

They haven't mentioned effect sizes or confidence intervals. Hopefully it is statistically significant - in which case the effect size has to be large to achieve statistical significance. I hope that is the case!

checker659 7y ago

This is an old paper, FYI. Published on Feb 20, which is eons ago given the state of things.

spitfire 7y ago

So I’m not seeing mention of this anywhere else chloroquine is being talked about. Chloroquine used to be taken daily in many of the tropical Britain colonies suffering from malaria. chloroquine in the form of quinine is where the gin and tonic drink came from. Quinine mixed with carbonated water was drunk as a prophylactic. The quinine tasted so terrible it had to be cut with something to make it tolerable - gin! That’s where gin and tonic came from - anti malaria treatment in the British colonies. If you look at tonic water even today you’ll find quinine listed as an ingredient. As a cheap, safe bet it’s not unreasonable to start having a g&t each day along with a zinc pill. The more you know.

grecy 7y ago
I recently spent three years driving around Africa. Chloroquine is still a very common anti-malarial in many parts of the continent.
- vezycash 7y ago
  Name specific countries, to the best of my knowledge, it's no longer in use because malaria has become resistant to Chloroquine. And I was glad to see it go out of use cos it caused crazy itching in many people. Touching water was like pouring fuel on fire. Anyway, even though I hated it, Chloroquine really worked while it worked.
JamesBarney 7y ago
From 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).[5] It is often recommended as a relief for leg cramps, but medical research suggests some care is needed in monitoring doses.[6] Because of quinine's risks, the FDA cautions consumers against using "off-label" quinine drugs to treat leg cramps.[7] For malaria prevention that's 25 liters of tonic or about about 200 gin and tonics per day.

1_over_n 7y ago

As far as I read over the past week or so this is in vitro, and not yet shown in vivo or humans.

phreeza 7y ago

Given the dynamic nature of this situation, maybe this needs a [Feb 18th] tag.

jamesblonde 7y ago

I posted this a week ago. I guess a week is a long time in politics... https://news.ycombinator.com/item?id=22523530 https://news.ycombinator.com/item?id=22523530

nikkwong 7y ago

Why haven't the markets reacted positively to this news?

ailideex 7y ago
You know, I read this, and then I read other things implying we will fix climate change from this crisis, and I wonder ... The markets has not reacted positively to this news because something possibly helping makes no difference. Actually making a difference to the situation makes a difference. Until the point where there clearly is something that makes a difference the outlook is really bleak.
- nikkwong 7y ago
  I suppose that may be the case. But let me play devil's advocate against it. Markets are supposed to price in values from expected future returns. Since this is "a cure", there should be positive sentiment for the future economic environment rather than the current negative sentiment. The paper says that people are being successfully treated with this medication. It sounds like a slam dunk and a definite end to all the uncertainty we're experiencing. It's somewhat akin to magically having a vaccine available today, no? A situation in which we'd expect markets to react positively. Maybe, this information has not disseminated widely enough in the media, and the markets are acting as a trailing, not leading, indicator.
  - nikkwong 7y ago
    After reading a bit more, maybe it's not such a panacea. Seems like it's standard of care, but may not help patients who have advanced symptoms; and, obviously, does not prevent infection. Therefore it may not stop us from imposing the preventative measures (quarantine, travel restrictions, the like) which are causing all the economic catastrophe. Still, seems like it would push a bit of a positive spin on things rather than allowing the economic free-fall we've witnessed.
cm2187 7y ago
Guessing why the markets do something is like reading the future in the guts of a chicken! But I think the market is reacting not to the virus, which by itself would have a limited economic impact (and if you think that it affects mostly the elderly, from a pure, cold economic point of view, would rather reduce the long term burden on healthcare, so would be a net economic benefit). I think the market instead reacts to the actions taken to contain the virus, which will likely severely supress the economic activity. Until there is any sign of these actions being reversed (and everything is pointing to the opposite, with France and the EU hinting at more restrictions yesterday), it is rational for the market to be bearish. Then as always there are other considerations, stocks were overly expensive, economic cycles, over leverage, etc.

ltbarcly3 7y ago

I think this is a red herring, everyone knows the only treatment is Forsythia.

adv0r 7y ago

There are at least several other sources talking about this, from more than 20 days ago. Try to google the spanish word: Cloroquina https://www.ncbi.nlm.nih.gov/pubmed/32147496 https://www.ncbi.nlm.nih.gov/pubmed/32147496 https://gacetamedica.com/investigacion/covid-19-el-fosfato-de-cloroquina-podria-tratar-la-neumonia/ https://gacetamedica.com/investigacion/covid-19-el-fosfato-d... https://www.sadi.org.ar/novedades/item/931-covid-19-uso-de-cloroquina-hidroxicloroqina-en-pacientes-con-neumonia-por-coronavirus https://www.sadi.org.ar/novedades/item/931-covid-19-uso-de-c...

cm2187 7y ago

For French speakers, a talk yesterday from Didier Raoult who is also testing Chloroquine in France [1] (and I believe who originally discovered the anti-viral benefits of that molecule on certain viruses). He finds that it reduces significantly the viral charge. He made an interesting point. It appears infected people remain contagious for 3 weeks. Taking this drug allows to significantly reduce this period. The current advice for people who are sick is stay at home and only show up at an hospital if you start having respiratory problems. He thinks a better approach is to get them to get tested quickly, and take a combination of anti-viral drugs. This will likely result in less contagions. [1] https://www.youtube.com/watch?v=n4J8kydOvbc https://www.youtube.com/watch?v=n4J8kydOvbc [edit] Adding slides link posted by chmike on this page: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-19.pdf https://www.mediterranee-infection.com/wp-content/uploads/20... [edit] corrected contagiousness from 4 weeks to 3 weeks.

nico_h 7y ago
that would make sense: test everybody, if positive take the drug for 5 days, rest for 2 more and back to work you go. a win for everybody!
- ianbooker 7y ago
  Because testing everybody is no big deal.
  - cm2187 7y ago
    According to Raoult, it doesn’t seem to be a technical limitation, the test is a standard procedure that labs around the country already do routinely for other viruses.
    - gordeh 7y ago
      It's the capacity that is the issue. Testing labs all over the world, are running far above capacity already. It's not something that can be scaled up overnight either.

j-james 7y ago

> It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system ... The wholesale cost in the developing world is about US$0.04. In the United States, it costs about US$5.30 per dose. [1] That's a little over 132x more expensive. Compared to other common medicines like ibuprofen ($0.04 in the developing world, $0.05 in the USA [2]), what makes chloroquine so uniquely pricey in the USA? (or, I suppose, ibuprofen so uniquely cheap?) [1] https://en.wikipedia.org/wiki/Chloroquine https://en.wikipedia.org/wiki/Chloroquine [2] https://en.wikipedia.org/wiki/Ibuprofen https://en.wikipedia.org/wiki/Ibuprofen

NullPrefix 7y ago
Ibuprofen can be sold on somewhat recurring cycle.
baybal2 7y ago
Not uniquely. USA is famous for very high prices of essential medicines, and being an expensive country in general.
- vinay427 7y ago
  This was already implied in the question. They're asking why something like ibuprofen is different.
  - baybal2 7y ago
    Maybe because it's one of few medicines being sold by foreign companies in USA? America doesn't have a lot of opportunities for foreign players, let alone in such militantly overregulated sector like medicines.
  - shermozle 7y ago
    I'm assuming because ibuprofen is OTC and chloroquin is prescription.
  - projektfu 7y ago

andybak 7y ago

When I first went backpacking in the 90s I remember people were sharing stories about really disturbing nightmares from taking Chloroquine and generally complaining about mental and emotional side-effects. Google returns a bit of corroboration but that isn't mentioned on the Wikipedia page.

CPLX 7y ago
Are you sure you’re not talking about Malarone? That’s the other anti-malaria drug which has very intense and emotional dreams as a side effect.
- arusahni 7y ago
  Lariam (Mefloquine) was the one I took in the 90s that had the psychological warnings attached. IIRC, Malarone is newer, and may not align with the OP's timeline.
  - CPLX 7y ago
    Whoops. You are correct. We were both wrong, Lariam is what I was thinking of.
    - andybak 7y ago
      Yep. It was Lariam I was thinking of.

chmike 7y ago

Dr Raoult has announced yesterday that the test of hydroxychloroquine on 24 patients showed positive results, especially when combined with an antibiotic against pneumonia. Slides of the presentation are here: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-19.pdf https://www.mediterranee-infection.com/wp-content/uploads/20..., results are on the last slide.

iamgopal 7y ago

Is this the same drug that was given to Harbert in Jule Verne's The Mysterious Island ?

philipkglass 7y ago
No. The Mysterious Island was written in 1874. Chloroquine was discovered in 1934: https://www.mmv.org/malaria-medicines/history-antimalarials https://www.mmv.org/malaria-medicines/history-antimalarials

deleted 7y ago

[deleted]

bryanrasmussen 7y ago

so when it says: "In the early in vitro studies, chloroquine was found to block COVID-19 infection at low-micromolar concentration," does this mean it might be a good idea to be taking it regularly to keep from getting covid-19 from contact with surfaces with low concentration of the virus?

shanth 7y ago

ELI5: Neem leaf will cure corona.

hydroreadsstuff 7y ago

Quercetin is over-the-counter and has similar properties Studies according to the video below on Ebola and Zikka used 50-100mg/KG - a lot lot. This Medcram video talks about Chloroquine and the others: https://www.youtube.com/watch?v=vE4_LsftNKM https://www.youtube.com/watch?v=vE4_LsftNKM

khafra 7y ago
> Quercetin is over-the-counter and has similar properties Source for the similarities between chloroquine and quercetin?

lokl 7y ago

Can anyone point to data about chloroquine use by people with quinine allergies? I am allergic to tonic water, perhaps to the quinine in it. Thanks.

IXxXI 7y ago

Previous previous discussion: https://news.ycombinator.com/item?id=22500063 https://news.ycombinator.com/item?id=22500063

zilian 7y ago

could there be interactions with anti IL-17a treatments such as cosentyx ?

QuantumGood 7y ago

Poland has formally registered Chloroquine as a drug for COVID-19 and will treat all patients with it. Chloroquine phosphate is a generic antimalarial drug derived from quinolone, in 10 trials for Covid-19 in China, including one in combination with Kaletra, as chloroquine phosphate is believed to have broad-spectrum antiviral activities. Basically the goal is to allow zinc to get into a cell, it needs a helper to get inside the cell (a Zinc Ionophore). Apparently Hydroxychloroquine / Plaquenil (which you can buy here: InHousePharmacy.vu/p-1106-plaquenil-tablets-200mg.aspx or here easyshopping4health.com/buy-plaquenil-usa.html) is even more effective than Chloroquine. Also see Medscape.com/viewarticle/736439 and https://www.ncbi.nlm.nih.gov/pubmed/32074550/ https://www.ncbi.nlm.nih.gov/pubmed/32074550/ title: "Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies" Quinolones like Chloroquine were used in malaria prevention for many, many years. they aren't used specifically against malaria anymore, because malaria adapted. But I always prefer a compound that can be manufactured easily and has been used by many many people over years. Regarding Zinc Ionophores, the flavonoid Quercetin (which you can buy in many places) has been shown to rapidly increase labile zinc in mouse cells as well as in liposomes. Source: https://pubs.acs.org/doi/abs/10.1021/jf5014633 https://pubs.acs.org/doi/abs/10.1021/jf5014633

Gajogo 7y ago

Do other malaria drugs also have potential for attacking COVID-19; ie Malarone (Atovaquone + Proquanil 250/100mm tab)? If also supplemented with Zinc?

Gajogo 7y ago

Do other malaria drugs such as Atovaquone/Proquanil (250/100 mg aka Malarone), or Mefloquine have any promise in combating Coronavirus COVID-19.