22 ms·

Chloroquine, past and present

261 points by ilamont 7y ago

hprotagonist 7y ago
And so to today. As I said yesterday, I find the reports of chloroquine/hydroxychloroquine activity against the coronovirus very interesting, but preliminary. There has as yet been no well-controlled trial, and unfortunately the effects seen are still the sort of thing that can look exciting but disappear when you look closely. I mean that. It happens all the time – ask anyone else who does drug research for a living. If this drug isn’t useful, then sending hundreds of millions of people out to swallow all of it that they can find will be a massive waste of time and money, and will actively harm people besides. This is not a benign compound; it should only be taken when you have a solid expectation of benefit, and (saying it again), we don’t yet have that. Better trials are cranking up right now: please, wait for those. The generic drug companies (Teva and Mylan, I’ve seen so far, and there’s this) that are cranking up production are doing the prudent thing – if this reads out well, we’ll need a lot of it. But we’ll need to give it to people who are in bad shape from the viral infection, too, remember that, and I fear that a lot of people around the world are just starting to take it now in hopes of a prophylactic effect, which is (saying it again) a bad idea.
- zwily 7y ago
  This snippet right here does a good job balancing optimism with caution. We need more of this.
- patrickbuckley 7y ago
  This is a great reminder, thank you for pointing it out. Interestingly during the 1918 Spanish flu aspirin was a new drug and was given to people in an effort to reduce fever. The problem is they gave it in doses that we now know is toxic. There is some evidence that patients treated in hospitals with aspirin had a 30x!!! deathrate vs those treated "homeopathically". This YouTube video goes into the history and context of it ... https://youtu.be/dT6mHi_8V5E https://youtu.be/dT6mHi_8V5E (go to 11:30 in video) I beleive in modern medicine and science but we should be careful about being overly optimistic and harming people by giving them a powerful drug that hasn't been tested properly. Edited to add time point in video.
  - mymacbook 7y ago
    Those that did not take aspirin during the Spanish flu had far lower morbidity rates. Fever is not something I rush to suppress with drugs until I exceed 104.0 - same for my family and even when our daughter was a little tiny thing. Preliminary unpublished information shows concerns on accelerating progression of SARS-CoV-2 virus to COVID-19 illness for ALL NSAIDs (not just aspirin). However, even with non-NSAIDs I exercise extreme caution when using (e.g. acetaminophen - Tylenol - 4000mg is considered VERY TOXIC for liver).
AdmiralBumbleB 7y ago
This chloroquinine rush is already out of control. My pharmacy is already out of it and is unable to procure from other pharmacies (which are also out already!) My pharmacist placed orders for all her patients to prefill prescriptions (where possible) for the next few months. I can understand a shortage when there's a clear evidence-based need, but the rumour-mill hasn't even ramped to full bore yet and it's already harming people with a pre-existing need for the medication. It's even worse _if_ the medication works to prevent or shorten c19 infections, because the people currently taking chloroquinine are very likely high-risk (immunocompromised) patients. Really wish people would chill out. Note - This affects me, as I take the medication. It's scary to think I could be without it at some point in the future as it's been practically life-changing.
- throwaway894345 7y ago
  I really hope this virus prompts our disaster management agencies to get their shit together, and specifically to consider supply chain security as part of their threat model (and no, we don't meaningfully do this or we wouldn't have such a pitiful national reserve of respirators and other respiratory treatment devices following SARS and MURS). Not sure exactly what this would look like, but identifying key partners in industry and working with them to enable them to turn-key ramp up production seems obvious.
  - blhack 7y ago
    How could our disaster management agencies have gotten their shit together to anticipate a run on an old anit-malaria drug?
    - throwaway894345 7y ago
      Optimize for the aspects of the supply chain that don't depend on the specific drug. For example, the packaging of pills probably doesn't need to vary that much in general. But the point isn't that we are prepared for every eventuality (e.g., chloroquine), but that we are doing due diligence in preparing for the likely eventualities (e.g., general purpose respiratory treatments like ventilators).
fny 7y ago
I was under the impression that chloroquine was used to facilitate cellular absorption of zinc and that the zinc was responsible for any antiviral behavior: https://www.youtube.com/watch?v=dT6mHi_8V5E https://www.youtube.com/watch?v=dT6mHi_8V5E
- travisporter 7y ago
  "One that I find particularly amusing, for personal reasons, is the idea of complexing zinc ions...So yeah, I can at least believe that these things complex zinc, for what that’s worth." Not sure if this statement supports or refutes your theory; I'm inclined to believe the latter.
- tristor 7y ago
  I was under the same impression. Zinc acts to disrupt cellular replication of viral cells, and this is true for MANY viruses. Cloroquine acts as a zinc ionophore providing a pathway for zinc to cross the cellular wall at much lower concentrations, greatly improving its effectiveness.
- submeta 7y ago
  Interesting! Could not find the part of the video where the claim is made. Can you help?
bpaddock 7y ago
The Quinism Foundation Warns of Dangers from Use of Antimalarial Quinolines Against COVID‑19. "Use of Chloroquine, Hydroxychloroquine, Mefloquine, Quinine, and Related Quinoline Drugs Risks Sudden and Lasting Neuropsychiatric Effects from Idiosyncratic Neurotoxicity." https://quinism.org/press-releases/dangers-of-antimalarial-quinolines-against-covid-19/ https://quinism.org/press-releases/dangers-of-antimalarial-q... The Anit-Malaria drugs They are pushing have a common ancestor to Fluoroquinolone antibiotics have MANY FDA warnings. The FDA says they should not be used unless all other options have been exhausted. Those that have already been devastated by Fluoroquinolones are extremely upset to hear that a related quinolines drug is being proposed. While these two drugs are technically in a different class, they share some common ancestors. They both share many of the devastating side effects. I have put all the FDA warnings for Fluoroquinolone antibiotics on my late wife's website. Levaquin was a significant contributor to Karen's suicide. :-( http://www.kpaddock.com/fq http://www.kpaddock.com/fq
- chimichangga 7y ago
  "Two drugs, chloroquine and remdesivir, are being designated for Expanded Access, or “compassionate use,” by the FDA." It's already available. Hopefully soon to the general public (it's prescription only btw).
- smoyer 7y ago
  Sorry for your loss
- wtallis 7y ago
  > Those that have already been devastated by Fluoroquinolones are extremely upset to hear that a related quinolines drug is being proposed. Raising awareness of the risks based on your personal experiences is reasonable. But the above statement seems to cross the line into irrationality by pre-deciding that quinolines aren't worth trying here. That casts doubt on whatever scientific arguments you put forth, because it doesn't seem like you're capable of being fair about this.
- twomoretime 7y ago
  Respectfully, though I understand your effort to warn others, I think it is dangerous at this time to conflate chloroquine derivatives with Chloroquine. Single substitutions in biologically active compounds can cause drastically different effects including substantially different therapeutic ratios. Compare for example the various drugs in the amphetamine family (methamphetamine, amphetamine, MDMA, etc). They are not equally dangerous. Similarly, the terrible results you report are AFAIK rare with Chloroquine. It is a well tolerated drug and if you're an older or immunocompromised patient playing Russian roulette with a late stage COVID19 infection, the minimal risk is highly preferable to no treatment.
deleted 7y ago
[deleted]
brucer 7y ago
I was intrigued by the results from the recent quick french study: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf https://www.mediterranee-infection.com/wp-content/uploads/20... I read through the paper, and it's not immediately obvious, but if you look at the two graphs at the bottom, the hydroxychloroquine is 75% effective in the first chart, but only 50% in the second one. That's because the actual test was: Control: 16 hydroxychloroquine: 14 hydroxychloroquine + azithromycin: 6 The first chart includes all 20 people who got hydroxychloroquine - including the 6 who also got azithromycin. My question: do we know how effective azithromycin would be on it's own? Maybe it's the wonder drug we should be focused on, which would be great since it's available everywhere. It should go without saying these are VERY preliminary results from a small trial but it's something!
- Nav_Panel 7y ago
  It's an antibiotic. Severe patients will be dealing with secondary (bacterial) infections, so it makes sense to use both. But on its own, I expect it would have little effect.
  - alkonaut 7y ago
    It’s already commonly used as both treatment and profylactic (in healthy risk group patients) for viral pneumonia. Why it works for I think is still not entirely clear. Being an antibiotic is also convenient because many times you would also get antibiotics to prevent a secondary infection from bacteria. It’s not exactly a miracle cure (like an antibiotic is against a bacterial pneumonia), but doctors have few tools when it comes to viral pneumonia, so even something that helps a little is welcome.
  - benjohnson 7y ago
    As I understand it - it interferes with mRNA transcription. Given that COVID-19 is RNA that may be useful.
- the8472 7y ago
  > but it's something! And that something may turn out to be noise.
Mountain_Skies 7y ago
How well does chloroquine mix with gin? Asking for a friend.
- ropiwqefjnpoa 7y ago
  Mixes well, only minimal brain damage ;)
- munk-a 7y ago
  It's much more often to mix in Quinine - and you're doing so every time you have a gin & tonic (with real tonic - not just carbonated water). Amusingly it's also an anti-malarial.
andreygrehov 7y ago
Does anyone have any information about the Favipiravir testing going on in China? From what I read, it has a 90% success rate treating coronavirus AND is a super safe drug in general.
- comicjk 7y ago
  Here's a short paper on it [pdf]: https://www.jstage.jst.go.jp/article/ddt/14/1/14_2020.01012/_pdf/-char/en https://www.jstage.jst.go.jp/article/ddt/14/1/14_2020.01012/... Not many details, just that it worked better than some HIV antivirals. Still, worth ramping up production of this in advance of trials. It's a surprisingly small and simple molecule.
- gnulinux 7y ago
  I read this X% success rate for many drugs, Remdesivir, chloroquine etc... What does it mean? Giving no drug, just ventilator alone has 97% success rate right? So how do we know that that 90% is due to the drug and not, you know, immune system itself? Moreover, a lot of people keep saying both Remdesivir and chloroquine are in official treatment suggestions in Italy, and seeing Italy is suffering a pretty bad mortality rate, how do we even know these drugs are better than placebo?
  - deleted 7y ago
    [deleted]
  - mypalmike 7y ago
    Was 97% a hypothetical? I have heard much lower figures for ventilator success rates.
    - gnulinux 7y ago
      Do they use these drugs only to severe patients who need ventilator? I was referring to the overall estimated CFR (3%). What is the success rate of ventilators then?
  - cm2187 7y ago
ropiwqefjnpoa 7y ago
Quinine is amazing stuff and quite easy to make, but the poison is in the dosage. Controlling that when you're making your own with cinchona bark isn't something you want to do trial and error style, serious side effects.
Munky-Necan 7y ago
Until there's a double blind placebo trial I will take this type of report with a truck load of salt. We want randomized control trials in medicine. We want highly vetted research in medicine. Lacking either is a bad idea. I am also not holding my breath about a vaccine. We tried making a vaccine with SARS-CoV with a significant amount of the animal models dying from cytokine storm after viral exposure. Drug trials are hard, but necessary.
- icelancer 7y ago
  >> Until there's a double blind placebo trial I will take this type of report with a truck load of salt. You're welcome to. The remainder of the world should have the choice. Some people can't - or don't - want to wait for an RCT with a sample size in the thousands before taking a cheap and well-known drug with well-tolerated side effects.
  - jki275 7y ago
    To be fair, I don't think that he's saying it should be banned -- he's saying that we need a lot more testing before claiming this is a cure based on one study with a tiny number of participants. His statement is accurate. And the quinine derivatives have some very subtle neurological effects that last a lifetime. Suicidal ideations -- for life and incurable -- are a well known side effect of mefloquine at least. Maybe this one doesn't have those effects, I don't know -- but there's a really good argument to do a lot of testing before taking this in any other than an in-extremis situation.
    - Munky-Necan 7y ago
      Bingo, we need nonbiased blinded drug trials otherwise the data could be seriously flawed. There's drug trials for reasons, and even in this pandemic we should respect the rationale for why we established those trials. Also, I'm finding that this forum is full of incredibly intelligent individuals who demonstrate the a little knowledge is a dangerous thing. It amazes me how often y'all will talk about medicine like you're experts but miss fundamental concepts. May points, like the other poster, sound awesome to lay people, but under the scrutiny of any medical professional would be laughed at.
guiriduro 7y ago
Is there not an argument that given chloroquine's apparent efficacy, albeit statistically weakly or improperly demonstrated (so far), along with its long history of relative safety in anti-malarial prophylaxis (with known caveats), set against an exponential growth in dangerous pneumonia - it is therefore rational to want to at least offer it to all suspected cases and healthworkers in balance of the serious risks they face?
- hannob 7y ago
  The possible side effects include permanent blindness. Giving this drug to people while you simply don't know if it does any good is only justifiable if you do it within a properly designed clinical trial. Which is the thing you should do. If you feel lots of people should get this drug - do a large trial. Will give us better data.
  - milofeynman 7y ago
    Permanent blindness typically takes many weeks / years of use. https://www.webmd.com/drugs/2/drug-8633/chloroquine-oral/details https://www.webmd.com/drugs/2/drug-8633/chloroquine-oral/det...
    - ginko 7y ago
      Which might be necessary for prophylactic use.
      - cm2187 7y ago
        You only need to mitigate the peak of infections from this virus. And I don’t think anyone is suggesting it to be used as a preventive tool. It is to reduce the contagiousness of people tested positive (and hopefully also help them with the virus).
      - uwuhn 7y ago
        No, the course is 10 days IIRC.
Animats 7y ago
Yesterday's paper from the COVID-19 hospital in China mentioned chloroquine. They use it, but only in a few specific situations.
cameldrv 7y ago
We definitely want more studies, but IMO we're reaching a tipping point. We have anecdotal evidence from China and South Korea, and this quite flawed, but at least data-containing study from France. Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. COVID isn't quite as bad as cancer, but Chloroquine, especially for a short course, isn't anywhere near as bad as most chemo drugs. Many people take it for years as prophylaxis -- not even to treat an existing disease.
- stcredzero 7y ago
  > COVID isn't quite as bad as cancer, but Chloroquine, especially for a short course, isn't anywhere near as bad as most chemo drugs. For certain individuals who just happen to have a bad reaction, COVID could well be just as fatal as cancer. In terms of how fast it can kill people, in certain cases, it can be worse than a lot of cancers.
  - caycep 7y ago
    use hydroxochloroquine then?
  - cameldrv 7y ago
    Do you mean COVID is as fatal as cancer or Chloroquine is?
    - gnulinux 7y ago
      COVID. For >70 y.o. individuals mortality rate is 30%. If you're >70 y.o. have heart condition and have diabetes (all risk factors) COVID is clearly more deadly than some (most?) cancers, not to mention it kills in the order of weeks, when cancer kills in the order of months or years.
      - cameldrv 7y ago
        Right. OTOH in the Chinese treatment guidelines, they say not to give it for >65 y.o. Unfortunately that's exactly the population it would potentially benefit the most. I'm guessing there must be some reason that's in there, but I'd like to see numbers.
axguscbklp 7y ago
It seems to me that we should immediately move to massively increase production of hydroxychloroquine. If it turns out to be part of a solution, great. If not, I doubt that more than a tiny fraction of the total resources dedicated to the pandemic would have been used up by the effort. There is no time to take things slowly in our situation. In any case, from what I've read on places like r/medicine, many people who have access to hydroxychloroquine have already begun to hoard it. So one way or another, if we do not ramp up production there will be trouble. Hydroxychloroquine has been around for decades, so it's not like we would be jumping into a total mystery about its side effects. It seems to me that, whether hydroxychloroquine ultimately turns out to be effective or not, it is the closest thing we have right now to something that might prove to be a very helpful medicine.
- travisporter 7y ago
  Looks like they are! "The generic drug companies (Teva and Mylan, I’ve seen so far, and there’s this) that are cranking up production are doing the prudent thing – if this reads out well, we’ll need a lot of it."
- waynecochran 7y ago
  > If this drug isn’t useful, then sending hundreds of millions of people out to swallow all of it that they can find will be a massive waste of time and money, and will actively harm people besides. I don't think folks are reading the whole article.
  - axguscbklp 7y ago
    I'm not suggesting immediately starting to dose millions of people with it. I'm suggesting massively ramping up production so that if it turns out to be useful, we can at that point immediately start dosing millions of people with it. I think it likely that the cost of massively increasing hydroxychloroquine production would be a drop in the bucket compared to the total resources being spent on tackling the crisis. So even if the drug turns out to not be effective, the attempt to mass-produce it would still have been a rational gamble.
ggm 7y ago
I think the drug combinations are going to turn out to be as important as the single instances. One to bind to receptors. One to limit related infection risk. One to be an anti-pyretic. This is how HIV was fought, with cocktails. Single drug treatment comes later. Chloroquine is a powerful drug. It needs to be treated with respect. Yes it is cheap. it also has effects on the mind and we don't need a wave a psychosis to follow the corona-virus illnesses.
- Red_Leaves_Flyy 7y ago
  We've already weathered at least one wave of panic induced psychosis. From panic buyers, to Congress members using privileged information to blatantly sell stock just before the first crash.
  - save_ferris 7y ago
    Neither of those are examples of psychosis. Overreactions to unusual instability in our society? Sure, but hyperbolic comparisons like this muddy the waters around what psychosis is.
jojo2000 7y ago
There are papers out there that qualify chloroquine and derivates as effective in case of viral infections with viruses related to covid-19 [0] and try to explain what the mechanism could be : « The exact mechanism of antiviral intervention by chloroquine is not yet elucidated but is possibly a multitarget mechanism, depending on the time point at which the drug is added » [0] https://aac.asm.org/content/53/8/3416 https://aac.asm.org/content/53/8/3416
tibbydudeza 7y ago
A vaccine was developed in haste for an outbreak of swine flu in 1976 (CDC feared it was a repeat of 1918 flu) and about 45 million Americans received it but 450 people developed GBS (Guillaine-Barre Syndrome) as a result. Going on a hunch or unproven stuff is simply going to give the anti-vaxxer idiots further ammo
- ApolloFortyNine 7y ago
  Taking your numbers as fact, that would be a .001% death rate. Coronavirus has a death rate ranging from .6-2% (overall), varying drastically to upwards of 20% with age. It's not a hard call to make.
  - tibbydudeza 7y ago
    https://www.discovermagazine.com/health/the-public-health-legacy-of-the-1976-swine-flu-outbreak https://www.discovermagazine.com/health/the-public-health-le... An abject failure all because of one President's obsession on getting re-elected ... kind of reminds me of the current occupant in the WH.
  - wtallis 7y ago
    > Taking your numbers as fact, that would be a .001% death rate. Death rate for GBS is more like 7.5%, not 100%. Though for today's challenge, the relevant stat may be that ~15% of GBP patients end up needing a ventilator. But even that wouldn't be a problem if we had such a vaccine for this coronavirus.
- gnulinux 7y ago
  I don't think even a scientific study would be effective against odds as small as 450 out of 45 million. Vaccines are tested by hundreds, or thousands of people before mass produced. Catching an event as unlikely as this doesn't seem possible. One would hope animal models would be helpful, but what if vaccine only causes GBS to humans?
- pbhjpbhj 7y ago
  That's a pretty good rate, ~10x GBS than you would expect deaths from regular flu. GBS is listed as a side-effect of UK's Fluenztetra flu shot IIRC. Most people reportedly fully recover from GBS.
aazaa 7y ago
Only one clinical study has been published on chloroquine (by a French group), and the results are lackluster. No patient was cleared of virus after six days using hydroxychloroquine alone. A tiny fraction of patients were cleared in 4 days using an adjunct therapy (azithromycin). The study itself has issues, and it's not even clear whether it will clear peer review. The President is doing something very dangerous here with his comments in the last two days. By stoking chloroquine hype, he's setting the country up for a massive disappointment should the drug fail to produce treatment, or unexpected side effects. Although the drug has been used in humans for decades to treat malaria, it has not been used to any extent on humans to treat COVID-19. There's a non-zero chance of adverse reactions, potentially serious given known problems with the chloroquines. Even worse, the idea that a "treatment" exists will encourage people to let down their guard and will very likely lead to even worse outbreaks. Unexpected things happen all the time in clinical trials. This is the main reason it costs billions to bring a drug to market. We can't predict jack squat.
- Judson 7y ago
  Are you referring to this study? https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWSHnGbj/view https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWS... Afaikt, 57% patients on HCQ alone were “virologically cleared” by day 6 and 100% on HCQ+Azithromycin were clear By day 6. Compared with ~12% of control group.
  - aazaa 7y ago
    Yes, and I'm looking at the aggregate data in the last two graphs, and also the big table. HCQ + AZ was the only group with clearance for all after six days. It was also the smaller of the two groups, which makes it hard to give any weight to the finding. But there are many other features of this study that make the result hard to interpret.
    - Judson 7y ago
      Great that we’re looking at the same study! I’m not sure what you mean by: “No patient was cleared of virus after six days using hydroxychloroquine alone.“ Because the percentages there are 57% Of patients on HCQ alone we’re cleared, vs 12% control.
transreal 7y ago
This is pretty interesting. I've been taking Plaquenil (hydroxochloroquine) regularly for 6 months now to control an auto-immune disease, and I came down with potential symptoms of covid-19 2 weeks ago, but it was very mild - just a sore throat and cough that lasted 4 days, and I had a slight fever the first night. I self quarantined just in case, but after recovering thought I must have just caught a cold, since my symptoms were so mild. But I wonder now if I got it and if taking Plaquenil helped me recover quickly. Too bad I can't get tested to know for sure :-( When I started Plaquenil, the doctor told me it takes about a month or two to really build up in the blood stream to help control my condition. I wonder if the need to take it for a while also applies for Covid-19.
- adrr 7y ago
  You can get an antibodies test that you can do at home with a finger prick. Need to google it. I am about to one since I had symptoms couple weeks ago after being in the same room with someone with an uncontrollable cough.
  - ignoramous 7y ago
    > You can get an antibodies test that you can do at home with a finger prick. Here's a recent discussion on $15 kit for SARS-CoV-2 serological test: https://news.ycombinator.com/item?id=22641946 https://news.ycombinator.com/item?id=22641946 iirc, Singapore announced a plan to do these tests to find total infections.
- axaxs 7y ago
  Please remember that greater than 90 percent of people who have covid like symptoms test negative. So while there's a chance you had it and recovered, it's very small. Stay safe and assume you're still vulnerable.
  - jennyyang 7y ago
    90% of tests reported negative. If someone is tested, they need to take 2 tests. If someone is tested positive, they need to be tested until they get 2 negative tests in a row. So the numbers are very skewed.
fspeech 7y ago
As non-specific antivirals the benefits of these drugs are most likely at disease onset or as preventives. A trial has started in the US for people with known exposure: https://clinicaltrials.gov/ct2/show/NCT04308668?term=hydroxychloroquine&recrs=ab&cond=COVID-19&draw=2&rank=4 https://clinicaltrials.gov/ct2/show/NCT04308668?term=hydroxy... Note the dosage being trialed is quite high. Definitely not something to do without proper medical supervision.
stevespang 7y ago
Derek's column does not ever post my responses (censorship ?) so here it is: The side effects of chloroquine are modest for most, especially on a 10 days or less regimen. Approx. 5% or higher risk of NOT taking it when ill from coronavirus it is you could end up in ICU on a ventilator, on the other hand, the risk of taking it and getting serious side effects is minimal, like at about 1.5% in the study below. Google this title: Reported Side Effects to Chloroquine, Chloroquine plus Proguanil, and Mefloquine as Chemoprophylaxis against Malaria in Danish Travelers Summary: 85% of Danish travelers reported no side effects minor side effects are: Diarrhea, stomach pain (take only with a full meal), dizziness the depression / anxiety incident was ONE person - - we don't base science on what happen to ONE person. severe side effects in only 1.5% of cases Only LONG TERM USE for many months or years can have retina involvement. So all those who want to bash the multiple recent published research results showing good results with chloroquine and hydroxychloroquine for COVID19 - - - maybe I'll read about you in morgue statistics somewhere soon. I have already got my 'script for chloroquine (cost me 70 cents total), I am ready and prepared - - - instead of being a naysayer with my head in the sand.
pazimzadeh 7y ago
Also take a look at thymoquinone, which supposedly inhibits mouse coronavirus, which is very similar to SARS-coronavirus. The effects of Nigella sativa (Ns), Anthemis hyalina (Ah) and Citrus sinensis (Cs) extracts on the replication of coronavirus and the expression of TRP genes family https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933739/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933739/ Thymoquinone is also generally protective of lung health in several models: https://www.tandfonline.com/doi/abs/10.1080/10520295.2019.1681511 https://www.tandfonline.com/doi/abs/10.1080/10520295.2019.16... https://www.ncbi.nlm.nih.gov/pubmed/31044379 https://www.ncbi.nlm.nih.gov/pubmed/31044379 https://www.ncbi.nlm.nih.gov/pubmed/31143688 https://www.ncbi.nlm.nih.gov/pubmed/31143688 It is found in orange peel and black seed (Nigella sativa) extract.
- taneq 7y ago
  Pardon the dumb question, but has anyone just tried quinine? I've been wondering if a hefty gin and tonic would help matters.
  - organicfigs 7y ago
    I'm not a doctor (yet) but I believe quinine has immunosuppressant effects so you don't want to take it preemptively, only when you have your own immune system in overdrive.
  - red-indian 7y ago
    I'm taking it, I've also got my family and neighbors on it. I was unable to convince doctors since February to take me seriously that hydroxychloroquine is likely to have prophylactic effects so I took matters into my own hands. I know what I'm doing. Those who don't know what they are doing should not just jump in since they need to manage and understand the dose, the drug interactions, and the side effects. None of which are a problem for most people. Most. The ones that aren't though the interactions are well enough known and documented. I am not recommending it to anyone, that would probably be a crime. I'm saying if you're smart and understand science and thoughtful and not reckless you might be able to use it with the same safety that indians did for thousands of years. I still don't think you should though. Push for HCQ instead. Commercial tonic is limited by federal law to 20mg per 8 oz, so I make my own tonic. It would be much much better and would likely stop this whole problem if we'd just mail prophylactic doses of HCQ to the whole population instead of mailing a $1500 check to everyone like they've decided instead. It's very humorous how people look at tropical countries that still have widespread HCQ use for anti-malaria and announce that they must be undercounting cases since their reported numbers are far too low. No, their numbers are not too low. It's just a lot of people in these regions are essentially vaccinated.
sabujp 7y ago
hydroxychloroquinine should be readily available in pharmacies in India. I expect many to start using those when they're in bad shape.
Haga 7y ago
https://indianpediatrics.net/mar1995/351.pdf https://indianpediatrics.net/mar1995/351.pdf Cloroquine can trigger psychosis in sleeper schizophrenia persons. It has quite a history in the Vietnam War.
duchenne 7y ago
Since this 13th of February, the Koreans recommend the use of hydrochloroquine for patients infected by the covid-19 [1]. The Covid-19 fatality ratio in Korea is one of the lowest in the world, around 1%. The study in France showing a spectacular drop in covid-19 viral load after only 6 days of hydrochloroquine treatment has been directed by Pr Didier Raoult who is the most cited researcher on infectious disease in the world. [2] Anecdotally, I personally know a patient who took hydrochloroquine, and indeed the viral load dropped quickly, even though the lung damage is still there. According to Pr Didier Raoult, the hydrochloroquine has been routinely prescribed for decades to prevent Malaria, with well known and limited side-effects. According to him, the in-vitro effectiveness of hydrochloroquine on covid-19 has been confirmed by several labs independently, including his own lab and the lab of Mr Zong the most cited researcher on infectious disease in China. (Sorry, I am not sure about the spelling) [1] http://m.koreabiomed.com/news/articleView.html?idxno=7428 http://m.koreabiomed.com/news/articleView.html?idxno=7428 [2] https://scholar.google.fr/citations?user=n8EF_6kAAAAJ&hl=fr https://scholar.google.fr/citations?user=n8EF_6kAAAAJ&hl=fr
- deleted 7y ago
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- roenxi 7y ago
  I'm reminded of the old armour-where-the-bullets-aren't story [0]. The most important things to watch out for are places where symptoms don't show up at all. One interesting challenge that the people doing studies must be facing is that by the time symptoms get bad the virus is probably to some degree irrelevant. If someone's lungs have given out then whether or not there are virus particles in their body probably doesn't matter so much; the damage is done. Raw viral load isn't putting people in hospital as much as that important parts of their body have been dissolved. For a drug to be effective against the virus maybe it needs to be cheap & administered very early before symptoms become too obvious. That'd be hard to study. [0] https://medium.com/@penguinpress/an-excerpt-from-how-not-to-be-wrong-by-jordan-ellenberg-664e708cfc3d https://medium.com/@penguinpress/an-excerpt-from-how-not-to-...
  - kayamon 7y ago
stevespang 7y ago
All you naysayers: The WHO Model List of Essential Medicines (EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system.[1] Cholorquine is on that list. Case Closed.
cgio 7y ago
Given the relationship with Malaria, does anyone know if correlation with G6PD has been subject of research? G6PD is a common genetic Deficiency that provides immunity from malaria. G6PD people have to avoid consuming e.g. blue colour, sulphites and other anti malarial drugs, aspirin, fava beans etc. at risk of haemolysis.
macinjosh 7y ago
I realize that the FDA serves a purpose, but in dire situations I think anyone should be able to take any drug if they sign a document stating they will hold no one liable for adverse affects of a drug that might have chance of saving their lives. Why does one have to follow the state's one-size-fits-all rules when their life is at stake and any potential harm is limited to themselves?
- odyssey7 7y ago
  It’s an interesting question what aspects of human behavior the government should be able to regulate. A couple of points beside that are 1) this would incentivize drug companies to use desperate patients as a low-cost way of screening drug candidates — “free” data with all liability signed away. And 2) the externalities of a person being injured can be huge, so the possible harm isn’t really limited to that patient. Edit: With some reasonable guardrails, I think “right to try” makes sense. I personally don’t know what the guardrails should be.
- narogab 7y ago
  Because when those adverse effects permanently disable those people the government will likely at some point have to pay for their care.
known 7y ago
https://en.wikipedia.org/wiki/Chloroquine#COVID-19 https://en.wikipedia.org/wiki/Chloroquine#COVID-19 is not suitable for people with heart disease or diabetes

261 points by ilamont 7y ago

And so to today. As I said yesterday, I find the reports of chloroquine/hydroxychloroquine activity against the coronovirus very interesting, but preliminary. There has as yet been no well-controlled trial, and unfortunately the effects seen are still the sort of thing that can look exciting but disappear when you look closely. I mean that. It happens all the time – ask anyone else who does drug research for a living. If this drug isn’t useful, then sending hundreds of millions of people out to swallow all of it that they can find will be a massive waste of time and money, and will actively harm people besides. This is not a benign compound; it should only be taken when you have a solid expectation of benefit, and (saying it again), we don’t yet have that. Better trials are cranking up right now: please, wait for those. The generic drug companies (Teva and Mylan, I’ve seen so far, and there’s this) that are cranking up production are doing the prudent thing – if this reads out well, we’ll need a lot of it. But we’ll need to give it to people who are in bad shape from the viral infection, too, remember that, and I fear that a lot of people around the world are just starting to take it now in hopes of a prophylactic effect, which is (saying it again) a bad idea.

zwily 7y ago
This snippet right here does a good job balancing optimism with caution. We need more of this.
patrickbuckley 7y ago
This is a great reminder, thank you for pointing it out. Interestingly during the 1918 Spanish flu aspirin was a new drug and was given to people in an effort to reduce fever. The problem is they gave it in doses that we now know is toxic. There is some evidence that patients treated in hospitals with aspirin had a 30x!!! deathrate vs those treated "homeopathically". This YouTube video goes into the history and context of it ... https://youtu.be/dT6mHi_8V5E https://youtu.be/dT6mHi_8V5E (go to 11:30 in video) I beleive in modern medicine and science but we should be careful about being overly optimistic and harming people by giving them a powerful drug that hasn't been tested properly. Edited to add time point in video.
- mymacbook 7y ago
  Those that did not take aspirin during the Spanish flu had far lower morbidity rates. Fever is not something I rush to suppress with drugs until I exceed 104.0 - same for my family and even when our daughter was a little tiny thing. Preliminary unpublished information shows concerns on accelerating progression of SARS-CoV-2 virus to COVID-19 illness for ALL NSAIDs (not just aspirin). However, even with non-NSAIDs I exercise extreme caution when using (e.g. acetaminophen - Tylenol - 4000mg is considered VERY TOXIC for liver).

AdmiralBumbleB 7y ago

This chloroquinine rush is already out of control. My pharmacy is already out of it and is unable to procure from other pharmacies (which are also out already!) My pharmacist placed orders for all her patients to prefill prescriptions (where possible) for the next few months. I can understand a shortage when there's a clear evidence-based need, but the rumour-mill hasn't even ramped to full bore yet and it's already harming people with a pre-existing need for the medication. It's even worse _if_ the medication works to prevent or shorten c19 infections, because the people currently taking chloroquinine are very likely high-risk (immunocompromised) patients. Really wish people would chill out. Note - This affects me, as I take the medication. It's scary to think I could be without it at some point in the future as it's been practically life-changing.

throwaway894345 7y ago
I really hope this virus prompts our disaster management agencies to get their shit together, and specifically to consider supply chain security as part of their threat model (and no, we don't meaningfully do this or we wouldn't have such a pitiful national reserve of respirators and other respiratory treatment devices following SARS and MURS). Not sure exactly what this would look like, but identifying key partners in industry and working with them to enable them to turn-key ramp up production seems obvious.
- blhack 7y ago
  How could our disaster management agencies have gotten their shit together to anticipate a run on an old anit-malaria drug?
  - throwaway894345 7y ago
    Optimize for the aspects of the supply chain that don't depend on the specific drug. For example, the packaging of pills probably doesn't need to vary that much in general. But the point isn't that we are prepared for every eventuality (e.g., chloroquine), but that we are doing due diligence in preparing for the likely eventualities (e.g., general purpose respiratory treatments like ventilators).

fny 7y ago

I was under the impression that chloroquine was used to facilitate cellular absorption of zinc and that the zinc was responsible for any antiviral behavior: https://www.youtube.com/watch?v=dT6mHi_8V5E https://www.youtube.com/watch?v=dT6mHi_8V5E

travisporter 7y ago
"One that I find particularly amusing, for personal reasons, is the idea of complexing zinc ions...So yeah, I can at least believe that these things complex zinc, for what that’s worth." Not sure if this statement supports or refutes your theory; I'm inclined to believe the latter.
tristor 7y ago
I was under the same impression. Zinc acts to disrupt cellular replication of viral cells, and this is true for MANY viruses. Cloroquine acts as a zinc ionophore providing a pathway for zinc to cross the cellular wall at much lower concentrations, greatly improving its effectiveness.
submeta 7y ago
Interesting! Could not find the part of the video where the claim is made. Can you help?

bpaddock 7y ago

The Quinism Foundation Warns of Dangers from Use of Antimalarial Quinolines Against COVID‑19. "Use of Chloroquine, Hydroxychloroquine, Mefloquine, Quinine, and Related Quinoline Drugs Risks Sudden and Lasting Neuropsychiatric Effects from Idiosyncratic Neurotoxicity." https://quinism.org/press-releases/dangers-of-antimalarial-quinolines-against-covid-19/ https://quinism.org/press-releases/dangers-of-antimalarial-q... The Anit-Malaria drugs They are pushing have a common ancestor to Fluoroquinolone antibiotics have MANY FDA warnings. The FDA says they should not be used unless all other options have been exhausted. Those that have already been devastated by Fluoroquinolones are extremely upset to hear that a related quinolines drug is being proposed. While these two drugs are technically in a different class, they share some common ancestors. They both share many of the devastating side effects. I have put all the FDA warnings for Fluoroquinolone antibiotics on my late wife's website. Levaquin was a significant contributor to Karen's suicide. :-( http://www.kpaddock.com/fq http://www.kpaddock.com/fq

chimichangga 7y ago
"Two drugs, chloroquine and remdesivir, are being designated for Expanded Access, or “compassionate use,” by the FDA." It's already available. Hopefully soon to the general public (it's prescription only btw).
smoyer 7y ago
Sorry for your loss
wtallis 7y ago
> Those that have already been devastated by Fluoroquinolones are extremely upset to hear that a related quinolines drug is being proposed. Raising awareness of the risks based on your personal experiences is reasonable. But the above statement seems to cross the line into irrationality by pre-deciding that quinolines aren't worth trying here. That casts doubt on whatever scientific arguments you put forth, because it doesn't seem like you're capable of being fair about this.
twomoretime 7y ago
Respectfully, though I understand your effort to warn others, I think it is dangerous at this time to conflate chloroquine derivatives with Chloroquine. Single substitutions in biologically active compounds can cause drastically different effects including substantially different therapeutic ratios. Compare for example the various drugs in the amphetamine family (methamphetamine, amphetamine, MDMA, etc). They are not equally dangerous. Similarly, the terrible results you report are AFAIK rare with Chloroquine. It is a well tolerated drug and if you're an older or immunocompromised patient playing Russian roulette with a late stage COVID19 infection, the minimal risk is highly preferable to no treatment.

deleted 7y ago

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brucer 7y ago

I was intrigued by the results from the recent quick french study: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf https://www.mediterranee-infection.com/wp-content/uploads/20... I read through the paper, and it's not immediately obvious, but if you look at the two graphs at the bottom, the hydroxychloroquine is 75% effective in the first chart, but only 50% in the second one. That's because the actual test was: Control: 16 hydroxychloroquine: 14 hydroxychloroquine + azithromycin: 6 The first chart includes all 20 people who got hydroxychloroquine - including the 6 who also got azithromycin. My question: do we know how effective azithromycin would be on it's own? Maybe it's the wonder drug we should be focused on, which would be great since it's available everywhere. It should go without saying these are VERY preliminary results from a small trial but it's something!

Nav_Panel 7y ago
It's an antibiotic. Severe patients will be dealing with secondary (bacterial) infections, so it makes sense to use both. But on its own, I expect it would have little effect.
- alkonaut 7y ago
  It’s already commonly used as both treatment and profylactic (in healthy risk group patients) for viral pneumonia. Why it works for I think is still not entirely clear. Being an antibiotic is also convenient because many times you would also get antibiotics to prevent a secondary infection from bacteria. It’s not exactly a miracle cure (like an antibiotic is against a bacterial pneumonia), but doctors have few tools when it comes to viral pneumonia, so even something that helps a little is welcome.
- benjohnson 7y ago
  As I understand it - it interferes with mRNA transcription. Given that COVID-19 is RNA that may be useful.
the8472 7y ago
> but it's something! And that something may turn out to be noise.

Mountain_Skies 7y ago

How well does chloroquine mix with gin? Asking for a friend.

ropiwqefjnpoa 7y ago
Mixes well, only minimal brain damage ;)
munk-a 7y ago
It's much more often to mix in Quinine - and you're doing so every time you have a gin & tonic (with real tonic - not just carbonated water). Amusingly it's also an anti-malarial.

andreygrehov 7y ago

Does anyone have any information about the Favipiravir testing going on in China? From what I read, it has a 90% success rate treating coronavirus AND is a super safe drug in general.

comicjk 7y ago
Here's a short paper on it [pdf]: https://www.jstage.jst.go.jp/article/ddt/14/1/14_2020.01012/_pdf/-char/en https://www.jstage.jst.go.jp/article/ddt/14/1/14_2020.01012/... Not many details, just that it worked better than some HIV antivirals. Still, worth ramping up production of this in advance of trials. It's a surprisingly small and simple molecule.
gnulinux 7y ago
I read this X% success rate for many drugs, Remdesivir, chloroquine etc... What does it mean? Giving no drug, just ventilator alone has 97% success rate right? So how do we know that that 90% is due to the drug and not, you know, immune system itself? Moreover, a lot of people keep saying both Remdesivir and chloroquine are in official treatment suggestions in Italy, and seeing Italy is suffering a pretty bad mortality rate, how do we even know these drugs are better than placebo?
- deleted 7y ago
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- mypalmike 7y ago
  Was 97% a hypothetical? I have heard much lower figures for ventilator success rates.
  - gnulinux 7y ago
    Do they use these drugs only to severe patients who need ventilator? I was referring to the overall estimated CFR (3%). What is the success rate of ventilators then?
- cm2187 7y ago

ropiwqefjnpoa 7y ago

Quinine is amazing stuff and quite easy to make, but the poison is in the dosage. Controlling that when you're making your own with cinchona bark isn't something you want to do trial and error style, serious side effects.

Munky-Necan 7y ago

Until there's a double blind placebo trial I will take this type of report with a truck load of salt. We want randomized control trials in medicine. We want highly vetted research in medicine. Lacking either is a bad idea. I am also not holding my breath about a vaccine. We tried making a vaccine with SARS-CoV with a significant amount of the animal models dying from cytokine storm after viral exposure. Drug trials are hard, but necessary.

icelancer 7y ago
>> Until there's a double blind placebo trial I will take this type of report with a truck load of salt. You're welcome to. The remainder of the world should have the choice. Some people can't - or don't - want to wait for an RCT with a sample size in the thousands before taking a cheap and well-known drug with well-tolerated side effects.
- jki275 7y ago
  To be fair, I don't think that he's saying it should be banned -- he's saying that we need a lot more testing before claiming this is a cure based on one study with a tiny number of participants. His statement is accurate. And the quinine derivatives have some very subtle neurological effects that last a lifetime. Suicidal ideations -- for life and incurable -- are a well known side effect of mefloquine at least. Maybe this one doesn't have those effects, I don't know -- but there's a really good argument to do a lot of testing before taking this in any other than an in-extremis situation.
  - Munky-Necan 7y ago
    Bingo, we need nonbiased blinded drug trials otherwise the data could be seriously flawed. There's drug trials for reasons, and even in this pandemic we should respect the rationale for why we established those trials. Also, I'm finding that this forum is full of incredibly intelligent individuals who demonstrate the a little knowledge is a dangerous thing. It amazes me how often y'all will talk about medicine like you're experts but miss fundamental concepts. May points, like the other poster, sound awesome to lay people, but under the scrutiny of any medical professional would be laughed at.

guiriduro 7y ago

Is there not an argument that given chloroquine's apparent efficacy, albeit statistically weakly or improperly demonstrated (so far), along with its long history of relative safety in anti-malarial prophylaxis (with known caveats), set against an exponential growth in dangerous pneumonia - it is therefore rational to want to at least offer it to all suspected cases and healthworkers in balance of the serious risks they face?

hannob 7y ago
The possible side effects include permanent blindness. Giving this drug to people while you simply don't know if it does any good is only justifiable if you do it within a properly designed clinical trial. Which is the thing you should do. If you feel lots of people should get this drug - do a large trial. Will give us better data.
- milofeynman 7y ago
  Permanent blindness typically takes many weeks / years of use. https://www.webmd.com/drugs/2/drug-8633/chloroquine-oral/details https://www.webmd.com/drugs/2/drug-8633/chloroquine-oral/det...
  - ginko 7y ago
    Which might be necessary for prophylactic use.
    - cm2187 7y ago
      You only need to mitigate the peak of infections from this virus. And I don’t think anyone is suggesting it to be used as a preventive tool. It is to reduce the contagiousness of people tested positive (and hopefully also help them with the virus).
    - uwuhn 7y ago
      No, the course is 10 days IIRC.

Animats 7y ago

Yesterday's paper from the COVID-19 hospital in China mentioned chloroquine. They use it, but only in a few specific situations.

cameldrv 7y ago

We definitely want more studies, but IMO we're reaching a tipping point. We have anecdotal evidence from China and South Korea, and this quite flawed, but at least data-containing study from France. Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. COVID isn't quite as bad as cancer, but Chloroquine, especially for a short course, isn't anywhere near as bad as most chemo drugs. Many people take it for years as prophylaxis -- not even to treat an existing disease.

stcredzero 7y ago
> COVID isn't quite as bad as cancer, but Chloroquine, especially for a short course, isn't anywhere near as bad as most chemo drugs. For certain individuals who just happen to have a bad reaction, COVID could well be just as fatal as cancer. In terms of how fast it can kill people, in certain cases, it can be worse than a lot of cancers.
- caycep 7y ago
  use hydroxochloroquine then?
- cameldrv 7y ago
  Do you mean COVID is as fatal as cancer or Chloroquine is?
  - gnulinux 7y ago
    COVID. For >70 y.o. individuals mortality rate is 30%. If you're >70 y.o. have heart condition and have diabetes (all risk factors) COVID is clearly more deadly than some (most?) cancers, not to mention it kills in the order of weeks, when cancer kills in the order of months or years.
    - cameldrv 7y ago
      Right. OTOH in the Chinese treatment guidelines, they say not to give it for >65 y.o. Unfortunately that's exactly the population it would potentially benefit the most. I'm guessing there must be some reason that's in there, but I'd like to see numbers.

axguscbklp 7y ago

It seems to me that we should immediately move to massively increase production of hydroxychloroquine. If it turns out to be part of a solution, great. If not, I doubt that more than a tiny fraction of the total resources dedicated to the pandemic would have been used up by the effort. There is no time to take things slowly in our situation. In any case, from what I've read on places like r/medicine, many people who have access to hydroxychloroquine have already begun to hoard it. So one way or another, if we do not ramp up production there will be trouble. Hydroxychloroquine has been around for decades, so it's not like we would be jumping into a total mystery about its side effects. It seems to me that, whether hydroxychloroquine ultimately turns out to be effective or not, it is the closest thing we have right now to something that might prove to be a very helpful medicine.

travisporter 7y ago
Looks like they are! "The generic drug companies (Teva and Mylan, I’ve seen so far, and there’s this) that are cranking up production are doing the prudent thing – if this reads out well, we’ll need a lot of it."
waynecochran 7y ago
> If this drug isn’t useful, then sending hundreds of millions of people out to swallow all of it that they can find will be a massive waste of time and money, and will actively harm people besides. I don't think folks are reading the whole article.
- axguscbklp 7y ago
  I'm not suggesting immediately starting to dose millions of people with it. I'm suggesting massively ramping up production so that if it turns out to be useful, we can at that point immediately start dosing millions of people with it. I think it likely that the cost of massively increasing hydroxychloroquine production would be a drop in the bucket compared to the total resources being spent on tackling the crisis. So even if the drug turns out to not be effective, the attempt to mass-produce it would still have been a rational gamble.

ggm 7y ago

I think the drug combinations are going to turn out to be as important as the single instances. One to bind to receptors. One to limit related infection risk. One to be an anti-pyretic. This is how HIV was fought, with cocktails. Single drug treatment comes later. Chloroquine is a powerful drug. It needs to be treated with respect. Yes it is cheap. it also has effects on the mind and we don't need a wave a psychosis to follow the corona-virus illnesses.

Red_Leaves_Flyy 7y ago
We've already weathered at least one wave of panic induced psychosis. From panic buyers, to Congress members using privileged information to blatantly sell stock just before the first crash.
- save_ferris 7y ago
  Neither of those are examples of psychosis. Overreactions to unusual instability in our society? Sure, but hyperbolic comparisons like this muddy the waters around what psychosis is.

jojo2000 7y ago

There are papers out there that qualify chloroquine and derivates as effective in case of viral infections with viruses related to covid-19 [0] and try to explain what the mechanism could be : « The exact mechanism of antiviral intervention by chloroquine is not yet elucidated but is possibly a multitarget mechanism, depending on the time point at which the drug is added » [0] https://aac.asm.org/content/53/8/3416 https://aac.asm.org/content/53/8/3416

tibbydudeza 7y ago

A vaccine was developed in haste for an outbreak of swine flu in 1976 (CDC feared it was a repeat of 1918 flu) and about 45 million Americans received it but 450 people developed GBS (Guillaine-Barre Syndrome) as a result. Going on a hunch or unproven stuff is simply going to give the anti-vaxxer idiots further ammo

ApolloFortyNine 7y ago
Taking your numbers as fact, that would be a .001% death rate. Coronavirus has a death rate ranging from .6-2% (overall), varying drastically to upwards of 20% with age. It's not a hard call to make.
- tibbydudeza 7y ago
  https://www.discovermagazine.com/health/the-public-health-legacy-of-the-1976-swine-flu-outbreak https://www.discovermagazine.com/health/the-public-health-le... An abject failure all because of one President's obsession on getting re-elected ... kind of reminds me of the current occupant in the WH.
- wtallis 7y ago
  > Taking your numbers as fact, that would be a .001% death rate. Death rate for GBS is more like 7.5%, not 100%. Though for today's challenge, the relevant stat may be that ~15% of GBP patients end up needing a ventilator. But even that wouldn't be a problem if we had such a vaccine for this coronavirus.
gnulinux 7y ago
I don't think even a scientific study would be effective against odds as small as 450 out of 45 million. Vaccines are tested by hundreds, or thousands of people before mass produced. Catching an event as unlikely as this doesn't seem possible. One would hope animal models would be helpful, but what if vaccine only causes GBS to humans?
pbhjpbhj 7y ago
That's a pretty good rate, ~10x GBS than you would expect deaths from regular flu. GBS is listed as a side-effect of UK's Fluenztetra flu shot IIRC. Most people reportedly fully recover from GBS.

aazaa 7y ago

Only one clinical study has been published on chloroquine (by a French group), and the results are lackluster. No patient was cleared of virus after six days using hydroxychloroquine alone. A tiny fraction of patients were cleared in 4 days using an adjunct therapy (azithromycin). The study itself has issues, and it's not even clear whether it will clear peer review. The President is doing something very dangerous here with his comments in the last two days. By stoking chloroquine hype, he's setting the country up for a massive disappointment should the drug fail to produce treatment, or unexpected side effects. Although the drug has been used in humans for decades to treat malaria, it has not been used to any extent on humans to treat COVID-19. There's a non-zero chance of adverse reactions, potentially serious given known problems with the chloroquines. Even worse, the idea that a "treatment" exists will encourage people to let down their guard and will very likely lead to even worse outbreaks. Unexpected things happen all the time in clinical trials. This is the main reason it costs billions to bring a drug to market. We can't predict jack squat.

Judson 7y ago
Are you referring to this study? https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWSHnGbj/view https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWS... Afaikt, 57% patients on HCQ alone were “virologically cleared” by day 6 and 100% on HCQ+Azithromycin were clear By day 6. Compared with ~12% of control group.
- aazaa 7y ago
  Yes, and I'm looking at the aggregate data in the last two graphs, and also the big table. HCQ + AZ was the only group with clearance for all after six days. It was also the smaller of the two groups, which makes it hard to give any weight to the finding. But there are many other features of this study that make the result hard to interpret.
  - Judson 7y ago
    Great that we’re looking at the same study! I’m not sure what you mean by: “No patient was cleared of virus after six days using hydroxychloroquine alone.“ Because the percentages there are 57% Of patients on HCQ alone we’re cleared, vs 12% control.

transreal 7y ago

This is pretty interesting. I've been taking Plaquenil (hydroxochloroquine) regularly for 6 months now to control an auto-immune disease, and I came down with potential symptoms of covid-19 2 weeks ago, but it was very mild - just a sore throat and cough that lasted 4 days, and I had a slight fever the first night. I self quarantined just in case, but after recovering thought I must have just caught a cold, since my symptoms were so mild. But I wonder now if I got it and if taking Plaquenil helped me recover quickly. Too bad I can't get tested to know for sure :-( When I started Plaquenil, the doctor told me it takes about a month or two to really build up in the blood stream to help control my condition. I wonder if the need to take it for a while also applies for Covid-19.

adrr 7y ago
You can get an antibodies test that you can do at home with a finger prick. Need to google it. I am about to one since I had symptoms couple weeks ago after being in the same room with someone with an uncontrollable cough.
- ignoramous 7y ago
  > You can get an antibodies test that you can do at home with a finger prick. Here's a recent discussion on $15 kit for SARS-CoV-2 serological test: https://news.ycombinator.com/item?id=22641946 https://news.ycombinator.com/item?id=22641946 iirc, Singapore announced a plan to do these tests to find total infections.
axaxs 7y ago
Please remember that greater than 90 percent of people who have covid like symptoms test negative. So while there's a chance you had it and recovered, it's very small. Stay safe and assume you're still vulnerable.
- jennyyang 7y ago
  90% of tests reported negative. If someone is tested, they need to take 2 tests. If someone is tested positive, they need to be tested until they get 2 negative tests in a row. So the numbers are very skewed.

fspeech 7y ago

As non-specific antivirals the benefits of these drugs are most likely at disease onset or as preventives. A trial has started in the US for people with known exposure: https://clinicaltrials.gov/ct2/show/NCT04308668?term=hydroxychloroquine&recrs=ab&cond=COVID-19&draw=2&rank=4 https://clinicaltrials.gov/ct2/show/NCT04308668?term=hydroxy... Note the dosage being trialed is quite high. Definitely not something to do without proper medical supervision.

stevespang 7y ago

Derek's column does not ever post my responses (censorship ?) so here it is: The side effects of chloroquine are modest for most, especially on a 10 days or less regimen. Approx. 5% or higher risk of NOT taking it when ill from coronavirus it is you could end up in ICU on a ventilator, on the other hand, the risk of taking it and getting serious side effects is minimal, like at about 1.5% in the study below. Google this title: Reported Side Effects to Chloroquine, Chloroquine plus Proguanil, and Mefloquine as Chemoprophylaxis against Malaria in Danish Travelers Summary: 85% of Danish travelers reported no side effects minor side effects are: Diarrhea, stomach pain (take only with a full meal), dizziness the depression / anxiety incident was ONE person - - we don't base science on what happen to ONE person. severe side effects in only 1.5% of cases Only LONG TERM USE for many months or years can have retina involvement. So all those who want to bash the multiple recent published research results showing good results with chloroquine and hydroxychloroquine for COVID19 - - - maybe I'll read about you in morgue statistics somewhere soon. I have already got my 'script for chloroquine (cost me 70 cents total), I am ready and prepared - - - instead of being a naysayer with my head in the sand.

pazimzadeh 7y ago

Also take a look at thymoquinone, which supposedly inhibits mouse coronavirus, which is very similar to SARS-coronavirus. The effects of Nigella sativa (Ns), Anthemis hyalina (Ah) and Citrus sinensis (Cs) extracts on the replication of coronavirus and the expression of TRP genes family https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933739/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933739/ Thymoquinone is also generally protective of lung health in several models: https://www.tandfonline.com/doi/abs/10.1080/10520295.2019.1681511 https://www.tandfonline.com/doi/abs/10.1080/10520295.2019.16... https://www.ncbi.nlm.nih.gov/pubmed/31044379 https://www.ncbi.nlm.nih.gov/pubmed/31044379 https://www.ncbi.nlm.nih.gov/pubmed/31143688 https://www.ncbi.nlm.nih.gov/pubmed/31143688 It is found in orange peel and black seed (Nigella sativa) extract.

taneq 7y ago
Pardon the dumb question, but has anyone just tried quinine? I've been wondering if a hefty gin and tonic would help matters.
- organicfigs 7y ago
  I'm not a doctor (yet) but I believe quinine has immunosuppressant effects so you don't want to take it preemptively, only when you have your own immune system in overdrive.
- red-indian 7y ago
  I'm taking it, I've also got my family and neighbors on it. I was unable to convince doctors since February to take me seriously that hydroxychloroquine is likely to have prophylactic effects so I took matters into my own hands. I know what I'm doing. Those who don't know what they are doing should not just jump in since they need to manage and understand the dose, the drug interactions, and the side effects. None of which are a problem for most people. Most. The ones that aren't though the interactions are well enough known and documented. I am not recommending it to anyone, that would probably be a crime. I'm saying if you're smart and understand science and thoughtful and not reckless you might be able to use it with the same safety that indians did for thousands of years. I still don't think you should though. Push for HCQ instead. Commercial tonic is limited by federal law to 20mg per 8 oz, so I make my own tonic. It would be much much better and would likely stop this whole problem if we'd just mail prophylactic doses of HCQ to the whole population instead of mailing a $1500 check to everyone like they've decided instead. It's very humorous how people look at tropical countries that still have widespread HCQ use for anti-malaria and announce that they must be undercounting cases since their reported numbers are far too low. No, their numbers are not too low. It's just a lot of people in these regions are essentially vaccinated.

sabujp 7y ago

hydroxychloroquinine should be readily available in pharmacies in India. I expect many to start using those when they're in bad shape.

Haga 7y ago

https://indianpediatrics.net/mar1995/351.pdf https://indianpediatrics.net/mar1995/351.pdf Cloroquine can trigger psychosis in sleeper schizophrenia persons. It has quite a history in the Vietnam War.

duchenne 7y ago

Since this 13th of February, the Koreans recommend the use of hydrochloroquine for patients infected by the covid-19 [1]. The Covid-19 fatality ratio in Korea is one of the lowest in the world, around 1%. The study in France showing a spectacular drop in covid-19 viral load after only 6 days of hydrochloroquine treatment has been directed by Pr Didier Raoult who is the most cited researcher on infectious disease in the world. [2] Anecdotally, I personally know a patient who took hydrochloroquine, and indeed the viral load dropped quickly, even though the lung damage is still there. According to Pr Didier Raoult, the hydrochloroquine has been routinely prescribed for decades to prevent Malaria, with well known and limited side-effects. According to him, the in-vitro effectiveness of hydrochloroquine on covid-19 has been confirmed by several labs independently, including his own lab and the lab of Mr Zong the most cited researcher on infectious disease in China. (Sorry, I am not sure about the spelling) [1] http://m.koreabiomed.com/news/articleView.html?idxno=7428 http://m.koreabiomed.com/news/articleView.html?idxno=7428 [2] https://scholar.google.fr/citations?user=n8EF_6kAAAAJ&hl=fr https://scholar.google.fr/citations?user=n8EF_6kAAAAJ&hl=fr

deleted 7y ago
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roenxi 7y ago
I'm reminded of the old armour-where-the-bullets-aren't story [0]. The most important things to watch out for are places where symptoms don't show up at all. One interesting challenge that the people doing studies must be facing is that by the time symptoms get bad the virus is probably to some degree irrelevant. If someone's lungs have given out then whether or not there are virus particles in their body probably doesn't matter so much; the damage is done. Raw viral load isn't putting people in hospital as much as that important parts of their body have been dissolved. For a drug to be effective against the virus maybe it needs to be cheap & administered very early before symptoms become too obvious. That'd be hard to study. [0] https://medium.com/@penguinpress/an-excerpt-from-how-not-to-be-wrong-by-jordan-ellenberg-664e708cfc3d https://medium.com/@penguinpress/an-excerpt-from-how-not-to-...
- kayamon 7y ago

stevespang 7y ago

All you naysayers: The WHO Model List of Essential Medicines (EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system.[1] Cholorquine is on that list. Case Closed.

cgio 7y ago

Given the relationship with Malaria, does anyone know if correlation with G6PD has been subject of research? G6PD is a common genetic Deficiency that provides immunity from malaria. G6PD people have to avoid consuming e.g. blue colour, sulphites and other anti malarial drugs, aspirin, fava beans etc. at risk of haemolysis.

macinjosh 7y ago

I realize that the FDA serves a purpose, but in dire situations I think anyone should be able to take any drug if they sign a document stating they will hold no one liable for adverse affects of a drug that might have chance of saving their lives. Why does one have to follow the state's one-size-fits-all rules when their life is at stake and any potential harm is limited to themselves?

odyssey7 7y ago
It’s an interesting question what aspects of human behavior the government should be able to regulate. A couple of points beside that are 1) this would incentivize drug companies to use desperate patients as a low-cost way of screening drug candidates — “free” data with all liability signed away. And 2) the externalities of a person being injured can be huge, so the possible harm isn’t really limited to that patient. Edit: With some reasonable guardrails, I think “right to try” makes sense. I personally don’t know what the guardrails should be.
narogab 7y ago
Because when those adverse effects permanently disable those people the government will likely at some point have to pay for their care.

known 7y ago

https://en.wikipedia.org/wiki/Chloroquine#COVID-19 https://en.wikipedia.org/wiki/Chloroquine#COVID-19 is not suitable for people with heart disease or diabetes