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Swedish hospital suspends Covid-19 treatment with chloroquine
- deleted 7y ago[deleted]
- grezql 7y agosideeffects are sudden heart stop (dont know the english word). they say they suspect some patients may have died because of the sideeffects and not the coronavirus in Sweden.
- goodcanadian 7y agoCardiac arrest is probably what you are looking for.
- deleted 7y ago[deleted]
- octocop 7y agoThe head at Karolinska said that they used Chloroquine becuase everyone else did. They had reports of side-effects that were more severe than expected, so now they stopped using it all together.
- ornornor 7y ago> The head at Karolinska said that they used Chloroquine becuase everyone else did. Really troubling if that’s the only metric they go by to decide whether to administer a particular treatment or not!
- hkeide 7y agoThis is pretty common in medicine. Consensus weighs heavier than actual evidence unfortunately.
- ornornor 7y agoI had no idea...
- sekh60 7y agoI didn't know that. I could see that trend in the U.S., given how litigious people can be about medical treatments and alledged malpractice by everyone following consensus before research one can defend a treatment by saying it is current best practice, everyone does it after all. Do you think something like that happens?
- hkeide 7y agoI haven’t considered that angle but I think it comes down to human nature mostly. Trust in authorities seem to be our default mode of operation, and critical thinking is not something that’s taught in med school or valued in hospitals. Doctors are mostly not scientists. Ask your doctor to read a study and they might read the abstract. Most have no ability to evaluate the quality of a study
- capableweb 7y ago> – Det började komma rapporter om misstänkta svårare biverkningar än vi först trodde. Vi kan inte utesluta svåra biverkningar, framförallt från hjärtat, och det är ett svårdoserat läkemedel. Dessutom har vi inga starka bevis på att klorokin har effekt vid covid-19. "There started coming reports about suspicious serious side-effects than we first thought. We can't conclude it doesn't have strong side-effects, particularly from the heart, and the drug is hard to dosage correct. Also, we don't have any strong evidence that Chloroquine has an effect with [SIC] covid-19" Reporter asks: "Har ni haft fall med svåra biverkningar?" "Have you had cases with strong side-effects?" Answer: "– Inte som jag känner till i Göteborg, men det finns rapporterat misstänkta fall från andra kliniker." "Not as far as I know in Gothenburg, but there is reports of suspicious cases from other clinics". > Alla sjukhus i Västra Götalandsregionen följer Sahlgrenskas exempel. Men de är än så länge ganska ensamma. På de stora sjukhusen i Stockholm ges fortfarande klorokin. "All hospitals in swedish region follows Sahlgrensk's example. But they are currently pretty alone. They still give patients Chloroquine in the big hospitals in Stockholm" Let me know with a reply if you want other parts translated, bit busy but can at least provide this for now.
- bufferoverflow 7y agoSeriously, the title of the article doesn't match the contents. The article itself contains very little factual information. We need numbers.
- capableweb 7y agoThe submission title kind-of doesn't match with the article (name of hospital in the article but just "hospital" here on HN and side-effects is not mentioned in the article title at all), but the contents of the article does match with it's title. Title is "Sahlgrenska stoppar behandling med malariamedicin mot covid-19" Which means "Sahlgrenska (name of Swedish hospital) stops treatment with malaria-medicine against COVID-19", which is exactly what the article's content is about, and it goes further to look at other hospitals as well.
- wolfhumble 7y agoThanks! A tiny little edit: > Vi kan inte utesluta svåra biverkningar, framförallt från hjärtat >We can't conclude it doesn't have strong side-effects, particularly for the health . . . particularly for the health => particularly from the heart
- deleted 7y ago[deleted]
- ornornor 7y agoWhat a surprise.... a crackpot theory by a less than reputable MD, tested on less than 100 people overall with no control and no double blind... I really wonder how other hospitals could have fallen for it. It’s the epitome of bad science. See https://news.ycombinator.com/item?id=22727359 https://news.ycombinator.com/item?id=22727359 for all the drama around Dr Raoult.
- threatofrain 7y agoMedicine has so much trouble with “good science” due to ethics. Random selection and assignment with controls are obvious techniques of science but it means not giving people medicine we suspect is interesting, or randomly assigning potentially bad effects to people. Double blind means the doctors and nurses who administer protocol won’t even know or care about your medical history or context, let alone whether or not they’re even giving you any medicine at all. So even clinical, experimental studies which start strong tend to compromise themselves after an initial impression of results.
- capableweb 7y agoIt's hard when the situation reaches panic-mode because people are dying around you. As a hospital worker, you feel very helpless when the only thing you can do is to help people die painlessly. As we're humans, we're easily affected by things around us, especially around death and life, and particularly at a pandemic. So when there is a slight possibility of helping people survive, even though you would normally never do something because you put emphasis on correct scientific procedure, you might give it a try, instead of doing nothing. I'm not arguing for it or against it, just trying to explain the situation and provide a different viewpoint for people who may never been there and hopefully never be.
- mardifoufs 7y agoYes, Dr Raoult is discredited at this point but it doesn't mean we know the treatment itself doesn't work. Here's a study with a control group, randomized selection, etc showing significant improvements not, in viral load as Raoult claimed, but in treating pneumonia caused by COVID. https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2 https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v...
- altacc 7y agoChloroquine is an anti-malaria and it's side effects are so severe and common that many people would prefer to run the risk of malaria than take it. Adding these side effects to a Covid-19 patient seems like an extreme measure, given there's little evidence so far that it's beneficial, let alone enough to outweigh these side effects.
- ldng 7y ago100s of million of people have taken it dayly over decades. And side effects generally happens when you've been taking the treatment for years for most people. And nowadays people take hydrochloroquine anyway. I've you taken it ? I have for ten years.
- jaclaz 7y agoI believe daily (recommended) dosage is very different, if I recall correctly 500 or 600 mg per day for the (supposed) Covid-19 treatment. What is (was) your daily dose for these ten years?
- ldng 7y agoI don't recall exactly, but 250 mg Nevaquine (Chloroquine) would sound about right. I was merely responding to "many people would prefer to run the risk of malaria than take it". It is simply not true. Even paracetamol at high dosage can kill. It is a very well know medicine. There are too many people repeating that it is dangerous without understanding the actual context. So, sure, at very high dosage for a very sick patient it can become dangerous. At low dosage on a daily basis I would (and have) take it instead of "running the risk of malaria". Anyway, it is Hydroxychloroquine that is prescribed nowadays for malaria, so not only the comment is spreading FUD but it is also not talking about the right molecule. Baseline, don't self-medicate based on what you read on internet and consult a real doctor.
- altacc 7y agoHydroxychloroquine / chloroquine: Neither are golden elixirs. Hydroxychloroquine is less toxic than chloroquine, but it's pharmacology is very similar and have similar side effects and contraindications. Whether or not to take a substance due it's side effects is a common decision for many people, both doctors and patients, and for many conditions, both acute and chronic.
- smdz 7y agoChloroquine's severe side effects may look similar to acute pneumonia and ARDS. Even if it helps destroy the virus, it might be complementing to the severity You can look up the severe symptoms here: https://medlineplus.gov/druginfo/meds/a682318.html https://medlineplus.gov/druginfo/meds/a682318.html
- bufferoverflow 7y agoThe question is how common they are compared to COVID-19. If not very, I'd rather risk and take it, than have no option.
- hurricanetc 7y agoAnother side effect is cardiac arrest. I am not a doctor but from basic reading I have done the dosage seems extremely important.
- rsynnott 7y ago> than have no option. What makes you think it is an option, though? There's really very little reason to think it's useful at this point.
- bufferoverflow 7y agoMultiple studies.
- lanevorockz 7y agoWhy does it feel like people are happy that there is a downside for a treatment? This hate Trump at all costs is starting to be really dark.
- grey-area 7y agoReality seems to have a strong anti-trump bias
- rsynnott 7y agoThis isn't a treatment, or at least there's very little reason to think it is at this point. If hospitals are discontinuing use of dangerous drugs with no credible evidence of efficacy, then, yeah, I can live with that. Await real trials, see if it actually does anything useful.
- ramblerman 7y agoThe irony is you are blaming people for interpreting this article with some hidden narrative to fulfill, yet you introduced the narrative into this thread. The knee-jerk reaction is yours.
- non-entity 7y agoWhat on earth does a failure of chloroquine treatments in Sweden have to do with Trump?
- rsynnott 7y agoTrump has been pushing chloroquine as a miracle cure on no evidence, so presumably for a certain sort of person, criticising chloroquine is tantamount to criticising Dear Leader himself.
- deleted 7y ago[deleted]
- lanevorockz 7y agoTrump has cited a drug used in South Korea, it is not a miracle drug but a current practice. My question is, why people are so excited that one hospital decided to stop using it? How about the other 99% that did not experience the same? I wonder when the Y-Combinator has become such a hate filled place.
- spzb 7y agoGoogle Translate of the article into English New drugs for covid-19 are well advanced. Therefore, they have experimented with existing drugs, developed for other diseases. Most commonly mentioned is the malaria drug chloroquine. A smaller French study that has shown positive results has spread like wildfire on social media and among others Donald Trump has declared that "Chloroquine will change the history of medicine". Swedish doctors also began to give malaria medication to severely ill patients, despite the lack of controlled studies. ANNONS - We did like everyone else and gave chloroquine to the patients in the beginning. There were test tube studies that showed that it had an effect on coronavirus and it was a drug we knew from the treatment of malaria, says Magnus Gisslén, professor and chief physician at the infection clinic at Sahlgrenska University Hospital / Östra. But now he has made a complete reversal. Last week, all treatment with chloroquine was stopped against covid-19 in Sahlgrenska. - There were reports of suspected more serious side effects than we first thought. We cannot rule out serious side effects, especially from the heart, and it is a hard-dosed drug. In addition, we have no strong evidence that chloroquine has an effect on covid-19. The fact that some seriously ill covid-19 patients have acute heart problems has raised concerns that chloroquine may be harmful to some patients. Have you had cases with severe side effects? - Not as I know in Gothenburg, but suspected cases from other clinics have been reported. The hospitals in Stockholm continue to provide chloroquine The risk of serious side effects, combined with the fact that there is still no evidence, ie controlled studies that show that the medicine is effective, is the basis for the decision. The French study that has become so mentioned does not give much to Gisslén. - It does not meet any requirements that we place on how a study should be done. It has very low evidence value. All hospitals in the Västra Götaland region follow Sahlgrenska's example. But they are still quite lonely so far. Chloroquine is still given at the major hospitals in Stockholm. How do you see that you receive different care in different places in Sweden? - We are receiving signals that several regions are about to stop giving chloroquine. I am very confident in what I have come up with and think that is how you should handle it. We cannot do experimental medicine. At least we need to know that we do no harm. Several major studies in the world have been initiated on drugs that may help covid-19 patients. Magnus Gisslén believes that the first answers may come within a month. - If it then turns out that chloroquine is good, then of course we should use it. But before that, we will not risk patients' health by giving it. READ MORE: Rumor or facts about the new corona virus Poison Information Center: Very unpleasant side effects Anna Myrnäs, chief medical officer at the Poison Information Center, has seen an increase in the number of questions from the health service regarding serious side effects of chloroquine. "The risk we see from our side is that it is a preparation that has very unpleasant side effects, including sudden cardiac death," she says. She confirms that there are signs that covid-19 patients have been harmed by the drug. - We do not think that everyone who now prescribes this in the intensive care units is fully aware of how severe the side effects can be, especially in already seriously ill patients. At Sahlgrenska, patients currently receive classic IVA treatment with oxygen, but no antiviral drugs. - We might have made another assessment if covid-19 was a disease with very high mortality, for example 80 per cent dead, but now we can manage most people who are intensive care anyway, says Magnus Gisslén. He is self-critical that he let himself be drawn into the chloroquine. - In retrospect, I can regret that we did. We were a bit naive and thought the side effect profile was much nicer. I have changed my mind and hope that the rest of the country does too. In Stockholm, the Södersjukhuset has also stopped giving chloroquine, this confirms chief physician Anders Håkansson in an e-mail: "It depends on the combination of factors: 1. We have not seen any obvious positive clinical effects. 2. Potential risk of side effects. 3. Against this background, we would like to await the results of the controlled studies in other countries. "
- garyclarke27 7y agoSouth Korea used HydroxyChloroquine routinely for WuFlu and they have had very low death rates.
- ModernMech 7y agoSouth Korea has a low death rate because they acted as a unified country to implement aggressive early testing, contact tracing, and social distancing. The best and most proven cure for Coronavirus at this point is to not catch it in the first place, and to isolate those who have gotten it or have come into contact with those who have.
- Ensorceled 7y agoI have no idea why this is getting downvoted.
- cameldrv 7y agoI'd say that's indirectly true. They have managed to largely contain it, and because of that, a large number of the cases are from the church/cult, which has a membership that skews heavily young female. These patients have a much better prognosis generally, so you see a low fatality rate.
- rsynnott 7y agoGermany has an even lower death rate; have you considered that it might be better to treat people by hospitalising them near autobahns? Correlation, as always, is not causation. I don't see any indication that it's in particularly widespread use in SK, btw. Looks like they definitely experimented with it around the time China was promoting it, but their figures were already good at that point.
- javagram 7y agoThis is incorrect, outdated information. CFR in South Korea is 1.67 percent so far and not all cases have resolved, so that will go up if any more of the people currently in hospital die. (Reminder , H1N1 Flu CFR was about 0.1%-0.5% in 2009)
- bobowzki 7y agoOk so I'm a Swedish intensivist working i Göteborg. We currently don't use chloroquine/hydroxychloroquine in the treatment of Covid-19 because: 1. We tried it and have not noticed any obvious positive effect. 2. No serious study have been able to replicate the success of the first French (severly flawed) study. 3. Potential severe sideeffects. Awaiting the completion of ongoing studies we are using other treatment protocols. Should chloroquine/hydroxychloroquine be shown to improve outcome we will of course use it.
- gallexme 7y agoDo you know about any treatment of chloroquine in combination with zinc to stop the replication of the virus? Zinc to stop RNA copying , chloroquine to let zinc into the cells
- ldng 7y agoYou tested hydroxychloroquine only or complemented with azithromycin as recommended by "the first French (severly flawed) study" for early symptoms as a containment measure, not a cure ? I ask because you say you tried but you're not saying what you've tried exactly. Please don't take it personally, It's just I which people would be much more precise when talking about this matter. The study might very well be flawed and/or plain wrong. But there is also a lot of people misrepresenting it. Which does not help at all. Also of note, the European study left out azithromycin and is only conduct on advanced cases. Edit: In lower comments (for now I hope) a more detailed, and thus interesting, info in the comment's link : https://news.ycombinator.com/item?id=22793659 https://news.ycombinator.com/item?id=22793659
- arghwhat 7y agoDo you mean "containment" as in "halt/retard further development" or as in "halt/retard spread"? The former could be useful for high-risk individuals, the latter is probably only of mild interest (those that would be getting this are already in hospital containment, so it would be an attempt to increase health-care worker safety). Assuming "the European study" and "the first French (severly flawed) study" are referring to the same thing, then that does indeed sound very broken: Recommending combination with azithromycin, and leaving it out themselves, leaves that recommendation without any value.
- yosoyubik 7y agoIt seems that Denmark is going to start using Chloroquine. See https://www.dr.dk/nyheder/indland/danske-forskere-vil-teste-omstridt-malariamiddel-pa-corona-patienter https://www.dr.dk/nyheder/indland/danske-forskere-vil-teste-... (translated: https://www.translatetheweb.com/?from=&to=en&dl=en&ref=trb&a=https%3A%2F%2Fwww.dr.dk%2Fnyheder%2Findland%2Fdanske-forskere-vil-teste-omstridt-malariamiddel-pa-corona-patienter https://www.translatetheweb.com/?from=&to=en&dl=en&ref=trb&a... )
- Fiadliel 7y agoIt is a trial, with 50% given "chloroquine" (according to the article). The Danish Medicines Agency has a list of current and upcoming drug studies here: https://laegemiddelstyrelsen.dk/da/nyheder/temaer/ny-coronavirus-covid-19/~/media/5B83D25935DF43A38FF823E24604AC36.ashx https://laegemiddelstyrelsen.dk/da/nyheder/temaer/ny-coronav... It has no mention of any chloroquine trials in Denmark, but mentions an upcoming one for azithromycin and hydroxychloroquine: "A Randomized, Placebo-controlled Double-blinded Trial Evaluating Treatment With Azithromycin and Hydroxychloroquine to Patients With COVID-19 N=226 patients with positive COVID-19 test/diagnosis during the hospitalization randomised to Azithromycin and Hydroxychloroquine or placebo". It seems more likely that the news article is slightly inaccurate here, rather than the agency's information being outdated, but either is possible.
- jamisteven 7y agoThis article's contents do not match the headline, they give no indication as to what these "serious" side effects even are. There seems to be a massive political fight taking place over the official treatment of this disease and it sickens me. Tell me, why is it that India has this so under control and are using Chloroquine almost exclusively for the treatment?
- javagram 7y agoIndia has not reported many cases at all (4000 confirmed cases, compared to over 300,000 in the USA) so pointing to HCQ/Chloroquine as that reason doesn’t make sense unless you are saying their reported case numbers are fake. Someone still gets counted in the case numbers even if they are treated and recover. I believe HCQ/CQ is also being used in Spain, France, and Italy, but there are still many deaths and a high CFR. It’s not a magic drug (there may or may not be some good effects from using it, and studies are ongoing), but some political leaders are touting it in desperation, while medical leaders are pointing out that scientific trials are ongoing to determine if it’s really working or not.
- bluGill 7y agoScience takes time. There might be unrelated other reasons India has it under control. It will take years to figure this out if we ever do (for obvious reasons everyone wants answers now). My guess is doctors in India have experience with chloroquine because it is useful for malaria, something that Swedish doctors would not be expected to have experience with. If Swedish doctors spent 6 months reviewing all the knowledge India has they might be able limit side effects and see good results. Remember, the first paragraph is the truth, but not helpful. The second is an educated guess, it seems likely but it may well be wrong.
- rurban 7y agoIndia is also the only country which licensed Plaquenil (HCQ) production. AFAIK its the only remaining producer, because others have stopped producing it. It's only used against Lupus nowadays, Malaria became resistant in the last decades.
- firasd 7y agoHere in India a Doctor has already died after taking this and having a cardiac issue (which is one of the potential complications): https://www.indiatoday.in/india/story/coronavirus-in-india-guwahati-doctor-dies-after-allegedly-taking-hydroxychloroquine-1661535-2020-03-30 https://www.indiatoday.in/india/story/coronavirus-in-india-g... I think people responding to Trump's advocacy of this drug are making a mistake by saying things like "there are no randomized controlled trials for this application" and "patients with other ailments need this, so don't hoard it". What really needs to be said is the plain facts: while doctors are trying out this medicine, there is no miracle cure. This disease causes different conditions in people that need to be addressed with different interventions. As a layman I found this chart very enlightening about how the disease has various dynamics (inflammation, etc): https://imgur.com/a/seG2KFS https://imgur.com/a/seG2KFS
- ldng 7y agoIsn't Malaria present in India ? I would expect doctor there to be specially aware of chloroquine.
- firasd 7y agoYup. It is apparently well known among medical practitioners here.
- matt_the_bass 7y agoI’m curious why the parent received down votes. I’d be quite interested in hearing Why from those who downvoted.
- montalbano 7y agoTwo papers on chloroquine induced psychosis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552796/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552796/ https://www.sciencedirect.com/science/article/pii/S0163834313002089 https://www.sciencedirect.com/science/article/pii/S016383431...
- pdkl95 7y agoFor several weeks my mother hasn't been able to fill her regular prescription for hydroxychloroquine that has been an important part of managing her lupus for >30 years. The rush to use it against covid-19 is starting to harm some of the people that need the medication for other reasons. > Lupus doc called me again expressing she wants me very isolated for the next 3 weeks especially because of my lungs and heart and no meds available. I never thought my lupus med would disappear. [...] Kaiser is refusing to give it to thier long term Lupus patients.
- drone 7y agoLikewise, on 3/25 a Dr. in New Orleans [0] also reported they were stopping using it as it wasn't helping and the side-effects were problematic. "Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post." [0] - https://texags.com/forums/84/topics/3102444 https://texags.com/forums/84/topics/3102444
- ldng 7y agoNow, that's more informative and more precise. "We are also using Azithromycin" Interesting. So it looks like it is the treatment they're advocating in Marseilles. And it does not work on ventilated patients (if I understood correctly).
- panpanna 7y agoI encourage every one to read the doctors post, it has tons of interesting information in it. Here are some extracts: "Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that." Also "Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. " While "worldwide 86% of covid 19 patients that go on a vent die."