7 ms·

If it had any effect on covid-19, it'd be very obvious by now. There isn't some massive conspiracy here, it just doesn't work. The reason trials have stopped is

If it had any effect on covid-19, it'd be very obvious by now. There isn't some massive conspiracy here, it just doesn't work. The reason trials have stopped is because France, Italy, Belgium & the UK have seen worse outcomes generally, directly because of it. I don't get the 'it needs to be taken before symptoms!' argument - like we can possibly give a immunosuppressant with non-negligible side-effects (e.g. arrythmia) to billions of people with no scientific evidence of it working on covid at all.

zackees 6y ago
It HCQ doesn't work, why is it the common first line of defense used internationally? Why does scholar.google.com list so many papers showing that it's effective?
- ceejayoz 6y ago
  Because it's a highly effective and widespread malaria (and RA/lupus) treatment?
  - vixen99 6y ago
    The dose for malaria is 200mg. It's the higher doses that are associated with heart arythmia in covid patients. According to a trial reported in https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-018-1188-2 https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s129... "No serious cardiac adverse effects were recorded in malaria clinical trials of 35,548 participants who received quinoline and structurally related antimalarials with close follow-up including 18,436 individuals who underwent ECG evaluation." "Chloroquine is the most widely used antimalarial drug in history. It has a terminal elimination half-life of one month and an annual consumption of hundreds of tonnes for over 50 years, so it may be the drug to which humans have been exposed to most. Despite producing consistent QT prolongation, the only case reports of TdP and sudden death have been for its use for non-malaria indications such as systemic lupus erythematosus or rheumatoid arthritis, where high doses are used for much longer than in malaria treatment, or in overdose"
    - marvin 6y ago
      Unless I'm mistaken, this paper refers to chloroquine, not hydroxychloroquine. They are often conflated in the media and colloquial reporting.
- acallaghan 6y ago
  Nothing is in the first line of defence against Covid - it's a novel virus
- zackees 6y ago
  I don't know why I'm getting downvoted. Anyone can verify what I'm saying if they go to scholar.google.com
  - nck4222 6y ago
    Because your statement is misleading. Some countries are are using it more frequently than the US, but Germany and the UK prescribe it much less. Italy had the highest prescription rates, but are no longer using it. While France prescribed it more often than the US but are also stopping. Lastly, the argument of "if countries outside the US are prescribing it, it must work" is just nonsensical. Doctors prescribing a drug is not evidence a drug works. https://www.google.com/amp/s/www.statista.com/chart/amp/21411/share-of-doctors-using-hydroxychloroquine-for-covid-19/ https://www.google.com/amp/s/www.statista.com/chart/amp/2141...
lbeltrame 6y ago
Not before symptoms, but after exposure, or early on during the course of the disease, like other antivirals. I reinstate, before people think I'm some sort of HCQ defender: I am not. The effect size is probably very small. It may be as well that it doesn't work, and I would be happy even if it doesn't. I just want to see a proper RCT done and sealed.
- jacques_chester 6y ago
  You're not unique in wanting an RCT, but the decisions can't wait. On currently-available evidence, the balance of risks is to not prescribe this drug for treatment of C19.
  - s1artibartfast 6y ago
    What decision can't wait for a RCT? C19 will be with us for decades to come and there is no shortage of patients. An RCT does not stop development of other solutions.
  - tinus_hn 6y ago
    This means that will be the forever-available evidence
cm2187 6y ago
The first symptoms aren't necessarily the shortness of breath. In my case I had a week of mild fever before the shortness of breath kicked in. Fever isn't severe. Difficulty to breath is. You can have a policy to be treated when you get the first symptoms, but before these symptoms are severe.
- rrmm 6y ago
  The difficulty there is you're talking about giving it to a lot of people in an outpatient setting. This is the worst case in terms of risk trade-offs: Without being admitted as a patient, you will not be monitored as closely especially for coronary complications. Since you'll be giving it to people before the onset of severe symptoms, you'll be risking side-effects giving it to people who might have been fine without it (and most people will survive with out it). You'll be giving it to a lot of people which again just increases the chances of serious side-effects. (PS I hope you're doing well now).
  - dpoochieni 6y ago
    But then the side-effects are pretty low no? How long has it been in the WHO basic medicine category without concerns for its safety, 50 years or so?
    - rrmm 6y ago
      Most of the side-effects aren't severe. The worst cited are usually blindness and deadly heart arrhythmia. The problem is when you start giving it out to a lot of people, you start to see those low-incidence side-effects increasingly often. It is a basic and important medicine. It's not that there are no concerns about its safety; it's that the safety concerns are well-known. Those are distinctly different statements. (As an aside, for example, Tylenol and aspirin can both be quite harmful, but under what conditions they're dangerous is well-known so they are widely used pretty safely. Even so, you still find people inadvertently destroying their livers with Tylenol/paracetemol when they don't realize two OTC medicines contain them and overdose). So then the question is how much harm are you doing by giving people the drug (under some set of circumstances) vs how great a benefit might someone derive from it. Clearly on one side, if you gave it to everyone as a prophylactic, that'd likely cause more harm than good. Perhaps, you give it to people who have tested positive but are not admitted to the hospital. Or you can give it to only those who are admitted. Or you can give it only to people who are doing poorly. Presuming the harmfulness of the medicine is well known you can run some easy hypothetical numbers about how many people will have serious harm or death from receiving it on a wide scale. We have a rough idea of the range of people who will die or have serious cases of COVID. The only thing left is the possible benefit people may get from the medicine. As of now there is no indication that the benefit is worth the harm to give it out to people in a wide-scale fashion. Additionally, the current studies don't even support giving it to people who are in-patients. In most studies, patients receiving it fare worse than those not.
dehrmann 6y ago
> If it had any effect on covid-19, it'd be very obvious by now. Not directly in response to this, but a broader observation I ran across was that lockdowns effectively shut down a lot of data creation (infections) about the virus, so there are still a lot of things we don't know, it makes it hard to make informed decisions.
rurban 6y ago
It's obvious since end of February that the only usage is in prevention. Give to all risk persons 3 weeks before. That's the Indian advisory: https://www.icmr.gov.in/pdf/covid/techdoc/V5_Revised_advisory_on_the_use_of_HCQ_SARS_CoV2_infection.pdf https://www.icmr.gov.in/pdf/covid/techdoc/V5_Revised_advisor...
- DanBC 6y ago
  It's too dangerous to give to high risk people.
  - rurban 6y ago
    If it would too dangerous, it would not be officially used for over 70 years, and be the official recommendation for over a billion people. You are mixing up it up.
dpoochieni 6y ago
Haha, then why did China, Russia and Japan use it so successfully? Let's not forget we live in geopolitically very interesting times, and that the WHO is pretty much under the influence of China.

zackees 6y ago

It HCQ doesn't work, why is it the common first line of defense used internationally? Why does scholar.google.com list so many papers showing that it's effective?

ceejayoz 6y ago
Because it's a highly effective and widespread malaria (and RA/lupus) treatment?
- vixen99 6y ago
  The dose for malaria is 200mg. It's the higher doses that are associated with heart arythmia in covid patients. According to a trial reported in https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-018-1188-2 https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s129... "No serious cardiac adverse effects were recorded in malaria clinical trials of 35,548 participants who received quinoline and structurally related antimalarials with close follow-up including 18,436 individuals who underwent ECG evaluation." "Chloroquine is the most widely used antimalarial drug in history. It has a terminal elimination half-life of one month and an annual consumption of hundreds of tonnes for over 50 years, so it may be the drug to which humans have been exposed to most. Despite producing consistent QT prolongation, the only case reports of TdP and sudden death have been for its use for non-malaria indications such as systemic lupus erythematosus or rheumatoid arthritis, where high doses are used for much longer than in malaria treatment, or in overdose"
  - marvin 6y ago
    Unless I'm mistaken, this paper refers to chloroquine, not hydroxychloroquine. They are often conflated in the media and colloquial reporting.
acallaghan 6y ago
Nothing is in the first line of defence against Covid - it's a novel virus
zackees 6y ago
I don't know why I'm getting downvoted. Anyone can verify what I'm saying if they go to scholar.google.com
- nck4222 6y ago
  Because your statement is misleading. Some countries are are using it more frequently than the US, but Germany and the UK prescribe it much less. Italy had the highest prescription rates, but are no longer using it. While France prescribed it more often than the US but are also stopping. Lastly, the argument of "if countries outside the US are prescribing it, it must work" is just nonsensical. Doctors prescribing a drug is not evidence a drug works. https://www.google.com/amp/s/www.statista.com/chart/amp/21411/share-of-doctors-using-hydroxychloroquine-for-covid-19/ https://www.google.com/amp/s/www.statista.com/chart/amp/2141...

lbeltrame 6y ago

Not before symptoms, but after exposure, or early on during the course of the disease, like other antivirals. I reinstate, before people think I'm some sort of HCQ defender: I am not. The effect size is probably very small. It may be as well that it doesn't work, and I would be happy even if it doesn't. I just want to see a proper RCT done and sealed.

jacques_chester 6y ago
You're not unique in wanting an RCT, but the decisions can't wait. On currently-available evidence, the balance of risks is to not prescribe this drug for treatment of C19.
- s1artibartfast 6y ago
  What decision can't wait for a RCT? C19 will be with us for decades to come and there is no shortage of patients. An RCT does not stop development of other solutions.
- tinus_hn 6y ago
  This means that will be the forever-available evidence

cm2187 6y ago

The first symptoms aren't necessarily the shortness of breath. In my case I had a week of mild fever before the shortness of breath kicked in. Fever isn't severe. Difficulty to breath is. You can have a policy to be treated when you get the first symptoms, but before these symptoms are severe.

rrmm 6y ago
The difficulty there is you're talking about giving it to a lot of people in an outpatient setting. This is the worst case in terms of risk trade-offs: Without being admitted as a patient, you will not be monitored as closely especially for coronary complications. Since you'll be giving it to people before the onset of severe symptoms, you'll be risking side-effects giving it to people who might have been fine without it (and most people will survive with out it). You'll be giving it to a lot of people which again just increases the chances of serious side-effects. (PS I hope you're doing well now).
- dpoochieni 6y ago
  But then the side-effects are pretty low no? How long has it been in the WHO basic medicine category without concerns for its safety, 50 years or so?
  - rrmm 6y ago
    Most of the side-effects aren't severe. The worst cited are usually blindness and deadly heart arrhythmia. The problem is when you start giving it out to a lot of people, you start to see those low-incidence side-effects increasingly often. It is a basic and important medicine. It's not that there are no concerns about its safety; it's that the safety concerns are well-known. Those are distinctly different statements. (As an aside, for example, Tylenol and aspirin can both be quite harmful, but under what conditions they're dangerous is well-known so they are widely used pretty safely. Even so, you still find people inadvertently destroying their livers with Tylenol/paracetemol when they don't realize two OTC medicines contain them and overdose). So then the question is how much harm are you doing by giving people the drug (under some set of circumstances) vs how great a benefit might someone derive from it. Clearly on one side, if you gave it to everyone as a prophylactic, that'd likely cause more harm than good. Perhaps, you give it to people who have tested positive but are not admitted to the hospital. Or you can give it to only those who are admitted. Or you can give it only to people who are doing poorly. Presuming the harmfulness of the medicine is well known you can run some easy hypothetical numbers about how many people will have serious harm or death from receiving it on a wide scale. We have a rough idea of the range of people who will die or have serious cases of COVID. The only thing left is the possible benefit people may get from the medicine. As of now there is no indication that the benefit is worth the harm to give it out to people in a wide-scale fashion. Additionally, the current studies don't even support giving it to people who are in-patients. In most studies, patients receiving it fare worse than those not.

dehrmann 6y ago

> If it had any effect on covid-19, it'd be very obvious by now. Not directly in response to this, but a broader observation I ran across was that lockdowns effectively shut down a lot of data creation (infections) about the virus, so there are still a lot of things we don't know, it makes it hard to make informed decisions.

rurban 6y ago

It's obvious since end of February that the only usage is in prevention. Give to all risk persons 3 weeks before. That's the Indian advisory: https://www.icmr.gov.in/pdf/covid/techdoc/V5_Revised_advisory_on_the_use_of_HCQ_SARS_CoV2_infection.pdf https://www.icmr.gov.in/pdf/covid/techdoc/V5_Revised_advisor...

DanBC 6y ago
It's too dangerous to give to high risk people.
- rurban 6y ago
  If it would too dangerous, it would not be officially used for over 70 years, and be the official recommendation for over a billion people. You are mixing up it up.

dpoochieni 6y ago

Haha, then why did China, Russia and Japan use it so successfully? Let's not forget we live in geopolitically very interesting times, and that the WHO is pretty much under the influence of China.