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Comment by erentz | Hacker News Reader

This is practically ancient news at this point. RCTs are already underway in China and now starting up in the US. The question that hasn't been well answered anywhere is, assuming it does prove to work, can we make enough of this stuff in the space of time to really make a difference? What would that look like? Would we need to stop producing other drugs to switch over production lines? Etc. What that would look like would be interesting to read about.

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Industrial chloroquine manufacturing was developed in the 1940s. There is an extensive description in this 1949 article from Industrial and Engineering Chemistry:

"Chloroquine Manufacture"

https://sci-hub.tw/10.1021/ie50472a002

I mention chloroquine specifically because

a) It looks like it was effective at a lower concentration than remdesivir, according to this Nature article.

b) It's a simpler molecule. High volume production started back during World War II.

Apparently Bayer was able to manufacture and ship an order of 300,000 chloroquine phosphate pills in 24 hours. I don't know exactly what that means, but it's definitely good.

https://www.shine.cn/biz/economy/2002202403/ https://tribune.com.pk/story/2162276/1-pakistan-effective-dr...

I'd imagine they can. I read just yesterday there were something like 8 Chinese companies now making knockoff remdesivir, patents be damned.

I certainly hope patents be damned at a time like this. Maybe once everything is settled they can get a pay out. But if they can conscript human bodies to die in trenches they can borrow fictional gifts to fictional people

That would certainly incentivize pharma to develop the next antiviral, wouldn’t it?

If there's no humans left, they'd have 100% of the market.

That's getting close to false dichotomy: rely on patents or get no research. Maybe a different financial model is required these days. Not everything needs to reach late stage capitalism.

They're still going to get paid a hell of a lot of money if this drug works. It's not just going to be taken from them without any kind of compensation at all from the US Government and others.

Chloroquine is extremely common and can be bought in big bottles at your local grocery store.

Not in the US. Nobody makes it here. Over $250 per 12 tablets at Kaiser. HCQ (hydroxychloroquine) is still used for autoimmune disease and is a lot cheaper.

Definitely. The State Department has a set of pages noting that mosquitoes with malaria have developed chloroquine resistance in every country with malaria, and recommends other drugs instead. The main manufacturer of chloroquine, Bayer, stopped producing it a while back. Not sure who if anyone even makes it these days. I'm assuming the Chinese trials are using some old stock.

They restarted old lines. These are not terribly hard to make. There was just no demand.

Do you know they (the Chinese presumably, if not who) restarted old lines, or are you guessing that you think they did?

It would be great if chloroquinine is back in production.

It was reported in the news. Also Bayer donated a bunch to China from their stock in Pakistan. It's possible that HCQ, which is widely available, has similar effectiveness.

Thanks, that enabled me to find the 1/28 donation news:

https://www.marketscreener.com/BAYER-AG-436063/news/Bayer-to...

It mentions "antibiotics and analgesics" but not quinine, but I'll accept you've seen a more detailed report.

I was unable to find a report saying that Chloroquine lines have started back up.

By HCQ do you mean Quinine Hydrochloride as is found in Tonic Water? Do you have any links to studies showing it has "similar effectiveness" as Chloroquine in treatment? I'm taking Quinine Hydrochloride at present since it's harmless and available, but have not seen any studies about it specifically regarding the new virus.

HCQ is hydroxychloroquine, an antimalarial that is still widely available because it is used for autoimmune diseases. It is a prescription only drug. The antiviral property is described in this Lancet article: https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

Thanks!

Cranking away: https://www.shine.cn/biz/economy/2002202403/

>Multinational and local drugmakers are speeding up manufacturing and supply of chloroquine phosphate after the anti-malarial drug was included in the latest version of treatment guidelines for novel coronavirus pneumonia by the National Health Commission.

>China Resources Group now has inventory of more than 325,000 boxes and is preparing for further demand

It is made and used in some countries. Belize for example has non resistant malaria.

Not original poster, but thinking this was a joke about Tonic water that contains Quinine, a close relative of Chloroquine.

Wikipedia says chloroquine is 'a quinine' - is the only joke that the amount in tonic water isn't enough to have the desired effect?

That is (historically) why it's there (and called 'tonic') after all, for malaria, which is also mentioned as a use on the chloroquine page.

Apparently there is a study just starting related to coronavirus and hydroxychloroquine.

See: https://clinicaltrials.gov/ct2/show/NCT04261517

You're right about it being much cheaper. A bit over a decade ago, I was looking into a 2-year supply of antimalarial medication for an extended stay in a place where malaria is a big problem, and where I would not have ready access to refill such medication. That amount of chloroquine would have cost me many thousands of dollars.

A doctor recommended hydroxychloroquine instead and after I demonstrated my intent to be abroad for such an extended period (had to show documents) a compounding pharmacist filled the prescription for around USD $20.

Yup, it's about $15 for 30 pills in my country (brand name, not generic), which isn't cheap, but pretty affordable.

What country are you in? It's a semi-controlled substance that tends to be out of stock everywhere I've looked.

Actually it can't. Doses over 3g (12 pills) tend to be fatal so a big bottle at the grocery store would be a bad idea.

I bought some. My experience - Bali - no one had any. Singapore - rare, need a persceiption. UK can get from online pharmacists by saying you are going to a malarial area. (£13 for 20 tabs) which is what I did. India it's about 1 or 2p/tab but they are not officially allowed to ship overseas. I got quoted $90 to ship 600 tabs overseas.

> can we make enough of this stuff in the space of time to really make a difference?

Many drugs are made in China too - terrible irony

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