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Comment by AdmiralBumbleB | Hacker News Reader

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.

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This is where having a fully funded CDC and pandemic team in the US pays off. They would have been paying very close attention for weeks on end in China, Italy and South Korea and many approaches could have been already dead-ended before it even significantly reached out shores.

To say nothing of actually being in the process of ramping up medications that HAVE shown to be effective. It feels like we are starting from ground zero when that should simply not be the case.

I think everyone would like to see the CDC be better funded. Hindsight makes that an obvious mistake, but monitoring C19 should have been their number one priority in any case. From January onwards it was clear that it was the number one threat. There's still no explanation (afaik) for why they rolled their own test instead of using the WHO's test, nor have they effectively communicated their plans for ramping up testing or medical capacity. I don't see how this is anything besides mismanagement (e.g., how does funding impact which test they used? Presumably being under-funded would prompt them to use the test that the rest of the world is going with instead of rolling their own), and I really hope congress or the justice dept rips into this after the crisis is averted.

EDIT: Note that I say all of this as someone who is a big believer in "it's almost always more complicated/nuanced than it looks", but there seems to be no information about said nuance or complexity.

There seems to be a really obvious explanation of why they rolled their own test instead of using the WHO's test: there was no WHO test when they did it, the two different tests were developed in parallel (and they're not the only country which developed their own test either, there are something like seven different ones used in various countries). The CDC had already been using its own test internally when the WHO announced the alternative German one they'd been using. Then when the CDC test didn't work when rolled out to labs, it's not like the WHO could have supplied them with testing kits instead. The CDC would have had to produced the WHO-designed test itself, verified it worked, arrange for it to be mass produced, and hope that the same problem didn't happen - all whilst their test rollout was massively delayed by essentially starting from scratch. Most of the media just doesn't seem to be interested in explaining this.

I didn't see any such explanation on the CDC page either, and I thought I was pretty thorough in searching for it. I did know that they were developed concurrently, but I'm unaware of any information about why they couldn't at any point pivot and use the WHO test, for example. Why is this information so hard to find?

There was this medical person on the white house press meeting yesterday and she said that the WHO test had terrible false positive rate (she said 45% but that doesn't sound right)

The problem is not the CDC developing their own test.

The problem is their banning the use of other tests for months!

Only by Dr Helen Chu finally ignoring that ban was the Seattle outbreak discovered.

They should have been developing more than one test anyway. This reduces the risk of failure, and if you get multiple working tests, it allows some cross-checking to reduce false results. Failure to diversify is also mismanagement (though clearly more money can help you try more things).

I don't agree at all. The WHO had a working test. We just needed to produce as many of them as we possibly could, and send them to labs to set up and validate.

They needed every resource they had going to the confirmed working test. Even if the CDC was better funded, they still would have needed to spend every resource on that.

> There's still no explanation (afaik) for why they rolled their own test instead of using the WHO's test

The explanation is obvious, isn't it? "We thought our test would work, and it would be better."

It was stupid, to be sure. It would have been a stupid risk even if it had paid off—although in that case, few would be chastising them, and many would be thankful.

Agree, and that's kind of my point. Being "fully funded" wasn't the problem--it was hubris/mismanagement.

So, I think this is the most frustrating part of living in this political era. I did start this off with "funding", but it wasn't just funding, it was cutting qualified staff. It's that even the best qualified staff aren't moving fast enough or adapting and looking at cases beyond our own borders. Even in a reduced regulation environment, the FDA is likely hampering response time.

The US has regressed to an early 19th century model of government (loosely federated) at a time we're more tightly coupled than we ever have been due to moderinity.

>> fully funded CDC

Is there evidence that more money would have solved the constant CDC problems and incompetencies that are coming up? It seems like a throwaway obvious statement, but plenty of government agencies - and private companies - don't operate a lot more effectively with more money.

Totally agree, and in one of my other responses I recognize the shortcomings of how I put it. Thanks for the good faith response.

with more money, the CDC would not have delivered one non working test, but like 2 or 3 non working tests.

Bingo. On Feb 18, China released the 6th edition of its treatment guidelines that included a Chloroquine recommendation. They've subsequently updated that guidance to reduce the dose

On Feb 19, Chinese authorities published this paper: https://www.ncbi.nlm.nih.gov/pubmed/32074550 which provides basically no details except that Chloroquine works.

Everyone who was paying attention saw this. The U.S. gov should have started ramping up production at that time, but four days later Trump tweeted "The Coronavirus is very much under control in the USA... Stock market starting to look very good to me!"

It's more than the rumour-mill. There was a scientific study with a small number of patients that showed clear results, and several countries have now launched larger studies to confirm those findings.

No, that's the rumor-mill, spreading the preliminary results as if they were a confirmed cure.

The rumour-mill is that it _will_ prevent or cure.

As you've said, studies are still being conducted. I've read the original chinese study and it's promising, but there's still work to be done.

Also, Bayer thinks there's enough merit to this to issue their own press release and donate 3M pills.

"New data from initial preclinical and evolving clinical research conducted in China, while limited, shows potential for the use of Resochin in treating patients with COVID-19 infection.

Bayer in recent days has been in talks with the White House, HHS, CDC, and the FDA, offering any assistance we can provide with a focus on donating Resochin to help in the government’s efforts to combat the virus.

Currently not approved for use in the United States, Bayer is working with appropriate agencies on an Emergency Use Authorization for the drug’s use in the U.S.

Bayer thanks the Trump administration for moving quickly to enable this donation and will continue to work closely with the administration to support its efforts in the fight against COVID-19."

https://bayer2019tf.q4web.com/news/news-details/2020/Bayer-P...

An optimist would say this is Bayer being benevolent, a pessimist would see this as them taking advantage of a situation to make a lot of money out of a possible snake oil during this time of panic.

We stocked up on my daughters medications last week, there was already a non-covid-19 related shortage. Thank god we got what we need for several weeks. Its pretty scary when you rely on a common drug and it runs out.

Reminds me of a comment I read on Reddit some week ago; the commenter was going from store to store looking for disinfectant for a family member that has a prosthetic and needs to disinfect it daily, lest an infection gets into the wound.

Those tiny square alcohol prep pads (e.g. for diabetics and others who need daily injections) are sold out everywhere. I suspect people who couldn't find hand sanitizer or Clorox just grabbed whatever sanitizing products they could.

I clean stuff with them. I don’t want water and some antibacterial agent, I just want some nice alcohol.

When there is not a pandemic happening you can get 99% isopropyl at a reasonable cost. Its great for cleaning electronics and lots of other things.

Yea, my wife takes plaquenil to treat arthritis and I asked her to double check her supply when these rumors started floating around. It's always scary to imagine a bunch of folks going out and hording the stuff to scalp it off later.

I bought aquarium chloroquine to use as a last-ditch resort if I basically have to choose between taking it or dying due to hospital overcapacity. No harm to patients there IMO. I spent $60 for the 10 grams recommended for a course (.5 g a day). That was last week, and it's so much more expensive now.

Is there any difference in aquarium cloroquine and prescription? I’m assuming mostly manufacturing conditions

How do you plan on measuring your dose and dosing it?

Do you have a source for it? I've had to buy through underground labs; could not find any Avaclor.

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.

How could our disaster management agencies have gotten their shit together to anticipate a run on an old anit-malaria drug?

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).

As a previous commentator noted, the Chinese were providing guidance on chloroquine a month ago.

How to people get it? I assume it’s a prescription drug everywhere? Is everyone friends with a doctor or is my expectations on doctors too high (that they shouldn’t prescribe something just because a patient asks for it, perhaps especially not if the patient asks for it)?

I bought chloroquine few weeks ago when there was still plenty of it. A week ago it was out of stock not necessarily due to rush buying but because government bought out all the stock to give it to hospitals to use if it turns out to be effective.

You must see my family whatsapp group ... all sort of weird folk remedies and weird home made concoctions (usually harmless involving mixing garlic and flu medicine) to protect against this new virus.

I implore you to make a post on HN if you run out. From reading posts on HN I would suspect many have bought it online and may be willing to do the right thing and mail it to you.

In Norway it has been restricted after doctors prescribed lots of it for themselves... Way to undermine the efforts.

How is this possible? It requires a prescription, no?

SMH...

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