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Comment by guiriduro | Hacker News Reader

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?

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> 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?

The term is "compassionate use". It's drug approval for patients where the drug is not fully tested.

It almost certainly wouldn't be approved for healthcare workers, but it might be approved for people who need ventilators.

The basic idea is that the situation is so dire - all of the normal medical options have been exhausted - that patients are legally allowed to essentially experiment on themselves.

These are approved drugs so the use would be "off label". Doctors are allowed to prescribe anyway they see fit.

The main dangers for the general public are the acute toxicity and drug interactions. Take chloroquine, which comes in 500mg tablets, it does not take many tablets to get to toxic or even lethal dose. The drugs can prolong QT intervals, so combination with other drugs with similar side effects like some antibiotics or antidepressants could be dangerous.

I have 250mg tablets. I also have bisoprolol to counteract prolonged qt interval. Be prepared :)

You may be interested in this study then: https://www.ncbi.nlm.nih.gov/pubmed/32150618

Note in the full text article they show simulation of how long it takes for the drugs to reach therapeutic concentration at the lung. Since we don't know exactly where the antiviral effect comes from, these are only guess works.

It's a misdirection of resources - of money, clinicians' time and study subjects. There's enough drug and patients to run a well-designed clinical study, once that is done we know if chloroquin is any good or if we need to keep looking. My guess is that we are better off looking at antivirals.

No. Because that vast majority of cases are mold or asymptomatic.

"mild" means "you probably have pneumonia, just not bad enough that it could suddenly kill you, so you don't need to be in the hospital (yet?)"

Not the GP, but "mild" probably actually means mild. Given that only (highly) symptomatic people are tested, we don't know how many people contracted the virus and only had mild cold symptoms. Developing pneumonia would already put you outside of that "mild" designation.

We have a pretty good idea in Italy how many cases are asymptomatic or very mild and it is enormous. Traveling right now but if you are interested I'll update tomorrow

Yes, please.

https://www.sanitainformazione.it/salute/scovare-i-positivi-...

In English:

https://mobile.twitter.com/andreamatranga/status/12397748625...

> According to Crisanti, the director of the virology lab of U Padua, as little as 10% of #COVID2019 carriers show any symptoms at all. He sampled repeatedly the entire 3k+ population of Vo ', one of the initial clusters.

https://grapevine.is/news/2020/03/15/first-results-of-genera...

> 700 have been tested. Kári says that about half of those who tested positive have shown no symptoms, and the other half show symptoms have having a regular cold.

https://www.repubblica.it/salute/medicina-e-ricerca/2020/03/...

> "The vast majority of people infected with Covid-19, between 50 and 75%, are completely asymptomatic but represent a formidable source of contagion". The Professor of Clinical Immunology of the University of Florence Sergio Romagnani writes

In the discussion of the study over on Reddit, there were anecdotes of physicians prescribing hydroxychloroquine for themselves and their families, in enough numbers to make it difficult for patients previously prescribed it.

https://twitter.com/ml_barnett/status/1241172371404357633

https://twitter.com/JeffreyLowMD/status/1241172812762468353

https://twitter.com/amberwvzz/status/1241196003425992704

From a convo with a pharmacist friend:

> This is 100% true and I hate doctors for it

> Record today was for 360 tablets with 2 refills, please fill them all concurrently, they'll pay cash

> 2nd place was an out-of-state opthamologist who couldn't spell it or provide proper dosage

> Md's are being real dicks around here

> Keeping in mind it's a necessary medication for people with lupus or arthritis, too

> It's an anti-malarial that treats rheumatism

> It's not crazy expensive or anything, but it's not something you keep lots of on hand

> So these md's trying to start a run on it are being shitty to the point of unethical

> I asked the opthamologist for their npi/dea so I could try to report them to some kind of body, but he hung up

> I'm legit furious about it

Sure, but what is rational and what's allowed by the FDA are entirely separate things.

I expect to see a lot of exploring of this outside the US. Maybe once bolder countries have sorted things out, we can use their findings.

The FDA has investigated Plaquenil and there is a clear record of the side-effects and directed usage - I don't know why you think it'd be any sort of impediment.

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.

Permanent blindness typically takes many weeks / years of use.

https://www.webmd.com/drugs/2/drug-8633/chloroquine-oral/det...

Which might be necessary for prophylactic use.

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).

No, the course is 10 days IIRC.

> The possible side effects include permanent blindness.

Yes, but only with massive doses or when treatment lasts for more than 5 years.

If you take it for years. Why is everyone ignoring that part?

Because blindness is a harsh outcome, so it jumps out and causes an emotional reaction.

because it doesn't generate enough offense. most online arguments seems to be attempts at creating the maximum possible offense to create "engagement"

the fact you need to have 1 kilogram of chloroquine during years of treatment is an inconvenient complicated fact, while the emotional appeal of blindness scores more indignation.

The half life is 2 months. That's crazy.

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