Swedish hospital suspends Covid-19 treatment with chloroquine
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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.
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
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.
No the European "big" study and the French very small study are not the same. But they are not testing the same thing and can't possibly get the same result.
Again, I'm not endorsing the French study, but I also know that the French government and the famous doctor are not exactly of the same political color and there is petty political in-fighting going on ...
"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.
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
We need numbers.
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.
Edit: ugh, too late to edit. Hope it got the point across at least, I notice now that HN hides the earmuffs (*) I added and made it italics, might be why the point didn't always go across.
> 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.
"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."
"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."
"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).
You can look up the severe symptoms here: https://medlineplus.gov/druginfo/meds/a682318.html
If not very, I'd rather risk and take it, 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.
What is (was) your daily dose for these ten years?
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.
There are several side effects with up to 10% occurrence rates: https://www.drugs.com/sfx/hydroxychloroquine-side-effects.ht...
Really troubling if that’s the only metric they go by to decide whether to administer a particular treatment or not!
Do you think something like that happens?
(translated: https://www.translatetheweb.com/?from=&to=en&dl=en&ref=trb&a... )
The Danish Medicines Agency has a list of current and upcoming drug studies here: 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.
they say they suspect some patients may have died because of the sideeffects and not the coronavirus in Sweden.
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.
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.
https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552796/
https://www.sciencedirect.com/science/article/pii/S016383431...
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
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. "
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.
First, tell us why you claim India has this 'under control'?
According to John Hopkins stats[1] (as of 2020-04-06:2200+11) shows India (population 1,600m) with confirmed case count of 4,300.
Meanwhile Australia, who's been relatively slow to trace and test, population 25m, with confirmed case count of 5,800
It's possible these numbers reflect realities, but it's a hard sell.
> ... and are using Chloroquine almost exclusively for the treatment?
This is going to need some even better citations, especially if the implied claim is that they're almost exclusively using Chloroquine for treatment with great success.
[1] https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594...
I don't believe either of those points is valid or compelling.
'Death rate' ... is a highly ambiguous term.
Case Fatality Rate (or equivalent) is the measure of mortality (attributed to the disease) per identified case. Obviously this metric can be easily hacked -- test fewer people so you have fewer confirmed cases.
Infection Fatality Rate (or equivalent) is the measure of people we estimate had COVID-19 and died from it, even if they weren't confirmed via testing. In countries that have been very slow to test, this number is expected to be relatively high, though not as frequently reported on.
It's very unlikely that IFR would vary significantly, absent significant medical intervention, between races / cultures / locations / etc.
EDIT: Citing The Atlantic last month: "For one, India is still not testing enough people, having conducted the fewest number of tests of any country with confirmed cases of the coronavirus, at just 10.5 per million residents (South Korea, by contrast, has conducted more than 6,000 tests per million residents). "
As to the Indian government's confidence being high ... there's no shortage of political hubris going around, and Modi's not immune.
I note that at the end of March "a $22.6bn economic stimulus plan [...] to provide direct cash transfers and food handouts to India's poor."
This does not sound like something that anyone in India believes is 'under control'.
[1] https://www.theatlantic.com/international/archive/2020/03/in...
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.