Where does the "if it inhibits replication it needs to be administered early" line come from? I've seen it elsewhere too, but why wouldn't inhibit replication lead to => continually declining amounts in the body => easier recovery at any stage?
They intended to use it to prevent virus replication in the cells at the early stages of the immune response to allow the immune system to build up a response at a slower pace.
The amount of treatment proposed in Europe is around 5 days of HCQ with about 800mg on D1 and then 400mg on D2-5. This is an incredibly low dosage and will have very little immunosuppressant effect. It takes a very long time to act as an efficient immunosuppressant (1 to 3 months for Lupus).
Expecting HCQ to suppress the immune system for cytokine storms in a matter of hours seems very strange.
As that controversial French doctor said in multiple interviews. If you are already in need of a respirator then your issue is no longer the virus but your own immune system killing you (cytokine storm or added bacterial pneumonia). At that stage, HCQ is not very useful. Not in these dosages at least.
Most people are only focusing on the immunosuppressing effect of HCQ for some reason which is very strange to me.
It takes time for chloroquine to act as a zinc ionophore as well and for zinc to enter the cells (and it needs to be in the cells to inhibit RNA polymerase). As you can see in the studies I posted. Between 24 and 72 hours it seems.
If the virus cannot replicate correctly (with the zinc idea), it might give more time to "flatten the curve" for the immune system. To build up antibodies and respond to the disease without inducing a cytokine storm.
This at least is their hypothesis. And it has not been confirmed in any other way than by observing that those with chronic Lupus+HCQ treatment seemed to be "immune" to the disease. And this was only done in Wuhan as far as I know.
Unfortunately Dr Zhan Zhang has not yet published his full results except for this preliminary https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v...
Which doesn't go into much detail about anything except that "it seems to work". Unfortunately ... Yet I do see logic in the idea.
I just wish people (with access to patient files in major hospital centers) would also look into this and they could maybe confirm this "once and for all" without even needing a full blown trial.
Reducing viral replication would also stop the storm (with some delay).
Apparently these drugs are not especially effective at it.
But if the virus replicates sufficiently before chloroquine + zinc is administered then much damage is already done.
So it's a race between the virus and the "cure". Get the "cure" in quickly and the virus stops replication before much harm occurs; get the "cure" in late and the virus has run most of its course and maximal damage is done.
Also, since the viral damage opens the door to opportunistic bacterial infections (e.g., pneumonia), antibiotics may be given to prevent bacteria from taking hold.