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Comment by koheripbal | Hacker News Reader

Yeah, the devil is really in the details about exactly when and how you administer it.

Doctors are already saying that it's definitely no magic bullet, but they debate whether it is effective at a certain stage of illness.

What I don't understand is why we're focusing so much on this specific drug when there are some great antivirals out thee that have a more effective theoretical mechanism of action. (eg Remdesivir)

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Remdesivir could be great, and there are a lot of studies ongoing about it. However, it has a long production time - Gilead says 6 to 8 months: see https://www.gilead.com/purpose/advancing-global-health/covid.... They're only projecting to have 500,000 treatment courses by October, so it could only help a relatively small fraction of the people that will have coronavirus.

Even a small volume of an effective treatment could still be helpful. Usage could be restricted just to patients with cases serious enough to otherwise require ventilators, for instance, which would both ease the strain on limited ICU resources and save lots of people who would otherwise die (since only around 10-30% of ventilated patients survive even with that treatment).

But antivirals tend to need to be given early to have a good effect. How will be know who is going to be severe?

By the time we have lots of it, we will have good statistics on demographics of people most likely to need it, so you could make educated guesses and still see a benefit.

To offer some perspective, in Montgomery County, just north of Philly (a suburban metro county harder hit than most), 10% of positive tests have been admitted to hospital, and 2.6% of positive tests have gone on ventilators.

So the subpopulation needing remdesivir is probably less than 5% of the positive cases (or 1250 of the 25,000 who tested positive here). BTW, the county population is 900,000.

Right, but it isn't a random sampling of that population that ends up on ventilators. For men over 65 with hypertension, it's about 50% of those who test positive.

...so a targeted application of anti-virals is definitely worthwhile.

You can make educated guesses based on age, preexisting conditions, etc.

Remdesivir (and other antivirals / T-inhibitors on trial) are all extremely difficult to manufacture (and expensive) compared to hydroxychloroquine. Most hospitals and countries will be unable to acquire the amounts required for even small trials. It will be many months before we can begin to see results for these drugs.

It's being focused on in the news, but the others are also being tested. The big problem is like the GP raised, we need proper testing to really be able to say much about the ability of any of these drugs to help.

[1] https://www.fiercebiotech.com/biotech/gilead-clinical-data-h...

Because it's become an arbitrary political football to separate "left" vs "right"

As insane as that is.

And how funny is it (at least to me) that this is only because Trump came down on one side initially. If he had come out saying exactly the opposite, that HCQ was bad and we should be skeptical, everyone hoping it doesn’t work now would be looking for the 10 person studies saying it totally works and defending its use.

It’s almost beyond reason how hyper partisan this specific issue is.

This isn't left vs right; it's an unqualified politician vs pretty much all of the scientific community.

This is not accurate and kind of exposes your own bias.

If you listen to virologist podcast, TWIV, they talk about the effectiveness of HCQ. They aren't all "it's amazing!", but they do not make the claim that it doesn't work.

Maybe we run in different circles but the two main sides I've seen are "This drug is a miracle cure" and "Maybe let's wait for some evidence". If the first side flipped to "This drug is terrible" then the other side would still be saying "Maybe let's wait for some evidence". I haven't seen very many people actively hoping the drug doesn't work just to spite the president.

For some issues there's plenty of partisan hackery to go around, but in this instance there is clearly one person to blame for turning this into a partisan issue. Politicians should not be offering their opinions on drug efficacy, full stop.

Honestly, if this were not linked so tightly at this point to a certain U.S. politician, then I doubt that it would receive much media attention at all. And it would probably be the sort of thing that HN and Reddit would view favorably.

It would be same as Remdesivir, nitric oxide, and favipiravir. They all have clinical trials going on and anecdotal evidence of efficacy . Most people have never heard of any of these treatments. Like most drug trials, they will probably show a limited or no improvement over the control group. We can get our hopes up, but we should be planning that there will be no effective and/or viable treatment deployed before a vaccine is released.

The difference of course is that HCQ is part of the existing treatment plan of SK, France, and other countries. At the very least we’ll have a large sample size in the next few months.

So far, the results are not looking good: https://sciencebasedmedicine.org/miracle-cure-testimonials-a...

Because it's easy to make, there's tons of it lying around already, and it doesn't need human safety trials (we already know safe dosages). If it works, it'll be a near-miracle.

No, that explains the initial attention, not the sustained attention in the face of clear and severe problems it is now getting.

They always were saying it wasn't magic bullet, but some people did not keep the context and started to spread only part of the story.

Because this drug can be cheaply manufactured out of patent. Let's say Remdesivir is the only drug that works, it's basically an admission that Gilead is going to have us over a barrel.

Only if we chose to let them bend us over said barrel?

The US government could simply seize the patent if Gilead acted in a manner against the public good.

The US government is not "we", even if we are in the US.

And then what happens next time? Why spend all the time and effort, only to have what you did nationalized?

Incentivizing people to not do productive things like develop drugs seems like a really bad idea.

I used to agree with you. Then I realized that drug companies spend more on lawyers than scientists.

This isn’t even remotely close to true. 0.67% on legal[1] versus 17% on R&D[2].

[1] https://ccbjournal.com/articles/benchmark-metrics-pharma-com... [2] https://www.investopedia.com/ask/answers/060115/how-much-dru...

And how much on marketing?

You are right of course. My mistake. Marketing is where they spend their money!

Nobody’s saying Gilead can’t make a profit. Just that they can’t make an obscene (“have us over a barrel”) profit.

The post I was responding to had the strong implication of a Mafiosi stopping by a store and saying "Nice store you have here - it would be a shame if something happened to it". "You might want to consider our needs and sell us stuff at what we consider a good price".

That's how the USA behaves literally all the time with other countries and foreign companies. It seems like a weird time to choose to play nice for once?

My comment was specifically in regards to extortion, and you'd need the court of public opinion on your side to do it anyways. The US government still does use eminent domain to do stuff people don't want - see recent examples involving the Keystone XL pipeline and the border fence where everyone from native american tribesfolk to ranchers have had their property seized by the government against their wishes.

So the reward for spending millions on neglected tropical diseases is nothing. That's a great motivator for the company that cured HIV and Hep C to keep working.

> it's basically an admission that Gilead is going to have us over a barrel

That's absolutely not what would happen. I was chatting with a family member who used to work in biotech/pharma and posed the question what would happen if Remdesivir is found to have efficacy against covid-19. What they said is basically there would be licensing done immediately to other pharma companies which would run manufacturing in parallel with what Gilead is doing. Gilead will be getting profits from each pharma company that gets a license. I am unsure why the lead time is so long, however it may be that the company does not want to create a huge supply of a drug that may not be effective. But this is very interesting, the pentagon is getting lots of remdesivir for troops so there must be some info that leadership has about its success rate: https://qz.com/1834939/how-the-military-secured-experimental...

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