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Comment by huy-nguyen | Hacker News Reader

I guess that's the end of the road for hydroxychloroquine/chloroquine as a treatment for COVID-19.

Yes it's probably the end medically, but it's not the end of its use as a political wedge.

To people who believe the current political rhetoric promoting hydroxychloroquine, a study in a medical journal doesn't change anything, as their interest in it was never based its medical efficacy, but rather as a symbol used to rally around their leader and their movement. Just look at the anti-vaccination movement, which continues despite being debunked for years.

And we shouldn't so quickly dismiss this phenomenon. We underestimate the power of that kind of fictional narrative group-think to our peril. The only way to fight falsehood based narrative is truth based narrative. The dry statistical or scientifically derived truth that eggheads like most of us wish would prevail is largely powerless. Stories are what ultimately wins.

It's been absurd that I have people on my Twitter feed attributing the low death rate in India to India's "widespread daily use of HCQ".

31 years in India and I've never even heard of it!

I suspect this was people thinking “chloroquine is a malaria drug and India has malaria, therefore it’s used in India”. Which sounds vaguely convincing at first glance, but malaria in India has been immune for decades.

Don't even get me started on the people hoarding tonic water because it has quinine in it

Easy to explain. HCQ as treatment is questionable. Always was. Even the Chinese retracted their recommendation in End of February. But it is still recommended as prevention, and there is a Indian study confirming its suitability as prevention. That's how it always worked. India is also the sole manufacturer of it, for their malaria problem. It's still in widespread use there.

Europeans were extra stupid to try it as treatment. If you read the early original Chinese reports they always mentioned that it worked as prevention, Lupus patients had an advantage.

And those two disliked presidents always promoted its usage as prevention, not treatment. But reading is apparently a rare skill.

Exactly. What, you think these hucksters like Laura Ingraham are going to apologize for their dangerous bullshit (spoiler - no: https://www.thedailybeast.com/laura-ingraham-trashes-promisi... )? Of course not. Apologies are for losers, instead when the facts are against you, you just double down and demonize those who try to convince you with those facts as nefarious enemies.

Those of us who live in the world of reality need to realize the only way to fight this "demon haunted world" is to make a scarier demon, not try to fight with facts.

It goes both ways. There are studies showing it is a statistically and clinically significant treatment [1]. Whether those results are reproducible or not remains to be seen. Most of these studies you never hear about because many people on the left want Trump to be wrong or have a knee jerk reaction to anything he says. It even has a name: Trump derangement syndrome.

Irrational behavior in both directions is indefensible.

[1] https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v...

[2] https://pubmed.ncbi.nlm.nih.gov/32335560/

> Irrational behavior in both directions is indefensible.

Agreed that any political side is capable of false narratives, but that's hardly what's going on here. Nobody with the fundamental desire for a treatment for themselves and those they care about should they fall severely ill would want any proven effective treatment to be dismissed for political reasons, whether that is hydroxychloroquine or anything else.

The problem is that what should have been left as an investigation into a medication with no political colors was turned into a political wedge by the US president who seemingly aspired to use it to regain relevance during this crisis.

The same thing has also happened for the various promotions of very preliminary vaccines, or of a fictional nationally deployed testing website that was claimed by POTUS to be under development by Google. This follows the basic principle guiding this administration and its leader that there is no such thing as bad publicity. And to a certain extent, they might even be right. Time will tell.

Every reference I've seen to Hydroxychloroquine in the media is quick to denounce it as a dangerous, discredited treatment. So I think this is not just irrationality on the part of the left, but an example of the gated institutional narrative suppressing ideas. Not to take away from the irrationality of blind faith in anything Trump says seen on the right.

If you look at the experts, they're still designing studies to test it, and there are some papers suggesting it does work. The jury is very much still out on this subject.

> If you look at the experts, they're still designing studies to test it, and there are some papers suggesting it does work. The jury is very much still out on this subject.

I'd like nothing more than for hydroxychloroquine to be an effective treatment, so we can end this crisis. It should continue to be explored and investigated. At the very least we might learn something new that will help with its known effective use in treating malaria or autoimmune diseases like lupus.

But it should never have been turned into a political football, and the person responsible for that is unmistakably the POTUS.

Yep, with you there. POTUS should not be making recommendations outside his field of expertise, unless he's merely quoting the experts.

Not necessarily. Some discussions[1] of potential mechanism focuses on hydroxychloroquine working as an ionophore to drive zinc into cells - so this potentially only works when given in conjunction with zinc. There are a few studies that suggest it is effective used that way. Whether those results hold up over time is an open question.

[1] (video) https://fast.wistia.net/embed/medias/td0v8taipc

The effective use is applying it 3 weeks before the infection. Not two days after. That's not enough time to fill up the cells with zinc.

Unfortunately, probably not; the general public won’t read this, and some people won’t believe it when they see news media’s take on it.

There was an article the other day that interviewed someone who’d been on long-term treatment with the drug (for lupus) they were shocked when they got covid, because they believed that the drug was a prophylactic. No reputable scientist ever claimed that, as far as I know; it was a popular myth encouraged by unscrupulous news outlets, which won’t go away just because of a study or two.

"We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2"

It may be the end of the road for hospitalized patients with heavy viral loads but, considering the fact that zinc is mentioned nowhere in the full text, it is not the end of the road for prophylaxis. Early action before hospitalization is necessary... see below.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Zinc does the hard work of inhibiting viral replication; HCQ is the zinc ionophore that lights the pathway. "First used in 1967, the term ionophore refers to the molecule’s ability to bind a metal ion and facilitate its transport across cellular membranes." In order to inhibit viral replication, zinc must enter the cell... HCQ and other zinc ionophores can facilitate this.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896753/

Pasting my previous comment below with slight modifications:

Hydroxychloroquine is just one of several zinc ionophores that inhibit viral replication. "Zinc Ionophores Pyrithione Inhibits Herpes Simplex Virus Replication" https://pubmed.ncbi.nlm.nih.gov/23867132/

"... the virus replicative cycle can be divided into 10 steps (Fig. 52-1): (1) adsorption, (2) penetration, (3) uncoating, (4) early transcription, (5) early translation, (6) replication of the viral genome, (7) late transcription, (8) late translation, (9) assembly, and (10) release of new virus particles."

If using HCQ as a zinc ionophore which targets replication, "antiviral drug treatment should be started early, before irreversible tissue damage occurs. Such timely treatment is not possible without early and accurate diagnosis, which is difficult for many viral infections (such as infections of the respiratory tract)" https://www.ncbi.nlm.nih.gov/books/NBK8119/

The end of the science road perhaps, but there's still political obstacles to setting it aside. It's not obvious why Trump is pushing it so hard.

https://www.vox.com/2020/4/7/21211872/trump-coronavirus-hydr...

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