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Comment by maaand | Hacker News Reader

Wasnt Zinc supposed to be part of the equation along with Hydroxychloroquine? Most anecdotal evidence from practitioners includes Zinc along with Hydroxychloroquine.

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Yes, and the practitioners boosting the drug combo have also said that in order to be effective, it should be administered early, similar to Tamiflu.

Was this done in the study linked?

All doctors I’ve seen promote hydroxychloroquine have been adamant that it must be administered early in the disease’s progression in order to have any effect.

But most of the studies being performed that I’ve heard of, have explicitly been on late-stage patients. This includes the central EU study.

It would be tragic if the drug works when administered early, but all the studies have happened at a late stage, incorrectly disqualifying a treatment that can save many lives.

As mentioned in the paper they only include people where the drug was given within 48 hours after diagnosis.

48 hours is two days! "48 hours after diagnosis" is NOT early treatment. See my earlier post!

So, the time between when symptoms first started and up to 48 hours after patients' test results came back positive.

I'm curious why there hasn't been a proper prophylactic study of HCQ. Every test I see are hospitalized and late stage. The vast majority of people are told to quarantine at home after testing positive.

I'm sure a test group could be made among them to test for severity of symptoms + testing to see the number who are later hospitalized.

Giving a dangerous drug to healthy people (presumably thousands of them, to be statistically useful), on no real evidence of efficacy, would be ethically dubious, to say the least.

There's plenty of evidence hydroxychloroquine works for SARS.

How would you justify giving hydroxychloroquine to hundreds of thousands of healthy people a year for malaria prophylaxis?

GP wasn’t suggesting prophylactic use on healthy people. The suggestion was to do this on diagnosed patients, maybe in risk groups, that haven’t progressed to a serious condition yet. But would be at great risk (>10%) to do so soon.

But this study is on outcomes where the treatment was administered within 48 hours of diagnosis.

48 hours after _diagnosis_ is pretty damned late. To rephrase that, it's "Two days after diagnosis"!

I'd expect the lungs to be fully invaded and serious damage done by the virus by that time. This is not an early, or even seriously prompt, treatment. Certainly if the patients were in a hospital setting this would be unacceptably slow treatment.

This appears to be yet another of several "studies" where HCQ was given late to patients that were already near death. Of course it had little effect.

The recommendation was always HCQ + AZITHROMYCIN + ZINC SULFATE given EARLY. Few, if any, studies have followed that recommendation.

This debate would be EASILY settled by doing real science like you suggest. Instead, we get these proud Trump debunkings that don’t answer the important question. Ok, HCQ doesn’t help critical patients. But we’ve already suspected that for two months.

I don’t get it. Just do a simple, proper frickin’ study where the cocktail you mention is used immediately after diagnosis, and compare outcomes with different treatments.

This seems so obvious that I wish someone could point out to me what obvious detail I’m not understanding. It’s as if proving Trump wrong is more important than answering the real and important yes/no question.

Thanks. That settles my question. It was administered much later than suggested by most doctors that have tentatively used it based on experiences with malaria and SARS.

So it’s sadly not very useful for drawing conclusions about that :(

As we would with any drug, we'd start with a small group and scale it to more as it was determined to be safe.

Excuse me. It is know to be safe for 70 years. It used widescale in the whole world. It is cheap and easily manifacturable (only India is doing it right now). It is known to be working as COVID-19 prophylaxe (not as treatment). There is no vaccination in sight.

https://www.icmr.gov.in/pdf/covid/techdoc/V5_Revised_advisor...

HCQ is given to millions in USA alone, since 1955.

https://en.wikipedia.org/wiki/Hydroxychloroquine

It is not a dangerous drug at all. Dangerous is CQ phosphat/Resochin, which was used only for a short time in history, until it was replaced by HCQ. In the 40ies already, at the German Africa campaign.

So if we kill another thousand people administering it differently how likely are we to discover it now works instead of substantially increasing mortality?

I don't know. We should follow whatever procedures we follow when testing any potential new treatment.

> Tamiflu.

Another drug that doesn't work nearly as well as some people think. https://www.bmj.com/tamiflu

> The reviewers concluded that there was no convincing trial evidence that Tamiflu affected influenza complications (in treatment) or influenza infections (in prophylaxis), and raised new questions about the drug’s harms profile.

> Hayashi pointed out that the key piece of evidence underpinning the previous Cochrane review’s conclusion--that Tamiflu reduced the risk of secondary complications such as pneumonia--was based on a manufacturer-authored, pooled analysis of 10 manufacturer-funded trials

Everything needed for FDA approval.

> no convincing trial evidence

It just sounds like Tamiflu efficacy studies to date haven't been thorough enough to be convincing.

Do we have some evidence to back that up?

I could find one study: https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v...

Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.

This one is underway: https://clinicaltrials.gov/ct2/show/record/NCT04377646

Do I read that they just found that zinc + hydroxychloroquine was better than just hydroxychloroquine?

That's great but that doesn't exactly tell us that hydroxychloroquine + zinc is better than other therapies or even better than nothing.

The clinical trial is regarding the efficacy as a prophylaxis for a small portion of the population that is most directly exposed. It would be great if it works but it will likely not be as useful as a treatment as we can't necessarily give our whole population a years worth without seeing other health consequences.

"They've" observed all sorts of beneficial effects of zinc against viral lung infections fora while, though. "They've" observed hydroxychloroquine molecularly interacts with zinc for at least half a decade.

"Chloroquine is a Zinc Ionophore" (2014): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/

This also mixes HCQ with CQ, which seems odd. CQ has a worse safety record and HCQ is normally preferred.

This provides data for both.

You're right, I was just confused until I saw the figures where they separated them.

The most impressive one I saw included zinc, but I thought that was unusual. Most do not AFAICT. In fact, zinc may be the beneficial part of that treatment. Any studies on zinc?

Hydroxychloroquine is just ionophore for zinc. It just increases concentration of zinc in cell. Zinc inhibits replication of RNA viruses.

https://journals.plos.org/plospathogens/article?id=10.1371/j...

Yes, zinc is a key part of the proposed prophylactic regimen. Anyone who thought HCQ by itself would be helpful as a ‘cure’ for those who already are suffering an infection misunderstood the original proposal and care more about politics than accuracy. (i.e. Mr. Trump)

Zinc is the purported mechanism of action, but cells can't pick up enough on their own, so an ionophore like hydroxychloroquine might help get more into the cell.

One might ask pointed questions why the original formulation (zinc + ionophore) is so consistently absent from these studies. I don't care one way or the other about the drug, but why are studies widely promoted that are irrelevant to the question?

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