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Comment by lbeltrame | Hacker News Reader

> It seems like we’re in trouble if we try to pursue a drug that has to be administered early in the disease process.

This is the same for remedisivir, and also for ritonavir/lopinavir/ribavirin: they must be given within 7 days of symptom onset to be effective. In fact, the latter was deemed unsuccesful in a first paper, because it was given late, then it was reconsidered when given earlier during the disease.

This is not surprising, given how the disease works (outlined also by the Cell paper from yesterday): at some point the consequences of the highly altered inflammatory reaction greatly surpass the effects of the replication of the virus itself.

This calls more for extensive and early testing, IMO.

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https://arstechnica.com/science/2020/05/the-antiviral-remdes...

participants who entered the trial more than 10 days after the onset of symptoms actually showed a better response to remdesivir than those who started being treated during the first 10 days of being symptomatic.

It's not a huge improvement, but it doesn't seem to be too dependent on starting treatment early.

Remdesivir doesn't have the sudden cardiac death side effect, though, does it?

HCQ's issue may be a bad combination of "has to be taken early" and "has significant side effects".

HCQ has been around for 70 years. Remdesivir's issue is that everyone gets to be the guinea pig. Sometimes it's better to go with the devil you know.

> HCQ has been around for 70 years.

Not in an antiviral context, and certainly not for SARS-CoV-2.

So? The point here is the safety of it, plus there's research going back to 2006 about its effectiveness for other Coronaviruses. I mean do whatever you want to do, but there's a reason most people in government are taking it. In my country they privately take it, while publicly not endorsing it to prevent shortages

Same stories I've heard. Many doctors prescribing it for prophylactic treatment to friends and family immediately after diagnosis. Some government officials (in France, notably! While at the same time shutting down public use) taking it immediately after diagnosis.

As has been mentioned elsewhere, we'll have to answer soon, but power speaks with a forked tongue in this case. Too many anecdotal observations to be comfortable in the very loud politicization of the science.

The Lancet study and others cannot be accepted a conclusion to the safety & efficacy of early/prophylactic use. Let's wait for and encourage some proper, specific studies.

> The point here is the safety of it

Yes, which is why all of the studies keep saying that it's too dangerous to use as treatment for covid-19.

Too dangerous (or even ineffective) to use it with patients with severe COVID-19. Whether it may be the same or not in a prophylaxis regime or for outpatient use (mild to moderate that does not require hospitalization) is yet unknown at this point (most papers that I've read are on hospitalized patients).

It may be too toxic, it may not cause a noticeable effect, but currently it is a big question mark.

You'd take the risk for people with severe Covid-19 because it might[1] save their life. You can't justify taking that risk in other people because they're probably not going to be killed by covid-19. Balancing harm from medication against not much harm from covid comes out against the meds.

[1] Except now we know (and we always thought this) that it won't save their life; it'll increase their risk of death.

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