France doesn't use HCQ consistently yet. Didier Raoult who heads the IHU in Marseille has been using it systematically on all cases, even mild ones for more than 2 weeks. I doubt such a difference in mortality rate could be explained by a difference in number of tests performed or other parameters.
Everyone can have all sorts of opinions on the efficacy of the treatment but in the end, mortality rates don't lie. And no, differences in the level of care, health or other smaller factors cannot explain an 8x difference.
In addition to that, most patients seem to have elevated ferritin which would be a side effect of consuming too much iron. In this case, it is theorized that when the virus replicates, it creates non-essential proteins that take place of the iron in hemoglobin thus preventing red blood cell from carrying O2 and CO2 from and back to the lungs. Based on molecular simulations, it seems that HCQ can bond to those viral proteins preventing them from expelling iron from hemoglobin. It would also explain why it's useful to treat someone early on rather than later when their hemoglobin lost their iron... Source here: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...
It also doesn't count for confounding factors. Were all the patients of the same health? Did they all have the same supportive equipment? Did they all begin treatment at the same time after symptom onset? These are all questions that need to be addressed, the sooner the better.
Each of the 3005 had proper full care and were closely watched. We don't know about the 79160. The difference in mortality could be a number of factors.
Prevent Senior in Brazil, an health operator with mosts of its patients on risk groups (60+ yo) are using hydroxychloroquine on all its COVID-19 patients with tremendous success.
Right now I choose to believe on MD in front line rather then in Health Societies, FDA, WHO and those bureaucrats who let the virus spread all around due to its incompetence
Doctors and clinicians on front lines in NYC and greater NYC area say it's not helping at all, that they've by and large given up on using it.
So I could reply that right now I choose to believe these MDs and ARNPs on front lines rather than commenters on HN. But that's not helpful compared to research.
This one is a mess, and the tiny sampling of articles we have are not definitive.
// Disclaimer: Lived in Africa for a decade, took anti-malarials. These and others can be nasty for a lot of people, some folks have to hunt to find things that aren't worse than the occasional bout of malaria. In fact, while my family took them, I never found anything tolerable. Curiously, the rest of the family got malaria, I did not.
Agreed, also Hydroxychloroquine cost only few cents per pill, its probably too hard to swallow for big labs that want to sell $$$$$ treatment instead ... Poor them ...
A proprietary drug whose maker has said they will donate all 1.5 million doses that they currently have. That's more than they'll be able to produce over the next year (1 million) even after greatly increasing that production capacity.
“ There is absolutely no evidence that HCQ or HCQ/azithromycin would have any effect on seriously ill patients with viral pneumonia.”
Correct. that’s against the thought right now. HCQ is great at preventing patients from getting to the serious pneumonia stage. Once they’re on a vent, they should be on another cocktail.
Yes, once they're on a vent, your main problem is not even the viral load, but rather that the body reacts to the infection in desperate ways like cytokine storm [0] which destroys organs.
The Danish Serum Institute runs a “sentinel” testing programme for the common flu, and they note in their report about covid-19 last week (available in Danish) that the common flu has mostly been eliminated since the social distancing and lockdown measure were implemented. They interpret this a leading indicator for the reduction in covid-19 since it has a similar transmission mechanism.
Isolation (physical distancing) would cause this. Flu doesn't have a long incubation, and doesn't survive as well (AFAICT, not a medic) outside bodies.
Isolation should reduce all virus transmission and so reduce incidence of flu, etc.. We'll need 3 weeks minimum of isolation to reduce Covid19 transmissions, assuming everyone is actually doing it.
In the UK (just England I think, might be England & Wales) our Office of National Statistics says there were <500 deaths from flu (ICD codes J10-11, https://bit.ly/39DZPCo) in the most recent year of records (2017; from c.60M population).
I'm not so sure. Let's say it halves the number of deaths or halves the time it takes for someone to get better. But also it requires a certain dose to be most effective. How would you know in this fog of war? You'd still have many patients who are sick or dying.
The whole point of this article is that it's really hard to know without controlled, randomized trials. And I agree.
I have G6PD deficiency and there are mixed opinions on whether this form of chloroquine is safe for me to take. The deficiency affects about 400M people worldwide, surprised to see that this part of the discussion rarely gets brought up.
> There is absolutely no evidence that HCQ or HCQ/azithromycin would have any effect on seriously ill patients with viral pneumonia
It's supposed to be taken BEFORE you become seriously ill and develop ARDS.
In fact, many elites are put on a short course of HCQ/Z-Pak as soon as they show symptoms, even before the results of their tests come back (which can take days).
Collectively, we need to get over the idea of all-or-nothing solutions to Coronavirus.
We're not going to wake up one day with a "cure" for COVID-19. No one in the medical field actually expects Hydroxychloroquine to produce miraculous recoveries at this point. The idea is that any treatment that slows the progress of the infection will also buy the patient's immune system more time to fight the infection. If we can push the peak symptoms back even 1-2 days relative to untreated individuals, that gives the immune system that much extra time to mount an effective defense against the virus.
When we finally confirm which treatments, if any, are useful for slowing the progress of the infections, we can combine them with earlier testing and identification to help reduce the number of patients who require hospitalization. It won't look like a cure, but it will be making improvements in treatment outcomes and reducing the burden on hospitals.
At this scale, a small modification of disease severity can still be useful for minimizing the burden on hospitals, even if it doesn't fit the narrative of a miracle cure.
Not to diminish the possible successes, but without a randomized control trial, there is no way the success can reliably be attributed to the medications.
That's not to say they should stop prescribing it, simply due to lack of formal trials. But the perceived benefits should not be taken at face value, yet.
You are commenting on an article that is nearly as apolitical as I can imagine one being to say that politicization of this topic makes it impossible to have a debate rooted in science.
Isn’t this precisely an injection of politicization into a summary of scientific work?
"If there was any effect of this drug on COVID-19, it was minimal. Hydroxychloroquine, whose toxicity is far lower, may be safer than chloroquine. But that doesn't matter if the drugs are ineffective."
What's political about that?
The whole idea that if there were a simple and cheap cure that it would be politicized to the point where it won't see widespread application is ridiculous.
Exactly! On one hand some scientists swear by these drugs and on the other hand other scientists are opposing it. It is science after all. It either works or it doesn't. There is no "probably isn't the answer" in this. It is almost like Big Pharma is fighting out their battles through these scientists.
I'm guessing it's because the organization has been praised by a number of well-known people on the right (e.g., Steve Forbes, Ben Carson).
And because the question of whether or not this drug works, or even should be used at all, seems to have become highly politicized. I think I read that at least one US governor threatened to pull the medical license of any doctor that used it.
I don't have any idea whether this drug might be useful, but I think our most boring, apolitical scientists should be making that call. It could well end up that it sort of works, some of the time, perhaps in combination with other drugs or factors. Conceivably this will be solved the way AIDS ultimately was, slowly zeroing in on a set of treatments that mostly work.
[+] [-] ucha|6 years ago|reply
France ex-IHU Marseille/AP-HP: 79160 cases, 7527 dead, mortality rate 9.5%
IHU Marseille/AP-HP: 3005 cases, 33 dead, mortality rate 1.1%
France doesn't use HCQ consistently yet. Didier Raoult who heads the IHU in Marseille has been using it systematically on all cases, even mild ones for more than 2 weeks. I doubt such a difference in mortality rate could be explained by a difference in number of tests performed or other parameters.
Everyone can have all sorts of opinions on the efficacy of the treatment but in the end, mortality rates don't lie. And no, differences in the level of care, health or other smaller factors cannot explain an 8x difference.
In addition to that, most patients seem to have elevated ferritin which would be a side effect of consuming too much iron. In this case, it is theorized that when the virus replicates, it creates non-essential proteins that take place of the iron in hemoglobin thus preventing red blood cell from carrying O2 and CO2 from and back to the lungs. Based on molecular simulations, it seems that HCQ can bond to those viral proteins preventing them from expelling iron from hemoglobin. It would also explain why it's useful to treat someone early on rather than later when their hemoglobin lost their iron... Source here: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...
[+] [-] rrss|6 years ago|reply
Pennsylvania: 11510 cases, 150 deaths, mortality rate 1.3%
Is Pennsylvania also using HCQ systematically on all cases? I don't think these crude CFRs are useful.
[+] [-] inamberclad|6 years ago|reply
[+] [-] wolco|6 years ago|reply
[+] [-] cma|6 years ago|reply
[+] [-] logicbombr|6 years ago|reply
Right now I choose to believe on MD in front line rather then in Health Societies, FDA, WHO and those bureaucrats who let the virus spread all around due to its incompetence
[+] [-] Terretta|6 years ago|reply
So I could reply that right now I choose to believe these MDs and ARNPs on front lines rather than commenters on HN. But that's not helpful compared to research.
This one is a mess, and the tiny sampling of articles we have are not definitive.
// Disclaimer: Lived in Africa for a decade, took anti-malarials. These and others can be nasty for a lot of people, some folks have to hunt to find things that aren't worse than the occasional bout of malaria. In fact, while my family took them, I never found anything tolerable. Curiously, the rest of the family got malaria, I did not.
[+] [-] jacquesm|6 years ago|reply
[+] [-] greatjack613|6 years ago|reply
[deleted]
[+] [-] hprotagonist|6 years ago|reply
[+] [-] js4ever|6 years ago|reply
[+] [-] tgafpc2|6 years ago|reply
[+] [-] cjhopman|6 years ago|reply
[+] [-] af33|6 years ago|reply
[+] [-] snapetom|6 years ago|reply
Correct. that’s against the thought right now. HCQ is great at preventing patients from getting to the serious pneumonia stage. Once they’re on a vent, they should be on another cocktail.
[+] [-] jojo2000|6 years ago|reply
[0] https://en.wikipedia.org/wiki/Cytokine_release_syndrome
[+] [-] gonational|6 years ago|reply
They are down from the normal 4.5k+ per week during this period to around 2.3k per week and they are falling parabolically as COVID-19 expands.
What could cause this?
[+] [-] mjul|6 years ago|reply
[+] [-] cjbprime|6 years ago|reply
[+] [-] pbhjpbhj|6 years ago|reply
Isolation should reduce all virus transmission and so reduce incidence of flu, etc.. We'll need 3 weeks minimum of isolation to reduce Covid19 transmissions, assuming everyone is actually doing it.
In the UK (just England I think, might be England & Wales) our Office of National Statistics says there were <500 deaths from flu (ICD codes J10-11, https://bit.ly/39DZPCo) in the most recent year of records (2017; from c.60M population).
[+] [-] jjeaff|6 years ago|reply
[+] [-] pbreit|6 years ago|reply
Do you have any pointers?
[+] [-] hamilyon2|6 years ago|reply
[+] [-] hprotagonist|6 years ago|reply
[deleted]
[+] [-] ysleepy|6 years ago|reply
[+] [-] Ozzie_osman|6 years ago|reply
The whole point of this article is that it's really hard to know without controlled, randomized trials. And I agree.
[+] [-] pbreit|6 years ago|reply
[+] [-] ck2|6 years ago|reply
https://www.sciencedirect.com/science/article/pii/S016635422...
https://www.who.int/bulletin/volumes/82/8/editorial30804html...
every dog, cat and horse that is on heartworm medication is already using it
[+] [-] fareesh|6 years ago|reply
[+] [-] af33|6 years ago|reply
It's supposed to be taken BEFORE you become seriously ill and develop ARDS.
In fact, many elites are put on a short course of HCQ/Z-Pak as soon as they show symptoms, even before the results of their tests come back (which can take days).
> https://www.cbsnews.com/news/coronavirus-treatment-drug-hydr...
[+] [-] podgaj|6 years ago|reply
Both ADAM17, which helps ACE2 shed from the cell, and ACE2 itself, are zinc finger proteins and use zinc as a cofactor.
[+] [-] PragmaticPulp|6 years ago|reply
We're not going to wake up one day with a "cure" for COVID-19. No one in the medical field actually expects Hydroxychloroquine to produce miraculous recoveries at this point. The idea is that any treatment that slows the progress of the infection will also buy the patient's immune system more time to fight the infection. If we can push the peak symptoms back even 1-2 days relative to untreated individuals, that gives the immune system that much extra time to mount an effective defense against the virus.
When we finally confirm which treatments, if any, are useful for slowing the progress of the infections, we can combine them with earlier testing and identification to help reduce the number of patients who require hospitalization. It won't look like a cure, but it will be making improvements in treatment outcomes and reducing the burden on hospitals.
At this scale, a small modification of disease severity can still be useful for minimizing the burden on hospitals, even if it doesn't fit the narrative of a miracle cure.
[+] [-] gus_massa|6 years ago|reply
Is there any serious trial that shows that Hydroxychloroquine has any effect at all?
[+] [-] swader999|6 years ago|reply
[+] [-] stri8ed|6 years ago|reply
That's not to say they should stop prescribing it, simply due to lack of formal trials. But the perceived benefits should not be taken at face value, yet.
[+] [-] hexl|6 years ago|reply
That's non-sense, if everyone that had cancer got cured by a miracle drug, would you still demand a randomized control trial?
[+] [-] pbreit|6 years ago|reply
[+] [-] mrfusion|6 years ago|reply
[+] [-] jkachmar|6 years ago|reply
Isn’t this precisely an injection of politicization into a summary of scientific work?
[+] [-] jacquesm|6 years ago|reply
What's political about that?
The whole idea that if there were a simple and cheap cure that it would be politicized to the point where it won't see widespread application is ridiculous.
[+] [-] abnry|6 years ago|reply
[+] [-] justin66|6 years ago|reply
[+] [-] shripadk|6 years ago|reply
[+] [-] brmgb|6 years ago|reply
[deleted]
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] nradov|6 years ago|reply
[+] [-] downerending|6 years ago|reply
And because the question of whether or not this drug works, or even should be used at all, seems to have become highly politicized. I think I read that at least one US governor threatened to pull the medical license of any doctor that used it.
I don't have any idea whether this drug might be useful, but I think our most boring, apolitical scientists should be making that call. It could well end up that it sort of works, some of the time, perhaps in combination with other drugs or factors. Conceivably this will be solved the way AIDS ultimately was, slowly zeroing in on a set of treatments that mostly work.
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] williesleg|6 years ago|reply
[deleted]
[+] [-] pbreit|6 years ago|reply
[deleted]