Ok so I'm a Swedish intensivist working i Göteborg.
We currently don't use chloroquine/hydroxychloroquine in the treatment of Covid-19 because:
1. We tried it and have not noticed any obvious positive effect.
2. No serious study have been able to replicate the success of the first French (severly flawed) study.
3. Potential severe sideeffects.
Awaiting the completion of ongoing studies we are using other treatment protocols. Should chloroquine/hydroxychloroquine be shown to improve outcome we will of course use it.
Do you know about any treatment of chloroquine in combination with zinc to stop the replication of the virus?
Zinc to stop RNA copying , chloroquine to let zinc into the cells
You tested hydroxychloroquine only or complemented with azithromycin as recommended by "the first French (severly flawed) study" for early symptoms as a containment measure, not a cure ?
I ask because you say you tried but you're not saying what you've tried exactly. Please don't take it personally, It's just I which people would be much more precise when talking about this matter.
The study might very well be flawed and/or plain wrong. But there is also a lot of people misrepresenting it. Which does not help at all.
Also of note, the European study left out azithromycin and is only conduct on advanced cases.
> – Det började komma rapporter om misstänkta svårare biverkningar än vi först trodde. Vi kan inte utesluta svåra biverkningar, framförallt från hjärtat, och det är ett svårdoserat läkemedel. Dessutom har vi inga starka bevis på att klorokin har effekt vid covid-19.
"There started coming reports about suspicious serious side-effects than we first thought. We can't conclude it doesn't have strong side-effects, particularly from the heart, and the drug is hard to dosage correct. Also, we don't have any strong evidence that Chloroquine has an effect with [SIC] covid-19"
Reporter asks: "Har ni haft fall med svåra biverkningar?" "Have you had cases with strong side-effects?"
Answer: "– Inte som jag känner till i Göteborg, men det finns rapporterat misstänkta fall från andra kliniker." "Not as far as I know in Gothenburg, but there is reports of suspicious cases from other clinics".
> Alla sjukhus i Västra Götalandsregionen följer Sahlgrenskas exempel. Men de är än så länge ganska ensamma. På de stora sjukhusen i Stockholm ges fortfarande klorokin.
"All hospitals in swedish region follows Sahlgrensk's example. But they are currently pretty alone. They still give patients Chloroquine in the big hospitals in Stockholm"
Let me know with a reply if you want other parts translated, bit busy but can at least provide this for now.
“Swedish region” here doesn’t mean “Sweden”, it’s Västra Götaland which is a biggish county, just nestling under the southern tip of Norway. Biggest city is Gothenburg, total county population 1.75 million.
For several weeks my mother hasn't been able to fill her regular prescription for hydroxychloroquine that has been an important part of managing her lupus for >30 years. The rush to use it against covid-19 is starting to harm some of the people that need the medication for other reasons.
> Lupus doc called me again expressing she wants me very isolated for the next 3 weeks especially because of my lungs and heart and no meds available. I never thought my lupus med would disappear. [...] Kaiser is refusing to give it to thier long term Lupus patients.
Likewise, on 3/25 a Dr. in New Orleans [0] also reported they were stopping using it as it wasn't helping and the side-effects were problematic.
"Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post."
I encourage every one to read the doctors post, it has tons of interesting information in it. Here are some extracts:
"Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that."
Also
"Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. "
While
"worldwide 86% of covid 19 patients that go on a vent die."
Interesting. So it looks like it is the treatment they're advocating in Marseilles. And it does not work on ventilated patients (if I understood correctly).
Chloroquine's severe side effects may look similar to acute pneumonia and ARDS. Even if it helps destroy the virus, it might be complementing to the severity
Chloroquine is an anti-malaria and it's side effects are so severe and common that many people would prefer to run the risk of malaria than take it. Adding these side effects to a Covid-19 patient seems like an extreme measure, given there's little evidence so far that it's beneficial, let alone enough to outweigh these side effects.
100s of million of people have taken it dayly over decades. And side effects generally happens when you've been taking the treatment for years for most people. And nowadays people take hydrochloroquine anyway. I've you taken it ? I have for ten years.
The head at Karolinska said that they used Chloroquine becuase everyone else did. They had reports of side-effects that were more severe than expected, so now they stopped using it all together.
It has no mention of any chloroquine trials in Denmark, but mentions an upcoming one for azithromycin and hydroxychloroquine:
"A Randomized, Placebo-controlled Double-blinded Trial Evaluating Treatment With Azithromycin and Hydroxychloroquine to Patients With COVID-19 N=226 patients with positive COVID-19 test/diagnosis during the hospitalization randomised to Azithromycin and Hydroxychloroquine or placebo".
It seems more likely that the news article is slightly inaccurate here, rather than the agency's information being outdated, but either is possible.
What a surprise.... a crackpot theory by a less than reputable MD, tested on less than 100 people overall with no control and no double blind... I really wonder how other hospitals could have fallen for it. It’s the epitome of bad science. See https://news.ycombinator.com/item?id=22727359 for all the drama around Dr Raoult.
I think people responding to Trump's advocacy of this drug are making a mistake by saying things like "there are no randomized controlled trials for this application" and "patients with other ailments need this, so don't hoard it".
What really needs to be said is the plain facts: while doctors are trying out this medicine, there is no miracle cure. This disease causes different conditions in people that need to be addressed with different interventions.
As a layman I found this chart very enlightening about how the disease has various dynamics (inflammation, etc): https://imgur.com/a/seG2KFS
New drugs for covid-19 are well advanced. Therefore, they have experimented with existing drugs, developed for other diseases.
Most commonly mentioned is the malaria drug chloroquine. A smaller French study that has shown positive results has spread like wildfire on social media and among others Donald Trump has declared that "Chloroquine will change the history of medicine".
Swedish doctors also began to give malaria medication to severely ill patients, despite the lack of controlled studies.
ANNONS
- We did like everyone else and gave chloroquine to the patients in the beginning. There were test tube studies that showed that it had an effect on coronavirus and it was a drug we knew from the treatment of malaria, says Magnus Gisslén, professor and chief physician at the infection clinic at Sahlgrenska University Hospital / Östra.
But now he has made a complete reversal. Last week, all treatment with chloroquine was stopped against covid-19 in Sahlgrenska.
- There were reports of suspected more serious side effects than we first thought. We cannot rule out serious side effects, especially from the heart, and it is a hard-dosed drug. In addition, we have no strong evidence that chloroquine has an effect on covid-19.
The fact that some seriously ill covid-19 patients have acute heart problems has raised concerns that chloroquine may be harmful to some patients.
Have you had cases with severe side effects?
- Not as I know in Gothenburg, but suspected cases from other clinics have been reported.
The hospitals in Stockholm continue to provide chloroquine
The risk of serious side effects, combined with the fact that there is still no evidence, ie controlled studies that show that the medicine is effective, is the basis for the decision. The French study that has become so mentioned does not give much to Gisslén.
- It does not meet any requirements that we place on how a study should be done. It has very low evidence value.
All hospitals in the Västra Götaland region follow Sahlgrenska's example. But they are still quite lonely so far. Chloroquine is still given at the major hospitals in Stockholm.
How do you see that you receive different care in different places in Sweden?
- We are receiving signals that several regions are about to stop giving chloroquine. I am very confident in what I have come up with and think that is how you should handle it. We cannot do experimental medicine. At least we need to know that we do no harm.
Several major studies in the world have been initiated on drugs that may help covid-19 patients. Magnus Gisslén believes that the first answers may come within a month.
- If it then turns out that chloroquine is good, then of course we should use it. But before that, we will not risk patients' health by giving it.
READ MORE: Rumor or facts about the new corona virus
Poison Information Center: Very unpleasant side effects
Anna Myrnäs, chief medical officer at the Poison Information Center, has seen an increase in the number of questions from the health service regarding serious side effects of chloroquine.
"The risk we see from our side is that it is a preparation that has very unpleasant side effects, including sudden cardiac death," she says.
She confirms that there are signs that covid-19 patients have been harmed by the drug.
- We do not think that everyone who now prescribes this in the intensive care units is fully aware of how severe the side effects can be, especially in already seriously ill patients.
At Sahlgrenska, patients currently receive classic IVA treatment with oxygen, but no antiviral drugs.
- We might have made another assessment if covid-19 was a disease with very high mortality, for example 80 per cent dead, but now we can manage most people who are intensive care anyway, says Magnus Gisslén.
He is self-critical that he let himself be drawn into the chloroquine.
- In retrospect, I can regret that we did. We were a bit naive and thought the side effect profile was much nicer. I have changed my mind and hope that the rest of the country does too.
In Stockholm, the Södersjukhuset has also stopped giving chloroquine, this confirms chief physician Anders Håkansson in an e-mail:
"It depends on the combination of factors:
1. We have not seen any obvious positive clinical effects.
2. Potential risk of side effects.
3. Against this background, we would like to await the results of the controlled studies in other countries. "
The irony is you are blaming people for interpreting this article with some hidden narrative to fulfill, yet you introduced the narrative into this thread.
This isn't a treatment, or at least there's very little reason to think it is at this point. If hospitals are discontinuing use of dangerous drugs with no credible evidence of efficacy, then, yeah, I can live with that. Await real trials, see if it actually does anything useful.
No one is happy in this comment section about there being downsides to a treatment. The majority are dissatisfied that treatment is being used because of hearsay and not scientifically tested, which puts huge doubts on our healthcare system. Furthermore, no one mentioned Trump.
Germany has an even lower death rate; have you considered that it might be better to treat people by hospitalising them near autobahns?
Correlation, as always, is not causation. I don't see any indication that it's in particularly widespread use in SK, btw. Looks like they definitely experimented with it around the time China was promoting it, but their figures were already good at that point.
This is incorrect, outdated information. CFR in South Korea is 1.67 percent so far and not all cases have resolved, so that will go up if any more of the people currently in hospital die. (Reminder , H1N1 Flu CFR was about 0.1%-0.5% in 2009)
South Korea has a low death rate because they acted as a unified country to implement aggressive early testing, contact tracing, and social distancing. The best and most proven cure for Coronavirus at this point is to not catch it in the first place, and to isolate those who have gotten it or have come into contact with those who have.
This article's contents do not match the headline, they give no indication as to what these "serious" side effects even are. There seems to be a massive political fight taking place over the official treatment of this disease and it sickens me. Tell me, why is it that India has this so under control and are using Chloroquine almost exclusively for the treatment?
India has not reported many cases at all (4000 confirmed cases, compared to over 300,000 in the USA) so pointing to HCQ/Chloroquine as that reason doesn’t make sense unless you are saying their reported case numbers are fake.
Someone still gets counted in the case numbers even if they are treated and recover.
I believe HCQ/CQ is also being used in Spain, France, and Italy, but there are still many deaths and a high CFR. It’s not a magic drug (there may or may not be some good effects from using it, and studies are ongoing), but some political leaders are touting it in desperation, while medical leaders are pointing out that scientific trials are ongoing to determine if it’s really working or not.
> Tell me, why is it that India has this so under control ...
First, tell us why you claim India has this 'under control'?
According to John Hopkins stats[1] (as of 2020-04-06:2200+11) shows India (population 1,600m) with confirmed case count of 4,300.
Meanwhile Australia, who's been relatively slow to trace and test, population 25m, with confirmed case count of 5,800
It's possible these numbers reflect realities, but it's a hard sell.
> ... and are using Chloroquine almost exclusively for the treatment?
This is going to need some even better citations, especially if the implied claim is that they're almost exclusively using Chloroquine for treatment with great success.
Science takes time. There might be unrelated other reasons India has it under control. It will take years to figure this out if we ever do (for obvious reasons everyone wants answers now).
My guess is doctors in India have experience with chloroquine because it is useful for malaria, something that Swedish doctors would not be expected to have experience with. If Swedish doctors spent 6 months reviewing all the knowledge India has they might be able limit side effects and see good results.
Remember, the first paragraph is the truth, but not helpful. The second is an educated guess, it seems likely but it may well be wrong.
[+] [-] bobowzki|6 years ago|reply
We currently don't use chloroquine/hydroxychloroquine in the treatment of Covid-19 because:
1. We tried it and have not noticed any obvious positive effect. 2. No serious study have been able to replicate the success of the first French (severly flawed) study. 3. Potential severe sideeffects.
Awaiting the completion of ongoing studies we are using other treatment protocols. Should chloroquine/hydroxychloroquine be shown to improve outcome we will of course use it.
[+] [-] gallexme|6 years ago|reply
[+] [-] ldng|6 years ago|reply
I ask because you say you tried but you're not saying what you've tried exactly. Please don't take it personally, It's just I which people would be much more precise when talking about this matter.
The study might very well be flawed and/or plain wrong. But there is also a lot of people misrepresenting it. Which does not help at all.
Also of note, the European study left out azithromycin and is only conduct on advanced cases.
Edit: In lower comments (for now I hope) a more detailed, and thus interesting, info in the comment's link : https://news.ycombinator.com/item?id=22793659
[+] [-] superfreek|6 years ago|reply
[+] [-] rurban|6 years ago|reply
[+] [-] capableweb|6 years ago|reply
"There started coming reports about suspicious serious side-effects than we first thought. We can't conclude it doesn't have strong side-effects, particularly from the heart, and the drug is hard to dosage correct. Also, we don't have any strong evidence that Chloroquine has an effect with [SIC] covid-19"
Reporter asks: "Har ni haft fall med svåra biverkningar?" "Have you had cases with strong side-effects?"
Answer: "– Inte som jag känner till i Göteborg, men det finns rapporterat misstänkta fall från andra kliniker." "Not as far as I know in Gothenburg, but there is reports of suspicious cases from other clinics".
> Alla sjukhus i Västra Götalandsregionen följer Sahlgrenskas exempel. Men de är än så länge ganska ensamma. På de stora sjukhusen i Stockholm ges fortfarande klorokin.
"All hospitals in swedish region follows Sahlgrensk's example. But they are currently pretty alone. They still give patients Chloroquine in the big hospitals in Stockholm"
Let me know with a reply if you want other parts translated, bit busy but can at least provide this for now.
[+] [-] wolfhumble|6 years ago|reply
A tiny little edit:
> Vi kan inte utesluta svåra biverkningar, framförallt från hjärtat
>We can't conclude it doesn't have strong side-effects, particularly for the health
. . . particularly for the health => particularly from the heart
[+] [-] bufferoverflow|6 years ago|reply
We need numbers.
[+] [-] robin_reala|6 years ago|reply
[+] [-] pdkl95|6 years ago|reply
> Lupus doc called me again expressing she wants me very isolated for the next 3 weeks especially because of my lungs and heart and no meds available. I never thought my lupus med would disappear. [...] Kaiser is refusing to give it to thier long term Lupus patients.
[+] [-] drone|6 years ago|reply
"Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post."
[0] - https://texags.com/forums/84/topics/3102444
[+] [-] panpanna|6 years ago|reply
"Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that."
Also
"Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. "
While
"worldwide 86% of covid 19 patients that go on a vent die."
[+] [-] ldng|6 years ago|reply
"We are also using Azithromycin"
Interesting. So it looks like it is the treatment they're advocating in Marseilles. And it does not work on ventilated patients (if I understood correctly).
[+] [-] smdz|6 years ago|reply
You can look up the severe symptoms here: https://medlineplus.gov/druginfo/meds/a682318.html
[+] [-] bufferoverflow|6 years ago|reply
If not very, I'd rather risk and take it, than have no option.
[+] [-] altacc|6 years ago|reply
[+] [-] ldng|6 years ago|reply
[+] [-] octocop|6 years ago|reply
[+] [-] ornornor|6 years ago|reply
Really troubling if that’s the only metric they go by to decide whether to administer a particular treatment or not!
[+] [-] yosoyubik|6 years ago|reply
(translated: https://www.translatetheweb.com/?from=&to=en&dl=en&ref=trb&a... )
[+] [-] Fiadliel|6 years ago|reply
The Danish Medicines Agency has a list of current and upcoming drug studies here: https://laegemiddelstyrelsen.dk/da/nyheder/temaer/ny-coronav...
It has no mention of any chloroquine trials in Denmark, but mentions an upcoming one for azithromycin and hydroxychloroquine:
"A Randomized, Placebo-controlled Double-blinded Trial Evaluating Treatment With Azithromycin and Hydroxychloroquine to Patients With COVID-19 N=226 patients with positive COVID-19 test/diagnosis during the hospitalization randomised to Azithromycin and Hydroxychloroquine or placebo".
It seems more likely that the news article is slightly inaccurate here, rather than the agency's information being outdated, but either is possible.
[+] [-] grezql|6 years ago|reply
they say they suspect some patients may have died because of the sideeffects and not the coronavirus in Sweden.
[+] [-] ornornor|6 years ago|reply
[+] [-] montalbano|6 years ago|reply
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552796/
https://www.sciencedirect.com/science/article/pii/S016383431...
[+] [-] firasd|6 years ago|reply
I think people responding to Trump's advocacy of this drug are making a mistake by saying things like "there are no randomized controlled trials for this application" and "patients with other ailments need this, so don't hoard it".
What really needs to be said is the plain facts: while doctors are trying out this medicine, there is no miracle cure. This disease causes different conditions in people that need to be addressed with different interventions.
As a layman I found this chart very enlightening about how the disease has various dynamics (inflammation, etc): https://imgur.com/a/seG2KFS
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] spzb|6 years ago|reply
New drugs for covid-19 are well advanced. Therefore, they have experimented with existing drugs, developed for other diseases.
Most commonly mentioned is the malaria drug chloroquine. A smaller French study that has shown positive results has spread like wildfire on social media and among others Donald Trump has declared that "Chloroquine will change the history of medicine".
Swedish doctors also began to give malaria medication to severely ill patients, despite the lack of controlled studies. ANNONS
- We did like everyone else and gave chloroquine to the patients in the beginning. There were test tube studies that showed that it had an effect on coronavirus and it was a drug we knew from the treatment of malaria, says Magnus Gisslén, professor and chief physician at the infection clinic at Sahlgrenska University Hospital / Östra.
But now he has made a complete reversal. Last week, all treatment with chloroquine was stopped against covid-19 in Sahlgrenska.
- There were reports of suspected more serious side effects than we first thought. We cannot rule out serious side effects, especially from the heart, and it is a hard-dosed drug. In addition, we have no strong evidence that chloroquine has an effect on covid-19.
The fact that some seriously ill covid-19 patients have acute heart problems has raised concerns that chloroquine may be harmful to some patients.
Have you had cases with severe side effects?
- Not as I know in Gothenburg, but suspected cases from other clinics have been reported. The hospitals in Stockholm continue to provide chloroquine
The risk of serious side effects, combined with the fact that there is still no evidence, ie controlled studies that show that the medicine is effective, is the basis for the decision. The French study that has become so mentioned does not give much to Gisslén.
- It does not meet any requirements that we place on how a study should be done. It has very low evidence value.
All hospitals in the Västra Götaland region follow Sahlgrenska's example. But they are still quite lonely so far. Chloroquine is still given at the major hospitals in Stockholm.
How do you see that you receive different care in different places in Sweden?
- We are receiving signals that several regions are about to stop giving chloroquine. I am very confident in what I have come up with and think that is how you should handle it. We cannot do experimental medicine. At least we need to know that we do no harm.
Several major studies in the world have been initiated on drugs that may help covid-19 patients. Magnus Gisslén believes that the first answers may come within a month.
- If it then turns out that chloroquine is good, then of course we should use it. But before that, we will not risk patients' health by giving it.
READ MORE: Rumor or facts about the new corona virus Poison Information Center: Very unpleasant side effects
Anna Myrnäs, chief medical officer at the Poison Information Center, has seen an increase in the number of questions from the health service regarding serious side effects of chloroquine.
"The risk we see from our side is that it is a preparation that has very unpleasant side effects, including sudden cardiac death," she says.
She confirms that there are signs that covid-19 patients have been harmed by the drug.
- We do not think that everyone who now prescribes this in the intensive care units is fully aware of how severe the side effects can be, especially in already seriously ill patients.
At Sahlgrenska, patients currently receive classic IVA treatment with oxygen, but no antiviral drugs.
- We might have made another assessment if covid-19 was a disease with very high mortality, for example 80 per cent dead, but now we can manage most people who are intensive care anyway, says Magnus Gisslén.
He is self-critical that he let himself be drawn into the chloroquine.
- In retrospect, I can regret that we did. We were a bit naive and thought the side effect profile was much nicer. I have changed my mind and hope that the rest of the country does too.
In Stockholm, the Södersjukhuset has also stopped giving chloroquine, this confirms chief physician Anders Håkansson in an e-mail:
"It depends on the combination of factors:
1. We have not seen any obvious positive clinical effects.
2. Potential risk of side effects.
3. Against this background, we would like to await the results of the controlled studies in other countries. "
[+] [-] lanevorockz|6 years ago|reply
[deleted]
[+] [-] ramblerman|6 years ago|reply
The knee-jerk reaction is yours.
[+] [-] rsynnott|6 years ago|reply
[+] [-] grey-area|6 years ago|reply
[+] [-] non-entity|6 years ago|reply
[+] [-] junipertea|6 years ago|reply
[+] [-] garyclarke27|6 years ago|reply
[deleted]
[+] [-] rsynnott|6 years ago|reply
Correlation, as always, is not causation. I don't see any indication that it's in particularly widespread use in SK, btw. Looks like they definitely experimented with it around the time China was promoting it, but their figures were already good at that point.
[+] [-] javagram|6 years ago|reply
[+] [-] ModernMech|6 years ago|reply
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] jamisteven|6 years ago|reply
[+] [-] javagram|6 years ago|reply
Someone still gets counted in the case numbers even if they are treated and recover.
I believe HCQ/CQ is also being used in Spain, France, and Italy, but there are still many deaths and a high CFR. It’s not a magic drug (there may or may not be some good effects from using it, and studies are ongoing), but some political leaders are touting it in desperation, while medical leaders are pointing out that scientific trials are ongoing to determine if it’s really working or not.
[+] [-] Jedd|6 years ago|reply
First, tell us why you claim India has this 'under control'?
According to John Hopkins stats[1] (as of 2020-04-06:2200+11) shows India (population 1,600m) with confirmed case count of 4,300.
Meanwhile Australia, who's been relatively slow to trace and test, population 25m, with confirmed case count of 5,800
It's possible these numbers reflect realities, but it's a hard sell.
> ... and are using Chloroquine almost exclusively for the treatment?
This is going to need some even better citations, especially if the implied claim is that they're almost exclusively using Chloroquine for treatment with great success.
[1] https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594...
[+] [-] bluGill|6 years ago|reply
My guess is doctors in India have experience with chloroquine because it is useful for malaria, something that Swedish doctors would not be expected to have experience with. If Swedish doctors spent 6 months reviewing all the knowledge India has they might be able limit side effects and see good results.
Remember, the first paragraph is the truth, but not helpful. The second is an educated guess, it seems likely but it may well be wrong.