Nobody seems to be talking about the actual reason Chinese doctors found chloroquine (and HCQ) interesting and it has nothing to do with it's immunosuppressing effect:

1) Chloroquine (and HCQ) is a zinc ionophore: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/

2) Zinc seems to inhibit RNA polymerase of Coronaviruses in vitro https://www.researchgate.net/publication/47794995_Zn_Inhibit...

Their conclusion was that chloroquine could indeed allow zinc to enter the cell and then inhibit replication (and therefore that the treatment needed to be administered early).

Nobody seems to be talking about a very easy way to verify chloroquine (and HCQ) efficiency by just using the same method used in China:

Cross-check the list of patients infected with Lupus (lupus erythematosus) and with chronic HCQ treatment (they take it for years) with the list of known infected COVID19 patients.

In China (and specifically in Wuhan), this is how they (team of Dr Zhang Zhan) found out about the efficiency of HCQ. They noticed that there were no patients with chronic HCQ treatment for lupus (lupus erythematosus) infected with covid19. This was in peoples Hospital of Wuhan University (source: https://www.jqknews.com/news/388543-The_novel_coronavirus_pn...)

This alone would be enough to prove some efficiency even as prophyalxis (as they are advocating officially in India). This should be quite trivial to check with the current amount of confirmed infection.

These details were all explained in this medcram vid: https://www.youtube.com/watch?v=Eeh054-Hx1U

Nobody is going to point out that of the 11 patients, "8 had significant comorbidities associated with poor outcomes (obesity: 2; solid cancer: 3; hematological cancer: 2; HIV-infection: 1)"?

I don't even understand what the point of this study was except as a rebuttal to the prior study. I mean, if people thought the prior study was cherry picking results. I don't even know what I'd call this...

There's _some_ anecdotal evidence that it _may_ work if treated early. Hopefully there are some real studies that are being done on that.

A really excellent review, published today, of the current state of knowledge on HCQ: https://blogs.sciencemag.org/pipeline/archives/2020/04/06/hy...

Note this is by Derek Lowe of "Things I won't work with" fame, an extremely informative series about entertainingly dangerous chemicals.

And here's a new piece of candy for people who want to get their hopes up about a promising treatment: https://stm.sciencemag.org/content/early/2020/04/03/scitrans...

(h/t Helen Branswell of STAT news, who is very much worth following, who retweeted Timothy Sheahan)

I have no medical expertise, but there's something that is confusing me. From what I read, typically, you get the virus, then an opportunistic bacterium gives you pneumonia, and that's what you die from. But this study seems to be saying "someone else found these meds reduced the virus and we didn't". But the meds are more or less antibiotics, aren't they? So could the explanation simply be that while the virus is the same, the bacteria are not, in the two tests?

By the time it's severe, it's often too late: https://twitter.com/yishan/status/1244717172871409666?s=20

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I am not in any way qualified in the medical domain but these methods look similar to the other Study that was viewed as flawed that showed it did work. Seems there is no solid data either way.

If the patients have a zinc deficient they can make all the zinc channels they want, it won't matter.

It is one thing to inhibit the virus, but zinc is needed to reduce the over active immune response,

Wonder when the Indian Council of Medical Research will release more papers - there were a few patients who responded positively under their suggested treatment plan:

> “We used a combo of Lopinavir and Ritonavir drugs which are usually given as a second line of treatment for HIV with drugs meant for curing malaria and swine flu. We administered this line of treatment to a 70-year-old Italian woman, who had come as a tourist to Rajasthan, who tested positive and was being treated by us, as well as another Italian, who is 69-year-old,” said Dr Sudhir Bhandari.

> ... “The team of doctors under the leadership of Dr Sudhir Bhandari, Principal of SMS Medical College held consultations with the ICMR and tried a combination medicines given for malaria, swine flu (Tamiflu) along with drugs for HIV and it worked well. All three persons including the Italians were cured this way,” said Rohit Kumar Singh, additional chief secretary, health of Rajasthan government.

Source: https://www.nationalheraldindia.com/india/three-coronavirus-...

> ... The three persons who tested positive were administered a combination of 200mg Lopinavir and 50 mg of Ritonavir twice a day besides Oseltamivir and Chloroquine that are given to the swine flu and malaria patients.

> However, the doctors at the SMS Hospital warned that this was only an emergency treatment and the HIV medicines were used only as an emergency measure that could help in regaining normalcy.

Source: https://www.nationalheraldindia.com/india/covid-19-magic-med...

COVID-19 attacks hemoglobin and that is how it damages the lungs. With your hemoglobin unable to exchange oxygen with blood in the lungs, it causes terrible damage.

https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...

Chloroquine prevents the virus from affecting hemoglobin, or reduces the effect. This is also how Chloroquine treats malaria.

The problem with a study on severe cases is that the damage is already done and the hemoglobin is already compromised.

It is best to start treatment with chloroquine prior to reaching the severe stage. By the time you are severe you’ve gotten permanent lung damage and the immune system is in a race condition unable to keep up with the virus.

If you want to detour into tinfoil hat territory, you could posit that these studies on severe patients were designed knowing it would show low or no efficacy, because it’s too late to protect the patient’s hemoglobin.

Azithromycin slows ribosonal RNA replication in bacteria. It is unclear how it helps with a Covid.

Antivirals are much more promising for severe cases, but even they can’t heal ground glass in the lungs.

An in-vitro pre-print study ( https://www.biorxiv.org/content/10.1101/2020.03.29.014407v1 ) showed that administering Hydroxychloroquine only after Covid-19 infection is not helping much, while administering it both before the infection and after the infection gives great outcomes. They tried different administration modalities of HCQ to in-vitro infected cells: some cells got nothing (control), some got HCQ only before infection, some got HCQ only after infection, some got HCQ both before and after infection. THe cells that got HCQ only before or only after infection had just slightly better outcome than control (they appear as heavily infected), while cells that received HCQ both before and after contagion were in much healthier conditions. If that would be the same in vivo as in vitro, that would entail that it would be possible to use HCQ as prophylaxis, given that the patients never stop taking the drug. Of course the caveat is "IF that would be the same in vivo as in vitro", that they didn't (yet) tested.

https://abc7news.com/amp/coronavirus-drug-covid-19-malaria-h...

Not a study but just another anecdote. Using zinc this time round rather than azithromycin.

The lack of productive discussion around a potential treatment tells us more about our bad decision-making under anxiety conditions than it does about the efficacy or not of the medical proposal. Although I posted a preprint of the French micro-study to HN a few weeks ago when this first became a topic of discussion, I now regret doing so due to the subsequent public confusion and imho very irresponsible promotion of it as a harm-free prophylactic by Trump.

Prescribe it before it gets severe then.

n = 11?

Not very surprising given the quality of the studies that this fad is based on:

https://respectfulinsolence.com/2020/04/03/zelenko-smith-aba...

That's a long read, but it's pretty damning.

TL;DR: China says "hey, this stuff might work". French doctor conducts two very sketchy rapid-fire studies, then starts promoting himself on TV, including on Dr. Oz. No red flags there, right?

So a bunch of people who have medical conditions which actually respond to HCQ have lost access to it, for no benefit to anyone else.

Great.

Maybe don't let them get that severe? One can still starve after eating.

[IANAD] hydroxychloroquine is an immunosuppressant and shouldn't be combined even with vaccines ( https://www.medicinenet.com/hydroxychloroquine/article.htm#w... ), so using it when immune system is really fighting an infection may happen to be very antiproductive unless it is a case of COVID triggered cytokine storm (hyperinflammation) when such immunosuppressant is probably what you'd really want. May be it is a reason why in come cases of COVID it works and in some doesn't.

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

"However, in hyperinflammation, immunosuppression is likely to be beneficial. Re-analysis of data from a phase 3 randomised controlled trial of IL-1 blockade (anakinra) in sepsis, showed significant survival benefit in patients with hyperinflammation, without increased adverse events.8 A multicentre, randomised controlled trial of tocilizumab (IL-6 receptor blockade, licensed for cytokine release syndrome), has been approved in patients with COVID-19 pneumonia and elevated IL-6 in China "

Notable fact is that majority of the deaths of the second wave (the deadliest, which in addition to children/weak/elderly was also strongly hitting healthy 25-35 years old) of Spanish flu was due to cytokine storm.