
Swedish hospital suspends Covid-19 treatment with chloroquine - kasperni
https://www.gp.se/nyheter/g%C3%B6teborg/sahlgrenska-stoppar-behandling-med-malariamedicin-mot-covid-19-1.26236140
======
bobowzki
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.

~~~
ldng
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.

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](https://news.ycombinator.com/item?id=22793659)

~~~
arghwhat
Do you mean "containment" as in "halt/retard further development" or as in
"halt/retard spread"? The former could be useful for high-risk individuals,
the latter is probably only of mild interest (those that would be getting this
are already in hospital containment, so it would be an attempt to increase
health-care worker safety).

Assuming "the European study" and "the first French (severly flawed) study"
are referring to the same thing, then that does indeed sound _very_ broken:
Recommending combination with azithromycin, and leaving it out themselves,
leaves that recommendation without any value.

~~~
ldng
The alleged effect of the cocktail is to lower the viral charge of the
patient. With less viruses in the body, the patient is supposed to fight it
better and are much less contagious combined with early testing it would be
helping in preventing/retarding the spread. I suppose high-risk individual
would eventually get infected but with hospital less overloaded they would be
treated better.

No the European "big" study and the French very small study are not the same.
But they are not testing the same thing and can't possibly get the same
result.

Again, I'm not endorsing the French study, but I also know that the French
government and the famous doctor are not exactly of the same political color
and there is petty political in-fighting going on ...

------
capableweb
> – 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.

~~~
wolfhumble
Thanks!

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

~~~
capableweb
Indeed! Was rushing a bit and made a typo, thanks for catching that. Updated
the comment.

------
pdkl95
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.

------
drone
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."

[0] -
[https://texags.com/forums/84/topics/3102444](https://texags.com/forums/84/topics/3102444)

~~~
panpanna
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."

------
smdz
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

You can look up the severe symptoms here:
[https://medlineplus.gov/druginfo/meds/a682318.html](https://medlineplus.gov/druginfo/meds/a682318.html)

~~~
bufferoverflow
The question is how common they are compared to COVID-19.

If not very, I'd rather risk and take it, than have no option.

~~~
rsynnott
> than have no option.

What makes you think it is an option, though? There's really very little
reason to think it's useful at this point.

~~~
bufferoverflow
Multiple studies.

------
altacc
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.

~~~
ldng
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.

~~~
jaclaz
I believe daily (recommended) dosage is very different, if I recall correctly
500 or 600 mg per day for the (supposed) Covid-19 treatment.

What is (was) your daily dose for these ten years?

~~~
ldng
I don't recall exactly, but 250 mg Nevaquine (Chloroquine) would sound about
right.

I was merely responding to "many people would prefer to run the risk of
malaria than take it". It is simply not true. Even paracetamol at high dosage
can kill.

It is a very well know medicine. There are too many people repeating that it
is dangerous without understanding the actual context. So, sure, at very high
dosage for a very sick patient it can become dangerous. At low dosage on a
daily basis I would (and have) take it instead of "running the risk of
malaria".

Anyway, it is Hydroxychloroquine that is prescribed nowadays for malaria, so
not only the comment is spreading FUD but it is also not talking about the
right molecule.

Baseline, don't self-medicate based on what you read on internet and consult a
real doctor.

------
octocop
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.

~~~
ornornor
> The head at Karolinska said that they used Chloroquine becuase everyone else
> did.

Really troubling if that’s the only metric they go by to decide whether to
administer a particular treatment or not!

~~~
hkeide
This is pretty common in medicine. Consensus weighs heavier than actual
evidence unfortunately.

~~~
sekh60
I didn't know that. I could see that trend in the U.S., given how litigious
people can be about medical treatments and alledged malpractice by everyone
following consensus before research one can defend a treatment by saying it is
current best practice, everyone does it after all.

Do you think something like that happens?

~~~
hkeide
I haven’t considered that angle but I think it comes down to human nature
mostly. Trust in authorities seem to be our default mode of operation, and
critical thinking is not something that’s taught in med school or valued in
hospitals. Doctors are mostly not scientists. Ask your doctor to read a study
and they might read the abstract. Most have no ability to evaluate the quality
of a study

------
yosoyubik
It seems that Denmark is going to start using Chloroquine. See
[https://www.dr.dk/nyheder/indland/danske-forskere-vil-
teste-...](https://www.dr.dk/nyheder/indland/danske-forskere-vil-teste-
omstridt-malariamiddel-pa-corona-patienter)

(translated:
[https://www.translatetheweb.com/?from=&to=en&dl=en&ref=trb&a...](https://www.translatetheweb.com/?from=&to=en&dl=en&ref=trb&a=https%3A%2F%2Fwww.dr.dk%2Fnyheder%2Findland%2Fdanske-
forskere-vil-teste-omstridt-malariamiddel-pa-corona-patienter) )

~~~
Fiadliel
It is a trial, with 50% given "chloroquine" (according to the article).

The Danish Medicines Agency has a list of current and upcoming drug studies
here: [https://laegemiddelstyrelsen.dk/da/nyheder/temaer/ny-
coronav...](https://laegemiddelstyrelsen.dk/da/nyheder/temaer/ny-coronavirus-
covid-19/~/media/5B83D25935DF43A38FF823E24604AC36.ashx)

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
sideeffects are sudden heart stop (dont know the english word).

they say they suspect some patients may have died because of the sideeffects
and not the coronavirus in Sweden.

~~~
goodcanadian
Cardiac arrest is probably what you are looking for.

------
ornornor
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](https://news.ycombinator.com/item?id=22727359)
for all the drama around Dr Raoult.

~~~
threatofrain
Medicine has so much trouble with “good science” due to ethics. Random
selection and assignment with controls are obvious techniques of science but
it means not giving people medicine we suspect is interesting, or randomly
assigning potentially bad effects to people.

Double blind means the doctors and nurses who administer protocol won’t even
know or care about your medical history or context, let alone whether or not
they’re even giving you any medicine at all.

So even clinical, experimental studies which start strong tend to compromise
themselves after an initial impression of results.

------
montalbano
Two papers on chloroquine induced psychosis:

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552796/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552796/)

[https://www.sciencedirect.com/science/article/pii/S016383431...](https://www.sciencedirect.com/science/article/pii/S0163834313002089)

------
firasd
Here in India a Doctor has already died after taking this and having a cardiac
issue (which is one of the potential complications):
[https://www.indiatoday.in/india/story/coronavirus-in-
india-g...](https://www.indiatoday.in/india/story/coronavirus-in-india-
guwahati-doctor-dies-after-allegedly-taking-
hydroxychloroquine-1661535-2020-03-30)

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](https://imgur.com/a/seG2KFS)

~~~
ldng
Isn't Malaria present in India ? I would expect doctor there to be specially
aware of chloroquine.

~~~
firasd
Yup. It is apparently well known among medical practitioners here.

------
spzb
Google Translate of the article into English

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. "

------
jamisteven
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?

~~~
Jedd
> 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_.

[1]
[https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594...](https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6)

~~~
jamisteven
1\. India has a death rate of 2.22 per million people, this is one of the
lowest rates of any country in the globe. 2\. Not only are they using
Chloroquine but their government is so confident in the drug that as of
yesterday wont allow its export to other countries.

~~~
Jedd
> 1\. India has a death rate of 2.22 per million people, this is one of the
> lowest rates of any country in the globe. 2. Not only are they using
> Chloroquine but their government is so confident in the drug that as of
> yesterday wont allow its export to other countries.

I don't believe either of those points is valid or compelling.

'Death rate' ... is a highly ambiguous term.

Case Fatality Rate (or equivalent) is the measure of mortality (attributed to
the disease) per identified case. Obviously this metric can be easily hacked
-- test fewer people so you have fewer confirmed cases.

Infection Fatality Rate (or equivalent) is the measure of people we estimate
had COVID-19 and died from it, even if they weren't confirmed via testing. In
countries that have been very slow to test, this number is expected to be
relatively high, though not as frequently reported on.

It's very unlikely that IFR would vary significantly, absent significant
medical intervention, between races / cultures / locations / etc.

EDIT: Citing The Atlantic last month: "For one, India is still not testing
enough people, having conducted the fewest number of tests of any country with
confirmed cases of the coronavirus, at just 10.5 per million residents (South
Korea, by contrast, has conducted more than 6,000 tests per million
residents). "

As to the Indian government's confidence being high ... there's no shortage of
political hubris going around, and Modi's not immune.

I note that at the end of March "a $22.6bn economic stimulus plan [...] to
provide direct cash transfers and food handouts to India's poor."

This does not sound like something that anyone in India believes is 'under
control'.

[1]
[https://www.theatlantic.com/international/archive/2020/03/in...](https://www.theatlantic.com/international/archive/2020/03/india-
coronavirus-covid19-narendra-modi/608896/)

