
Hydroxychloroquine associated with less mortality in critical Covid-19 patients - drocer88
https://www.medrxiv.org/content/10.1101/2020.04.27.20073379v1
======
joshstrange
Interesting, I'm bullish on Hydroxychloroquine (not because of any political
reasons) but everything I've seen on it working has to do with using it as
early as possible (so as close as the onset of symptoms). This study appears
to have only administered it to critically ill patients which I would expect
to have less of an effect.

That said I'm not going to be mad that it appears to have worked for the
critically ill (something I have not seen anywhere else really). However, this
NOT a randomized-double blind, they say at the end they still need to do one
of those to be sure but a fatality rate of 18.8% (with HCQ) vs 45.8& (without)
and a p<0.001 is very good news if proven true. Remember this is a pre-print,
NOT peer reviewed.

It's interesting that we aren't seeing very many studies done with early HCQ
dosing. Antivirals like Tamiflu (for the flu) only really help if administer
very close to the start of symptoms showing up. We have seen a few Remdesivir
that specifically break out when the onset of symptoms was, I wonder why we
haven't seen the same for HCQ? Could it be the price difference between HCQ
and Remdesivir?

~~~
nrr
(Disclaimer: I'm not a medical professional, and I don't lay any claim to
being authoritative. This is mostly anecdotal.)

I suspect the difference in HCQ and remdesivir dosing studies mostly has to do
with the classes of drugs those are. One's an antimalarial, and the other's an
antiviral. There might be more of a priority to explore what existing
antivirals could have an effect. There could also be a sheepishness in wanting
to conduct those studies with HCQ given that we still largely don't understand
how it works.

That said, apropos HCQ being associated with less mortality in advanced cases:
As an antimalarial, it has some interesting immunosuppressive properties.
Notably, it's used as a treatment for lupus in order to temper or moderate the
kind of immune responses seen in those patients.

I imagine that there's possibly some sort of (fatal if left untended) immune
response that manifests in advanced COVID-19 that HCQ happens to keep down.
Writing as an asthmatic who's had his fair share of IV antibiotics to deal
with some truly gnarly bouts of pneumonia, acute respiratory distress syndrome
is no joke. Any little bit to keep folks off ventilators is truly helpful.

~~~
joshstrange
> There could also be a sheepishness in wanting to conduct those studies with
> HCQ given that we still largely don't understand how it works.

How it works in what way? We have been using it since 1955 and people take it
regularly. The risks are largely known. Remdesivir, on the other hand, is just
over a decade old and is a drug in search of a problem (it was not useful in
treating Ebola and I can't find any reference to it being used for other
treatments). Maybe I should say it's an R&D budget in search of recouping the
cost.

Look, I don't hate Gilead, in fact they make drugs to both treat and
preventive HIV/AIDS. The latter being something I've taken before. But
something about this all stinks.

~~~
giardini
joshstrange says> _" We have been using it since 1955 and people take it
regularly. The risks are largely known."_<

This.

Actually "we" (the Western World) have been using it [quinine and variants]
since the 17th century! And it is a fascinating story of political and medical
intrigue and skill. Without quinine derived from the bark of the Peruvian
cinchona tree, the British, Dutch et al could not have built their empires in
malaria-infested regions of the world:

"The global history of quinine, the world’s first anti-malaria drug":

[https://medium.com/@tcassauwers/the-global-history-of-the-
wo...](https://medium.com/@tcassauwers/the-global-history-of-the-world-s-
first-anti-malaria-drug-d1e11f0ba729)

There's are many books that discuss this history, among them:

"The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the
World" by Fiammetta Rocco

[https://www.amazon.com/Miraculous-Fever-Tree-Malaria-
Medicin...](https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicine-
Changed-ebook/dp/B0084WVECE)

"The Fever: How Malaria Has Ruled Humankind for 500,000 Years" by Sonia Shaw

[https://www.amazon.com/Fever-Malaria-Ruled-Humankind-
Years-e...](https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-
ebook/dp/B003R0LBT4)

There was apparently as much anguish between rival groups (Roman Catholics vs.
reformists) about cinchona bark (from which quinine was first extracted) in
days gone by as there is today between Democrats and Republicans on the use of
quinine's descendents, the sythetic drugs known as (hydroxy)chloroquines. It
has been said that Oliver Cromwell's death of malaria in 1658 was a result of
his refusal to take "Jesuit's bark" because of Protestant suspicion of
anything associated with Roman Catholics. Similarly today, Democrats may
choose to die refusing "the Trump cure" rather than accept the shame of
admitting even the possibility that HCQ/CQ might actually work against
Covid-19.

~~~
joshstrange
Wow, that is utterly fascinating, I might have to grab one of those books.
It’s not entirely surprising but I had not idea of all the history there. We
really are doomed to repeat it.

> Similarly today, Democrats may choose to die refusing "the Trump cure"
> rather than accept the shame of admitting even the possibility that HCQ/CQ
> might actually work against Covid-19.

One of my biggest fears. Trump just latched on to any good news to try and
rescue “the economy” but it just so happens it might turn out to be right. The
longer they wait the worse the blowback and higher the death count. Swallow
your pride and get more studies done on this! <he screamed into the void>

~~~
giardini
Problems that divide people politically and religiously have dominate man's
history, often subsuming all topics of discussion and slowing the development
of science. Note the reference to "the arrogance of sects [and] the hatred of
the parties" in the following paper, titled

"Products of the Empire: Cinchona: a short history" (well worth reading) at:

[https://www.lib.cam.ac.uk/collections/departments/royal-
comm...](https://www.lib.cam.ac.uk/collections/departments/royal-commonwealth-
society/projects-exhibitions/products-empire-cinchona)

 _" Despite “the promptness of its effect and its infallibility” which “made
it suspect for such a long time”, according to Ignace Vincent Voullonne
writing in the early 18th century, cinchona bark “finally triumphed over the
multiple reproaches that were heaped upon it … by ignorance, prejudice, the
arrogance of sects [and] the hatred of the parties.” The use of this “Popish
powder” had elicited considerable religious prejudice because of its
association with the Jesuits. As demand grew, however, lack of experience of
the bark, uneven consignments, incorrect identification, and the frequent and
deliberate pollution of the product by adding the bark of other trees, all
ensured the argument over its value was kept alive well into the 19th
century."_

Does anyone else see significant parallels to today's discussions of what
should be done, what is best, who is in charge, who supplies what, etc. in
regard to Covid-19 and it's potential cures and treatments? One might think we
have made little progress as a society in the intervening centuries!

