That's a little over 132x more expensive. Compared to other common medicines like ibuprofen ($0.04 in the developing world, $0.05 in the USA ), what makes chloroquine so uniquely pricey in the USA? (or, I suppose, ibuprofen so uniquely cheap?)
Chloroquine exists in a walled garden where pharmaceutical companies and the government have rigged it so that rent-seeking behavior is the optimal financial strategy.
Does anyone know if there's a lot of supply in hand and if it can be made in large quantities fast?
"FDA cannot assure the safety and efficacy of unapproved drugs" is the main excuse used in drug importation court cases.
France has stopped over-the-counter sales of Ibuprofen as of mid January.
"This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.
The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.
The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection. " 
There are also the brilliant MedCram updates, where the issue of ace inhibitors et. al just happened to be discussed yesterday. In it he describes the mechanics of ACE-i and ARB treatment: https://www.youtube.com/watch?v=1vZDVbqRhyM
But based on what we're seeing so far, it seems plausible that this virus prefers cooler northern climates. So hopefully it will turn out to be an unnecessary precaution.
Weather: Maybe 10 oF increases the doubling time 2x (steady-state reduction in exterior virus levels by 50%
per Pubmed 22312351, plus reducing time × concentration of people indoors).
I don't think a paper about SARS-CoV-2 and temperature has been written yet (that I've seen), but people are hoping it reacts like SARS-CoV. See here: https://www.ncbi.nlm.nih.gov/pubmed/22312351
Keep in mind, that doesn't mean zero cases in hot weather, just that it is less contagious.
Iirc, Maylasia has a pretty strong breakout on its hands. They recorded their first death today and are at something like 670 cases. I think their double rate was 2-3 days. Edit-it’s 1 day today. See link. Not good news I think for the hypothesis.
Certainly not the best citation, and I have no idea where GS gets their analyses, but seems plausible enough that I'm at least hoping there could be some truth to it. See e.g. India, the virus doesn't seem to have taken off there despite a few early cases.
If it's wrong, I fear things could get really bad, especially in heavily populated cities like Lagos.
Largest cities in Africa
Largest cities in USA
The Ebola virus " spreads to people initially through direct contact with the blood, body fluids and tissues of animals. Ebola virus then spreads to other people through direct contact with body fluids of a person who is sick with or has died from EVD". 
This thing is in the early stages still and there are already 7x more recorded cases than the largest Ebola outbreak.
Wuhan has temps around 50F-75F (~15C-22C). Certainty not hot, but not a cooler climate given how it's still winter in this hemisphere.
Italy and Spain aren't known for being especially cold either, mountainous areas notwithstanding.
To an extent that the French govt has officially released it as a statement. https://edition.cnn.com/2020/03/16/health/coronavirus-ibupro...
USA is famous for very high prices of essential medicines, and being an expensive country in general.
America doesn't have a lot of opportunities for foreign players, let alone in such militantly overregulated sector like medicines.
FDA rules make it expensive to start new production or enter from abroad, so a new manufacturer is in for as price war they will probably lose.
There are lots of super cheap prescription meds. Many for a penny a dose wholesale. They have robust competition but still make money at that price point, although some makers may be selling fraudulent drugs.
In theory, when the patent on a popular medication is over, new players should pull the price down to marginal cost. These days that is not happening for many products and I’d like to know why. Any economists know?
He made an interesting point. It appears infected people remain contagious for 3 weeks. Taking this drug allows to significantly reduce this period. The current advice for people who are sick is stay at home and only show up at an hospital if you start having respiratory problems. He thinks a better approach is to get them to get tested quickly, and take a combination of anti-viral drugs. This will likely result in less contagions.
 Adding slides link posted by chmike on this page: https://www.mediterranee-infection.com/wp-content/uploads/20...
 corrected contagiousness from 4 weeks to 3 weeks.
test everybody, if positive take the drug for 5 days, rest for 2 more and back to work you go. a win for everybody!
Chloroquine used to be taken daily in many of the tropical Britain colonies suffering from malaria.
chloroquine in the form of quinine is where the gin and tonic drink came from. Quinine mixed with carbonated water was drunk as a prophylactic.
The quinine tasted so terrible it had to be cut with something to make it tolerable - gin! That’s where gin and tonic came from - anti malaria treatment in the British colonies.
If you look at tonic water even today you’ll find quinine listed as an ingredient.
As a cheap, safe bet it’s not unreasonable to start having a g&t each day along with a zinc pill.
The more you know.
> In the United States, the US Food and Drug Administration (FDA) limits the quinine content in tonic water to 83 ppm (83 mg per liter if calculated by mass), while the daily therapeutic dose of quinine is in the range of 500–1000 mg, and 10 mg/kg every eight hours for effective malaria prevention (2100 mg daily for a 70 kg adult). It is often recommended as a relief for leg cramps, but medical research suggests some care is needed in monitoring doses. Because of quinine's risks, the FDA cautions consumers against using "off-label" quinine drugs to treat leg cramps.
For malaria prevention that's 25 liters of tonic or about about 200 gin and tonics per day.
Great news. I'll only have to cut down a little.
The amount of quinine in tonic water off the mixers shelf is definitely not enough to have a medical impact. The flip side of how bitter it is, is that you need very little quinine to get the flavoring. "Real" tonic water like brits drank in india or whatever is muuuuch more bitter than the stuff you get today.
Maybe if you drank tonic syrup straight.
It is even used as the normalizing reference index for a common bitterness index, at least according to Wikipedia.
> In capsule form it's not used much any more for malaria because the taste of the dust on the outside of the capsule made people throw up.
I would suspect that it is not used widely anymore for prophylaxis because there is chloroquine-resistant malaria parasites all over the (malarial) world.
The sell coated capsules, which are't bitter; these have been around for a while 
Yes, that and other reasons. Quinine used to be over-the-counter in the US; people took it for leg cramps. But they made it Rx-only in the 80s (or 90s; not certain) because it can have dangerous side-effects (including cardiac issues) in some people. It's kind of a nasty drug, but it's better than malaria. There are now better drugs for the conditions Quinine was used for.
Make that a zinc lozenge, though. Zinc works by coating the esophagus, and killing the virus on contact there. Zinc pills that you simply swallow don't work at all.
I recommend the nasty zinc supplements: they're cheap, pack a lot of zinc and you'll know when you feel them work. One bottle of 100 tablets 50 mg Zinc gluconate costs for $7 should last you through years of pandemics. In contrast a package of 25 Zicam sugary zinc lozenges costs $15.
I usually split or even quarter a 50 mg zinc tablet - they're that bitter. Don't take too much b/c they may dull sense of smell. Some people claim to have lost their sense of smell due to zinc overdosing. I usually don't take zinc but for this pandemic I've committed to an occasional nasty disgusting fragment of a zinc tablet each day.
Best is to lie down on your back and allow the zinc lozenge or zinc pill to dissolve in your mouth slowly so you can coat the epithelial cells in the mouth, throat and nose. You could gargle with the zinc and then swallow it.
In any case, swallow the zinc b/c that will allow it to be absorbed by the stomach and intestines and then move to your bloodstream, where it can deactivate some virus (more below).
But new virus production occurs inside each cell in the cytoplasm, and little zinc normally passes through the cellular membrane.
Chloroquine and other quinine compounds apparently "punch holes" in the cellular membrane and allow Zn++ ions to flood through. Once inside the cytoplasm Zn++ halts viral replication.
Tonic water has very low levels of chloroquine/quinine but it is by no means established that the full 500 mg chloroquin/day dose used for malaria is necessary to stop covid-19. Probably less, perhaps even far less, will create enough ionic "gateways" to move Zn++ through the cells' membranes. But, in any case, this requires adequate zinc as Zn++ in your system.
And the Zn++ on your throat will inactivate most viruses that land in your throat, nose and mouth anyway.
And I was glad to see it go out of use cos it caused crazy itching in many people.
Touching water was like pouring fuel on fire.
Anyway, even though I hated it, Chloroquine really worked while it worked.
Basically it was invented by the British to not die in India. We like to call it our national drink ;)
You're going to need more than one ;)
There isn't enough quinine in tonic water to benefit you and the alcohol is going to leach nutrients that your body needs, lower your white blood cell count, kill good flora in your mouth, lower your body's immune response, and leave you more susceptible to catching the virus.
You shouldn't present nonsense as fact, it doesn't help anyone, and in this case is actively dangerous.
The scientific studies being cited for these COVID-19 vaccines using Chloroquine specifically state zinc supplements by themselves are not ionized and are therefore useless for fighting the virus. Even though zinc entering cells is a key part of how it works, zinc can't enter the cells in question unless it's properly ionized, which is why they use Chloroquine... an ionized zinc delivery system... jumping to "lets all take some Zinc pills with gin & tonic" is irresponsible advice IMO.
These sorts of Naturopathy proposals is exactly how we got COVID-19 in the first place (ie, people eating Pangolins in east asia for Chinese medicine purposes - the most trafficked animal in the world - which just happens to be infected with a coronavirus that matches 99%+ to the one currently making the rounds).
This sort of weak adherence to a scientific approach to medicine + some vague historical reasoning is the problem, not the solution.
Also: Gargling a zinc/water solution has an astringent effect and removes the bacterial film in your throat, which seems to help in the initial phase of an infection.
There was a video of a doctor breaking down the biochemistry of it that got posted here the last time Chloroquine came up, which I can't find just now.
If it were only just as easy as taking zinc pills... I take vitamins daily already just to be safe (there's far more than coronaviruses floating around). I just don't expect them to be enough to prevent something as serious as COVID-19. There's a reason Chloroquine is being studied and not zinc by itself and is 100x more expensive to buy on the internet than zinc supplements, even before it became a meme. It's just not that simple.
That hasn't stopped naturopathy from spreading before though.
Given that the common cold without any treatment typically lasts around 5 days or so, it might point to some efficacy of the treatment.
I bought some cinchona bark (cut, but is powdery) and they have a recipe on the bag but no specification of strength or how much to drink.
Remember, it’s this kind of thing that brought us HIV so it could get even worse.
Please people, speak to trained medical people before reaching to the drug cabinet.
I am not a doctor. This advice is not meant to contradict the rule of only taking medical advice from medical professionals.
One of the most serious side effects is a toxicity in the eye (generally with chronic use). People taking 400 mg of hydroxychloroquine or less per day generally have a negligible risk of macular toxicity, whereas the risk begins to go up when a person takes the medication over 5 years or has a cumulative dose of more than 1000 grams. The daily safe maximum dose for eye toxicity can be computed from one's height and weight using this calculator. Cumulative doses can also be calculated from this calculator. Macular toxicity is related to the total cumulative dose rather than the daily dose. Regular eye screening, even in the absence of visual symptoms, is recommended to begin when either of these risk factors occurs.
woowza a Kg worth of drug !!! this doesn't look correct to me !
400mg/day for 5 years is 730 grams.
has a cumulative dose of more than 1000 grams
And the calculator they link out to gives the same number I calculated.
IMO we in the US need to take the coronavirus as a wake up call to stop ignoring the medical systems of other countries and admit that they might have something to teach us. We shouldn’t just assume the American medical system is always the best one.
That's absolutely meaningless, some countries are nuts. Just about anything gets sold over the counter somewhere. There's even countries where guns are sold over the counter.
Financial status deciding who gets health care is the ultimate death panel.
The US health care system is awful in all ways.
These medicines are not something you should take if you do not need them. "how dangerous can it really be" is pretty much why rule one exists. Not the least of which is, antibiotics are available over-the-counter in some countries, and this contributes to why antibiotics are not as potent as they used to be.
Restricting what people can buy because they might hurt themselves with it doesn’t work (because everything can be misused) and only creates problems because sometimes restricted things turn out to be really important.
(see rule one: this is not medical advice)
Managed to catch malaria in Hebei out of all places, during my first trips to China with my father.
Worst part is that it gives you weird dreams that puts you into a weird, almost bad trip head space.
An alternative proposed method of action for Chloroquine is that it binds to proteins created by sars-cov-2 (ORF3a, ORF10, ORF8). Those ORF proteins bind to heme (red in red blood cells), preventing oxygen from being transported -
David Sinclair based his tweets on this paper:
But most organizations are going with the Zinc theory of Chloroquine. So take Chloroquine with Zinc supplements (France, South Korea, China are doing clinical trials).
Here is a translation of a Chinese study intermediate results - no data was released, which makes some people sceptical:
Here is a great summary of available treatments used in different countries
Although untested in-vivo, many clinicians prefer hydroxycholorquine due to its superior safety profile - and 4X better efficacy in-vivo (not in humans, in cells). I tried ordering that last week when the paper came out, not sure if i will get it, though.
Chloroquine is kind of old news. There has been a lot of talk around Chloroquine, starting around 6 weeks or so ago - the UK banned export of it nearly 4 weeks ago https://www.pharmaceutical-technology.com/comment/parallel-e.... I managed to order some before that.
"Chloroquine Is a Zinc Ionophore"
I'll repost the paper posted as a top response then: https://www.sciencedirect.com/science/article/pii/S016635422...
I'll also note that chloroquine is very dosage sensitive and lethal when overdosed.
Additional possible drugs are alluvia, actemra. I think there's a study out for alluvia.
Things to avoid are aspirin (suspected basses on ) and ibuprofen (French govt recommendation).
Someone should come up with a summary page of the potential therapeutic drugs and their current state (suspected/in study/recommended)
Sorry for the brevity. On a phone.
The Medcram video shared elsewhere in this thread (https://www.youtube.com/watch?v=U7F1cnWup9M) does mention that hydrochloroquine is a relative of chloroquine and is also being administered in some places when chloroquine is not available (at a different dosage). They take pains to point out that they should not be administered at the same time as that can lead to a fatal complication, and also that chloroquine as a treatment overall has not been subjected to a rigorous medical study.
Maybe that'd ameliorate the <70 factor.
Apparently the possible utility of chloroquine was discoevered because SLE patients on it in China weren't getting Covid-19 during the outbreak.
It did. Since then they've done more studies, have started even more studies, and have deployed it en masse as a treatment. It's part of the official treatment recommendations in China, South Korea, Poland, and Italy. It's been described as a "cure" where it was used in Australia after Chinese patients demanded they be treated with it, and Australia is starting a nationwide trial. Pakistan had Bayer start up the closed production line and deliver 300,000 doses.
Chloroquine seems to work best if you start it within the first few days of infection. So if you are say the US and have widespread BS regarding testing and prevent people from getting it, by the time they are tested and their results back it's too late. There's no chance the US will come to their senses and start using or even producing this drug in time to help stop mass deaths. Some people bought animal grade chloroquine and are self treating, but all that supply is gone now for purchase. Doctors won't prescribe it in the US either, for their own reasons.
In China and South Korea you can get tested if you have symptoms and you can start treatment if you have symptoms. So we are seeing things turn around in both places because of this and other actions.
(Although given that we seem to have a fairly aggressive mortality curve, I'm not optimistic about this one).
Basically the goal is to allow zinc to get into a cell, it needs a helper to get inside the cell (a Zinc Ionophore). Apparently Hydroxychloroquine / Plaquenil (which you can buy here: InHousePharmacy.vu/p-1106-plaquenil-tablets-200mg.aspx or here easyshopping4health.com/buy-plaquenil-usa.html) is even more effective than Chloroquine.
Also see Medscape.com/viewarticle/736439 and https://www.ncbi.nlm.nih.gov/pubmed/32074550/ title: "Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies"
Quinolones like Chloroquine were used in malaria prevention for many, many years. they aren't used specifically against malaria anymore, because malaria adapted. But I always prefer a compound that can be manufactured easily and has been used by many many people over years.
Regarding Zinc Ionophores, the flavonoid Quercetin (which you can buy in many places) has been shown to rapidly increase labile zinc in mouse cells as well as in liposomes. Source: https://pubs.acs.org/doi/abs/10.1021/jf5014633
This Medcram video talks about Chloroquine and the others: https://www.youtube.com/watch?v=vE4_LsftNKM
Source for the similarities between chloroquine and quercetin?
Medical advice is given by doctors and other health professionals.
Treatment decisions are made by patients, those entrusted by patients to make decisions, or parents, guardians, or custodians who make decisions on behalf of patients.
I actually have more nuanced views on this. Doctors are not gods, and there are situations where patients have better medical knowledge than the doctor on an important issue. But based on what I've seen so far (including confidently spread misinformation on HN) I strongly suspect that numerically these cases are far outweighed by people with just enough knowledge to be dangerous. That's all am cautioning here.
does this mean it might be a good idea to be taking it regularly to keep from getting covid-19 from contact with surfaces with low concentration of the virus?
Of course, chloroquine is not a vaccine, it's not a tool to contain the spread of SARS-CoV-2. We need massive and rapid propagation of testing, and meaningful progress toward a vaccine.
" Chloroquine Is a Zinc Ionophore"
then it _is_ a tool to contain the spread of SARS-CoV-2 b/c it could also be used prophylactically. i.e., the virus can't replicate in the human cell if the cell already has adequate chloroquin + Zn++ present.
edit: might be able to do some acid-base work for better results.
I've seen no studies backing up the use of zinc for anything related to COVID-19. A search of pubmed for the terms 'covid zinc' or 'coronavirus zinc' show no papers referencing treatments. Same goes for medrxiv.
There are a lot of cold "treatments" involving the use of zinc in the way you suggest. I have even seen studies which support its use as a prophylactic to the common cold (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/) though that one makes no reference to a common side effect, particularly the way you recommend its use, which is loss of sense of smell.
Further, I haven't read anywhere about the mechanism of infection you propose for this disease. It is said to attack the lungs, liver and small intestine due to its furin cleavage site (https://www.biorxiv.org/content/10.1101/2020.02.10.942185v1).
Finally, I am nearly certain you are spreading bad information about how this treatment works. Chloroquine is provided after active symptoms present. The first few days of infection are asymptomatic for most patients, certainly the first 4-7 days, if not longer. There is no medical call for treatment until a patient presents symptoms, and your advice risks leading people to attempt to hoard this medication.
We agree that chloroquine is indeed cheap.
Citation requested, that cytokine storms are a common pathology associated with Covid-19.
Because (a) I haven't seen that in the literature, & (b) it's at odds with the published age-banded mortality rates.
Not common but very serious.
It’s like quicksand in 19th century pop culture.
This just isn't true. It maybe true for a subset of patients in some circumstances. To quote your first link:
Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome.
So quinine is indeed arguably the original “active” ingredient, sugar was second (to mask the flavor), and alcohol “let’s just pretend this isn’t happening” was third.
And do you mean 3-4 days from the appearance of symptoms or from the initial infection? From what I read, 3-4 days is not always long enough for someone to even know they have it.