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Comment by m0zg | Hacker News Reader

Counterpoint: http://www.leparisien.fr/societe/sante/chloroquine-ne-perdon...

You can do double blind studies until your patients are literally blue in the face, or you can try what works now. That is literally the choice at the moment.

According to Peter Navarro, a good percentage of NYC patients are getting HCQ at the onset of symptoms now. Cuomo wants more of it, because it "appears to be working". Oklahoma is giving it to patients, too (https://www.news9.com/story/41972631/state-secures-possible-...), as does LA (https://twitter.com/ABC7/status/1246998628331163649). Italy saw its numbers of deaths stabilize once they started giving it. Marseille (where Raoult's hospital is) has the lowest fatality rate in all of France. If it works, we should see the recoveries shoot up in 5-7 days.

HCQ is also available _over the counter_ in some countries, and is given out like candy all over Africa where there's risk of malaria.

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Substantial numbers of C19 patients are being given HCQ in C19 trials, but more than that, substantial numbers of newly-diagnosed C19 patients are already taking HCQ, since it's part of the standard of care for widespread conditions like rheumatoid arthritis. And those patients will of course have had the HCQ intervention before acquiring C19, not late in the course of their illness. It doesn't look like anyone is reporting unusual clinical success for those patients, while you can find clinical reports of QT disturbances (so: people are paying attention to this stuff).

Dosages for arthritis are pretty low, though.

Based on my experience, the standard dosage for rheumatoid arthritis is 400 mg/day vs 600 mg/day for COVID-19. To start with, anyway. I opted for 200 mg/day, and my rheumatologist concurred.

Dang. 400mg made me freak out. I have to take half that and can barley tolerate it.

Works great for my autoimmune condition.

What symptoms from it do you have?

I can only stand it at night.

Like drinking a double sized energy drink.

If I take it at night, I will toss and turn all night. Also a lot of vivid dreams.

>> a lot of vivid dreams

Remarkably, zinc sports supplement ZMA has the same side effect.

Looks like the C19 dosages are comparable to the standard arthritis dosages?

“You can do double blind studies until your patients are literally blue in the face, or you can try what works now.”

https://en.wikipedia.org/wiki/Politician%27s_syllogism

Linking to wikipedia articles about logical fallacies isn't a debate tactic.

That's debatable.

https://en.wikipedia.org/wiki/Rimshot

> Kentucky is giving it to patients, too.

Source?

> Italy saw its numbers of deaths stabilize once they started giving it.

It appears the total number of cases also decreased. Which would suggest effect is likely due to social distancing.

> Marseille (where Raoult's hospital is) has the lowest fatality rate in all of France

Source?

The fact that you can buy the drug over the counter doesn't mean it's universally safe. The people being hospitalized here are already doing poorly so exposing them to additional risk is not something you should just do on a whim. As the linked post mentions, there are clear signs of potential risks associated with the use of HCQ. I hope for the patients being dosed with it now that it both works and is safe, but it's incredibly reckless to go 'it's over the counter so it's fine'. A healthy person taking a reasonable dose as a malaria countermeasure is not the same as a person on a ventilator in the ICU. Their immune system is in a different condition, so is their heart.

> A healthy person taking a reasonable dose as a malaria countermeasure is not the same as a person on a ventilator in the ICU.

Well I don’t think a person on a ventilator is in any position to self medicate, a doctor who presumably knows what they’re doing would be the one to direct the course of treatment. What’s the problem with that? There’s literally no “established” treatment for Covid 19 other than “hope we can keep you alive long enough for your immune system to beat it”, so under a doctor’s care I really don’t think there’s a lot of downside to trying to establish the efficacy of certain drugs in lieu of a long trial process.

Is it being used as a treatment for those already on a ventilator? My impression is that it is being used as a way to help prevent patients from getting to the point of needing a ventilator.

I should have been more precise - even if you're not already on a ventilator, your respiratory system is under some stress that isn't going to be equivalent to the experience of most people taking HCQ under normal circumstances. There are also various reports of COVID stressing the heart which is another potentially scary thing that could change the safety of the drug.

As Derek notes in the article, "Many people are saying that perhaps it will work best if taken early in the course of infection" - so at that point your lungs and heart are probably doing great, so the risks aren't quite as severe if we're talking about early intervention... but in the event that it doesn't help and your condition worsens, now you've got HCQ in your system getting up to its side effect business while the virus goes to town on your cells.

Ultimately if a doctor is prescribing this stuff as an early preventative measure or attempting to use it to help patients who are in bad shape, best of luck to them - I hope it works. But it's really depressing to see laymen telling each other that it's safe to just take this drug.

> doesn't mean it's universally safe

_Table salt_ is not safe. Eat 100 grams of it and you will die. This does, however, mean that it's not as "dangerous" as the mainstream press wants you to believe. It's a 50 year old drug used all over the world. If it was "deadly", we'd know it by now.

CDC itself recommends taking it _as a prophylaxis_ when heading to the areas where malaria might be present: https://www.cdc.gov/malaria/travelers/drugs.html

This drug is not administered to everyone though. It's only been tested and verified for people with I believe lupus and malaria. So we don't know the implications of rolling it out to millions of people worldwide.

That's why you do clinical trials.

> So we don't know the implications of rolling it out to millions of people worldwide.

It’s 70+ years old. It’s a well-understood drug. It’s an experimental treatment, not an experimental medicine.

It’s also frequently prescribed to grandmas with rheumatoid arthritis.

Being 70 years old and widely prescribed does not mean the function and associated risks of the drug are well-understood. I literally saw a physician mention today in a video ( https://www.youtube.com/watch?v=ILowf7Tw7QY ) that the exact mechanisms at work here are not fully understood. He explained a half dozen different things HCQ/CQ might be doing in this scenario that are all biologically plausible based on what we believe we know.

HCQ/CQ aren't unique in this either. Lithium is widely used as a psychiatric treatment and has been in use for a long time even though for most of that time period we haven't had a good detailed understanding of how exactly it works. Gaps in understanding like that can lead to disaster unless we apply enough caution to match.

Another way to put this: We know some things the drug does, but that doesn't mean we know the complete set of what it does. We know some of the side effects and some of the risks, but unless we have a complete end-to-end understanding of everything happening here there is always going to be a risk worth considering.

> It’s a well-understood drug

For treating the issues it was designed for. Not for treating COVID-19.

You could technically say that about Tylenol, but I doubt there’d be anyone jumping up and down about how dangerous it would be for a Covid 19 patient to take 500mg of it daily as part of a treatment regimen. There’s literally NO drugs approved specifically for Covid 19, but there are drugs, like HCQ, which are promising and well-understood in general.

Tylenol is an odd choice of example here given that it poses a risk of liver damage and for some subsets of the population it's actively dangerous to take it. We literally lace some drugs with Tylenol to make them "abuse-deterrent" because we know taking too much of it would harm you.

500mg of Tylenol daily poses a risk of liver damage?

Listed contra-indications for tylenol include:

    caloric undernutrition

    acute liver failure

    liver problems

    severe renal impairment

    a condition where the body is unable to maintain adequate blood flow called shock

    acetaminophen overdose

    acute inflammation of the liver due to hepatitis C virus

Obviously doctors are experts and will make the right decision based on risks and advantages, but tylenol is a poor choice of example for 'effectively risk-free drug'. I've seen multiple people mention that their meds are laced with it even though it's contra-indicated for them

But would Tylenol at 500mg daily be a good choice? That's what parent was giving as an example, not your overdose contra-indications.

We treat COVID-19-like illnesses with Tylenol all the time. We do not use HCQ in the same way.

I think we can all intuitively see the distinction in risk tolerance between table salt consumption and HCQ consumption.

> I think we can all intuitively see the distinction in risk tolerance between table salt consumption and HCQ consumption.

Good thing we have doctors that can decide the best course of treatment via HCQ then.

I completely agree.

> Good thing we have doctors that can decide the best course of treatment via HCQ then.

Except in New York.

Asked about the progress of the trials at his daily press briefing, Cuomo noted that state officials have allowed use of the drug hydroxychloroquine in combination with the antibiotic Zithromax in hospitals “at their discretion.” He said the federal government would increase supplies to New York pharmacies, but that New York has imposed a 14-day limit to protect the supplies for people who rely on it to treat other medical conditions. [1]

It would suck to be one of the 200+ people dying daily [2] who didn't have a chance to try this combination to save their life because of a 14 day limit.

1. https://thehill.com/homenews/state-watch/491358-cuomo-use-of...

2. https://news.ycombinator.com/item?id=22805612 and https://news.ycombinator.com/item?id=22787800

Now try to estimate the risk of _not_ consuming HCQ when you have C19 symptoms. Armchair virology and statistical studies are fun right up until the moment you get dry cough and shortness of breath.

You mean, like, that I'll have an infarction because of Q-T disruption, probably won't do anything to ward off C19, and, if I'm dosing it "over the counter" "like candy", might not have even had C19 in the first place? Seems like I can distinguish the risks between that and table salt too.

> Peter Navarro

An economist with zero medical background who from media reports is fighting against Fauci on this issue.

Any hint of a cure will be taken by people as a reason to ignore social distancing and stay at home rules. Which will directly cause an uptick in cases and deaths. Hence we need to be very, very sure that any cure is a real one.

Opting to listen to Navarro over Fauci is a very odd choice.

Look, I get that certain discussions on this damn site resist dragging politics into it all, but this is pretty important: Navarro has nowhere near the qualifications that Fauci does and there is no reason to listen to him on this.

You're contributing to a larger problem with misinformation at a time when it's not needed. Listen to the medical professional, not the economist.

I think he's just relying on Navarro's reporting that HCQ is being used in NYC, which, it clearly is; it looks like it's being tried all over the place. You can probably safely quote administration officials on something that simple. If he quoted Navarro saying HCQ was working, that would be problematic, especially because it doesn't seem to be working.

I don't interpret the comment that way, but more power to you if you do.

Going on to note these places where it supposedly work(s|ed) is indirectly bolstering Navarro's status in a discussion where he shouldn't be involved, and more or less implying that it does work when it clearly isn't working as described.

> or you can try what works now

If you don't do studies, how else do you know if it works? Or what dosage? Or when to administer? Or downsides?

Any drug with a high efficacy should be seen in small sample sizes.

E.g. As a sample size of one, I know that consuming alcohol has a relaxing effect. And that's highly testable, one I wouldn't mind participating in.

If n=11 and there was no deviation from the normal expectation, it's possible that there was some undetectable effect, but it's far more likely there was no effect.

Yale School of Medicine is onboard with HCQ as well. I guess they're total schmucks over there, nowhere close to the genius of Derek Lowe, who's not even a doctor. /s

Why can't you people admit that Trump was right?

https://files-profile.medicine.yale.edu/documents/7801c631-3...

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