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What you need to know about the virus in China "2019 Novel Coronavirus (2019-nCoV)"

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Willem said:
It is prescribed here in the Netherlands but thus far it does not seem to of benefit. For a third of the patients its use had to be stopped because it degraded their cardiac performance.
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That is interesting to know, but it does bring up the question as to why so many people have been able to take it for so many years against malaria and not had this cardiac degradation. I suppose that could be because they were in overall good health.
 
MarcT said:
That is interesting to know, but it does bring up the question as to why so many people have been able to take it for so many years against malaria and not had this cardiac degradation. I suppose that could be because they were in overall good health.
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When I went to India in 2006 to work on the Jimmy Carter project they issued a prophylactic prescription without any questions.
 
MarcT said:
That is interesting to know, but it does bring up the question as to why so many people have been able to take it for so many years against malaria and not had this cardiac degradation. I suppose that could be because they were in overall good health.
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Those side effects are known since at least the early 80ies. This is precisely why Raoult (the guy who started that chloroquine debate in the west) has this in his protocol

Patients with no contraindications (Supplementary document 1) were offered a combination of 200 mg of oral hydroxychloroquine sulfate, three times per day for ten days combined with azithromycin (500mg on D1 followed by 250mg per day for the next four days). For patients with pneumonia and NEWS score≥5, a broad spectrum antibiotic (ceftriaxone) was added to hydroxychloroquine and azithromycin. Twelve-lead electrocardiograms (ECG) were performed on each patient before treatment and two days after treatment began. All ECGs were reviewed by senior cardiologists. The treatment was either not started or discontinued when the QTc (Bazett’s formula) was > 500 ms and the risk-benefit ratio was estimated to be between 460 and 500 ms. The treatment was not started when the ECG showed patterns suggesting a channelopathy and the risk-benefit ratio was discussed when it showed other significant abnormalities (i.e., pathological Q waves, left ventricular hypertrophy, left bundle branch block). In addition, any drug potentially prolonging the QT interval was discontinued during treatment. Symptomatic treatments, including oxygen, were added when needed. An ionogram and verification of serum potassium levels in particular, was systematically performed upon admission. When needed, standard blood chemistry was checked.
 
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PierreV said:
Those side effects are known since at least the early 80ies. This is precisely why Raoult (the guy who started that chloroquine debate in the west) has this in his protocol

Patients with no contraindications (Supplementary document 1) were offered a combination of 200 mg of oral hydroxychloroquine sulfate, three times per day for ten days combined with azithromycin (500mg on D1 followed by 250mg per day for the next four days). For patients with pneumonia and NEWS score≥5, a broad spectrum antibiotic (ceftriaxone) was added to hydroxychloroquine and azithromycin. Twelve-lead electrocardiograms (ECG) were performed on each patient before treatment and two days after treatment began. All ECGs were reviewed by senior cardiologists. The treatment was either not started or discontinued when the QTc (Bazett’s formula) was > 500 ms and the risk-benefit ratio was estimated to be between 460 and 500 ms. The treatment was not started when the ECG showed patterns suggesting a channelopathy and the risk-benefit ratio was discussed when it showed other significant abnormalities (i.e., pathological Q waves, left ventricular hypertrophy, left bundle branch block). In addition, any drug potentially prolonging the QT interval was discontinued during treatment. Symptomatic treatments, including oxygen, were added when needed. An ionogram and verification of serum potassium levels in particular, was systematically performed upon admission. When needed, standard blood chemistry was checked.
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Well, my understanding is that Raoult is claiming a pretty high success rate with his protocol, so the patients must have overall been able to tolerate the protocol. If not, that would indicate a miraculous recovery for a lot of the patients that has not been seen elsewhere.
 
scott wurcer said:
Probably, I certainly have no memory of the details.
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The main problem is a bit like with paracetamol (for other reasons) - paracetamol perfectly safe at small doses (say up to 3 grams per day), but letal at 20+ grams per day (OK, N-acetylcysteine has a good chance to help you there). Higher doses of chloroquine interfere with your internal pacemaker in many ways.

That is one of the issues with Raoult's study (there are many others): there are many (justified) exclusions to begin with for all kinds of risk factors. Fair enough, but there is a bit of overlap with those risk factors and the risk of death anyway, and risk of death of COVID. That is essentially preselecting patients in better shape in the chloroquine group, to begin with.

Then, it is very different from popping a pill as prevention or blind treatment of possible symptoms.
And yes, doctors all over the world have been trying hydroxychloroquine without miraculous results and with some incidents/deaths.

It is not a magic bullet.

And since we love graphs here, this is - potentially - your heart on an excessive dose of chloroquine (or if you have risk factors)

https://en.wikipedia.org/wiki/Torsades_de_pointes#/media/File:Torsades_de_Pointes_TdP.png
 
MarcT said:
Well, my understanding is that Raoult is claiming a pretty high success rate with his protocol, so the patients must have overall been able to tolerate the protocol. Otherwise, he has some explaining to do.
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Leaving aside all the other factors, yes, his patients were apparently able to tolerate the protocol because he excluded those who would not...

Edit: which is, I repeat, the whole point. Even if chloroquine was wildly successful, we would want to exclude all the patients at risk with a battery of test. Those are obviously not happening in self and random medication cases.
 
Reference Image:

US map (less Alaska) overlaid with European states...

1586145442988.png
 
Went to the beer and wine store for more sippin rye and they built a separate entrance that is separated from the main store. Customers don't enter the store they request their product at the window and pay by wireless interac. Adapting to the situation. This is going to become the norm for awhile.
 
Defensa [Spain] moviliza hasta otoño a decenas de sanitarios en la reserva
https://www.vozpopuli.com/espana/Defensa-moviliza-sanitarios-reserva-otono-brote_0_1342666939.html

Defense [Spain] mobilizes dozens of health workers in the reserve until autumn
https://translate.google.es/transla...itarios-reserva-otono-brote_0_1342666939.html

[ This is the first official finding that the Ministry of Defense extends its plans against the coronavirus until at least autumn. In recent weeks, it has mobilized dozens of military personnel in the reserve with a health specialty to rejoin the Armed Forces in September, October and November. Doctors, nurses and psychologists to deal with the pandemic for the next half year... ]

You know, the second wave seems inevitable and we have to prepare well this time.
 
Doodski said:
Went to the beer and wine store for more sippin rye and they built a separate entrance that is separated from the main store. Customers don't enter the store they request their product at the window and pay by wireless interac. Adapting to the situation. This is going to become the norm for awhile.
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I'd love to see it become "just the norm" forever, personally. I've long envied Japanese vending machine culture for so many staples (and at the same time been perplexed and mortified by some). This has nothing to do with COVID-19 specifically, but everything to do with a broad spectrum of infectious diseases which endanger millions each year. The unnecessary risk to both the public, and more specifically the (largely underpaid) employees of many stores, could be mitigated significantly without undue inconvenience to most.

Sure there are some things where interaction is both welcomed and necessary - but there are so many things where it is neither... and automation of the distribution of those items will reduce the number or cold and flu cases as well. Not to mention allowing anti-social vampires such as myself to get a dozen eggs, a nice can of bread, and some fresh-squeezed orange juice at 2am... when I'm most active. ;)

Certainly Amazon is performing most of this in an even more agoraphobia-enabling manner... but I'd greatly prefer to support independent local operators stocking machines, than further centralizing commercial distribution in the hands of a single mega-corporation. Especially one that can decide at any time to simply refuse shipping of anything considered "non-essential". No, I'm not saying my car polishes and tools should take precedence over medicine or staples, and I'm happy to wait the 3 months it's currently estimated. However, if I ran an auto-detailing business my family relied upon for income... I'd be a bit less understanding. Centralizing everything does have a few advantages... but it has even more disadvantages IMO.
 
digicidal said:
Sure there are some things where interaction is both welcomed and necessary
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Wowowow. The beer and wine stores here have hundreds of different spirits, many kinds of wine and huge stacks of beer. :D If they automate all that I might go back in business doing either electro-mechanical or mechatronics repairs again. :D The process engineers would have a great time of that too.
 
PierreV said:
The main problem is a bit like with paracetamol (for other reasons) - paracetamol perfectly safe at small doses (say up to 3 grams per day), but letal at 20+ grams per day (OK, N-acetylcysteine has a good chance to help you there). Higher doses of chloroquine interfere with your internal pacemaker in many ways.

That is one of the issues with Raoult's study (there are many others): there are many (justified) exclusions to begin with for all kinds of risk factors. Fair enough, but there is a bit of overlap with those risk factors and the risk of death anyway, and risk of death of COVID. That is essentially preselecting patients in better shape in the chloroquine group, to begin with.

Then, it is very different from popping a pill as prevention or blind treatment of possible symptoms.
And yes, doctors all over the world have been trying hydroxychloroquine without miraculous results and with some incidents/deaths.

It is not a magic bullet.

And since we love graphs here, this is - potentially - your heart on an excessive dose of chloroquine (or if you have risk factors)

https://en.wikipedia.org/wiki/Torsades_de_pointes#/media/File:Torsades_de_Pointes_TdP.png
Click to expand...
http://jdmichel.blog.tdg.ch/archive...tiles-et-comment-je-me-suis-gueri-305601.html
Another stunner from Geneva professor Jean-Dominique Michel who's been providing consistently high-level comment since the beginning of this mess. Michel doesn't mince words saying this will turn out to be a major public health scandal.
I keep reading over and over that Pr Raoult's protocol had been promised as a kind of "miracle cure", but Raoult NEVER claimed such or used such language. This is the language used by his detractors to paint him as a charlatan. Meanwhile I keep seeing blatantly dishonest media reporting completely misrepresenting his protocol and overall epidemiologic recommendations (re: testing and detection strategies in particular, which he formulated as far back as February). French authorities have initiated two studies purporting to verify Raoult's results, but with the wrong protocol, seemingly on purpose. Meanwhile some stats are posted daily by Raoult's institution (an organization with 800 staff, the largest in Europe of its kind).
1586162164535.png
 
Doodski said:
Wowowow. The beer and wine stores here have hundreds of different spirits, many kinds of wine and huge stacks of beer. :D If they automate all that I might go back in business doing either electro-mechanical or mechatronics repairs again. :D The process engineers would have a great time of that too.
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I'm thinking that's a fairly small number - and easily handled by a scaled down version of archival systems and warehouse logistics systems currently in use. Plus they're super fun to watch in action (if you're a geek, that is). :p
 
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