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2019–20 Coronavirus Pandemic (COVID-19) Thread


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4 hours ago, SitTwizzle said:

Over-the-counter chloroquine would just help (for coronavirus) treating people under medical supervision until marketing authorisation for this particular use, because the prescribing doctors couldn't get or officially prescribe due to lacking MA for this use.

I never do self-medication for internal things, except a very, very rare (last was more than 10 years ago) 500mg paracetamol (and some vitamins and "food complement").

But also, patients with a known condition needing chloroquine, such as lupus, were used to buy it over-the-counter, following a more ancient medical prescription (in France, you cannot have a prescription for more than 6 months, and this is for recurrent ones, most patients seeing their doctor every year or even every other year, with the MD severe shortage we have). As everything was stopped, even medical "ordinary" appointments, without any warning, and the forbidding of over-the-counter chloroquine was not publicized, some people are already short of (medically prescribed but too old to buy some in a pharmacy) chloroquine for their lupus.

 

And YES, there IS now evidence of how useful chloroquine is against coronavirus, it IS being peer-reviewed, and the Professor who led the last trial is the most quoted infectiologist in the world.

I translate his message, I used DeepL and fixed.

https://www.mediterranee-infection.com/epidemie-a-coronavirus-covid-19/

Marseille, March 22d 2020

 

Covid-19 coronavirus epidemic

In the current context of the spread of the Covid-19 coronavirus epidemic on French territory and throughout the world.
In accordance with the Hippocratic oath we have taken, we are obeying our duty as doctors. We provide our patients with the best possible care for the diagnosis and treatment of a disease. We respect the professional standards and the most recently acquired data of medical science.

We have decided:
- For all febrile patients who come to us, to perform the tests for the diagnosis of Covid 19 infection;
- For all infected patients, many of whom, who have only mild symptoms, show lung damage on CT scans, to offer the earliest in the disease, as soon as the diagnosis :
- treatment with a combination of hydroxychloroquine (200 mg x 3 per day for 10 days) + Azithromycin (500 mg on the first day then 250 mg per day for 5 more days), as part of the precautions for use of this combination (with in particular an electrocardiogram on D0 and D2), and outside the MA. In cases of severe pneumonia, a broad-spectrum antibiotic is also associated.

We believe that it is unethical that this association is not systematically included in therapeutic trials concerning the treatment of Covid-19 infection in France.

 

 

 

 I have some serious concerns about the methodology of the French hydroxychloroquine/azithromycin study. 23% of the treatment group was excluded from analysis - 3 because they went to the ICU, 1 because they died, 1 left the study prematurely after improving, and 1 for an unknown reason. There were no ICU transfers or deaths in the control group.  The primary endpoint of the study was virological clearance, not a clinical outcome... but mortality and need for intensive care seem like a pretty important secondary outcome to explore, not to just say "lost to follow up." Children and pregnant women were excluded from the study despite no contraindications in those groups. The study arms were not randomly selected, the control group was made of patients with either an exclusion criteria for the treatment arm, or patients who refused the treatment arm.

 

Chloroquine and its derivatives have always looked promising in vitro for other viral infections, but unfortunately it's never been particularly useful in vivo. I don't think the evidence is there to routinely recommend its use, especially as it does have cardiac side effects. Also, in the US, we don't have enough medication to use it as a treatment for COVID-19 (and especially not a prophylactic treatment) and for those patients with lupus and rheumatoid arthritis for whom it has proven benefit.

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I personally don't understand the use of Azithromycin or any other antibiotics against COVID-19, in that the type of pneumonia patients develop (according to data from Italy) is not associated with any bacterial infection. COVID patients present with bilateral interstitial pneumonia * (as seen on diagnostic CT scans), a type of pneumonia caused by inflammation of the lungs, not by bacterial invasion. So unless Azithromycin does other things besides kill bacteria (or unless the virus has some bacteria-like biology (which would be an incredible first in the world of microbiology)), using it makes no sense at all. 

 

 

 

*Scroll down this article to see a translation of the information I took this fact from: 

https://www.weforum.org/agenda/2020/03/suddenly-the-er-is-collapsing-a-doctors-stark-warning-from-italys-coronavirus-epicentre/

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Chloroquine IS contraindicated for pregnant women as far as I know; and children eliminate the virus enough by themselves, there have been no mortality up to now and little to no intensive care, and they seem to keep the virus less too, so there is a reason to avoid them a treatment which can have secondary effects.

Lost to follow-up means the person was cured and left the premises for good, they were not jailed.

Yes, the objective is to lessen contagion and viral content.

Pr Raoult and his peers don't advise any prophylactic treatment with chloroquine! Only for contaminated people, who appear to have lung damage even with mild symptoms.

I really don't know US situation in terms of available amount.

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3 minutes ago, SitTwizzle said:

nd children eliminate the virus enough by themselves, there have been no mortality up to now and little to no intensive care,

That may be changing:

https://www.nytimes.com/2020/03/24/us/california-coronavirus-death-child.html

 

 

To sum up: we only have part of the picture about coronavirus. It's a bad idea to be making any assumptions about it at all. 

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4 minutes ago, rockstaryuzu said:

I personally don't understand the use of Azithromycin or any other antibiotics against COVID-19, in that the type of pneumonia patients develop (according to data from Italy) is not associated with any bacterial infection. COVID patients present with bilateral interstitial pneumonia (as seen on diagnostic CT scans), a type of pneumonia caused by inflammation of the lungs, not by bacterial invasion. So unless Azithromycin does other things besides kill bacteria (or unless the virus has some bacteria-like biology (which would be an incredible first in the world of microbiology)), using it makes no sense at all. 

 

 

Azithromycin have been chosen among antibiotics, for their "side" antiviral action. And basically, an antibiotic was added to the treatment because viral pneumonia frequently get also bacterial.

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Just now, SitTwizzle said:

Azithromycin have been chosen among antibiotics, for their "side" antiviral action. And basically, an antibiotic was added to the treatment because viral pneumonia frequently get also bacterial.

Prophylactic antibiotic use has its own drawbacks. All in all, this is not a treatment I would want my doctor to give me unless he was prepared to be at my side monitoring me every hour on the hour. 

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Just now, rockstaryuzu said:

Prophylactic antibiotic use has its own drawbacks.

Oh yes, it has been a plague in France from the 70s to the end of last century, the systematic prescription of antibiotics for benign viral infections "just in case".

I think here the case is different.

I understand this treatment need a two-day rather close monitoring, to detect any secondary effect of chloroquine. 2 electrocardiograms are included here, among others. (A close relative has lost part of his eyesight in two days of prophylactic chloroquine, decades ago, but his eyes were quite painful from the beginning and nobody had told him about the risk, and there was no monitoring at all.)

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27 minutes ago, SitTwizzle said:

A close relative has lost part of his eyesight in two days of prophylactic chloroquine, decades ago, but his eyes were quite painful from the beginning and nobody had told him about the risk, and there was no monitoring at all.

exactly my point. 

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1 hour ago, SitTwizzle said:

Chloroquine IS contraindicated for pregnant women as far as I know; and children eliminate the virus enough by themselves, there have been no mortality up to now and little to no intensive care, and they seem to keep the virus less too, so there is a reason to avoid them a treatment which can have secondary effects.

Lost to follow-up means the person was cured and left the premises for good, they were not jailed.

Yes, the objective is to lessen contagion and viral content.

Pr Raoult and his peers don't advise any prophylactic treatment with chloroquine! Only for contaminated people, who appear to have lung damage even with mild symptoms.

I really don't know US situation in terms of available amount.


I’m an obstetrician. Hydroxychloroquine is not contraindicated in pregnancy, it is one of the preferred meds for lupus in pregnancy, at least in the US. I’ve read the study, not sure why you’re insisting that lost to follow up means they got better and left - I’m literally just reporting why those patients were not included in the final analysis, which was only due to clinical improvement in one of the six. And we do not have enough medication for everyone who is diagnosed - it is currently in such a shortage that prescriptions are being heavily scrutinized.

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2 hours ago, river said:


I’m an obstetrician. Hydroxychloroquine is not contraindicated in pregnancy, it is one of the preferred meds for lupus in pregnancy, at least in the US. I’ve read the study, not sure why you’re insisting that lost to follow up means they got better and left - I’m literally just reporting why those patients were not included in the final analysis, which was only due to clinical improvement in one of the six. And we do not have enough medication for everyone who is diagnosed - it is currently in such a shortage that prescriptions are being heavily scrutinized.

Well, there seem to be new data, and in France at least, the MA have been modified in 2018 : no breastfeeding, and contraception prescribed up to 8 months (half life : 30 to 60 days) after use because there is now evidence of genetic mutations and chromosomal damage, and that the molecule passes in milk (and by placenta).

https://www.vidal.fr/actualites/22940/nivaquine_chloroquine_contre_indication_pendant_l_allaitement_et_contraception_efficace_chez_les_adultes_en_age_de_procreer/

We have a chloroquine plant but it went under administration after the cease of over-the-counter sale. It still produces though. I have no idea of industrial processes in pharmacy, so I don't know if production could start from units usually producing other medicines, nor of the availability of raw substances. Building new plants would be nonsense, I think.

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7 hours ago, SitTwizzle said:

 

Well, there seem to be new data, and in France at least, the MA have been modified in 2018 : no breastfeeding, and contraception prescribed up to 8 months (half life : 30 to 60 days) after use because there is now evidence of genetic mutations and chromosomal damage, and that the molecule passes in milk (and by placenta).

https://www.vidal.fr/actualites/22940/nivaquine_chloroquine_contre_indication_pendant_l_allaitement_et_contraception_efficace_chez_les_adultes_en_age_de_procreer/

We have a chloroquine plant but it went under administration after the cease of over-the-counter sale. It still produces though. I have no idea of industrial processes in pharmacy, so I don't know if production could start from units usually producing other medicines, nor of the availability of raw substances. Building new plants would be nonsense, I think.


I don’t speak French, but even this link says that chloroquine is acceptable for use in pregnancy for anti-malarial prophylaxis if Google translate is right. I can find no information in English to back up your assertion that chloroquine and hydroxychloroquine are contraindicated in pregnancy, and several sources stating that they are appropriate for certain conditions in pregnancy. (CDC, WHO). I can certainly tell you that it is recommended practice in the US to continue hydroxychloroquine (which was the drug in the study, not chloroquine) in pregnant patients with lupus. Therefore, it is critical that pregnant patients be included in these studies - the physiology of pregnant women is so different that it can be misleading to generalize results from non-pregnant patients, and I could certainly use the clinical guidance as COVID-19 becomes more of an emerging issue where I live.

 

Sorry, we’re getting off topic here. But the unnecessary exclusion of pregnant patients from clinical trials is clearly a sore spot for obstetricians, self included.

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11 hours ago, river said:


I don’t speak French, but even this link says that chloroquine is acceptable for use in pregnancy for anti-malarial prophylaxis if Google translate is right. I can find no information in English to back up your assertion that chloroquine and hydroxychloroquine are contraindicated in pregnancy, and several sources stating that they are appropriate for certain conditions in pregnancy. (CDC, WHO). I can certainly tell you that it is recommended practice in the US to continue hydroxychloroquine (which was the drug in the study, not chloroquine) in pregnant patients with lupus. Therefore, it is critical that pregnant patients be included in these studies - the physiology of pregnant women is so different that it can be misleading to generalize results from non-pregnant patients, and I could certainly use the clinical guidance as COVID-19 becomes more of an emerging issue where I live.

 

Sorry, we’re getting off topic here. But the unnecessary exclusion of pregnant patients from clinical trials is clearly a sore spot for obstetricians, self included.

No, they just warn that another official site (CRAT) was not up-to-date when they published this alert, and still allowed it during pregnancy at doses as low as possible; and that this alert had not reached another medicine, SAVARINE, though this contains the molecule.

I am sorry, I haven't searched yet the original survey(s) which prompted such warning.

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Tokyo achieved a new height in no. of new cases today (41), surpassed Hokkaido to be the hottest spot of nCoV in Japan. Geez thanks God no more Olympic :knc_brian3:

Edit: And what they're doing:

 

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I am kind of hopeless of my government. Today, Tokyo had 63 cases and Chiba had 58 but they didn't declare any specific policy and are just repeating "don't go outside if it is not really needed, don't gather, don't stay in the packed room" etc. Abe held press conference tonight but my impression was that he cared more about economy while a lot of us feel today was the best timing for declaration of a state emergency to prevent the country from entering the worst scenario. But we have to go to work taking trains and buses from Monday as if nothing has happened. I mean, can we all just stop working and staying at home at least for a week? And schools are about to start in like two weeks, but I say no way in Tokyo. Sorry if I sound annoying to you since I know many people around the world want to go out and work now, but I have reached the point that I don't want to go anywhere and want to stop working to protect my parents who live with me.  

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My mother is still insisting on running all over town, getting groceries and haunting Home Depot for weedkiller ( there's still snow in her yard!!!) 

 

She finally confessed yesterday that she's afraid of food shortages. Apparently she's more afraid of that than the virus...:headdesk:

 

Pray for me

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