Ok so I'm a Swedish intensivist working i Göteborg.
We currently don't use chloroquine/hydroxychloroquine in the treatment of Covid-19 because:
1. We tried it and have not noticed any obvious positive effect.
2. No serious study have been able to replicate the success of the first French (severly flawed) study.
3. Potential severe sideeffects.
Awaiting the completion of ongoing studies we are using other treatment protocols. Should chloroquine/hydroxychloroquine be shown to improve outcome we will of course use it.
Do you know about any treatment of chloroquine in combination with zinc to stop the replication of the virus?
Zinc to stop RNA copying , chloroquine to let zinc into the cells
You tested hydroxychloroquine only or complemented with azithromycin as recommended by "the first French (severly flawed) study" for early symptoms as a containment measure, not a cure ?
I ask because you say you tried but you're not saying what you've tried exactly. Please don't take it personally, It's just I which people would be much more precise when talking about this matter.
The study might very well be flawed and/or plain wrong. But there is also a lot of people misrepresenting it. Which does not help at all.
Also of note, the European study left out azithromycin and is only conduct on advanced cases.
Do you mean "containment" as in "halt/retard further development" or as in "halt/retard spread"? The former could be useful for high-risk individuals, the latter is probably only of mild interest (those that would be getting this are already in hospital containment, so it would be an attempt to increase health-care worker safety).
Assuming "the European study" and "the first French (severly flawed) study" are referring to the same thing, then that does indeed sound very broken: Recommending combination with azithromycin, and leaving it out themselves, leaves that recommendation without any value.
> – Det började komma rapporter om misstänkta svårare biverkningar än vi först trodde. Vi kan inte utesluta svåra biverkningar, framförallt från hjärtat, och det är ett svårdoserat läkemedel. Dessutom har vi inga starka bevis på att klorokin har effekt vid covid-19.
"There started coming reports about suspicious serious side-effects than we first thought. We can't conclude it doesn't have strong side-effects, particularly from the heart, and the drug is hard to dosage correct. Also, we don't have any strong evidence that Chloroquine has an effect with [SIC] covid-19"
Reporter asks: "Har ni haft fall med svåra biverkningar?" "Have you had cases with strong side-effects?"
Answer: "– Inte som jag känner till i Göteborg, men det finns rapporterat misstänkta fall från andra kliniker." "Not as far as I know in Gothenburg, but there is reports of suspicious cases from other clinics".
> Alla sjukhus i Västra Götalandsregionen följer Sahlgrenskas exempel. Men de är än så länge ganska ensamma. På de stora sjukhusen i Stockholm ges fortfarande klorokin.
"All hospitals in swedish region follows Sahlgrensk's example. But they are currently pretty alone. They still give patients Chloroquine in the big hospitals in Stockholm"
Let me know with a reply if you want other parts translated, bit busy but can at least provide this for now.
The submission title kind-of doesn't match with the article (name of hospital in the article but just "hospital" here on HN and side-effects is not mentioned in the article title at all), but the contents of the article does match with it's title.
Title is "Sahlgrenska stoppar behandling med malariamedicin mot covid-19"
Which means "Sahlgrenska (name of Swedish hospital) stops treatment with malaria-medicine against COVID-19", which is exactly what the article's content is about, and it goes further to look at other hospitals as well.
“Swedish region” here doesn’t mean “Sweden”, it’s Västra Götaland which is a biggish county, just nestling under the southern tip of Norway. Biggest city is Gothenburg, total county population 1.75 million.
No, I do know that, I just didn't want to try to translate Västra Götaland, but be my guest and I'll update my post :) In the meantime I'll update the comment to say Västra Götaland instead of `swedish region`.
Edit: ugh, too late to edit. Hope it got the point across at least, I notice now that HN hides the earmuffs (*) I added and made it italics, might be why the point didn't always go across.
For several weeks my mother hasn't been able to fill her regular prescription for hydroxychloroquine that has been an important part of managing her lupus for >30 years. The rush to use it against covid-19 is starting to harm some of the people that need the medication for other reasons.
> Lupus doc called me again expressing she wants me very isolated for the next 3 weeks especially because of my lungs and heart and no meds available. I never thought my lupus med would disappear. [...] Kaiser is refusing to give it to thier long term Lupus patients.
Likewise, on 3/25 a Dr. in New Orleans [0] also reported they were stopping using it as it wasn't helping and the side-effects were problematic.
"Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post."
I encourage every one to read the doctors post, it has tons of interesting information in it. Here are some extracts:
"Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that."
Also
"Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. "
While
"worldwide 86% of covid 19 patients that go on a vent die."
Interesting. So it looks like it is the treatment they're advocating in Marseilles. And it does not work on ventilated patients (if I understood correctly).
Chloroquine's severe side effects may look similar to acute pneumonia and ARDS. Even if it helps destroy the virus, it might be complementing to the severity
Chloroquine is an anti-malaria and it's side effects are so severe and common that many people would prefer to run the risk of malaria than take it. Adding these side effects to a Covid-19 patient seems like an extreme measure, given there's little evidence so far that it's beneficial, let alone enough to outweigh these side effects.
100s of million of people have taken it dayly over decades. And side effects generally happens when you've been taking the treatment for years for most people. And nowadays people take hydrochloroquine anyway. I've you taken it ? I have for ten years.
The head at Karolinska said that they used Chloroquine becuase everyone else did. They had reports of side-effects that were more severe than expected, so now they stopped using it all together.
It has no mention of any chloroquine trials in Denmark, but mentions an upcoming one for azithromycin and hydroxychloroquine:
"A Randomized, Placebo-controlled Double-blinded Trial Evaluating Treatment With Azithromycin and Hydroxychloroquine to Patients With COVID-19 N=226 patients with positive COVID-19 test/diagnosis during the hospitalization randomised to Azithromycin and Hydroxychloroquine or placebo".
It seems more likely that the news article is slightly inaccurate here, rather than the agency's information being outdated, but either is possible.
Readit News
We currently don't use chloroquine/hydroxychloroquine in the treatment of Covid-19 because:
1. We tried it and have not noticed any obvious positive effect. 2. No serious study have been able to replicate the success of the first French (severly flawed) study. 3. Potential severe sideeffects.
Awaiting the completion of ongoing studies we are using other treatment protocols. Should chloroquine/hydroxychloroquine be shown to improve outcome we will of course use it.
I ask because you say you tried but you're not saying what you've tried exactly. Please don't take it personally, It's just I which people would be much more precise when talking about this matter.
The study might very well be flawed and/or plain wrong. But there is also a lot of people misrepresenting it. Which does not help at all.
Also of note, the European study left out azithromycin and is only conduct on advanced cases.
Edit: In lower comments (for now I hope) a more detailed, and thus interesting, info in the comment's link : https://news.ycombinator.com/item?id=22793659
Assuming "the European study" and "the first French (severly flawed) study" are referring to the same thing, then that does indeed sound very broken: Recommending combination with azithromycin, and leaving it out themselves, leaves that recommendation without any value.
"There started coming reports about suspicious serious side-effects than we first thought. We can't conclude it doesn't have strong side-effects, particularly from the heart, and the drug is hard to dosage correct. Also, we don't have any strong evidence that Chloroquine has an effect with [SIC] covid-19"
Reporter asks: "Har ni haft fall med svåra biverkningar?" "Have you had cases with strong side-effects?"
Answer: "– Inte som jag känner till i Göteborg, men det finns rapporterat misstänkta fall från andra kliniker." "Not as far as I know in Gothenburg, but there is reports of suspicious cases from other clinics".
> Alla sjukhus i Västra Götalandsregionen följer Sahlgrenskas exempel. Men de är än så länge ganska ensamma. På de stora sjukhusen i Stockholm ges fortfarande klorokin.
"All hospitals in swedish region follows Sahlgrensk's example. But they are currently pretty alone. They still give patients Chloroquine in the big hospitals in Stockholm"
Let me know with a reply if you want other parts translated, bit busy but can at least provide this for now.
A tiny little edit:
> Vi kan inte utesluta svåra biverkningar, framförallt från hjärtat
>We can't conclude it doesn't have strong side-effects, particularly for the health
. . . particularly for the health => particularly from the heart
We need numbers.
Title is "Sahlgrenska stoppar behandling med malariamedicin mot covid-19"
Which means "Sahlgrenska (name of Swedish hospital) stops treatment with malaria-medicine against COVID-19", which is exactly what the article's content is about, and it goes further to look at other hospitals as well.
Edit: ugh, too late to edit. Hope it got the point across at least, I notice now that HN hides the earmuffs (*) I added and made it italics, might be why the point didn't always go across.
> Lupus doc called me again expressing she wants me very isolated for the next 3 weeks especially because of my lungs and heart and no meds available. I never thought my lupus med would disappear. [...] Kaiser is refusing to give it to thier long term Lupus patients.
"Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post."
[0] - https://texags.com/forums/84/topics/3102444
"Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that."
Also
"Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. "
While
"worldwide 86% of covid 19 patients that go on a vent die."
"We are also using Azithromycin"
Interesting. So it looks like it is the treatment they're advocating in Marseilles. And it does not work on ventilated patients (if I understood correctly).
You can look up the severe symptoms here: https://medlineplus.gov/druginfo/meds/a682318.html
If not very, I'd rather risk and take it, than have no option.
What makes you think it is an option, though? There's really very little reason to think it's useful at this point.
What is (was) your daily dose for these ten years?
Really troubling if that’s the only metric they go by to decide whether to administer a particular treatment or not!
(translated: https://www.translatetheweb.com/?from=&to=en&dl=en&ref=trb&a... )
The Danish Medicines Agency has a list of current and upcoming drug studies here: https://laegemiddelstyrelsen.dk/da/nyheder/temaer/ny-coronav...
It has no mention of any chloroquine trials in Denmark, but mentions an upcoming one for azithromycin and hydroxychloroquine:
"A Randomized, Placebo-controlled Double-blinded Trial Evaluating Treatment With Azithromycin and Hydroxychloroquine to Patients With COVID-19 N=226 patients with positive COVID-19 test/diagnosis during the hospitalization randomised to Azithromycin and Hydroxychloroquine or placebo".
It seems more likely that the news article is slightly inaccurate here, rather than the agency's information being outdated, but either is possible.