S4to911

I tend to agree with this, though I'll repeat what I said earlier in this thread:

HCQ is relatively non-toxic. I say relatively, since we need to worry about drug interaction with QT prolongation.

As an aside, with G6PD deficiency (very common in Italian men) there is a higher incidence of hemolytic anemia with HCQ, and for this reason it is my understanding not used for malaria prophylaxis (or autoimmune disease and RA) in Italy that commonly. Could this be the reason for the higher death rate from COVID 19 in Italy than the rest of the world? Just a thought--not necessarily true, but just a thought.

Given that it is not that toxic, could be prescribed today (and is), I think HCQ is reasonable to give to COVID 19 patients with progressive symptoms at the dose recommended by the South Korean guidelines. When the randomized trials announce shortly, we can always stop if there is no benefit shown.

In terms of prophylaxis, my guess is that these trials will be rushed to announce preliminary data within 4-6 weeks, but that will likely be a bit late as the first wave of the virus may have passed through (with fewer deaths hopefully than projected, since in a lot of countries the recovery rate is starting to exceed the death rate, and has anyone noticed that). Hopefully it will work, and we will have another tool to suppress future outbreaks in addition to herd immunity.

I'd love to hear my colleagues thoughts on this, a Porsche 992 forum, and I'd glad for the discussion .

pitt911

HCQ is a very benign medication , only concern with short term use is skin rash which can be severe requiring short term medium dose steroids. It classically happens 3 weeks, to the dot, after start of HCQ
also some patients report some mild insomnia but not a big deal .
My classmates are allover the world , and I am hearing some anecdotal reports about HCQ helping
my patients are getting concerned that this will lead to shortages , so hope every one will be careful with use and production will ramp up

S4to911

There is so much of this drug (it is over the counter in a lot of the world) that hopefully we will have enough.

AKSteve

I just read an article about how countries that have malaria just aren't getting the virus at the moment. It included a quote from a post by Dr. Roy W. Spencer:

"WOW.

On the subject of using antimalarial drugs for COVID-19 treatment, I've compared COVID-19 cases versus malaria incidence by country....

This is amazing. I downloaded all of the data for 234 countries, incidence of total COVID-19 cases (as of 3/17/2020) versus the incidence of malaria in those countries (various sources, kinda messy matching everything up in Excel).

RESULTS, Multi-country average malaria cases per thousand, COVID-19 cases per million, in three classes of countries based on malaria incidence:

Top 40 Malaria countries: 212 malaria = 0.2 COVID-19;
Next 40 Malaria countries: 7.3 malaria = 10.1 COVID-19
Remaining (81-234) countries: 0.00 malaria = 68.7 COVID-19

Again, the units are Malaria cases per thousand "population at risk", and COVID-19 cases per million total population.

In all my years of data analysis I have never seen such a stark and strong relationship: Countries with malaria basically have no COVID-19 cases (at least not yet)"

S4to911

I saw this last night. Not quite sure of what it means, but it supports the HCQ hypothesis, for now. There are lots of other reasons for there to be low COVID 19 cases (low reporting of numbers, misdiagnoses, etc). The death rate from COVID 19 in a few weeks in these countries will be a better measure of this hypothesis. If there are fewer deaths, then there may be something here.

rk-d

I suspect countries with high Malaria incidence have a younger population than non-Malaria countries. We know that age matters. Reporting in these countries may also be suboptimal given sometimes marginal healthcare infrastructure. Do we have data on active use of HCQ in these countries as well? Lots of variables, but I would love nothing more than something as simple as plaquenil being the game changer.

soniczum

The nations with the highest incidence of Malaria are in Sub-Saharan Africa. What you've picked up on is interesting but there are some simpler factors that come to mind:

• Less international travel. Quite simply, there are less people flying in and out of Africa than between the most robust economies of China, Europe, and the US.
• Less reliable reporting. Given the lacking infrastructure it's highly likely that many cases have gone undetected or unreported, especially early on.
• Younger population. Self explanatory. Much of the population is less vulnerable to the virus.

That said, it's confirmed the virus has arrived throughout the continent. The vulnerabilities there are unique which makes the threat especially ominous. Many places are following suit with restricting non-essential activities, travel, etc. Hope they can get ahead of it.

eyedoc

It's my understanding that malaria cases have reduced over the past decade; where it still exists, hydroxychloroquine may still be used both b/c it's been effective in the past, and it's relatively inexpensive.
The countries where malaria exists are those where tourism into and travel out from is not huge in volume. May explain why malaria is not an epidemic in western world centers, and Covid19 may not be huge in case #'s there, notwithstanding potential inaccurate reporting from their health officials.

Bartleby7334

Read the source paper yourself: it’s a tiny sample, not controlled, and while it holds some promise, it’s not a cure AFAICT

https://drive.google.com/file/d/186B...IlWSHnGbj/view

S4to911

Your point being? If your hospitalized COVID 19 patient has a fever of 102, is on low flow oxygen (say 2-3 liters/min), and could tip over that night into the ICU, what would you do? Try to call the FDA and get remdesivir by compassionate use, knowing it would take at least 24-48 hours possibly, and with supplies limited and likely next to impossible to get? Wring your hands and worry about offending someone by doing something that the NY Times says tonight on their front page is "unscientific?" Or give hydroxychloroquine 400 mg (2 pills) orally immediately, with 400-600 mg (2-3 pills daily for 3-4 days after that), for a total cost of $10 and low risk of any side effects (do an EKG do be sure of no long QT)? What is the darn downside risk? What do you have to lose, even if it in the end it may not work? At least you left nothing on the table--and that is what we owe our patients.

This is what docs right now are dealing with EVERY SINGLE HOUR (sorry for the caps, but I am worked up, and I know I'm not supposed to cuss) in wards in downtown NYC. Guidelines in several countries suggest its use for exactly the patient above.

The trials will come out, hopefully shortly, and be either positive or negative, or in between (how's that for clarity ). This drug is so cheap and so relatively non-toxic it's a no brainer unless the trials are dead negative.

Prophylaxis--meaning that the drug can work in asymptomatic people to block acquisition of the virus or reduce viral load in airway secretions to reduce or prevent transmission? Preclinical modeling suggests that a single 400 mg dose (two pills, $2) weekly can generate enough HCQ in the lungs to reduce viral load for several days to a week. It doesn't have to be 100% reduction of viral load, and not 100% of people have to take it--just enough to reduce transmission below an R0 < 1, and this whole mess goes away. Randomized controlled trials are ongoing in health care workers exposed to COVID 19, as well as family members of COVID 19 positive patients living in the same house.

I think with the potential catastrophic damage to the economy looming with each consecutive day of lockdown, the pressure will build to try something like this on a large scale, perhaps without waiting for the trials to be complete. That, my friends, is the true endgame. Do we roll the dice with incomplete data? Or do we continue to wait in total lockdown for a fuller dataset (the proper scientific way to do it) and tank our way of life, possibly for a long time?

I for one would at least want to see data from a larger controlled randomized population than what we have right now (perhaps 100-500 patients or unaffected people). But I for one would not want to wait for more than another few weeks of lockdown, with perhaps a better idea of the shape of the epidemic to guide me.

That's my opinion, ranting on a Porsche 992 site (probably not the right venue), and I apologize. I hope beyond hope that we don't have to make these decisions in the absence of evidence, but events may force us to.

pitt911

I think we all have good old cabin fever. I have to do some research and figure out what virus causes that

Dan Nagy

It was over 80 degrees here yesterday, so I washed the 911, had a little ride, then took a walk at Prime Hook park to get over the cabin fever. It is a four mile loop through a variety of terrain. This time of year it’s not well attended and passed only a few people on the trail - six feet away at least. Part of the trail goes out along the bay and it was lovely to hear the ocean birds and snow geese. There was a huge snapping turtle on the trail that was a bit groggy from the winter - I wonder if it had just crawled out of a hole. I came home, shed my clothes into the washing machine and took a precautionary shower. As the song goes, “ you better calm down, you’re being too loud”.

pitt911

great
trying to do the same , actually I am still working with almost full schedule , which is a blessing , but still this crisis have taken us out of our eco system and usual habits , but as always human body is great at adjusting to our environment

S4to911

Great idea. It's only 33 degrees here, but not raining. A great idea to take out the car, wash it, and go for a long ride.

Bartleby7334

My point is simply to provide the study on which the current speculation is based.
Proviidng the original source instead of relying on solely rumor and speculation is a good thing, I think.

Oh,and I just got through a back-country route to drive off the cabin fever.It feels good.