Chloroquine, past and present • Hacker News Board

Re: Chloroquine, past and present

#221

Post by paulmd » Fri, Mar 20, 2020, 11:32 PM UTC

01100011 wrote: post #217

paulmd wrote: post #215

Earlier quoted context omitted.

We're not even on the "couple of weeks" scale here. Unless we have a drug that can effectively treat coronavirus, we will have to shelter in place until a vaccine is available. 12-18 months.

When did we switch from 'flattening the curve' to 'trying to keep anyone from getting sick'? I thought we were mostly all going to get it this year, but we didn't want everyone getting it in a 1 month period?

Well, never, but we have 20 ventilators per 100k people, "flattening the curve" so strongly that we can treat everybody was always a bit of a pipe dream. You need to flatten the curve almost to zero to get to a "sustainable" level of disease. They are nearly the same goal. Any non-trivial level of disease that is not controlled will rapidly push you past the "flatten the curve" threshold. And we will certainly be here for longer than 2-3 weeks.

It is a little white lie that is important to tell the public to help build compliance, the lower you can push it the fewer people will die, but hospitals simply are going to be overloaded regardless. The choice we can make is one between "very overwhelmed" and "overwhelmed to the point of non-functionality".

"shelter for 12-18 months" is a little bit of an exaggeration but not much. Simulations suggest that after an initial harsh quarantine period (up to several months) to get transmission under control, we will need to shelter for about 2/3rds of the time (2 months on, 1 month off) for 12-18 months, and other measures for 100% of the time. The vaccine will be what finally terminates the situation. https://www.imperial.ac.uk/media/imperial-college/medicine/s...

Even then that may be optimistic (especially if the population is not fully compliant). Italy is not just working from home and social distancing, they are straight up quarantining everyone, and they still have overloaded hospitals and bodies piling up faster than they can cremate them. Presumably the quarantine will slow things down on the order of weeks to months, but right now things are brutal.

https://vimeo.com/398334975

https://mobile.twitter.com/foxmulder22791/status/12404540564...

The Chinese strategy of requiring everyone to get a phone app, to track them via GPS, doing widespread testing and then quarantining the people who have been in contact appears to be a much more effective strategy than blind quarantine or social distancing. No app, no uber, no groceries, no public transit, etc. The US citizenry absolutely will not stand for the mark of the beast though.

The Korean thing about masks and gloves probably helps too. Too bad the hospitals are down to about 11 days of masks let alone for the citizenry.

I'm not trying to be a downer but if chloroquine works that's a really fucking big deal, because that would give us a fairly straightforward alternative to treat cases or even prophylactically treat vulnerable populations. Unless you have a tool in your toolbox we are mostly just moving the deck chairs here and choosing between "really bad" and "oh shit".

Re: Chloroquine, past and present

#222

Post by pkaye » Fri, Mar 20, 2020, 11:42 PM UTC

teddyvangogh wrote: post #201

cameldrv wrote: post #189

Earlier quoted context omitted.

You don't need compassionate use for Chloroquine. It's FDA approved, so it's just off-label, which doesn't require any hoops, just a prescription from a doctor.

Great. I hope it becomes available to everyone. "Novartis, Mylan and Teva to supply tens of millions of chloroquine tablets to fight COVID-19" https://www.fiercepharma.com/pharma/new-commitments-mylan-an...

Might need to check for G6PD genetic deficiency before taking it though.

https://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogen...

Re: Chloroquine, past and present

#223

Post by pkaye » Fri, Mar 20, 2020, 11:48 PM UTC

paulmd wrote: post #214

jennyyang wrote: post #197

Earlier quoted context omitted.

One of the comments in the article: I prescribe Plaquenil extensively in patients with autoimmune conditions.The safety profile of this drug is excellent. It is also still used for malaria prophylaxis in healthy individuals .it is not a new drug. I don’t see the reason of labeling it as dangerous. The question is : does it work for Covid19 prevention and treatment? The answer is “the current limited evidence suggests…

This whole incident hasn't done much to shake my impression that US doctors are interested first and foremost in making sure they get their "cut" on every prescription, even when the drug is relatively innocuous. Like fine, we can have this discussion about chloroquine. It's behind-the-counter in the UK, so on par with sudafed in terms of access control, and OTC in a lot of countries that actually have to deal with m…

Do doctors "get a cut" when their patients buy from a neighborhood pharmacy?

Re: Chloroquine, past and present

#224

Post by teddyvangogh » Fri, Mar 20, 2020, 11:58 PM UTC

pkaye wrote: post #222

teddyvangogh wrote: post #201

Earlier quoted context omitted.

Great. I hope it becomes available to everyone. "Novartis, Mylan and Teva to supply tens of millions of chloroquine tablets to fight COVID-19" https://www.fiercepharma.com/pharma/new-commitments-mylan-an...

Might need to check for G6PD genetic deficiency before taking it though. https://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogen...

right. we need to wait for FDA approval. and since it's prescription only, you need to check with your doctor.

Re: Chloroquine, past and present

#225

Post by headmelted » Sat, Mar 21, 2020, 12:03 AM UTC

paulmd wrote: post #214

jennyyang wrote: post #197

Earlier quoted context omitted.

One of the comments in the article: I prescribe Plaquenil extensively in patients with autoimmune conditions.The safety profile of this drug is excellent. It is also still used for malaria prophylaxis in healthy individuals .it is not a new drug. I don’t see the reason of labeling it as dangerous. The question is : does it work for Covid19 prevention and treatment? The answer is “the current limited evidence suggests…

This whole incident hasn't done much to shake my impression that US doctors are interested first and foremost in making sure they get their "cut" on every prescription, even when the drug is relatively innocuous. Like fine, we can have this discussion about chloroquine. It's behind-the-counter in the UK, so on par with sudafed in terms of access control, and OTC in a lot of countries that actually have to deal with m…

I would love to know where in the UK chloroquine is behind-the-counter and not prescription only.

Re: Chloroquine, past and present

#226

Post by Haga » Sat, Mar 21, 2020, 12:06 AM UTC

https://indianpediatrics.net/mar1995/351.pdf

Cloroquine can trigger psychosis in sleeper schizophrenia persons. It has quite a history in the Vietnam War.

Re: Chloroquine, past and present

#227

Post by lbeltrame » Sat, Mar 21, 2020, 12:19 AM UTC

paulmd wrote: post #215

_red wrote: post #85

Earlier quoted context omitted.

>Lets stay home instead. For a couple of weeks, fine. However on the other end of this spectrum is "Millions starve". At some point we need to ask is that fair to the youth? (note: I'm an old fart)

We're not even on the "couple of weeks" scale here. Unless we have a drug that can effectively treat coronavirus, we will have to shelter in place until a vaccine is available. 12-18 months.

How would this be possible without severe consequences to everything else?

I'm already locked up (Italy). I'll go insane, seriously, if I need to stay shut in for 18 months.

Re: Chloroquine, past and present

#228

Post by paulmd » Sat, Mar 21, 2020, 12:21 AM UTC

pkaye wrote: post #223

paulmd wrote: post #214

Earlier quoted context omitted.

This whole incident hasn't done much to shake my impression that US doctors are interested first and foremost in making sure they get their "cut" on every prescription, even when the drug is relatively innocuous. Like fine, we can have this discussion about chloroquine. It's behind-the-counter in the UK, so on par with sudafed in terms of access control, and OTC in a lot of countries that actually have to deal with m…

Do doctors "get a cut" when their patients buy from a neighborhood pharmacy?

They get a couple hundred bucks for a 5 minute office visit to write the prescription, yeah.

I'm fine if there's a serious reason for a physical examination, but a lot of stuff the doctor is effectively filling the role of a pharmacist: telling you side effects and if you have this set of serious side effects then to stop it and/or go to a hospital, here's your script, pay at the front desk. A lot of stuff is unnecessarily shoehorned into Rx-only, and despite a lot of talk about "reducing costs" there is no real drive to actually do so.

A great example is oral contraceptives. You may have to try a couple different blends before you find the right mix for your body. Some of them will be uncomfortable. Some may cause dangerous bleeding and you need to go to a hospital. There is not zero risk here, or with any drug. But the doctor has no way of telling which might be which for your particular body, they are there to tell you the risks, sign the paper and let you try it out. And that's why oral contraceptives specifically are being looked at as something that could be moved out of Rx only and to either OTC or pharmacist-prescribable - but the problem is there are really a lot of drugs that don't belong there.

A pharmacist can read the risks to you just as easily and not charge you $250 for a 15 minute office visit and another $250 for a one-month followup 15 minute office visit.

I have lots of 6-month maintenance visits that are literally 5 minutes. Everything going well? "Yup!" "OK, we'll call in your prescription, pay up front". They're just using their gatekeeping power to extract a check.

Re: Chloroquine, past and present

#229

Post by paulmd » Sat, Mar 21, 2020, 12:23 AM UTC

headmelted wrote: post #225

paulmd wrote: post #214

Earlier quoted context omitted.

This whole incident hasn't done much to shake my impression that US doctors are interested first and foremost in making sure they get their "cut" on every prescription, even when the drug is relatively innocuous. Like fine, we can have this discussion about chloroquine. It's behind-the-counter in the UK, so on par with sudafed in terms of access control, and OTC in a lot of countries that actually have to deal with m…

I would love to know where in the UK chloroquine is behind-the-counter and not prescription only.

Chloroquine is class P (pharmacy medicines), which is effectively "behind-the-counter but the pharmacist tells you how to use it".

The idea being that if you want to take a trip to somewhere tropical, you don't have to tie up a GP with a standard, low-risk medication, but it's not quite so low-risk that you just put it on the shelf. Behind-the-counter, if you will.

https://en.wikipedia.org/wiki/Over-the-counter_drug#United_K...

> Pharmacy Medicines (P) are medicines which are legally neither a POM or GSL medication. These can be sold from a registered pharmacy but should not be available for self-selection (although directions to discuss a 'P' product may be allocated shelf space with associated GSL items). 'P' medications are reserved from the GSL list as they are either associated with a need for advice on use, or used in conditions which may require referral to a medical prescriber. Suitable trained counter assistants may sell a 'P' medication under the supervision of a pharmacist and will ask questions to determine if the customer needs to be referred for a discussion with a pharmacist.

Re: Chloroquine, past and present

#230

Post by notatoad » Sat, Mar 21, 2020, 12:45 AM UTC

paulmd wrote: post #221

01100011 wrote: post #217

Earlier quoted context omitted.

When did we switch from 'flattening the curve' to 'trying to keep anyone from getting sick'? I thought we were mostly all going to get it this year, but we didn't want everyone getting it in a 1 month period?

Well, never, but we have 20 ventilators per 100k people, "flattening the curve" so strongly that we can treat everybody was always a bit of a pipe dream. You need to flatten the curve almost to zero to get to a "sustainable" level of disease. They are nearly the same goal. Any non-trivial level of disease that is not controlled will rapidly push you past the "flatten the curve" threshold. And we will certainly be her…

The Chinese have an app for this? Why aren't we using that?

I'd happily be tracked 24/7, and I'm sure so would many many others, if it meant reducing the spread and getting back to some sense of normalcy a bit quicker.