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The Politics of Hydroxychloroquine

I had not been planning to return to the topic of hydroxychloroquine so soon, but here we are. This will not be a calm, measured blog post – fair warning.

Yesterday, Dr. Rick Bright was pushed out of his post at HHS, where he was deputy assistant secretary for preparedness and response and director of BARDA, the Biomedical Advanced Research and Development Authority. This didn’t look good at the time, but now it turns out that Dr. Bright is not planning on going quietly. The New York Times reports this statement of his to their reporter Maggie Haberman:

“I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions. . .I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way. 

. . .To this point, I have led the government’s efforts to invest in the best science available to combat the Covid-19 pandemic. Unfortunately, this resulted in clashes with H.H.S. political leadership, including criticism for my proactive efforts to invest early into vaccines and supplies critical to saving American lives. I also resisted efforts to fund potentially dangerous drugs promoted by those with political connections.

Specifically, and contrary to misguided directives, I limited the broad use of chloroquine and hydroxychloroquine, promoted by the administration as a panacea, but which clearly lack scientific merit. While I am prepared to look at all options and to think ‘outside the box’ for effective treatments, I rightly resisted efforts to provide an unproven drug on demand to the American public. I insisted that these drugs be provided only to hospitalized patients with confirmed Covid-19 while under the supervision of a physician. . .”

He’s asking the HHS inspector general to investigate the circumstances of his firing and political influence on BARDA, specifically pressure to fund what he terms “companies with political connections and efforts that lack scientific merit

This is a grenade. It was clearly meant to be one, and I have to applaud Dr. Bright for his refusal to shrug his shoulders and just walk off. These are really serious charges to make during this pandemic, and if his accusations have merit, this is just the sort of malfeasance that can’t be tolerated. Dead bodies are piling up, the economy is at a standstill, we are in a public health crisis the likes of which none of us have ever experienced, and the administration is making sure to take funding decisions out of the hands of career scientists so that cash can be steered to well-connected snake oil artists? We have to know the truth.

This of course comes just a couple of days after yet another look at the use of chloroquine and hydroxychloroquine (with and without azithromycin), this time from the VA health care system, that found that administration of these drugs to coronavirus patients actually increased the chances of death and of serious respiratory problems. That study by itself is not enough to prove that these drugs don’t work, of course: it has a standard-of-care control group for comparison, but it’s all retrospective, not an intentional blinded clinical trial. But it’s not meaningless, either, and when you add that in to the other studies that are showing no effect (at best), the ones that claim benefit are not enough for a person to say that anything is working. If Rick Bright was calling for these drugs to be administered under controlled conditions and to not declare them as great therapies for the epidemic, then good for him: those are the right decisions. And if he was fired for them and for similar calls, then there should be an investigation.

Unfortunately, the conduct of many members of this administration does not allow anyone to dismiss these allegations out of hand. I will resist the temptation to list details; they are abundant. The president’s fans will wave these aside as exaggerations or fabrications, and nothing I or anyone else can say will convince them otherwise. Every administration, every government has some of these people, though, and as far as I’m concerned we have a lot more than our share right now. Sadly, I find it completely believable that Trump administration officials could take this opportunity to grease campaign donors and reward their friends at the expense of the public health and at the expense of scientific evidence. Completely.

Don’t you? Look at the commentary of veteran industry observers like Steve Usdin of Biocentury, whose frustration comes through when he writes about this administration’s behavior during the pandemic (update). He’s not alone. Honestly, just step back a little and take a look at the whole DC landscape in light of the coronavirus: can you say that George Packer is wrong? Get to the bottom of this. Get to the bottom of it as quickly as possible. This is supposed to be a great nation, not a racket run by a bunch of smirking grifters.

229 comments on “The Politics of Hydroxychloroquine”

  1. David Young MD says:

    My Sentiments exactly.

    I can not imagine a former president behaving in this manner. Neither former Democrat or Republican president. Make America Great Again? Hardly! Instead, Trump has made the United States look like fools to the rest of the world

    1. colintd says:

      He does make the flawed Nixon, Clinton and Bush jnr all look like well balanced, honest, intellectual giants by comparison.

      1. jcranmer says:

        I was thinking more of James Buchanan, who makes Nixon et al look like competent presidents.

        1. Duane says:

          Nixon was a highly competent executive. More than most presidents, actually. He just suffered from character flaws (paranoid, ruthless, and dishonest) that ultimate brought him down. He was far more competent than JFK or LBJ, or Jimmy Carter, for Gods sakes. But he was not a good guy.

          Trump is the poster child for utter incompetence and self-service, as well as lack of intelligence and lack of character. I expect he has set the all time floor for those characteristics in our republic. He makes even Jimmy Carter look fairly competent, by comparison.

          1. Hap says:

            I don’t know much, but I thought Buchanan was competent, just evil.

            If Trump is incompetent and evil, does that make him rank higher or lower?

        2. Rick Rude says:

          What is it about Nixon that didn’t seem competent? Do you know what you are talking about?
          So many people posting here must hate Trump for fact that he got where he is without having to kiss ass in the corporate or academic or government worlds. And because he doesn’t have the measured speech of a professor he must be stupid is another thing people want to believe. This president reveals a lot about people’s biases. Further research is definitely justified for the hcq, and in the mean time there is enough evidence to give it try in some situations. The president’s talk of using uv light and disinfectant (Ozone) is now being twisted to make it look like he said to inject lysol. People should be reading about uv blood therapy which I have been learning about this morning thanks to the president’s comments.

          1. Hap says:

            I don’t think people are unimpressed by his lack of use of formal speech – his speech is perfectly clear – but are unhappy that he doesn’t know what he doesn’t know (and doesn’t seem to care), is repeatedly dishonest (even by politician standards, which is really saying something), is a festering anus to other people (publicly and repeatedly) and is either racist or willing to court racists to get what he wants. He might be better served by being grandiloquent – that way it wouldn’t sound like he’s saying what he’s actually saying.

            His lack of understanding of medicine is not really surprising, because it’s not what he knows (or is supposed to know). On the other hand, he should know that he doesn’t know it and not talk about it so much; he can’t do that, because he either loses control over the conversation or feels impotent, or both, and so commits repeated public facepalms.

          2. Bryan Zemlicka says:

            Finally someone who is actually thinking. Thank you for staying inside the box and telling it like it is. I love President Trump because he doesn’t fall into step with past presidents. This country has needed a president like Donald J. Trump for quite some time.

    2. Steve says:

      I can’t imagine the CEO for *any* large corporation not being fired by the board of director for the dozens of boneheaded things Trump has said and done over the past three years. I think it also explains why Trump Organization never went public. The stockholders would have taken away his sandbox after all his screwups in the 1980s.

      1. Dave Saint says:

        Who really gives a shit what Trump did in the 80s. He didn’t need this job.
        If of you Demorats Are so smart please run for President. 18 democrats ran for president and lost to Sleepy joe. I can’t wait till us deplorables show up at the polls.

      2. Chris R says:

        I believe Trump is doing the best anyone can.. The Democrats have fought him tooth and nail. I do believe as a health care provider that there is efficacy in Hydroxychloroquine and such at the correct stage and age of Covid-19. I am saddened that there is a political agenda to this virus on the part of the left. There is no vaccine and we cannot wait a year or so.. Therapeutics are the answer.. Many OTC are available for off label use which reduce or inhibit this virus from mortality.. Get over it and get to work! This is a virus that carries a 1.2% chance of mortality over the seasonal flu!!

    3. DENNIS D BRLETICH says:

      H1N1 Pandemic
      Obama administration

      Great article.
      I learned a lot.
      Moving from hard right To Center on the HCQ/AZ trials.
      When will the NY trials be completed?

      Why is this doctor having so much success with his patients?
      https://twitter.com/ABC7Jory/status/1247209594088091648

      Thanks for the education!

      1. jz78817 says:

        who says he’s having success, other than himself? There are charlatans everywhere.

        besides, if someone does come up with a “miracle” treatment for this disease, you are not likely to hear about it from some stupid local news broadcast.

    4. Springerst94 says:

      Sounds more like Dr. Rick Bright was taken out and doesn’t like it.I suspect the Good Dr.’s personal politics played a part in all this. The AMA has little room to talk. It’s practices seem designed to limit the number of Drs in the country rather than one of concern for the American People. No drug is without side effects. I personally have has more than one Dr prescribe drugs that had bad interactions with drugs I was already taking. So stop the holier than thou rant. I’m not buying it.

      1. Barry says:

        It is precisely because “no drug is without side-effects” that no one should prescribe a drug like hydroxychloroquine where there is no demonstrable benefit.

      2. Jim Hartley says:

        Please, the point was that he was taken out … oh wait. Springer is one of them. Never mind.

    5. David says:

      Ha. The title of the article is quite ironic. The studies cited aren’t using the recommended protocol as used in the marseilles study.

      Stop with the partisan politics. Without question I’d take the plaquenil + zpack combo.

      Talal Nsouli: The Arab who became doctor to US presidents
      https://www.arabnews.com/node/1663411/world

      1. Christine Marr says:

        Exactly… this is sciencemag.org where’s the science in this article? VA study of hydrochloroquine covid said to cause cardiac deaths and Dr. Raoult, And Vererans Association Secretary’s critique and others critique of it
        https://www.youtube.com/watch?v=Vf_AaL7ZPP0
        https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf
        study included only the most severely affected end stage covid patients, mainly over 65 years old, African American males (not representative of general population and which are known to be more likely to die from covid. The study also did not list doses administered or times for some. Not the same protocol shown 91-100% successful with doctors from 30 countries, and several research studies.

        Those treated were primarily elderly males with other chronic and fatal diseases, while the control group were composed of patients generally without such problems. Those in the “study” had a plethora of medical issues, in addition to COVID-19, including heart disease, asthma, liver disease, diabetes, cancer, and even AIDS.

        The study’s author, Scott Sutton, has been paid to do three studies for Gilead Sciences, Inc., maker of Remdesivir, also a drug in trials to treat COVID-19! The stock price of Gilead has risen markedly since February, when it was announced that the drug has been identified as a potentially a medication to treat the virus.

        Secretary of Veterans Affairs Robert Wilkie disputed the importance of the VA “study.” He noted that it was only “an observational study,” rather than a “clinical study.” Wilkie added, “It was done on a small number of veterans, sadly those of whom were in the last stages of life. We know the drug has been working on middle-aged and younger veterans.”
        critique of Fauci’s NAID study on remdesivir- added hundreds of new subjects mid analysis (can do to get statistically significant result), placebo included azythromycin another drug with positive results for treating covid (not a true placebo) for control group, and cut all of the death subjects out of the study as well as the other 3 most severe categories subjects so the “study” really just analyses the healthiest of the people receiving the drug
        http://covexit.com/dr-fauci-announces-remdesivir-to-become-standard-of-care-for-covid-19-while-chinese-study-finds-it-ineffective-other-research-also-ignored

        we’ve all heard fauci call hydrochloroquine covid success anecdotal- he headed the NIH in 2005 when they did this study finding it successful with another SARS with the same A2 receptor involved
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/

        Covid treatment successes and research with hydrochloroquine
        http://covexit.com/initiative-by-us-medical-doctors-recommends-early-covid-19-treatment-combining-hydroxychloroquine-azithromycin-zinc/
        https://aapsonline.org/aaps-letter-asking-gov-ducey-to-rescind-executive-order-concerning-hydroxychloroquine-in-covid-19/
        scroll down for studies
        https://danpursermd.com/hydroxychloroquine-studies

        Renowned microbiologist Didier Raoult replicates hydrochloroquine success that he showed end of February this time with over 1000 patients, 91% success
        https://www.mediterranee-infection.com/early-treatment-of-1061-covid-19-patients-with-hydroxychloroquine-and-azithromycin-marseille-france/
        http://covexit.com/professor-didier-raoult-releases-the-results-of-a-new-hydroxychloroquine-treatment-study-on-1061-patients/

    6. Sam says:

      I’ve read that this man has been in hot water at his job for a year for being ineffective. The article doesn’t mention that.

      1. Derek Lowe says:

        Please tell us where you’ve read that. Thanks!

        1. loupgarous says:

          Don’t know if this is what Sam’s talking about, but an article in politico.com, “Ousted vaccine expert battles with Trump team over his abrupt dismissal” by Dan Diamond gives Dr. Bright’s side and that of the Trump admnistration officials who (as Sam said) alleged performance and effectiveness issues on Bright’s part as a reason for his reassignment to NIH. The preponderance of news reports agree with your assessment.

    7. ghost of q.mensch says:

      -Risks of hydroxychloroquine: What are they now (2020), and what were they pre-Trump recommendation (for 70 yrs up until 2019 ? (~>minute 10:40)

      -Scientific integrity vs ideological rigidity? (~>minute 38:00)

      Chris Martenson asks and explains:

      https://www.youtube.com/watch?v=rN_YpFhdii4

    8. Rob says:

      Giving HCQ in isolation to a group of the most ill elderly patients who are probably zinc deficient and expecting this medication to anything is absolutely absurd and you know this.
      It`s the zinc that kills the virus not HCQ, that`s only the carrier, if the patient is deficient in zinc none will get into the cell. this treatment needs to be given early with zinc. The study mentioned is garbage.

    9. mario lento says:

      The vitriol of your statement (complaining without substance) is telling about you straight away. Learn how to make a cogent statement. “This policy [fill in the blank] does this and this [fill in the blank] is what I think about it. Otherwise, what you write is plain drivel.

      Are you against HCQ and Zn for any specific reason? If so state it and tell us something cogent. Of course that leaves you vulnerable, so you complain with no substance.

    10. John A Mcwilliams says:

      LOL. I am not 1

  2. Brian says:

    Has anybody thought about adding Zinc?

    1. Mister B. says:

      Indeed.
      Today, it’s adding zinc to the protocol to make it effective.
      Tomorrow, it’s gonna be adding zinc AND lithium.
      The day after, one will requiere the patient to dance naked in the moonlight to be cured.

      HCQ + whatever you want is no magic therapy, no help at all in fact.

      1. Brian says:

        Follow-up question. On cloudy days, when no moonlight is available, is there a backup plan?

        1. colintd says:

          Leeches. The cure is always the time tried application of leeches. And if that doesn’t cure you, then you’ve either not applied enough of them, or you forgot to chew on a piece of zinc at the same time.

          1. mayfin says:

            This is fake news. You don’t ask the patient to chew on a piece of zinc first – that would be ridiculous. Instead it’s the leeches that need to be dosed up on zinc – everyone knows that zinc-enhanced leeches can cure everything.

          2. yuri says:

            how dare you mock the mighty Hirudo medicinalis

        2. jcranmer says:

          Have you tried sending the patients to the moon, where the moonlight is unaffected by weather? We’ll need to scale up our launch capabilities first, though.

          1. chiz says:

            Clearly we need another medical moonshot program.

        3. DrOcto says:

          Placebos. The back up plan is Placebos.

          In stark contrast to any HCQ combination therapy, placebos actually have a documented clinical effect. And they are are available generically now over the counter.

          1. loupgarous says:

            Just be sure you’re prescribing stevia pills. The standard of care, sugar pill placebos, are associated wth metabolic syndrome, decreased glucose tolerance, and in long-term users, obesity, dental caries and NIDDM.

      2. theg9 says:

        The problem is there are in vitro studies showing Zn combined with Zn ionophores (like chloroquine derivatives) inhibit viral RNA dependent RNA polymerase. Here’s one for example: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176. Zinc’s extensive interactions with nucleotides are quite well known by those with a knowledge of bioinorganic chemistry.

        The question asked is perfectly reasonable, considering the fact that most of the HCQ clinical trials did not include zinc supplementation as part of the regimen.

        ProgenaBiome is carrying out a clinical trial to examine HCQ+zinc as a prophylactic against Covid 19.

        But you seem to be quite convinced that this combination will “never work”. Please tell us the biochemical details on why this potential therapy will be ineffective, based on your knowledge.

        1. Rocker says:

          First, Mr. Lowe already addressed the tactic of stringing together single results, in vitro studies, and spurious results into an untested treatment plan. His writing speaks for itself, I suggest you read the article.

          What I really wanted to write was a response to is “Please tell us the biochemical details on why this potential therapy will be ineffective.” Science is not done by hypothesizing, and then declaring yourself correct because no one can or will disprove you. If you have a hypothesis go write a grant, get funding, and prove that hypothesis yourself! Don’t have the credentials and experience to do that? Then stand back with the rest of us (me included) and try to follow along as best you can. If that makes you feel helpless then give your representatives a call and demand more funding for scientific research (or start researching graduate schools). There’s a reason we allocate our taxpayer funding to more qualified people to conduct research for us; science is hard!

          “I think there’s a teapot full of a flawless COVID-19 vaccine in orbit between the Earth and Mars, but no one will listen to me! Why doesn’t Elon Musk just launch a mission to go get it!”

          1. Stanislav Radl says:

            Your very strict statement is not appropriate. Similar statements are published from the White House very often, but they are not very consistent.
            By the way, real science is based on hypothesis, which is then either proven or not. There is no progress without this type of scientific approach.
            What will you say if the mentioned ProgenBiome study is effective? Probable answer is: „I have thought it from the beginning that a zinc supplementation would be a good idea…“.

          2. Pathcoin says:

            There are mechanistic reasons why hydroxychloroquine should be effective.
            The main reason is that at therapeutic doses, the medication interferes with the production of TMPRS22. TMPRS22 activates the corona virus, enhancing its binding to AEC2 and allows entry into the cell after the virus binds the AEC2 receptor.

            The medication alters the pH of the cell and interferes with viral replication.
            The medication is safe. Like all medications there potential side effects. The medication has been used safely for decades for the treatment of lupus and rheumatoid arthritis.

            Diabetes type II uniquely increases the virulence of the virus. The reason is not fully known but a potential mechanism is. In diabetes type II there is an increase in circulating furan. Furan is the natural substrate for TMPRS22 and increases its expression. Increased expression allows the virus to enter the cell.

            TMPRS22 is sensitive androgen like testosterone. Testosterone increases its expression. This may explain the increased middle age male sensitivity to the corona virus, especially if the patient is was on androgen replacement therapy.

            In many ways the corona virus follow a natural history like influenza:

            Most people exposed to a new flu virus do not notice any symptoms. A small minority develops critical illness. Some of this extremely broad variation in susceptibility is explained by the size of the initial inoculum or the influenza exposure history of the individual; some is explained by generic host factors, such as frailty, that decrease resilience following any systemic insult. Some demographic factors (pregnancy, obesity, and advanced age) appear to confer a more specific susceptibility to severe illness following infection with influenza viruses. As with other infectious diseases, a substantial component of susceptibility is determined by host genetics. Several genetic susceptibility variants have now been reported with varying levels of evidence. Susceptible hosts may have impaired intracellular controls of viral replication (e.g. IFITM3, TMPRS22 variants), defective interferon responses (e.g. GLDC, IRF7/9 variants), or defects in cell-mediated immunity with increased baseline levels of systemic inflammation (obesity, pregnancy, advanced age). These mechanisms may explain the prolonged viral replication reported in critically ill patients with influenza: patients with life-threatening disease are, by definition, abnormal hosts. Understanding these molecular mechanisms of susceptibility may in the future enable the design of host-directed therapies to promote resilience.
            Clohisey, Sara and Baillie, Kenneth: T1 – Host susceptibility to severe influenza A virus infection; Vol 23, Critical Care, Sep 2019, p 303; DO – 10.1186/s13054-019-2566-7

          3. Rich Stern says:

            First, let me say that I have the credentials and qualifications to do relevant science in this area (a PhD in immunology and molecular biology). You are being a little harsh. The paper theg9 cites is published in a reputable journal. I have only briefly reviewed it, and certainly not critically, but its main finding is very interesting. It basically shows that the addition of an ionophore and zinc to a cell culture is able to inhibit replication of SARS-CoV. It further shows, in an assay (in a tube) that zinc is able to inhibit the SARS-CoV RNA-dependent RNA polymerase. Thus, they hypothesis that the ionophore allows increased intracellular concentrations of zinc, which then acts to inhibit viral replication. Their data supports that hypothesis. It is enough that, assuming the studies are accurate and reproducible, I would consider further exploration of a treatment based on the results. In fact, this is all they say at the end of the article: “This provides an interesting basis for further studies into the use of zinc-ionophores as antiviral compounds, although systemic effects have to be considered…”

            Certainly there are caveats with this research. First is that it is done in cell culture. I would be curious to know if zinc supplementation could actually increase intracellular levels in vivo (in a body). I would imagine the intracellular levels of zinc, like other metals, is tightly controlled. I don’t know. Similar thoughts apply to ionophores. Which, if any, is the right one? Are they stable in the body? Clearance rates, inactivation rates, etc. Would variants arise that are not as inhibited by zinc? Things to consider.

            Based on the cited article, I cannot dismiss this idea out of hand. I do wonder why there is no follow-up on this work. I briefly scanned PubMed and did not find work by this group, or any others, following up on this idea. Maybe they tried and it did not work? Maybe they lost funding and disbanded or moved on to other, funded work? Maybe I didn’t teach hard enough (I do have a job that I am supposed to be doing) As someone with the “credentials and experience”, I too would be interested in hearing more about this topic. While, like everybody else, I have a particular political bent, it is not relevant here, and we should follow the science.

            Finally, a nit picky point: you say to write a grant and prove your hypothesis. That’s not really how it works. You don’t prove your hypothesis. You put forth a hypothesis and then you test it. You actually try to disprove it. If the data goes against your hypothesis, then maybe you were wrong. If it does not, you have not proven anything. But you have produced data that supports your hypothesis. Eventually, if after a long time, and much testing, your hypothesis cannot be disproven, it comes to be accepted as “correct”…until someone finds data that questions it. Einstein’s general theory of relativity has still not been “proven”. But the data sure supports that he was right. That’s how science progresses. That is why it is so hard and takes so long.

          4. David Gerken says:

            There’s no many to be made from HCQ. Which is why this article is ridiculous on its face and which is why it’s hard to get funding except from the government.
            Much more money to be made with on-patent drugs.

        2. Charles H. says:

          Well, it’s possible. But *I* wouldn’t want to invest in a trial. Still, if you’re paying the money, and recruiting the volunteers, and properly informing them, well, it’s your money. And there is no good “standard treatment” to compare it against, so your control group is going to need to be carefully matched.

          FWIW, I’d consider air enhanced with both oxygen and tobacco smoke as a more reasonable alternative. (Because of a recent French study…hit the Guardian today.)

      3. Kings Harvest says:

        I tried dancing in the moonlight. I wouldn’t call it a magical therapy – more like a supernatural delight. The trick is you have to keep things loose, keep things light. The only side effect I experienced was feeling warm and bright. 🙂

      4. Charles H. says:

        I don’t know…compare to HCQ dancing naked in the moonlight has a lot to recommend it. But you need to be in shape first.

        1. JasonP says:

          Ok, you got me! I read it…. Now for those too lazy to follow a few snippets…

          Things I Won’t Work With: Dimethylcadmium

          >>>Cadmium is bad news. Lead and mercury get all the press, but cadmium is just as foul, even if far fewer people encounter it. Never in my career have I had any occasion to use any, and I like it that way. There was an organocadmium reaction in my textbook when I took sophomore organic chemistry, but it was already becoming obsolete, and good riddance, because this is one of those metals that’s best avoided for life. It has acute toxic effects, chronic toxic effects, and if there are any effects in between those it probably has them, too.<<>>Dimethyl cadmium, then, represents the demon plunked in the middle of the lowest circle as far as this element is concerned.<<>> It’s toxic to the lungs, naturally, but since it gets into the blood stream so well, it’s also toxic to the liver, and to the kidneys (basically, the organs that are on the front lines when it’s time to excrete the stuff), and to the brain and nervous system. Cadmium compounds in general have also been confirmed as carcinogenic, should you survive the initial exposure.<<<

          So a dose of that stuff, toxic to the lungs, sounds like just the cure for a disease like COVID-19 that hits the lungs. After all, who needs lungs? Gotta have heart?

      5. Ian Malone says:

        “Tomorrow, it’s gonna be adding zinc AND lithium.”

        A good try, but in all honesty, I don’t think any of us saw “and dettol” coming.

      6. mario lento says:

        You should understand the mechanism. Zn is the substance that blocks RNA replication within the alveola cells. An ionophore is the key that lets the positively charged ion through. Why do you suggest Li? HQC happens to be a Zn ionophore, so you use both together. I use quercetin and it works fine. No prescription needed.

  3. Tom Rogers says:

    This is fucking important! This is, of course, the sort of thing Trump has made commonplace, but the media and we as citizens shouldn’t just shrug our collective shoulders and move on with life. Democrats need to find out what the hell is going on with this crap, tout de suite.

    1. Olandese Volante says:

      I think it’s not a good idea to make this a partisan issue.
      The malfeasance of the Trump administration in handling the covid crisis hurts republicans too.

      1. bob says:

        I disagree. The GOP is 100% complicit in letting Trump desecrate our country.

        1. Hap says:

          The GOP members that don’t like him are either silent (because they want their jobs) or aren’t GOP any more. As long as the people left voting for the GOP want the Trump Administration and their MCs to do this, they will (because the congresspeople like their jobs).

          At this point, the GOP and its voters want the federal government not to be competent; they just don’t want the consequences of that incompetence and the moral costs it imposes. For a party that has branded itself as rational and reasonable in accounting for the costs of behavior, this is…interesting.

        2. Micha Elyi says:

          “desecrate”?

          You’re saying President Trump made the country less sacred. Words mean things. Don’t be mean.

    2. David Gerken says:

      Who is going to make money of HCQ?

  4. Paul Zhang says:

    Depending on how deep the malfeasance goes, I think this has the potential to be bigger than the Trump-Ukraine scandal. Especially because it has direct implications for the health of millions of Americans.

    1. JS says:

      I think Trump blackmailing Ukraine is huge, but you’re right in the sense that this has OBVIOUS, DIRECT, LIFE-THREATENING implications for the health of the country.

      It’s sort of amazing they’re letting him work at NIH. I assume it’s only to try to muzzle him. Didn’t work.

      1. Shazbot says:

        The worst part of the Ukraine scandal was also the violation of the concept of soverign immunity.

        Protect your fellow americans from foreign threats by.. bribing said foreigners to go after your political allies.

        1. Hap says:

          I thought it was previously known that the US and UK cooperated by spying on each other – domestic agencies couldn’t spy on their own citizens, but they could spy on the other’s citizens and then give the other the info. (James Bamford, I think). So this is less atypical than we’d like.

          1. loupgarous says:

            The news about ECHELON (Anglo-American-Australian- Canadian-NZ cooperative signal intelligence on everyone, including our own citizens) came out in a 1972 article in Ramparts by Perry Fellwock, but was largely ignored because Ramparts had its own credibility issues, including an accurate perception they were also playing the agent of influence game for KGB. Then came James Bamford’s 1982 book The Puzzle Palace.

            However, most Americans hadn’t head of ECHELON until 1988, when Margaret Newsham, a Lockheed employee under NSA contract, disclosed the full extent of the ECHELON domestic surveillance system to Congress. But people forget, and so the press breathlessly re-discovers that “our spy agencies are spying on us!!!!!”

  5. Zee Bendelstein says:

    Sadly we’re now generating a list of instances where the bar for regulatory approval is subject to interference/input from biased third parties. The DMD oligos, a certain Alzheimer’s antibody, and now in the midst of a pandemic, this. Perhaps now is the time to correct this once and for all and subject the inteference to its very own investigation.

    1. loupgarous says:

      I agree. Why do we even bother with scientific advisory committees when we don’t follow their advice? When the decisions we make at variance with ADCOM advice fly in the face of scientific findings for safety and efficacy? The problems, unfortunately, go back to the orphan drug/fast track programs and before. Eli Lilly’s Xigris, which got fast-tracked and approved with the help of a PR firm despite equivocal evidence it had any effect on sepsis at all, is an excellent example. It took much post-marketing study to confirm that Xigris just didn’t work, after millions had been spent treating people with it to little or no avail, before it was withdrawn from the market.

  6. MTK says:

    Career bureaucrat. Deep State gonna deep state.

    Just to be clear I don’t really believe but that’s what the supporters of this Administration are going to say. Unfortunately there’s no way to counter that argument. That’s the beauty of a conspiracy theory. Impossible to disprove.

    People will believe what they want to believe.

  7. Cynde says:

    Wake up Republican people what will it take for you to smarten up

    1. x says:

      You might have Pelosi brag to the poors about her gelato cave some more – but if that doesn’t work, and it might not, then reminding Republicans that even though Democrats continually grandstand and fundraise against the Republicans, when they’re actually at work they support almost everything the Republicans want: more tax cuts and handouts for the rich, bigger military budgets, expended surveillance power, right-wing judge appointments, etc.

      If that doesn’t phase them, go for the nuke: remind them that Democrats, too, are fighting to elect a mentally incompetent, corrupt, racist, right-wing molester with a closet full of scandals, and they even pulled out every stop to sideline a modest center-left social democrat to do it.

      If you’re looking to scrape a barrel for political sanity and wisdom, forget the Dem and GOP barrels; only cult members and grifters there.

    2. Anon says:

      You know the author of this blog is Republican right

      1. Derek Lowe says:

        Technically, ex-Republican. I still have conservative/libertarian principles in general, but I walked out of the Republican party when Trump walked in.

    3. loupgarous says:

      Trump would be a footnote in US political history if the DNC hadn’t gratefully let the Clintons pay off their campaign debts in the 2015-16 Presidential campaign, then sold themselves to Hillary Clinton, who remains the Russians’ most useful idiot – and the one they’ve given the most money to.

      Trump had absolutely no power to stop American pushback against Russia – after the Russian-Georgian War in 2008 – until Putin decided to continue invading US allies in Eastern Europe. It took Secretary of State Clinton, Vice President Biden and their boss to apologize to the Russians for that mean old George W. Bush’s sanctions against them, and then to create a clogged septic tank out of our foreign policy toward the Ukraine and China.

      The fact is, Democrats have been sound asleep, verging on comatose, for years, too. The current mess has required both major political parties. Trump ran as a populist and won because the GOP doesn’t run a rigged game at Presidential level. Sanders ran as a populist and had no prayer of winning because the DNC is still a cynical tool of their large corporate donors. Half of DNC’s funding this year has come from Mike Bloomberg’s campaign. I’ve been a Libertarian most of my life, because you can depend on both major parties to sell our country’s policy to the highest bidder.

      1. Hap says:

        The problem with Sanders, though, is that he didn’t bring new people in to the primaries, which he needed to do to have a better chance of beating Trump than Clinton. He did well in places where peer pressure was dominant (caucuses, where voting is open, rather than anonymous), which is the opposite of the pattern you’d expect from someone who was the anti-establishment person (where there would be bureaucratic pressure to vote for its candidate). Center to center-right people likely would have had an easier time voting for Trump if the alternative was Sanders (at least before he had a record to run on), and in the absence of a lot of extra further left voters, that would have helped Trump more.

  8. smbeast says:

    “Compared to the no HC group, the risk of death from any cause was higher in the HC group
    (adjusted hazard ratio, 2.61; 95% CI, 1.10 to 6.17; P=0.03) but not in the HC+AZ group
    (adjusted hazard ratio, 1.14; 95% CI, 0.56 to 2.32; P=0.72). The risk of ventilation was similar in the HC group (adjusted hazard ratio, 1.43; 95% CI, 0.53 to 3.79; P=0.48) and in the HC+AZ
    group (adjusted hazard ratio, 0.43; 95% CI, 0.16 to 1.12; P=0.09), compared to the no HC group.”

  9. JasonP says:

    So when do we expect the Gold Standard HCQ CTs to finally read out so we can stop speculating, politicizing science and see “real” results?

    1. Duane Schulthess says:

      This Brazilian trial in pre-print is quite interesting. The control was self-selected (opt-out), but the test arm appears to have higher rates of co-morbidity (obesity, etc).

      I know saying ANYTHING one way or another on this issue gets you painted politically, but the fact is, I can simultaneously think Trump is a douchenozzle, and find this data hopeful. The ‘other’ Brazilian test that was stopped was up to 12g for 10 days, this was a much lower dose, 800mg.

      https://www.dropbox.com/s/5qm58cd4fneeci2/2020.04.15%20journal%20manuscript%20final.pdf?dl=0

      Time will tell I supposed.

  10. theg9 says:

    Some additional perspective from a Politico article (https://www.politico.com/news/2020/04/22/hhs-ousts-vaccine-expert-as-covid-19-threat-grows-201642):

    “The move was more than a year in the making — Bright had clashed with department leaders about his decisions and the scope of his authority — but came abruptly, said five current and former HHS officials”

    Considering HHS officials admit that his resassignment was a year in the making definitely reduces the significance of the “he was fired because he didn’t support hydroxychloroquine” theory. It was still probably a minor factor, but just not the primary reason as it may seem to be.

    ” “BARDA was not as responsive during the crisis” as it could have been, said one former official. “Rather than prioritizing therapeutics that could be available in weeks, Bright focused on products that would take weeks or months.” For instance, BARDA didn’t make what’s known as a broad agency announcement to solicit potential investments in diagnostics, vaccines or treatments until March, five weeks after HHS Secretary Alex Azar declared a public health emergency over the Covid-19 outbreak.”

    Why he would wait so long to put out a BAA is also a mystery.

    “But the Trump administration’s leadership team long faulted Bright for an array of management problems, including complaints about BARDA’s pace and strategy, concerns echoed by outside observers. For instance, Bright steered multiple investments with companies like Roche and Sanofi to develop what are known as IL-6 inhibitors, which target potential drivers of inflammation in Covid-19 patients with severe disease; scientists have found evidence that the IL-6 agents could prevent some of the ravages of Covid-19. But leaders and observers thought the decisions were duplicative, noting that Eli Lilly is also pursuing a government-backed investigation into IL-6 inhibitors too. “That’s three bets on basically the same mechanism of action,” said one outside analyst with knowledge of BARDA operations. “To do it to the exclusion of all else was insane.”… Bright clashed with his boss, Robert Kadlec, the Trump administration’s assistant secretary of emergency and preparedness, over his leadership style and specific issues like whether BARDA was hewing to its mission of research and development or inappropriately expanding its portfolio into procurement too, said three people.”

    So in summary, the hydroxychloroquine did probably play a role, but it seems that he had plenty of other internal issues dogging him as well.

    1. JasonP says:

      @theg9 Thank you for posting this! Important to get the WHOLE perspective! So the truth maybe nothing to see here, or somewhere in the middle? I think it debunks the hypothesis proffered.

      I am shocked that so many scientists who rail on just examining the facts of CTs, fail to collect all of the facts in a situation and go off based on their belief. Where is the collecting data and information? Where is digging into things? So an opinion was stated or a hypothesis offered, yet when the facts come in it appears this hypothesis goes the way of many ALZ drugs!

      To those who salute this knee-jerk reaction: You want to be a politician, then get into politics and head to Washington and that game. You want to be a scientist, then do that. Oh sure, everyone is entitled to stand in the town square and spout their beliefs. But there are consequences to being political when a scientist and that is that the general public starts to discount science because of the spoken politics. Don’t dilute your expertise and the useful science we all need as imho THAT is the major tragedy here. Do work to educate, not denigrate the ignorant.

      Going off half cocked without all of the facts in hand…….

      1. x says:

        “You want to be a politician, then get into politics and head to Washington and that game. You want to be a scientist, then do that.”

        In a democracy, even a representative one, everyone is a politician, and our scientists at least have the education and experience to form valid opinions. If you want a society where people who are not officials have no business considering, promoting, or making public policy, then you want dictatorship or feudalism – though the US is perilously close to becoming one of those, and I suppose from your remarks that you would be fine with that.

      2. Hap says:

        The question would be whether the decision to (over)invest in IL-6 therapies is enough to fire someone over. I would suspect not, which lends credence to the idea that his firing is motivated by other things.

        1. loupgarous says:

          It’s not just Rick Bright’s firing that raises eyebrows for good reason. There was a fracas over budget cuts to DHHS’s pandemic response program in 2017 or so, and the program head resigning. The problem being so many Obama appointees were resigning, the signal-to-noise ratio was very low – you couldn’t tell who was quitting out of sheer political disenchantment, and who had legitimate complaints. People were screaming “wolf” before Trump had much time to offend them legitimately with his policy decisions.

          But I agree that you don’t treat pandemic response as pork without excellent reasons to do so. I consider pandemic response a part of our national defense. You don’t merrily take a crowbar to it while you and your predecessor Obama are handing Lockheed Martin and Northrop Grumman huge checks to rebuild the nuclear deterrent.

          Our nuclear defense policy ought to have a lot more “consequence management” to it to reduce foreign threats and deter aggression than what we’ve been doing instead. If we’d learned from the Germans and Swiss, and made FEMA a more muscular, focused disaster management agency, we’d probably have had a quicker response to Covid-19, because effective pandemic response would be dialed in already as part of defense against biological warfare.

          Having studied civil defense from the 1970s, though, I’d have to say that our response has been pretty rapid and muscular lately compared to prior administrations. The National Strategic Stockpile had about 16,000 ventilators plugged in and ready to go, constantly maintained. That’s a vast improvement over, say, FEMA response to Katrina – and it turned out we had a “bridge” capacity while we bought more ventilators. Could have been better, but FEMA’s done a lot worse, too, over its history. Its response to ordinary people made homeless by floods has been a sadistic joke.

      3. Ears wide open says:

        Hear! Hear!

      4. loupgarous says:

        If Trump just allows the IG at the Department of Health and Human Services to do the investigation, we’ll know for sure who was right.

        If he doesn’t, we’ll never know and this will be the quintessence of political clustergropes.

    2. anonymous says:

      Some additional perspective from the SAME Politico article quoted above:

      “An individual with knowledge of BARDA operations suggested that criticism of Bright’s investments in IL-6 was wrongheaded, given that the organization continues to have flexibility in how it crafts its response. The health department also has been plagued with broader questions about its responsiveness that go beyond BARDA, such as whether its agencies appropriately coordinated with each other on Covid-19 testing.

      Other current and former health officials — including a prominent Trump appointee, former FDA Commissioner Scott Gottlieb — praised Bright’s work as the organization’s leader.

      “At BARDA, Rick Bright was an outstanding partner to me, to FDA, and to our shared public health goals; including the approval of a historic treatment for smallpox and a vaccine for Ebola,” Gottlieb tweeted. “I look forward to his continued contributions to advance the health and safety of our nation.”

    3. francisT says:

      Relatedly there’s this screen capped message exchange from January 2.

      https://twitter.com/ddiamond/status/1253097522811359239

      He [Bright] is going to be removed from his job for incompetence and insubordination.

      1. Hap says:

        If that was sufficient (and accurate), though, why wasn’t he fired then? Coronavirus wasn’t an issue for us then, and insubordination is one of those things that tend to make bureaucracies cranky. At least had his superiors started the process then, he wouldn’t be where he is. If it is only coming up now, that suggests that either his action wasn’t enough to fire him at the time (and probably not more so now).

        1. loupgarous says:

          It’s hard to tell how much of the Bright debacle was bureaucratic latency (justifiable actions occurring after deliberation) and how much was vindictiveness. Trump’s impulsiveness really hurt him here, because he fires people in the White House just as dramatically as he did on his TV show. Sudden vindictiveness becomes a plausible reason for anything the man does.

          On the other hand, Dan Diamond’s article in Politico shows months and months of dispute between Dr. Bright and those who dealt with him. Who else has been fired for contradicting Trump on CQ and HCQ? Fauci and others have been pretty clear about the lack of clinical proof backing those drugs – to the point that Trump’s Twitter base has had #firefauci and other discussions up for a while. But there’s also a wide range of opinion on Twitter regarding Fauci, most of it favorable.

          All Trump’s done with that is retweet some of the #firefauci posts. I don’t consider that a good or wise thing to do with the public face of your Covid-19 policy – loyalty ought to go both ways, especially when considerable responsibility goes with positions like Dr. Fauci’s and Dr. Bright’s. But everyone else in Twitter seems to be allowed to retweet things they don’t necessarily agree with.

          1. Hap says:

            It depends who I speak for, though. If I speak for my employer (or someone else and not just me) than I have different responsibilities (or should) in talking. I can pipe up about lots of things (including some I probably shouldn’t) because it’ll only be my reputation that I smear poop on if I do. If people are tweeting with department/govt imprimatur when they shouldn’t, that seems like even more of a problem than insubordination (at least talk, rather than actual disobedience), and something that a bureaucracy ought to be cranky about.

  11. MattF says:

    Thank you Derek. We need to see knowledgeable people stand up and speak the truth.

  12. Trew says:

    Structural analysis of the chloroquine molecule leads to considerable doubt concerning the validity of the ionophore claim through passive diffusion similar to that seen with zinc pyrithione. The monodentate nature of binding coupled with the lack of charge neutralization by the Zn(II) suggests a different mode of action. The high concentration of positively charged chloroquine (100–300 µM chloroquine) more likely causes disruption to the lysosomes, allowing for the increase in zinc concentration.

  13. Alan Goldhammer says:

    Why did it take until April 21 for NIH to issue treatment guidelines for for COVID-19? See: https://www.nih.gov/news-events/news-releases/expert-us-panel-develops-nih-treatment-guidelines-covid-19 It explicitly talks about not giving unproven drugs for pre- or post-exposure prophylaxis and whenever possible use drugs for treatment within the confines of clinical trials. For hydroxychloroquine, that horse has already left the barn and finished the race. the drug is now standard of care with and without azithromycin in many clinical settings. I counted 145 trials registered at the NLM website today (there are likely more than that). Does anyone here think that any other drug stands a chance of getting patient enrollment?

    It took a group of deep thinkers led by Dr. Collins a month to come up with a paradigm for conducting research in a pandemic: https://fnih.org/news/press-releases/nih-launches-partnership-to-speed-covid19-vaccines-treatments Is this to bureaucratic to get anything done? Why did it take so long?

    If hydroxychloroquine +- pick your drug doesn’t work there is going to be a very ugly post-mortem.

  14. ghost of q.mensch says:

    Speaking of politics, watch how the UVA sponsored HCQ VA critical icu (mostly Black) covid pt “study design” [cough-cough] differs from the upcoming UVA sponsored remdesivir “early symptomatic pt, double-blinded control’ study:

    (starts at ~minute 4:30) https://www.youtube.com/watch?v=dLSYRqcg0wo

  15. Rock says:

    Spot on. What is even worse is that all of Trump’s policy decisions come directly from Fox “News”, including the use of hydroxy chloroquine. After the senate impeachment vote, the president knows he can act with impunity. How he still stands a good chance for reelection is beyond belief. I have already started efforts to obtain permanent residency in Canada if he is wins in November. (seriously).
    Everyone in the country should watch John Oliver’s most recent take on the Fox-Trump influence loop.
    https://youtu.be/dRFbwjwQ4VE

  16. Lane Simonian says:

    You can bluff your way past many things, but you cannot bluff your way past a virus.

    1. Derek Lowe says:

      Lane, you sure have that right.

    2. eub says:

      Exponential growth will out.

    3. Hap says:

      The “Nature cannot be fooled” for current events. Unfortunately, if 50% + one of voters can be fooled, then we get to find this out, repeatedly.

  17. PB says:

    You state the study “found that administration of these drugs to coronavirus patients actually increased the chances of death and of serious respiratory problems.”
    No it didn’t. The authors specifically state that HCQ was given to patients “with more severe disease.” They attempt to adjust for that in Table 4 of the study by only comparing patients that received treatment pre-ventilation. I’m sure you can figure out that still doesn’t do the job, but the result of that adjustment in Table 4 gives results that fully negate your statement. Don’t throw in with CNN and their ilk. We need an objective randomized double blind study that evaluates HCQ plus zinc when given as an antiviral treatment not as a Hail Mary for patients with severe disease.

    1. Randy says:

      In the study of 368 patients, 97 patients who took hydroxychloroquine had a 27.8% death rate. The 158 patients who did not take the drug had an 11.4% death rate.

      https://www.cnn.com/2020/04/21/health/hydroxychloroquine-veterans-study/index.html

      1. Charles H. says:

        What he was asserting was that the populations of the different cohorts were not matched. If this is true, then it definitely calls into question the relative effectiveness. OTOH, it still demonstrates that it wasn’t very effective.

  18. JP Leonard says:

    I don’t know what Dr. Bright meant by investing in “safe and scientifically vetted solutions” for novel coronavirus. Are there any? They somehow escaped my attention, although it has been focused on the search for such solutions for weeks. “proactive efforts to invest early into vaccines and supplies critical to saving American lives” – supplies ok, but vaccines saving lives already?
    “fund potentially dangerous drugs promoted by those with political connections.” Nobody is promoting chloroquine, and hydroxychloroquine (HCQ) is on the WHO list of safe and essential medicines. It’s generic so nobody is likely going to get rich overnight. Maybe he’s thinking about remdesivir and Gilead.
    Have a little respect for MD’s. No one here seems interested in the Sermo.com surveys of what doctors worldwide are prescribing. Their top choices are HCQ and Zpack. Is this because Trump said so, or is he saying this because he listened to Dr. Zelenko, MD? US doctors lag far behind Europe in HCQ use – up to 83% of doctors were using it in Italy.
    HCQ became the favorite of physicians worldwide, not because it’s so great, but because they don’t have anything better.
    If they were following Trump’s bidding, they might already have something better. They would be adding 220 mg of zinc to it, following Dr. Zelenko, because Trump endorsed adding zinc on April 8th.
    I doubt anybody is going to get very rich off of zinc. Me for sure not.
    Read me…
    How to Stop the Virus And the Quarantines Now
    https://tinyurl.com/Shutdown-Virus-Not-People
    We have a few doctors reporting HCQ+zinc is effective and safe, but it’s not scientifically vetted yet. What are the world’s scientifical vetters waiting for? The moon?

    1. CJones1 says:

      Have doctors and researchers been stumped and throwing out hypotheses on how to prevent Wuhan coronavirus (Covid 19/SARS2) infection and how to treat the ARDS & organ faikures associated with it.
      There are millions of people from similar demographic and genome types who have not taken Hydroxychloroquine, Zithromax, or Zinc. Do people taking Hydroxychloroquine for Lupus or Rheumatoid Arthritis get infected at the same rate as the general population? President Trump opened up the use of Hydroxychloroquine to treat the coronovirus for doctors.
      I’ve heard the VA study was flawed in many ways. Many subjects of the study were already suffering from ARDS or organ damage resulting from the Wuhan coronavirus (Covid 19/SARS2) before HCQ was administered. The ventilators sure aren’t working in the majority of cases. They’re pumping against a clogged system.
      A MIT article on March 25th mentioned that the capillaries were coagulating in the lungs, heart, kidneys, and other organs where ACE2 is expressed based on autopsies. They were studying using tPA to restore fibrinolysis balance and restore oxygenation. Previous ARDS studies demonstrated the effectiveness of nebulized tPA. Recent stories from Mt. Sinai hospital on tPA demonstrated an temoorart solution where Heparin was needed use to achieve long term benefit. It should probably be applied before a ventilator is used from what I’ve read.
      Hydroxylchloroquine has been used for 60+ years and the side effects are known. It appears to scrambles the ACE2 receptor and preventing further coronavirus infection and replication.
      As far as the political furor, President Trump’s political opponents have cornered themselves into a “let them eat cake” and die position. They were wrong about the Russian collusion narrative where it was actually the Clinton campaign & Mueller’s former Obama administration colleagues who collaborated with Russian operatives, lied to the FISA court, and lied about Hillary’s national security violations. VP Biden committed the impeachable act in corrupting & coercing the Ukrainian government in a conflict of interest. He basically sold out as much to the Chinese as WHO did. It is also worth noting that the worst hit areas have been represented by the Democratic party.
      Trump opened up promising available remedies for the general public, but told them to consult their doctors. He was ahead of the pack in limiting international egress. Any blame on testing, treatment, and deaths might be in the long run attributed to the meducal gurus advising him and his political opponents.

      1. Bill says:

        You were fine until you brought up Russia

  19. JP Leonard says:

    – 1st post above, where i wrote “adding 220 mg of zinc to it” above that should be zinc sulfate.
    – 2nd post, study conclusion “Serum zinc on initiation of ventilation had no predictive value” – could the issue be intracellular zinc rather than serum zinc? need an ionophore to get serum zinc into the cells?
    Empirically, it does seem that HCQ (ionophore) and zinc need each other to work. Either one on its own doesn’t do much for acute coronavirus infection.
    (That’s why my clinical trial proposal has HCQ as control and HCQ+Zinc as test.)

    1. loupgarous says:

      @JPLeonard:

      “Empirically, it does seem that HCQ (ionophore) and zinc need each other to work. Either one on its own doesn’t do much for acute coronavirus infection. (That’s why my clinical trial proposal has HCQ as control and HCQ+Zinc as test.).

      Which doesn’t do a thing for capturing tox signals on HCQ, which is something we need badly, especially given the allegations that the Trump administration improperly promoted HCQ despite a lengthy list of contraindications for the drug in what would be its target, high-risk for death patients.

      If you’re confident HCQ’s safe in that patient population, I’d think you’d be really, really ready to do a clinical study with standard of care (no HCQ or CQ in any way) as the control arm. We’re seeing suggestive if not conclusive evidence that HCQ’s toxicity contributed to excess mortality in the VA study. It’s a reason to back off of HCQ, given the stuff doesn’t seem to hit study endpoints that show it’s got any value at all. Even the HCQ+azithromycin arm of the VA study would, if the study had been more powerful, been dropped for futility under normal circumstances.

      1. JP Leonard says:

        @loupgarous, I think you may be mistaken about the dangers of HCQ (as distinguished from CQ). A lot of ppl have posted here how it’s given out like candy for travelers to the tropics. Can you reference the long list of contraindications? I only know of arrythmia. Dr Beeth in Bruxelles recommends an EKG before administering. As one poster here noted, risk of heart failure from covid is some order of magnitude greater than risk from HCQ.
        As I noted most doctors in the world are already prescribing HCQ so that can be the control arm, HCQ + zinc the test arm that needs attention.
        Any other comments on the proposed design with two groups alternating 5 days zinc vs 5 days placebo?
        I have been trying to post something here that won’t stick, maybe it’s too long I’ll try to make it 2 posts.

    2. Tox says:

      if you use zinc monoflouroacetate salt in the control group you will see less patients dying in the group on zinc sulphate

    3. Steve says:

      Just wondering why does it need to be Zinc Sulphate? Wouldn’t Zinc Citrate or picolinate work in a similar way?

    4. Steve says:

      Just wondering, wouldn’t Zinc citrate or Zinc picolinate be equally effective? I know it is cheaper but is there another specific reason zinc sulphate should be used?

      1. Red Agent says:

        In any superstition, the smallest details matter most.

        1. loupgarous says:

          Irving Langmuir observed that in his description of pathological science.
          So far we’ve seen arguments for:

          “The maximum effect that is observed is produced by a causative agent of barely detectable intensity, and the magnitude of the effect is substantially independent of the intensity of the cause.
          The effect is of a magnitude that remains close to the limit of detectability, or many measurements are necessary because of the very low statistical significance of the results.”

          That lines up very neatly with the “zinc ionophore” hypothesis in CQ and HCQ – which just happened to pop up when CQ and HCQ began tanking in objective retrospective analysis. What was the main hypothesis – that CQ and HCQ are potent antivirals in humans against SARS_CoV2 – gave way to the zinc ionophore hypothesis. The problem with that line of thought is that there’ll always be another magic additive missing from the formula for those of us who are invested (for whatever reason) in CQ and HCQ working in humans at all.

  20. JP Leonard says:

    Thank you, PB, for “We need an objective randomized double blind study that evaluates HCQ plus zinc when given as an antiviral treatment”.
    I would be very happy to receive comments or suggestions on this proposed study design:
    At https://tinyurl.com/Shutdown-Virus-Not-People
    “I propose a fast-track test model for a double-blind controlled test, based on HCQ as the control and HCQ+zinc as the test. All patients to get zinc either in the first or second phase, HCQ in both.
    Patients are given HCQ plus zinc or placebo for 5 days. Evaluation after 5 days. Continue treatment another 5 days, switching placebo and zinc between the two groups. Evaluation after 10 days. Compare results to see in which phase patients improved more, with zinc or placebo.
    The beauty of this is that researchers already obtain controlled results comparing zinc vs. placebo after the first 5 days. The second period ensures that no patient is disadvantaged by getting placebo only, which is more ethical and makes it easier to recruit subjects.”
    “What we can not afford is to waste more precious time. Delay is costing us thousands of deaths a day and ballpark $1 trillion in losses a week! Let’s make up for lost time now.”

    There was an Australian trial held last week with intravenous zinc late-stage to protect organs from damage from lack of oxygen. Impatiently awaiting results. If positive then zinc could be helpful all the way from prevention through mild symptoms through critical condition. https://anzctr.org.au/ACTRN12620000454976.aspx “High-dose intravenous zinc (HDIVZn) as adjunctive therapy in COVID-19 positive critically ill patients: A pilot randomized controlled trial”. Fingers X.
    Support from the literature?
    1. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-6576.2011.02425.x “Results: Low serum zinc was frequent (95.8%) at the onset acute respiratory failure.” “Conclusions: Serum zinc on initiation of ventilation had no predictive value for 30‐day mortality, ventilatory support time or intensive care unit LOS.” Not sure how to interpret that. Maybe no correlation since 96% were zinc deficient anyway, or the outcomes were random due to complications.
    2. “Zinc deficiency primes the lung for ventilator-induced injury” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453708/
    3. “Therapeutic modulation of zinc for lung injury and mechanobiology” (ongoing longterm study) https://grantome.com/grant/NIH/R01-HL142093-01A1
    “the zinc-dependent metallothionein pathway exerts anti-inflammatory and cytoprotective effects… during ventilator-induced lung injury in vivo, and in human subjects with ARDS…. and is an inherently protective pathway for lung function”

    1. matt says:

      What’s with the assumption that it would be unethical to give a placebo over hydroxychloroquine? If you believe that, you have already turned in your science card and joined the cargo cult.

      Don’t do that.
      Or, if you do, don’t bother posting here, because no matter how much you post, you are just smearing your ignorance wider and wider. It doesn’t help you, it just gets crap everywhere and makes responsible adults annoyed.

      A decent trial of HCQ would include a placebo control, because that’s the standard of care, and because you must compare, despite your ignorant certainty to the contrary, to a controlled baseline to find out what your comparative benefit is. Add arms for HCQ, HCQ + azithromycin, and now you want HCQ + zinc, too. Fine. There are organizations who can register and conduct such a trial for you in a proper way, pay them for their expertise and watch the results flow in. But you’d better hope the mass stupidity with which you have been infected has not spread too far, because they won’t be able to register enough patients. Why sign up for a trial which might or might not give you this wonder drug, as you think, when you can get it certainly from the local pill farm?

  21. Jen C says:

    We need to be rewarded for our investments in innovation and recognized and praised for the rich pharmaceutical armamentarium arising from our efforts.

  22. aairfccha says:

    Meanwhile the next “miracle” is coming out of France, this time preventative: Nicotine.

    (via Daily Fail, so YMMV)
    https://www.dailymail.co.uk/health/article-8246939/French-researchers-plan-nicotine-patches-coronavirus-patients-frontline-workers.html

    1. Martin (still not Shkreli) says:

      Took a quick look on what the French media says about it, and it has been reported by other media sources (with more credibility as the Daily Mail).
      The reasoning is roughly: at La Pitie-Salpetriere, only 5% of the sick are smokers, that is (all things being equal), almost 80% less than you would expect, given the prevalence of smoking in the general population. There is apparently a chinese study showing a similar effect (~13 % of patients were smokers, when ~28% of the chinese population smokes, published in the NEJM a few weeks ago according to Le Monde). Maybe nicotine somehow helps? Let’s try it.
      It looks like an observational study: they plan on giving various doses of nicotine, through patches, to hospital personnel (to see if it protects), to hospitalized patients (to see how the symptoms evolve), and to patients in reanimation (to see if they get better). No mention of control groups or anything like this. Hope that, if the results seem positive, cooler heads will prevail (compared to the HCQ/CQ mess)

      1. Covidiot19 says:

        Is it possible that the amount of crap smokers inhale while puffing away makes the inside of /cells lining the lungs a more hostile place and less ideal for viral replication?

        1. loupgarous says:

          Pulmonary dead space is a hostile environment for viruses for the same reason it’s hostile to exchange of blood gases. It’s dead. But that doesn’t mean we should encourage people to destroy their lungs before Sars _CoV2 can do it for them.

    2. JP Leonard says:

      Niacin is also known as nicotinic acid, niacinamide and nicotinamide. Maybe something was lost in Frenglish translation?
      They are talking about using Niacin (vitamin B3) instead of HCQ for zinc here https://www.researchgate.net/post/Is_a_combo_of_chloroquine_and_Zinc_a_cure_for_coronavirus
      Also liked this comment “having the two pre-mixed or even pre-complexed (in the same tablet) would help to ensure that the complex forms”
      I couldn’t quickly find confirmation that niacin is a zinc ionophore. Saw a comment somewhere that you might get too much niacin when combined with zinc

      1. aairfccha says:

        With the mention of nicotine patches, this is unlikely.

  23. Pathcoin says:

    The headlines of the VA study are misleading. Looking into the structure of the study we find a selection of patients already in advances stages of the disease, without a control arm, without delineation of underlying co-morbid conditions such as age of the patient, diabetes type II, hypertension, kidney or liver function status that are associated with a high death rate with the virus.

    The Secretary of the VA indicated that hydroxychloroquine worked very well in mild to moderate disease . He also noted this is an observational study (with all the limitations stated above), including the fact that some patients in the non-hydroxychloroquine group were on azithromycin, as well as the patients on hydroxycholoroquine.

    Like many diseases COVID-19 is best treated in the early stages. Hydroxychloroquine is best used to prevent progression to stage 4 (ventilator reason). This is quite similar to Tamiflu for influenza. Tamiflu is most effective when given within 48 hrs of flu like symptoms, with the dose modified for kidney and liver status. This is the experience of multiple health centers where hydroxychloroquine is a first line therapy to prevent progression of the disease. In fact, this is the strategy used everywhere in medicine: a medication that is effective at the early stages hopefully prevents progression to the later stages; but at the later stages, such a medication may no longer be effective.

    Those requiring ventilation are often in a cytokine storm, an overwhelming and out of control immune reaction that usually ends with the death of the patient. A cytokine storm is to a standard immune reaction like a hurricane is to a thunderstorm. At this point, other types of medication are needed, such as anti-IL6 and other immunosuppressives. Treating the virus at this point is like snuffing out a match that started a house fire. The house is still on fire.

  24. Richard_U says:

    All “scientists” with ties to established medicine
    (Pharma) are constantly ignoring studies that very strongly indicate HCQ is working, but ONLY in combination with zinc.
    Why ?
    Why are you (again) citing a study of HCQ given without zinc ?
    In fact you have not mentioned it ONCE in your crusade against HCQ.

    History will judge any false pretence, incompetence and prejudice of Trump yes.

    It will also judge yours….

  25. Doug says:

    “This will not be a calm, measured blog post – fair warning.”

    You obviously have not been watching Fox or Breitbart or any of the other right wing media outlets. Your outrage needs more venom and spittle if you want it to appear un-calm or un-measured! Also fewer big words and shorter sentences peppered with dog whistle words/phrases would improve the tenor of your statements.

    Well said. My fear, no my expectation, is that any investigation will be directly subverted by both Trump and Mitchell so the bad behavior and enforced ‘dear leader’ behavior will continue until the whole lot is voted out. Early on Trump said he could shoot someone and get away with it and the entirety of his tenure has proved him right.

    1. Derek Lowe says:

      I also see a real possibility of another Inspector General being fired. Why not? It’s worked so far.

  26. Richard_U says:

    One more thing:
    When eventually the dust settles from this Covid-storm, there will be results & reflections.
    We will do a ranking then of crappiest studies made during this period.

    Surely Dr. Raoult will rank high, for obvious reasons, but the VA-study by “Dr.” Ambati you are mentioning (exploiting for your narrative) is a serious contender.

    1. Frank Schaper says:

      Unfortunately not in the broad public eye. Should HCQ turn out to be beneficial (Hey, I said should!), he will be the hero of the public eye, but the study is still ***.

  27. t says:

    It is an irrefutable fact based on the piles of dead bodies, that the U.S. has had the worst response to this pandemic versus any other country (the most striking, even on a per capita basis, is U.S. v. S. Korea). This is a direct result of incompetence and malfeasance at the federal level. I just do not comprehend any other PoV on this. This crisis shows how much of a personality cult there is on the right along with its own media ecosystem bubble. At this point, I don’t see any pathway for us to come back together as a republic when, even in the face of death, we cannot even agree upon basic facts or trust in expert advice and science. For myself and the safety of my family, I’m looking to either flee this tinpot dictatorship or pray that the rational parts of this country secede as it’s clear that Trump will never leave office (even if he loses) and he’s clearly lined up his family to take over. Sorry for the rant comment on a blog that I’ve always viewed as a haven from politics, but this tidal wave of crimes being committed in the face of a crisis is just too much.

    1. Derek Lowe says:

      I feel it, too. This has been a multiyear nightmare.

    2. Surfactrant says:

      Taiwan’s handling of the crisis has been stellar, a rare ‘good news’ these days.

      Covid cases in Taiwan went from 23 to 430.
      In the same time the US went from 1 to 1,000,000.

    3. Craken says:

      The worst response is the U.S.? Have you ever heard of per capita death rates? Are you aware that the pandemic is far from over? In what bubble of TDS idiocy do you reside? And after making that moronic claim–“worst response”–you go on to whine about information bubbles. You have zero self-awareness. People like you are precisely why Trump needs to be re-elected and why Trumpism must continue after 2024. As Nietzsche noted: victory makes men stupid. You Leftists have been victorious in America for generations and you have become stupid (and insane).
      And, yes, I am well aware of Trump’s flaws. We nationalists could have hoped for a less flawed leader, but everyone else is apparently bought off by the system. Trump is perhaps the least corrupt member of America’s political elite, taking the term corruption in the broad sense that includes spiritual corruption. Even the modest role Trump has had in the mishandling of this pandemic will not prevent his reelection. The Russia Hoax, the second worst political crime in American history after secession, ensures massive support on the Right and a total mistrust of the manufacturers of consent.

      1. Madcow says:

        are you suffer from mad-cow disease in the US instead of covid19?

        1. Madcow says:

          herwith the symptoms of MCD or CJD:
          loss of intellect and memory.
          changes in personality.
          loss of balance and co-ordination.
          slurred speech.
          vision problems and blindness.
          abnormal jerking movements.
          progressive loss of brain function and mobility.

    4. jskdn says:

      Here’s the latest data on the countries with the highest death rates, excluding very small countries:

      Belgium 612
      Spain 496
      Italy 441
      France 350
      UK 305
      Netherlands 261
      Ireland 220
      Sweden 217
      Switzerland 186
      USA 166

      Korea was likely the best. Like several other countries in the region, it’s SARS classic experience had much to do with that. These countries are also organized politically differently than the U.S. with its disperse authority and greater privacy concerns. Our greatest obstacle to a better response was the CDC’s tragic failure of it’s test.

  28. anon says:

    Sorry to say this but, this is just another day. It’s been like this for a great number people, it’s just giving Business Pharma/Biotech the shaft this time both in reputations/trust with the public. The war on science continues unabated.

  29. Philip M says:

    This article is just another RANT, which is not helpful to sort through actual evidence pro and con on the effectiveness of Hydroxychloroquine alone or in combination with other treatment approaches.

    1. Derek Lowe says:

      You should go through all the other posts where I have reviewed that evidence. This post is more of a rant about Trump than a rant about hydroxychloroquine.

  30. Rob says:

    Thanks for the tour of the fever swamp. This political stuff is available everywhere you turn; do we really need it here?

    1. Derek Lowe says:

      It’s not a regular feature here, as you’ve probably noticed. Feel free to skip any post that has the word Trump in it.

  31. Red Agent says:

    The politics of Trumpism really is a religion. People believe what that want to believe, evidence and reason be damned. For the same reason you can’t argue with a true believer of a religion, you can’t argue with a Trumpy; they are not bound by logic.

  32. Larry says:

    Derek,
    Please resist the virtue-signaling and commentary abundantly and redundantly available elsewhere on MSDNC and the like.

    1. Derek Lowe says:

      No virtue is being signaled; I have no one to impress. I honestly and thoroughly loathe that Donald Trump is president, and I believe, on what I believe is abundant and easily available evidence, that he has been doing a catastrophic job. I am not trying to advance my career by saying this, nor do I believe that I suffer from any neurological or psychological impairments that prevent me from seeing Trump’s competence and greatness.

      That said, this is not at heart a political blog, God knows. But every so often politics and drug discovery intersect, and it’s rarely a good collision.

      1. blogreader01 says:

        TDS on raw and ugly display here.

        Hey people, get over it. You voted for Hillary Rodham Clinton and she lost. Trump beat her fair and square. It wasn’t even close.

        Sore losers who can’t let go are not appreciated by independent voters as, methinks, you are going to find out, in spades, this coming November …

        1. Hap says:

          I sort of figured based on the general level of discourse that TDS refers to his supporters (at least as well, if not instead of).

          The suggestion I read is that you can judge a President only on the people who chooses and the things he chooses to say because those are the only things he has unalloyed control over. I am not sure what in Trump’s statements or personnel choices would indicate that he has in fact been a good President. His good (qualified?) personnel choices can be listed on one hand (and, other than Gorsuch, none of those are still around), while his interesting tweets…cannot. Either not choosing people or choosing unqualified people to run the government is partly why we’re where we are – if you want government small enough not to do anything you don’t want, it’s also going to be small enough not to actually protect you from anything.

  33. Uncle Al says:

    What is the fundamental money cost of HCQ + Z-pack + zinc course of treatment? Piddles.
    What are the acute side effects? Minor.

    What is the fundamental money cost of remdesvir course of treatment? Astounding.
    https://i2.wp.com/i.sozcu.com.tr/wp-content/uploads/2020/02/25/remdesivir-wiki.jpg
    What are the acute side affects? Near-lethal and co-lethal, 25% incidence.

    Follow the money. Wuhan virus ablates Inner Cities (slums), homeless, illegals; generic Browns, Blacks, Muslims, geriatrics; the shiftless and the stupid. Wuhan virus is a demographic rebalancing long term fiscal good thing – Hitler’s camps without the carbon footprint and opprobrium. Just saying….

    1. CMCGuy says:

      Invoking Godwin’s law?

  34. JP Leonard says:

    @Tox @Steve
    No it doesn’t have to be zinc sulfate, that is just what Zelenko uses.
    Zinc sulfate, zinc monoflouroacetate salt, zinc citrate, zinc picolinate, zinc orotate. A friend of mine swears by zinc orotate.
    Tox, I couldn’t understand your comment “if you use zinc monoflouroacetate salt in the control group you will see less patients dying in the group on zinc sulphate”

    1. Derek Lowe says:

      That’s because (toxicology lesson time) monofluoroacetate is a deadly poison.

      1. Tox says:

        thanks Derek, probably you are one of the only ones on the blog who understands drug discovery and in the mean time knows some very toxic agents….you see how easy you can mislead people…..just use zinc, Oh NO not metallic zinc, but a salt…doesn’t matter sulfate or monofluoroacetate salt. Even if you are Mr Tox it does not ring a bell, pfff

        1. Hap says:

          1068 will stop the virus, too – if its vectors die before they can infect others, then it loses. It’s just that we sort of prefer drugs that don’t kill us. (Fluoroacetate kills the citric acid cycle, and hence, us).

          1. loupgarous says:

            Hap, you mean “compound 1080”, right? Or is there a variant that’s not sodium fluoroacetate?

          2. Hap says:

            Sorry – I pwned myself. Yes, 1080.

    2. Steve says:

      Tox’s poor idea of a joke I think. It’s a poison.

      1. Tox says:

        Not really a joke, rather a wake-up call to see if some people stay sharp and humble if you elaborate on drug discovery.. (fortunately Derek is)…. sooner or later some president (not in my country) may suggest to inject a disinfectant such as isopropyl alcohol and you reason that indeed it seems OK to inject 1-2ml (lethal dose in humans translated from animal tox: 200 ml and ingestion of 20 ml in man you see serious side effects)….what a world. Please use your money and expertise to discover e.g. a better Cov2-RNA-polymerase inhibitor…remdesivir was on the bench and a nice attempt, but not tailor made for this RNA-pol I am sure you can find better ones (better potency, selectivity and po instead of iv); there are a few thousand interesting modified nucleosides known for which phosphorylated prodrugs can be prepared and tested; hopefully some synthesis started already in China, UK and India. Would be surprised if Pharma in the US has medicinal chemists left (age >70) who work on modified nucleosides

        1. Darby says:

          Check the news.

  35. JP Leonard says:

    Thank you, @PB, for “We need an objective randomized double blind study that evaluates HCQ plus zinc when given as an antiviral treatment”.
    I would be very happy to receive comments or suggestions on this proposed study design:
    At https://tinyurl.com/Shutdown-Virus-Not-People
    “I propose a fast-track test model for a double-blind controlled test, based on HCQ as the control and HCQ+zinc as the test. All patients to get zinc either in the first or second phase, HCQ in both.
    Patients are given HCQ plus zinc or placebo for 5 days. Evaluation after 5 days. Continue treatment another 5 days, switching placebo and zinc between the two groups. Evaluation after 10 days. Compare results to see in which phase patients improved more, with zinc or placebo.
    The beauty of this is that researchers already obtain controlled results comparing zinc vs. placebo after the first 5 days. The second period ensures that no patient is disadvantaged by getting placebo only, which is more ethical and makes it easier to recruit subjects.”
    “What we can not afford is to waste more precious time. Delay is costing us thousands of deaths a day and ballpark $1 trillion in losses a week! Let’s make up for lost time now.”

  36. JP Leonard says:

    Here is the 2nd part of the post that wouldn’t stick last night – maybe it was too long. (it’s still long:-) The 1st part is “Thank you, @PB”.)
    There was an Australian trial held last week with intravenous zinc late-stage to protect organ damage from lack of oxygen. If positive then zinc could be helpful all the way from prevention through mild symptoms through critical condition. https://anzctr.org.au/ACTRN12620000454976.aspx “High-dose intravenous zinc (HDIVZn) as adjunctive therapy in COVID-19 positive critically ill patients: A pilot randomized controlled trial”. Fingers X.
    Support from the literature?
    1. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-6576.2011.02425.x “Results: Low serum zinc was frequent (95.8%) at the onset acute respiratory failure.” “Conclusions: Serum zinc on initiation of ventilation had no predictive value for 30‐day mortality, ventilatory support time or intensive care unit LOS.” Not sure how to interpret that. Maybe no correlation since 96% were zinc deficient anyway, or the outcomes were random due to complications. Or could the issue be intracellular zinc rather than serum zinc? need an ionophore to get serum zinc into the cells? If so that might bode ill for this intravenous zinc study. I’m not an advocate of zinc on its own for this disease.
    2. “Zinc deficiency primes the lung for ventilator-induced injury” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453708/
    3. “Therapeutic modulation of zinc for lung injury and mechanobiology” (ongoing longterm study) https://grantome.com/grant/NIH/R01-HL142093-01A1
    “the zinc-dependent metallothionein pathway exerts anti-inflammatory and cytoprotective effects… during ventilator-induced lung injury in vivo, and in human subjects with ARDS…. and is an inherently protective pathway for lung function”

  37. Dr Joe says:

    I read the VA study preprint.
    The control group has significant (positive) differences in respiratory and liver function. The authors used median values for a continuous variable.
    At least one author associated with Gilead.
    C-
    😉

  38. Tom says:

    In a long line of poorly designed studies, the VA study seems to fit perfectly. It is amusing (or it would be if this was less serious) to watch as people pick their favorite from among the flawed HCQ studies based on their politics. This VA study is a non-randomized retrospective study, with an after-the-fact non-disclosed attempt at retrofitting some sort of risk adjustment. It is not yet peer reviewed, with a slew of competing financial interests noted. Does it tell us anything? Maybe. Maybe not. What I got out of it was “why the heck aren’t we testing azithromycin as a stand-alone? How hard would it be to do a randomized, double-blind study (preferably administered early in the course of the disease, since it seems likely that early treatment to control viral activity is going to be different than immunomodulation of a cytokine storm)? You know, science. Before science became a function of one’s belief system.

    1. Lambchops says:

      There are ongoing UK studies that are using azithromycin alone as well as hydroxychloroquine alone – given both are adaptive trials and more treatment arms can be added I’m assuming they are waiting on monotherapy data before adding a combination arm.

      Hospital population: https://www.recoverytrial.net/

      General practice population (older patients): https://www.phctrials.ox.ac.uk/principle-trial

      Hopefully along with other trials elsewhere we’ll start to see a more complete picture emerge.

  39. William Prendergast, M.D. says:

    Is there money to be made in (hydroxy) chloroquine? I mean serious, big money? It wouldn’t seem that there would be with a generic like this with so many sources and potential sources. And, if not, why would it be a vehicle for any serious political graft or corruption?

    1. JP Leonard says:

      Maybe compounding pharmacies could make an honest living compounding tablets of say zinc, HCQ and niacin?

    2. Sunyilo says:

      There is always money to be made if there is government funding (and forcing) its use. As it has been the case with the Trump administration

  40. David Lessard says:

    South Korea has been one of the most successful countries in dealing with the Corona virus. The use of hydroxychloroquine and zinc is at the core of their national response. How many Americans do you think have died as a result of this evil bureaucrat’s campaign to limit this treatment option to people who are already to far gone to benefit from it?

    1. JP Leonard says:

      David, do you have a reference for South Korean use of HCQ+zinc? Have been looking for that and wasn’t able to find one. Thanks.

    2. Derek Lowe says:

      Can you back up that statement on South Korean use of this combination?

    3. James Thomas says:

      This seems to be contradicted (at least through mid-February) by this review: http://www.koreabiomed.com/news/articleView.html?idxno=7428

    4. Correlation is not causation says:

      Test, track, trace contacts, contain?

    5. chiz says:

      The claim about Korea using zinc comes from, or is transmogrified from, a remark Zelenko made in an interview, if I’m not mistaken. He also claimed, immediately afterwards, that Raoult’s HCQ studies were in vitro. Ignore it, and him.

  41. Tom Boyer says:

    Of course firing qualified scientists in the midst of an epidemic is horrific. A president who is unbalanced and growing more so is even more horrific.

    But those are things we do not control. What we do control is our own emotions and our own intellect.

    Rooting for or against any drug in a deadly epidemic based on one’s political leanings is wrong and destructive. This is not a freaking football game. Whether one drug associated with right-wingers is successful, or another drug from a California biotech wins — it doesn’t matter. We need drugs that will help and save lives, the more the better.

    I probably despise this incompetent president as much as anybody. But if I were asked to choose between re-electing this incompetent boob or 3,000 people a day dying, I would not hesitate — I would take the lives; I would accept four more years. I would like to think most people would.

    Saving the lives of our grandmothers and grandfathers and aunts and uncles is the ONLY important thing. If there’s a drug that can save some lives, I don’t care if it’s Trump’s drug or Fox News’s drug, I really don’t.

    I really wish the people writing about HCQ, and the thousands of doctors and scientists and thoughtful people commenting on it, could just check their politics at the door and wait for the evidence to answer whether it can save lives or not. And not shade their eyes and block their ears if the evidence suggests it works.

    I am disgusted when news organizations I respect gleefully trumpet every negative tidbit they can find about what they see as Trump’s drug, and ignore or downplay every positive bit of evidence. This does real damage.

    The absurd misinformation about HCQ being a dangerous drug, based on studies in which dying patients were given huge overdoses — this does real harm because there may come a time when people need to take it, and they’ll be afraid to because of the litany of biased bad press.

    Most of the rest of the world couldn’t care less whose drug it is — they believe it saves lives and they have made it standard treatment protocol — these countries include Italy, Spain, South Korea, India, Costa Rica, Malaysia, Taiwan.

    It’s time to check the politics at the door and see, with an open mind, whether HCQ or any drug might help because right now we have NOTHING. NADA. While we play Hatfields and McCoys, we are losing 3,000 friends and loved ones each day.

    1. a says:

      “I probably despise this incompetent president as much as anybody. But if I were asked to choose between re-electing this incompetent boob or 3,000 people a day dying, I would not hesitate — I would take the lives; I would accept four more years. I would like to think most people would”

      do you think re-electing this guy will only cost the world a net 3k a day lives?.

    2. He spoke to a reporter on his own. That has not been allowed for a long time. To do that you have to be elected to your position.

  42. JP Leonard says:

    Hear, hear for keeping politics out of science.
    Altho…. since this thread is about politics… and no one else has brought it up… Has anyone else seen the story where RFK Jr is making monstrous accusations against Fauci?
    – accusing him of plotting mass death for profit by moving bioweapons research to China after Obama stopped it here.
    – Suppressing a coronavirus cure because he owns vaccine patents – that he stole from underlings and then fired them, during his tenure at NIAID since 1 9 8 4.
    https://www.naturalnews.com/2020-04-20-robert-f-kennedy-jr-anthony-fauci-fraud-poisoned-americans.html
    Whew. It doesn’t get much hotter than that.
    (I didn’t listen to the podcast where RFK is supposed to make these claims)
    Some hints of this in mainstream media
    https://www.dailymail.co.uk/news/article-8211291/U-S-government-gave-3-7million-grant-Wuhan-lab-experimented-coronavirus-source-bats.html

    Earlier, top Harvard scientist Charles Lieber was charged by the FBI for lying about selling knowhow to China for the Wuhan lab, as Derek reported then https://blogs.sciencemag.org/pipeline/archives/2020/01/29/harvards-chemistry-dept-chairman-in-fbi-custody

  43. drsnowboard says:

    Just inject disinfectant and sit in the sun, it could be good?
    I like the sound of it, but, you know, I’M NOT A DOCTOR
    https://www.bbc.com/news/world-us-canada-52407177

    I still don’t get how Emperor’s New Clothes doesn’t apply here. As Marx* said ” A child of five could understand this.. Send for a child of five!”

    *Groucho

    1. JP Leonard says:

      You guys keep making one rhetorical fallacy after another. Saying something is helpful is not the same as saying not to do anything else. Major fallacy: taking the bile duct for the organ of ratiocination.
      Coronavirus and the Sun: a Lesson from the 1918 Influenza Pandemic
      https://medium.com/@ra.hobday/coronavirus-and-the-sun-a-lesson-from-the-1918-influenza-pandemic-509151dc8065
      1918 “Put simply, medics found that severely ill flu patients nursed outdoors recovered better than those treated indoors. A combination of fresh air and sunlight seems to have prevented deaths among patients; and infections among medical staff.[1] There is scientific support for this. Research shows that outdoor air is a natural disinfectant. Fresh air can kill the flu virus and other harmful germs. Equally, sunlight is germicidal and there is now evidence it can kill the flu virus.
      `Open-Air’ Treatment in 1918
      During the great pandemic, two of the worst places to be were military barracks and troop-ships. Overcrowding and bad ventilation put soldiers and sailors at high risk of catching influenza and the other infections that often followed it.”
      2020 results: 40% of pandemic deaths in NJ were in nursing homes.
      2020 orders: stay indoors, don’t go out in the sun for fresh air

      1. JP Leonard says:

        All sorts of vermin like dark and dank places. Viruses, bacteria and fungi are no exception.

        1. drsnowboard says:

          and taking bleach internally? You think that is great evidence of lateral thinking?

          Are you watching?

          1. Bleach? What is that? Something terrible I suppose.

            FYI…Most water is chlorinated. If it isn’t…you have do do it yourself. How could you do that? Most recommendations call for a dilute solution of sodium hypochlorite.

      2. skillful_ignorance says:

        I suppose then that people are ok to socialize closely as long as they are in the sunlight, right? after all, their respiratory droplets will be immediately vaporized upon exposure to sunlight, like vampires, and not pose a danger to others. good grief

      3. ToXDoX says:

        Why are you still posting here? Outdoor air is a natural disinfectant? Jesus Christ, they must have furloughed you immediately.

        Also lol @ using medium as a source.

        1. JP Leonard says:

          As I said, you guys put out a rhetorical fallacy a minute. You just came up with four more. Thank you for instant validation of the thesis.
          The top folly seems to be the appeal to the ridiculous.
          Apparently, logic isn’t on the syllabus in STEM majors.
          Zinc + ionophore isn’t religion. It’s a science-based hypothesis that needs to be tested in practice. Unfortunately, the doctors claiming success with it didn’t validate it very well. No placebos, no data.
          If it works, it will be well worth taking the trouble to test it. If it doesn’t, end of story.
          Have any of you tested it? If not, then pipe down and stop bragging about your open mind and grasp of scientific method because AFAICS it’s on the detox ward.

  44. Greetjam says:

    It’s a problem when a top health adviser has an agenda in tearing down the duly elected president for an issue that has not yet been settled by clinical trial data. I dont want that dude making decisions for our health, full stop.

    1. Ian Malone says:

      So, I’m curious whether you wrote this before or after the disinfectant press conference? That’s not been settled yet by clinical trial data either, so I suppose they should stay schtum. Wouldn’t want to undermine the duly elected president after all.

  45. The White Tornado says:

    The Donald-led GOP and COVID19 are a perfect storm of virulence and destruction exploiting compromised herd immunity. In the case of COVID19, we’re simply sitting ducks because of the novelty of the virus to our immune systems, hence the need for vaccines. In contrast, the Donald is a well trodden pathogen based on longstanding social and political vulnerabilities to democracy, namely racism, xenophobia, bigotry, greed, corruption… The mechanism-of-action of the Donald is simply an overwhelming cytokine storm of swill to cover exploitation. His capacity to infect American and global politics exposes a severely weakened democratic infrastructure, as well as a brainwashed electorate – the George Packer article in The Atlantic is spot on.

    If only it were as simple as applying copious amounts of ammonium chloride to cleanse the systems. For the birthers out there, feel free to dose up!

    https://www.nbcnews.com/politics/donald-trump/trump-suggests-injection-disinfectant-beat-coronavirus-clean-lungs-n1191216

    1. COVID HOAX says:

      Do you think spray tan would work just as well?

    2. ghost of q.mensch says:

      Well, you must admit SOMETHING is WORKING (vs covid) for Trump. He is up at the white house CV task force podium every day (including weekends), elbow to elbow with other presenting members, for ~2hr, plus during which he is constantly taking loads of venomous/infectious(?) spew from corporate TDS media reporters.

  46. cynical1 says:

    This is our Chernobyl and we literally have Donald Trump in charge. Ignorance can be educated, crazy can be medicated. What is the cure for stupid? This guy would literally lose at tic-tac-toe. People think he has dementia. He doesn’t. He’s just a plain old fashioned idiot. The hardest thing to watch is the narcissistic ego coupled with a 4th grade intellect.

    1. James Millar says:

      Would take a lot of Chernobyls to make a day of this

  47. Ezra Abrams says:

    I use to try engaging with Trump supporters, but gave it up; at least those on line are like slashdot fanboys (once upon a time, fanboys on slashdot argued passionately that you could make money mining Platinum from asteroids; not kidding)

    It really isn’t worth it; it is like playing Calvinball with someone who is a mean drunk

    just let them be
    Like the whole discussion of Zn/ionophores/binding RNA replicase; it is truly religion and you won’t ever ever get anywhere
    or as we use to say, don’t feed the trolls

  48. Olandese Volante says:

    Now we now where the latest Trumpian nonsense came from:

    https://www.theguardian.com/world/2020/apr/24/revealed-leader-group-peddling-bleach-cure-lobbied-trump-coronavirus

    Why, it’s the Miracle Mineral Solution quacks alright, these fine people selling industrial bleach as a cure-all.

    1. Now we now? Proof? Of what?

  49. rtah100 says:

    @JP Leonard: I don’t understand why a blog with such intelligent contributors was so sarcastic about your post on fresh air and sunlight. Sunlight is indeed a great disinfectant (check out the use of plastic water containers as solar sterilisers for water in the third world). Previous influenza pandemics found much better survival in tent wards than indoors, because of better ventilation and reduce nosocomial infection. It’s not woo-woo, it’s basic hygiene in public health. Oh, and the other thing that previous pandemics used and we could be using is iodine, preferably Lugol’s solution for the I3+ ion concentration. It can be used in low concentrations in an aerosol / humidifier as an environmental viricide. It can also be sprayed on a surgical mask to improve protection.

    Also, given the HCQ/AZT/ZN scepticism, it is part of the Italian COVID-19 treatment pathway. Along with anti-clotting agents, ARBs and IV vitamin C.

    I cannot find the more recent guidance in which anticoagulants were recommended but the earlier version is here:
    http://www.asl4.liguria.it/wp-content/uploads/2020/04/gestione-clinica-del-paziente-covid19.pdf

    1. JP Leonard says:

      Dear @rtah100,
      Thank you very much for your kind and thoughtful reply.
      Yes and I see the antiviral qualities of sunlight trending on the news. The iodine as a surface viricide sounds good too.
      I downloaded the italian protocol and ran Abbyy reader on it but couldn’t find the word zinc or zinco anywhere in it, unfortunately. Italy has the highest use of HCQ of any country on the weekly Sermo surveys. I may post an overview of the latest Sermo report later.
      Regarding Trump and disinfectant I really doubt he meant Lung Lysol. He was referring to some other procedure in his layman’s terms. Yes, it is his style to shoot from the hip..
      Regarding Raoult I don’t get how he missed that Plaquenil may be working as an ionophore when it has zinc to work with, but then almost nobody looks at that. Un train peut en cacher…
      Here is a link to a protocol with zinc and HCQ for early stage infection but not later on. https://www.evms.edu/media/evms_public/departments/internal_medicine/Marik-Covid-Protocol-Summary.pdf I wrote to Dr. Marik asking if the 75/100 mg zinc is elemental or a compound, and why Zinc+HCQ only applied early stage. He was kind enough to reply saying “The literature does not support its use late in the course of the disease.” I replied, with reference to my review of the literature here https://tinyurl.com/Think-Zinc , that zinc “has been found to be an antiviral with a central role in the immune system”, but no second reply from him was forthcoming. However, the most recent weekly Sermo report shows no correlation between early vs late stage in frequency of zinc use by doctors.

      1. Zinc is readily detectable on skin at high enough levels to interfere with routine environmental monitoring and exploratory field geochemistry. I used the test hundreds of times and might still have it in my field kit.

        Why zinc? Antiviral skin? Makes sense.

        1. It was the “dithizone test”. https://pubs.acs.org/doi/abs/10.1021/ac60060a048

          It works very well and is specific for Zinc although it can be made to detect other heavy metals, Cu, and Pb but with less sensitivity.

          Could there be a way to screen for zinc deficiency? Could zinc deficiency correlate with susceptibility? Give it a go!

  50. CheckYourHat says:

    What is frustrating beyond belief is that at least half the posts here summarize to:

    Trump sucks, he’s an idiot, and anything that might possibly look good for him sucks and is idiotic.

    It’s fine not to like Trump. But if it blinds you to evaluating science in a level-headed manner, then that makes your views worthless.

    Check the Trump vitriol at the door and stick to the science.

    1. Elliott says:

      Did you even read the many earlier posts from Derek on the science? A level-headed evaluation of the science leads one to the conclusion that HCQ is likely to be worthless. Trump popularized and politicized this alleged treatment. It is the right and duty of people who are scientists and citizens to point out the flaws and fallacies of his actions. If you believe that not-liking Trump is behind this, then go read the actual science, not the distorted versions that you’ll get on the Trump fanboi sites.

      1. ghost of q.mensch says:

        I’ve been perusing Derek’s med chem blog ever since way back when it was on the Corrante (sp?) platform. He has had “John McCain/Rachel Maddow” level TDS even before Trump was elected.

        For example:
        https://blogs.sciencemag.org/pipeline/archives/2016/11/07/politics-unfortunately

        1. Derek Lowe says:

          I’m going to regret asking this, but is it possible to dislike Trump without having some sort of psychological imbalance, would you say?

          1. ghost of q.mensch says:

            And I am going to probably regret rising to the bait, but here goes anyway:

            What I see going on in multiple topic posts on your med chem blog, since a general awareness of the true seriousness of the Covid pandemic finally began to sink in (in late Feb/early Mar) with the US general public, and our county’s oblivious leadership** gradually started to wake up and react to the fact that “Hey, we’re not in Kansas anymore”, seems an ongoing concerted effort (obvious to me at least, and better explained by others; (ie https://www.youtube.com/watch?v=rN_YpFhdii4 >min 10:40, repeated from upthread) to attack by PROXY one particular side of the country’s leadership.

            It is not just Derek doing this of course. The great and powerful domestic reality-warping Wurlitzer, aka our controlled corporate media, launched the proxy war attacks on that ‘crazy dictator’ Dr. Raoult, and “deadly” hydroxychloroquine (HCQ), shortly after people who Trump evidently trusts put the HCQ bug in his ear, probably in mid-March. https://www.washingtonpost.com/politics/2020/04/24/rise-fall-trumps-obsession-with-hydroxychloroquine/

            Now I don’t know anything much about this (“Trumpian” ? really?) French Dr. Raoult beyond his bio-sketch and his 9400+ PubMed citations, besides the fact that his reputation was smeared heavily on this blog (and in the comments section frequented by a hovering retinue of sycophantic flying monkeys, and ‘special needs’ trolls who think it is really cute to suggest readers take lithium, or the Zn salt of a rat poison with their HCQ (!!), among other things) over the course of at least two of Derek’s postings subsequent to the mid-March HCQ embrace/endorsement by Trump.

            However, I DO know Dr, Raoult is but one of many who had been studying HCQ/CV and writing up case study reports well before Trump ever mentioned HCQ.

            Did any such posts questioning Raoult’s ‘dodgy’ HCQ /CV tx protocols and ‘horrible dicatorial’ (paraphrasing) tendencies appear before the mid-march pro-HCQ stance Trump?

            And regarding those ‘extremely dangerous HCQ toxicities’ so much text and comment space has been devoted to:

            This is something I (or rather my corporeal form, quinoline mensch, who curiously seems unable to post here anymore) do have some firsthand knowledge of, ie quinolines—having spent a good number of years making them for my Phd thesis work under the mentorship of one of the inventors of amodiaquine (ADQ), a close analog of HCQ, which was the first curative ‘single agent’ tx for the most dangerous, falciparum, form of malaria.

            That is, until resistant falciparum strains became recognized in the 1960s-Vietnam War era, whereupon ADQ was superseded, first by mefloquine (MFQ) under WRAIR (Walter Reed Army Inst of Research) sponsored work. Resistance to MFQ in turn arose in new circulating falciparum malaria strains. These are now dealt with effectively with combination tx employing either ADQ or MFQ with an artemisinin derivative.

            HCQ, chloroquine, ADQ, and MFQ are believed share mechanisms/sites of action in common and they are grouped together within the “4-aminoquinoline” class of antimalarial/antiparasitic drugs. The order of “chronic use” safety (based on >65 years’ worth of data gathered from tx experience of literally millions of human subjects) is ~HCQ>CQ>ADQ , and the relative daily dose/pt cost of these three derivatives (which incidentally are all in the range from a few pennies (3rd World) to ~$1-2/day (1st World).

            Furthermore, and this is important, all three agents, HCQ, CQ, and ADQ, are on the World Health Organization’s List of Essential Medicines, the SAFEST and most effective medicines needed in a health system.

            So, yes, I think it is rather irresponsible, and possibly even dangerous in the long term, particularly in cases of young physicians caring for covid patients, or concerned family members/guardians of same, who are unfamiliar with the historical background and extensive (if somewhat dust-covered) body of safety data on these “old tropical disease drugs”, and come here looking to an objective, authoritative “data-driven, just the facts” med chem blog that they may have found informative in the past, to help them find solid info regarding treatment options. Instead they get skillfully written cautionary tomes that basically reinforce and harmonize with the corporate media’s politically/ideologically driven “Trump’s HCQ is both worthless AND possibly deadly” Wurlitzer propaganda narrative, while essentially neglecting to point out the extensive ~70 yr long safety data record with HCQ .

            Why would anyone reading such, from a ‘trusted unbiased, non-agenda driven source’, ever even consider to try HCQ under practice of medicine for their early symptomatic covid patients??

            **(No, Pres. Trump (Feb 24): Come back from that meaningless and risky (to your family’s health) photo-op [eg. Children spontaneous hindi cha-cha dancing] state visit to India.

            No, Speaker Nancy (~Feb 24): Stop exhorting the public to ‘Come-On-Down’ for SanFran’s Chinatown festivities. https://www.nbcbayarea.com/news/local/nancy-pelosi-visits-san-franciscos-chinatown/2240247/

            No, Secs of State/Navy (~Mar 1(?)): Do NOT order USS Roosevelt carrier task force to Da Nang, Viet Nam for backdrop optics on a previously planned US/Viet Ambassadors’ dog-and-pony show, and furthermore, Do Not permit several days of ‘good-will-building’ crew shore-leave (do a google search for “DaNang haircut”) 2-4 weeks AFTER Vietnam had just evacuated its personnel from Wuhan and locked down its borders to China and S. Korean (mostly young male) tourists who frequent those $4 DaNang “haircut++” parlors).

  51. Nathan Raven says:

    I am not a fan of any politician, including the current president. Now:
    In explanation, as I see it, of Dr. Raoult’s reasoning on the treatment that he proposes (hydroxychloroquine + azithromycin, henceforward DRP, for Didier Raoult Protocol).

    In his much-criticized small study, Dr. Raoult observed concrete changes in the viral load of his patients who received DRP, and these were much bigger than the changes in those who received only azithromycin or nothing (the control groups). Quoting: “On the sixth day of the study 100% of patients who received the combination of hydroxychloroquine and azithromycin” ”had a negative viral load compared to 57.1% in those who received chloroquine alone and 12% in the control group. The viral load is the quantity of virus present in the fluids obtained in particular by nasopharyngeal samples in the case of this study.”

    Put another way, if I understand correctly, the DRP seemed to show concrete changes in the body in terms of viral load. It wasn’t just a “black box” study to see which group did better; it was a study that tracked changes in the body.

    Many hospitals are trying hydroxychloroquine for late-stage patients and reporting poor results, or negative results. Dr. Raoult has explained his view of why this is the case, and he does not recommend using these medications late in the game. “From a therapeutic point of view,” he wrote, “what we are seeing is that the patients, when they have respiratory failure and when they return to intensive care, have almost no virus left. then it’s too late to treat people with antivirals. It’s when they have moderate, medium, or starting to get worse forms that they should be treated. When they returned to intensive care, the problem was no longer the virus.”

    The results that are reported by mainstream media stating that late-stage patients are harmed by administration of hydroxychloroquine would thus be predictable: It is a dangerous drug that cannot help at that stage.

    On another matter, the French state has announced controlled trials of various combinations — but NOT of the DRP! I have no explanation of this oversight.

    In terms of credibility, Dr. Raoult is one of the world’s most eminent scientists. “According to the Thomson Reuters source “Highly Cited Researchers List”, Raoult is among the most influential researchers in his field and his publications are among the 1% most consulted in academic journals. He is one of the 99 most cited microbiologists in the world and one of the 73 most highly cited French scientists. He is a world reference for Q fever and Whipple’s disease. In April 2017, on Google Scholar citations, he cumulated over 104,000 citations and an h index of 148. He is also on the list of the 400 most cited authors in the biomedical world…”

    “Since the 1990s, Raoult and his team have identified and described approximately 96 new pathogenic bacteria and showed their implication in human pathologies. The eponymous bacteria genus Raoultella and the species Rickettsia raoultii have been named after him. He introduced a treatment for Whipple’s disease that became the reference treatment by doxycycline and Plaquenil and describes the acute forms of the disease which include pneumopathies.”

    “Microbial culturomics is a field that was created by Raoult’s team in 2008 to characterize the multiplication of culture techniques, identification by MALDI-TOF and confirmation by sequencing of the 16S RNA. This culture technique allowed [the lab] to collect twice as many microbial species as the rest of the laboratories of the world together.”

    (I have not checked these quoted claims myself but they fit with other sources I have read about this researcher. If they are wrong, please let us all know.)

    None of that makes him right, and none of it proves that the DRP is effective. I don’t know, myself. But I would rather listen to him and at least pay serious attention to the claim that he has now treated over 1,000 patients with very good outcomes than dismiss him as a crank.

  52. Dr. Juan M. Luco says:

    Response to work of Magagnoli, et. al. , the VA article (sham for medical science!!), MedRxiv, 2020.
    Here link of response by M. MILLION, Y. ROUSSEL, D. RAOULT
    https://www.mediterranee-infection.com/wp-content/uploads/2020/04/Response-to-Magagnoli.pdf

    Response to Magagnoli, MedRxiv, 2020Matthieu MILLION1,2, Yanis ROUSSEL1,2, Didier RAOULT1,21IHU-Méditerranée Infection, Marseille, France2Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France

    In the current period, it seems that passion dominates rigorous and balanced scientific analysisand may lead to scientific misconduct. Thearticle by Magagnoli et al. (Magagnoli, 2020) is an absolutely spectacular example of this. Indeed, in this work, it is concluded, in the end, that hydroxychloroquine (HCQ) would double themortality in patients with COVIDwith a fatality rate of 28% (versus 11% in the NoHCQ group), which is extraordinarily hard to believe. The analysis of the data shows two major biases, which show a wellingto be convinced before starting the work :
    The first is that lymphopenia is twice as common in the HCQ groups (25% in the HCQ, 31% in the HCQ+AZ group versus 14% in the no HCQ group, p =.02) and there is an absolute correlation between lymphopenia(<0.5G/L) and fatality rate, which is well known (Tan, 2020) and confirmed here : 28% deaths, 22%and 11% in the HCQ, HCQ+AZ and No HCQgroup, respectively. Lymphopenia is the most obvious criterion of patient severity (in our cohort, lymphocytes in deadindividuals(n=22, mean ± standard deviation, 0.94 ± 0.45), versus in the living (n=2405, 1.79 ± 0.84, p < .0001)). As the authors acknowledge, the severity of the patients in the different groups was very different, and their analysis can only make sense if there is a selection of patients with the same degree of severity, i.e. the same percentage of lymphopenia.
    The second major bias is that in an attempt to provide meaningful data, by eliminating the initial severity at the time of treatment, two tables are shown: onetable where drugs are prescribed before intubation, and which shows no significant difference in the 3 different groups (9/90 (10%) in the HCQ group, 11/101 (10. 9%) HCQ+AZ, and 15/177 (8.5%) in the group without HCQ, chi-square = 0.47, ddl = 2, p = 0.79), and one table, where it is not clear when the drugs were prescribed, where there are significant differences. These differences are most likely related to the fact that the patients had been intubated for some before receiving hydroxychloroquine in desperation.
    It is notable that this is unreasonable at the time of the cytokine storm, as it is unlikely that hydrochloroquine alone would be able to control patients at this stage of the disease.

    Moreover, incomprehensibly, the “untreated”group actually received azithromycin in 30% of cases, without this group being analyzedin any distinct way. Azithromycin is also a proposed treatment for COVID(Gautret, 2020)with in vitroefficacy (Andreani, 2020), and to mix it with patients who are supposedly untreated is something that is closer to scientific fraud than reasonable analysis. Altogether these 3 voluntary biases are all pushing to the idea of dangerosity of hydroxychloroquine safest drug as reported on nearly 1 million people (Lane, 2020).

    All in all, this is a work that shows that, in this period, it is possible to propose things that do not stand up to any methodological analysis to try to demonstrate that one is right.

    References
    Andreani J, Le Bideau M, Duflot I, Jardot P, Rolland C, Boxberger M, Wurtz N, Rolain JM, Colson P, La Scola B, Raoult D. In vitro testing of combined Hydroxychloroquine and Azithromycin on SARS-CoV-2 shows synergistic effect. Microbial pathogenesis. 2020. In press. Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, Doudier B, Courjon J, Giordanengo V, Vieira VE, Dupont HT, Honoré S, Colson P, Chabrière E, La Scola B, Rolain JM, Brouqui P, Raoult D.Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-labelnon-randomized clinical trial. Int J Antimicrob Agents. 2020 Mar 20:105949. doi: 10.1016/j.ijantimicag.2020.105949.Lane JCE, Weaver J, Kostka K, et al. Safety of hydroxychloroquine, alone and in combination with azithromycin, in light of rapid wide-spread use for COVID-19: a multinational, network cohort and self-controlled case series study. medRxiv 2020.04.08.20054551; doi: https://doi.org/10.1101/2020.04.08.20054551Magagnoli J, Narendran S, Pereira F, Cummings T, Hardin JW, Sutton SS, Ambati J. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. medRxiv 2020.04.16.20065920; doi: https://doi.org/10.1101/2020.04.16.20065920Tan, L., Wang, Q., Zhang, D. et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Sig Transduct Target Ther 5, 33 (2020). https://doi.org/10.1038/s41392-020-0148-4.

    1. Tony M says:

      I don’t know if I should post the following analysis here. I just thought it may be of interest. I am not a Medical Professional or Researcher.

      An attempt to Calculate Final Outcomes – Based on Pre-Ventilation Treatment using the data in the research paper on the United States Veterans

      In the article “Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19” they refer to:
      “There were 27 deaths (27.8%) in the HC group, 25 deaths (22.1%) in the HC+AZ group, and 18 deaths (11.4%) in the no HC group (Table 3).” These outcomes are based on “Table 3 – Outcomes based on treatment exposure.” which has a total of 368 patients with 97 patients in the HC group, 113 patients in the HC + AZ group and 158 patients in the No HC Group.
      Table 4. details Outcomes based on pre-ventilation treatment which has a total of 368 patients with 90 patients in the HC group, 101 patients in the HC + AZ group and 177 patients in the No HC Group. The differences in patient numbers between the two tables represent a total of 19 patients from the No HC group receiving HC (7) or HC+AZ (12) after commencement on ventilation.

      No where in the paper is the Final Outcome based on pre-ventilation treatment shown, which I thought would be interesting information. Although you cannot derive the exact result, comparing the two tables allows you to construct what these results could be. The exact result would be one of these scenarios.

      We know:
      – From Table 3 we know a total of 70 Patients died in total;
      – HC Group – of this group 9 died initially and 12 were transferred to ventilation, a total of 21 patients. An addition of 7 patients from the “No HC” group were added to this group at the ventilation stage. However, at the end on ventilation only 1 additional patient was discharged. This means that at most only 1 of the 12 patients transferred to ventilation survived resulting in final deaths for the pre-ventilation category of either 20 or 21 patients;
      – HC+AZ Group – of this group 11 died initially and 7 were transferred to ventilation, a total of 18 patients. An addition of 12 patients from the “No HC” group were added to this group at the ventilation stage. At the end on ventilation 5 additional patient was discharged (88-83). This means that at most 5 of the 7 patients transferred to ventilation survived resulting in final deaths for this pre-ventilation category of between 13 to 18 patients;
      – No HC Group – of this group 15 died initially and 25 were transferred to ventilation a total of 40 patients. However, at the end of ventilation both discharges and deaths had both increased by 3, deaths from 15 to 18 and discharges from 137 to 140. The remaining 19 patients were now categorised in the HC or HC+AZ categories.
      From the above we can work out what the final outcome for patients could have been. There are a possible 11 slightly different possibilities with the HC Group having 20 or 21 final deaths and the HC+AZ group having between 13 to 18 deaths.

      The following table should represent all possible scenarios for Final Outcomes based on Pre-Ventilation treatment derived from the data contained in Tables 3 and 4 of the report:
      HC HC+AZ No HC Total
      N 90 101 177 368
      Deaths % Deaths % Deaths % Deaths %
      70 19.0%
      20 22.2% 13 12.9% 37 20.9%
      20 22.2% 14 13.9% 36 20.4%
      20 22.2% 15 14.9% 35 19.8%
      20 22.2% 16 15.8% 34 19.2%
      20 22.2% 17 16.8% 33 18.6%
      20 22.2% 18 17.8% 32 18.1%
      21 23.3% 13 12.9% 36 20.4%
      21 23.3% 14 13.9% 35 19.8%
      21 23.3% 15 14.9% 34 19.2%
      21 23.3% 16 15.8% 33 18.6%
      21 23.3% 17 16.8% 32 18.1%
      21 23.3% 18 17.8% 31 17.5%

      (Hope the above table comes out)

      I just thought it interesting in that the above table of all the possible scenarios for the Final Outcome based on Pre-Ventilation Treatment shows that the HC+AZ (treated with hydroxychloroquine and azithromycin) category had a possible Final Outcome Death rate range from a possible low of 12.9% to a high of 17.8%. In contrast, the No HC (or unexposed to hydroxychloroquine) category had a possible Final Outcome Death rate which range from a low of 17.5% to a high of 20.9% (ie. Based on Pre-Ventilation Treatment the patients receiving hydroxychloroquine and azithromycin had a better or equal outcome to the unexposed patients as measured by lowest death rate.

      These results contrast with the result shown in “Table 3 – Outcomes based on treatment exposure” which showed that the “No HC” category had the lowest death rate of 11.4% compared with the “HC+AZ” category which had a death rate of 22.1%.

      It would be good if the final report on this research included an additional table detailing the Final Outcome based on Pre-Ventilation Treatment.

      Regards

      Tony M

    2. Tony M says:

      I don’t know if I should post this here or not but will give it a go anyway. I am not a professional medical practitioner or Researcher.

      An attempt to Calculate Final Outcomes – Based on Pre-Ventilation Treatment using the data in the research paper on the United States Veterans
      In the article “Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19” they refer to:
      “There were 27 deaths (27.8%) in the HC group, 25 deaths (22.1%) in the HC+AZ group, and 18 deaths (11.4%) in the no HC group (Table 3).” These outcomes are based on “Table 3 – Outcomes based on treatment exposure.” which has a total of 368 patients with 97 patients in the HC group, 113 patients in the HC + AZ group and 158 patients in the No HC Group.
      Table 4. details Outcomes based on pre-ventilation treatment which has a total of 368 patients with 90 patients in the HC group, 101 patients in the HC + AZ group and 177 patients in the No HC Group. The differences in patient numbers between the two tables represent a total of 19 patients from the No HC group receiving HC (7) or HC+AZ (12) after commencement on ventilation.
      No where in the paper is the Final Outcome based on pre-ventilation treatment shown, which I thought would be interesting information. Although you cannot derive the exact result, comparing the two tables allows you to construct what these results could be. The exact result would be one of these scenarios.
      We know:
      – From Table 3 we know a total of 70 Patients died in total;
      – HC Group – of this group 9 died initially and 12 were transferred to ventilation, a total of 21 patients. An addition of 7 patients from the “No HC” group were added to this group at the ventilation stage. However, at the end on ventilation only 1 additional patient was discharged. This means that at most only 1 of the 12 patients transferred to ventilation survived resulting in final deaths for the pre-ventilation category of either 20 or 21 patients;
      – HC+AZ Group – of this group 11 died initially and 7 were transferred to ventilation, a total of 18 patients. An addition of 12 patients from the “No HC” group were added to this group at the ventilation stage. At the end on ventilation 5 additional patient was discharged (88-83). This means that at most 5 of the 7 patients transferred to ventilation survived resulting in final deaths for this pre-ventilation category of between 13 to 18 patients;
      – No HC Group – of this group 15 died initially and 25 were transferred to ventilation a total of 40 patients. However, at the end of ventilation both discharges and deaths had both increased by 3, deaths from 15 to 18 and discharges from 137 to 140. The remaining 19 patients were now categorised in the HC or HC+AZ categories.
      From the above we can work out what the final outcome for patients could have been. There are a possible 11 slightly different possibilities with the HC Group having 20 or 21 final deaths and the HC+AZ group having between 13 to 18 deaths.

      The following table should represent all possible scenarios for Final Outcomes based on Pre-Ventilation treatment derived from the data contained in Tables 3 and 4 of the report:
      HC HC+AZ No HC Total
      N 90 101 177 368
      Deaths % Deaths % Deaths % Deaths %
      70 19.0%
      20 22.2% 13 12.9% 37 20.9%
      20 22.2% 14 13.9% 36 20.4%
      20 22.2% 15 14.9% 35 19.8%
      20 22.2% 16 15.8% 34 19.2%
      20 22.2% 17 16.8% 33 18.6%
      20 22.2% 18 17.8% 32 18.1%
      21 23.3% 13 12.9% 36 20.4%
      21 23.3% 14 13.9% 35 19.8%
      21 23.3% 15 14.9% 34 19.2%
      21 23.3% 16 15.8% 33 18.6%
      21 23.3% 17 16.8% 32 18.1%
      21 23.3% 18 17.8% 31 17.5%

      Hope the above table comes out

      I just thought it interesting in that the above table of all the possible scenarios for the Final Outcome based on Pre-Ventilation Treatment shows that the HC+AZ (treated with hydroxychloroquine and azithromycin) category had a possible Final Outcome Death rate range from a possible low of 12.9% to a high of 17.8%. In contrast, the No HC (or unexposed to hydroxychloroquine) category had a possible Final Outcome Death rate which range from a low of 17.5% to a high of 20.9% (ie. Based on Pre-Ventilation Treatment the patients receiving hydroxychloroquine and azithromycin had a better or equal outcome to the unexposed patients as measured by lowest death rate.

      These results contrast with the result shown in “Table 3 – Outcomes based on treatment exposure” which showed that the “No HC” category had the lowest death rate of 11.4% compared with the “HC+AZ” category which had a death rate of 22.1%.

      It would be good if the final report on this research included an additional table detailing the Final Outcome based on Pre-Ventilation Treatment.
      Regards
      Tony M

    1. ghost of q.mensch says:

      That is yet another example of corrosive dangerous election year hate-politics gaslighting/ poisoning 70yrs worth of accumulated safety data, based on millions of pts taking HCQ. It is just disgusting.

      From upthread:
      (~>minute 10:40) https://www.youtube.com/watch?v=rN_YpFhdii4

      1. loupgarous says:

        It’s an example of FDA doing what Congress told it to do, assess risks associated with drugs it regulates and warn those who prescribe them to take appopriate precautions to manage foreseeable side-effects.

        Sorry if that offends you. I hear Russia’s much more understanding of Covid-19 drugs that aren’t proven to work.

        1. mario lento says:

          Doctors who understand efficacy and recall their training and understanding of chemistry and biology can make smart decisions without waiting for a double blind study. Why would they prescribe HCQ and Zn and for whom and when?

          Why?: Because waiting for the time it takes (several months) to get through testing means that people can’t benefit right now when it is needed.

          For whom?: People who are him relatively high risk group

          When?: As soon as there is evidence they are infected. Later, after a cytokine storm when the virus has inundated the body, and lungs, the treatment can’t help.

          Anyone here who does not understand this, is not thinking clearly.

          1. loupgarous says:

            Coming from someone who didn’t help compile safety and efficacy information professionally for years, that stings.

            Small words explanation: When we study how a drug acts in a new population it’s never been used in before, we always are alert for previously unseen adverse drug effects and drug interactions. Merck’s odanacatib did a great job of treating osteoporosis. But its Phase I trial was in healthy volunteers, not older women who have osteoporosis, so we didn’t see significant adverse events. Phase II also failed to turn up AEs.

            But in Phase III, ALL the patients were osteoporotic older women. It worked great to stop osteoporosis, but Merck discovered its study patients on the odanacatib arm had strokes, while the control arm ladies didn’t.

            THAT is why we want to study the toxicity of HCQ in Covid-19 sufferers specifically – we haven’t done that until this year, we’re seeing signs of toxicity (cardiac death, among them).

            We want double-blind randomized studies to make sure no one’s even unconsciously “cheating” for or against HCQ, with or without AZ, with or without zinc, and with or without quercetin, cayenne pepper, or whatever else people say is the crucial missing ingredient two weeks from now.

          2. JasonP says:

            @loupgarous

            >>>THAT is why we want to study the toxicity of HCQ in Covid-19 sufferers specifically – we haven’t done that until this year, we’re seeing signs of toxicity (cardiac death, among them). <<<

            I keep watching these MedCram videos (Updates 61 & 65) and they suggest that COVID-19 is a disease of the endothelial cells lining the blood vessel walls. The way I understand it is that SARS-Cov-2 attacks the ACE2 in these cells. If I have it right, resultant inflammation leads to release of coagulant factors and then thrombus. So the strokes and cardiac death, are they toxic effects?

            https://youtu.be/22Bn8jsGI54
            https://youtu.be/Aj2vB_VITXQ

          3. theasdgamer says:

            Reply to loupgarous

            By your reference to cardiac deaths I assume you are talking about the Brazil study where inordinately high (toxic) doses of chloroquine were given (600 mg bid 10 days). The prudent thing to do is to look at the history of hydroxychloroquine which is the more active form of chloroquine and can be effective at lower doses than chloroquine. There are doctors who have done that and they are called “rheumatologists”. They have posted the side effects of HC on their rheumatology.org website. The recommended dosage is also listed there (200 mg bid). Five million patients have taken HC–there is a plethora of data and the history is well established. It takes seven years of continuous daily dosing for HC to reach the maximum level in the body. Dr. Zelenko’s regimen is only given for five days. I fail to see any major safety concerns. Doctors know to check for congenital QT prolongation and similar issues. Balancing risks, the choice seems clear to me.

  53. Proof comes in flavors…induction, exhaustion, double reduction ad absurdum, weight of evidence, no unreasonable risk, statistical, deterministic, repeatable…etc. Anyone who asks for “scientific proof” of something is asking to be duped. Will that plane really fly? What if we test it a million times first?

  54. ghost of q.mensch says:

    Good for Novartis! (April 20, 2020 press release)

    https://www.novartis.com/news/media-releases/novartis-sponsor-large-clinical-trial-hydroxychloroquine-hospitalized-covid-19-patients

    “Basel, April 20, 2020 — Novartis has reached an agreement with the US Food and Drug Administration (FDA) to proceed with a Phase III clinical trial with approximately 440 patients to evaluate the use of hydroxychloroquine for the treatment of hospitalized patients with COVID-19 disease. The clinical trial drug supply will be provided by Sandoz, the generics and biosimilars division of Novartis.
    The large trial sponsored by Novartis will be conducted at more than a dozen sites in the United States. Novartis plans to begin enrollment for this study within the next few weeks and is committed to reporting results as soon as possible. To help achieve broad access to hydroxychloroquine as quickly as possible in these extraordinary circumstances, Novartis will make any intellectual property within our control that relates to the use of hydroxychloroquine to treat or prevent COVID-19 available through non-exclusive voluntary licenses, appropriate waivers, or similar mechanisms.
    “We recognize the importance of answering the scientific question of whether hydroxychloroquine will be beneficial for patients with COVID-19 disease,” said John Tsai, Head of Global Drug Development and Chief Medical Officer at Novartis. “We mobilized quickly to address this question in a randomized, double-blind, placebo-controlled study.”
    As the new virus continues to spread and claim lives around the globe, doctors and patients are eager for treatment options. In some cases, clinicians are evaluating drugs that have been approved for other diseases, hoping that these will also work against COVID-19.
    Patients in the trial will be randomized into three groups. The first group or arm will receive hydroxychloroquine. The second group will receive hydroxychloroquine in combination with azithromycin, which is an antibiotic therapy. The third group will receive placebo. Patients in all treatment groups are receiving standard of care for COVID-19. Researchers at the company compressed months of work into a few weeks to design the large clinical trial in order to rapidly respond to the need for COVID-19 disease treatments. “

    1. loupgarous says:

      Interesting reading. I noted with interest that whoever wrote this presser for Novartis cited a controversial journal article by Gautret et al (of Didier Raoult’s group in Marseilles).

      Elizabeth Bik did a better analysis of Gauchet et al and its myriad flaws and weaknesses than I can in this post, but to summarize:
      The Gautret et al paper was peer-reviewed and accepted for publication by the International Journal of Antimicrobial Agents as an online pre-proof on March 20, 2020, in a very short span of time suggesting that peer review happened in 24 hours.

      How do you get that kind of turn-around time on peer review in a medical journal? It helps if the journal’s editor-in-chief is also one of your co-authors. In this case that would be J.M. Rolain. This isn’t the first Science Direct journal to show a gaping crater where its publication ethics should have been, but given the issues at stake it may live in infamy.

      – Tallies of the patients who were enrolled in the study, those who completed therapy, and those lost to follow-up were a bit confusing. Quoting Elizabeth Bik:

      “Six missing patients
      Although the study started with 26 patients in the HQ or HQ+AZ group, data from only 20 treated patients are given, because not all patients completed the 6-day study. The data for these 20 patients looks incredibly nice; especially the patients who were given both medications all recovered very fast. What happened to the other six treated patients? Why did they drop out of the study? Three of them were transferred to the intensive care unit (presumably because they got sicker) and 1 died. The other two patients were either too nauseous and stopped the medication, or left the hospital (which might be a sign they felt much better). So 4 of the 26 treated patients were actually not recovering at all. It seems a bit strange to leave these 4 patients who got worse or who died out of the study, just on the basis that they stopped taking the medication (which is pretty difficult once the patient is dead).”

      It’s difficult to feel comfortable with this new study, based on the Gautret et al paper (see Bik’s article for a full appreciation of the article’s other shortcomings in analysis and clinical data significant to its scientific validity).

      But this trial, at least as described, compares HCQ and HCQ/AZ to placebo, so we may get good information on how well patients with and without the study drugs. It’s what, in this long thread, many people have asked for. And it’s very far away from Marseilles.

  55. JP Leonard says:

    Regarding the power of ol’ sol.
    On a tip, I googled on 3 little words, UV virus nih.
    All hits on first page are peer reviewed articles on the efficacy of UV against viruses.
    (Good idea to look before you leap, or jump to dump on Trump)
    Then I tried uv irradiation blood nih
    Up comes UBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122858/
    Ultraviolet Irradiation of Blood: “The Cure That Time Forgot”?
    “Ultraviolet blood irradiation” (UBI) was extensively used in the 1940s and 1950s to treat many diseases… with the development of antibiotics, UBI use declined… No resistance of microorganisms to UV irradiation has been reported, and multi-antibiotic resistant strains are as susceptible as their wild-type counterparts. Low and mild doses of UV kill microorganisms by damaging the DNA, while any DNA damage in host cells can be rapidly repaired by DNA repair enzymes.”
    Might be useful.
    Remember ECMO? extracorporeal membrane oxygenation, sometimes used with coronavirus ARDS or pneumonia patients.
    So they could do UBI during ECMO.
    Googled on “Ultraviolet blood irradiation” ECMO Covid 19,
    found this: https://www.reddit.com/r/medicine/comments/flxx1d/is_there_a_reason_why_we_havent_been_using_ubi_in/
    “Medical device (ret.) engineer here…. Based on my rudimentary knowledge of ECMO, it would seem simple to add a UV-C light, with a virus-deactivating dose of 254 nm light… Some references…”
    On a more practical and immediate level, one would recommend to install far UV lighting in hospitals and nursing homes.

    1. Derek Lowe says:

      Extracorporeal irradiation of blood is not a crazy idea. Worth noting, though, that in the actual clinical trials of it that it took several weeks of treatment to reduce viral load: https://www.tandfonline.com/doi/full/10.1080/2331205X.2019.1614286.

      1. JP Leonard says:

        Thanks, Derek.
        Cuiously the article I cited notes that “The optimum amount of blood to be irradiated was determined to be only 5–7% of the estimated blood volume.” Not sure why, but then it wouldn’t take weeks, and it would be in combination with other procedures, most conveniently with ECMO.

  56. Truth9834 says:

    What a garbage article. So basically the author is stating that the Italians (and other countries (South Korea, Poland, Costa Rica, Russia, etc.) are trying to kill off their population by promoting the use of this drug! In Italy the drug is free and you are encouraged to take it for this virus. This drug has been around for 70 years and until Trump pushed for using it for this virus there was barely a comment on its side-effects. So you are also arguing that South Dakota wants to kill off its population as they are making hydroxychloroquine available despite FDA warnings. Ok, and don’t bring up that biased VA study that was blown apart by numerous scientists when it was peer reviewed. So to all you complete retards who are pushing against this drug please provide some other treatment options. Oh wait there are no other treatment options? Then if there are no other options and as this drug alone is safe then allow Doctors and their patients to decide what is best. People are smart and they will do their research. My guess is they will try hydroxychloroquine with zinc or hydroxychloroquine with zinc and a Z pack with careful supervision.

  57. Pajas says:

    Forget using disinfectants or UV light, your Great Leader was just being sarcastic…

  58. jo says:

    The retrospective “study” at the VA was worse than meaningless, please don’t quote it. It compared a group of critically sick people who were given hydroxychloroquine as a last resort, they were already nearly dead, with a group of people who were not severely sick. You cannot compare those two groups – they are not matched in any way. It’s not science, its slander (quite obviously deliberate – as no scientist is ever going to publish comparison results like that except to create a headline and damage a drugs reputation!)
    Don’t get drawn into the politicization of the drug and the emotive manipulation by its alignment with Trump, trump probably did get rid of that guy unfairly because he didn’t do what trump asked. BUT that doesnt mean the drug doesnt work. Its irrelevent.

    The chinese trial which showed “no difference between HCQ and standard of care” did so because BOTH groups has 100% cure/recovery rate. The control group wasn’t a placebo – and both groups received multiple drugs – so no conclusion can be drawn except that one or more drugs in both groups worked. In that study HCQ was part of a group which succesfully treated Covid19 in that trial too.

    1. mario lento says:

      Jo you’re correct. Giving any credence to the VA so-called study, is a waste of time. This post gets lost in the details without taking steps to understand the big picture.

      Simple: The HCQ without ample Zn is not a treatment for viruses. The mechanism for proper use as a virus treatment is abundantly clear. Proper treatment prevents or drastically reduces RNA replication of viruses within the infected cells. So taking the combo early is best, late is too late. It does not kill the virus it prevents replication of more virus.

      It’s like closing the door that allowed an army of people to enter AFTER they almost all have entered. Duh right?

      The VA study did not understand the basis of its use and the resulting data is shows only that the study was not capable of being informative. It does nothing whatsoever to measure effectiveness of proper use of HCQ for Covid 19.

  59. ghost of q.mensch says:

    Why are our Fake Media and ‘Fauci’ Science advisors NOT talking about these Hydroxychloroquine prophylaxis study data?

    1. From South Korea (peer reviewed, published online April 17, 2020):

    [ Case Study of broad hydroxychloroquine post-exposure prophylaxis (PEP) success at a Daegu area long-term care hospital to patients and staff following an index exposure event by a covid-19 “superspreader” care worker who was also a member at the covid-19 cluster outbreak Daegu Shincheonji religious group church]

    https://www.sciencedirect.com/science/article/pii/S092485792030145X

    ”Highlights
    In the context of the ongoing COVID-19 pandemic, management of exposure events is a concern.
    There was a large COVID-19 exposure event at a long-term care hospital in Korea.
    Post-exposure prophylaxis using hydroxychloroquine was provided to 211 individuals.
    Disease development was successfully prevented without severe adverse events.”

    2. From Italy (April 28; pre-exposure prophylaxis (PREP) with hydroxychloroquine [Plaquenil] vs covid-19) : https://www.iltempo.it/salute/2020/04/28/news/coronavirus-farmaci-efficaci-news-danni-cura-annalisa-chiusolo-artrite-terapia-idrossiclorochina-sars-cov2-1321227/

    [For those of you who, unlike Dr. Fauci (whose grandparents on both sides immigrated from Italy) do not read Italian or are unfamiliar with using google-translate] I offer the following English partial summary:

    https://www.unz.com/isteve/in-italy-practically-nobody-who-takes-hydroxychloroquine-for-lupus-or-rheumatoid-arthritis-got-cv/

    “…Finally, further confirmation of this hypothesis is the data collected in the register of the SIR (Italian rheumatology society). To assess the possible correlations between chronic patients and Covid19, SIR interrogated 1,200 rheumatologists throughout Italy to collect statistics on infections. Out of an audience of 65,000 chronic patients (Lupus and Rheumatoid Arthritis), who systematically take Plaquenil / hydroxychloroquine, only 20 patients tested positive for the virus. Nobody died, nobody is in intensive care, according to the data collected so far.”

    So I ask again: Why are the US fake media and the Fauci science advisors ignoring completely these (and likely other) hydroxychloroquine PEP and PREP study data, and just hyping Gilead’s shaky $1000 (sourced only in Chindia?)/day/dose (IV only)drug data??

  60. ghost of q.mensch says:

    Experience with HCQ/Zpac/Zn cocktail PEP (post exposure prophylaxis) at Austin TX nursing home:
    https://www.fox7austin.com/news/fox-26-gets-unprecedented-access-to-texas-1st-nursing-home-to-treat-covid-19-with-hydroxychloroquine

    “Two of our residents had symptoms and that’s when we tested everybody,” said nursing home Executive Director Jan Piveral.

    56 residents and 33 staff members were COVID-19 positive.”

    “If we didn’t make the decision quickly then we could potentially lose 15 to 20% of the residents which was not an option,” said the Doctor.

    Armstrong’s approach was to begin administering Hydroxychloroquine a Zpac and Zinc just as soon as a resident first started showing symptoms.

    The patients were being monitored daily.

    “We did EKGs on each of these patients to make sure they didn’t have the cardiac side effects that everyone talks about,” Armstrong said. “None of our patients did.”

  61. mark Jones says:

    The politics of HCQ are simple. Trump spoke favorably of the drug so every liberal mouthpiece is opposed to – end of story. If Obama got behind HCQ, all you would hear about was how insightful he was to bring this to everyone’s attention. Every liberal with an audience is doing anything and everything possible to hurt his image so he loses the election – period.

    1. tt says:

      Nope…data is data. To date, no drug has shown to be effective (or ineffective for that matter). It’s all conjecture. What we do know is that HCQ has risks and it is completely unethical to prescribe this given that there is no real evidence of benefit and clear evidence of harm. This was not a political question until Trump made it so. Please read all of the posts carefully on this topic. Scientists and doctors go with the data.

  62. Joe says:

    The way this thing is politicised is ridiculous. They’ve tried a few drug candidates and have invested heavily in vaccine development since the crisis began.

  63. Charles Cavanaugh says:

    Live and let live.

    Hydroxychloroquine, Quercetin, EGCg are zinc ionophores. Zinc puts the brakes on the RdRP enzyme that replicates the RNA virus (covid 19). Add in vitamin C, D and Melatonin to support the immune system. Their primary moment of effectiveness is before you are infected. It is not a cure. It may prevent or shorten the length of a virus infection.

    I follow the Marik Covid Protocol. If I get an allergy or the beginning of a virus I increase the Quercetin/C/D/Zinc for a few days then go back. I also use Nettipot with saline solution to keep the nasal passages clean and 1 tbsp per hour of pressed garlic/apple cider vinegar/honey to keep my throat clean. Drink plenty of water. Keep moving.

    Research Pubmed/Youtube on zinc ionophore. Research the Marik Covid Protocol.

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