Coronavirus: Outcry after Trump suggests injecting disinfectant as treatment

[sumskilz]

Thought so.

Trump is now plugging the ineffective and potentially dangerous drug hydroxychloroquine by boasting that he takes it himself. He is also 'ramping up' the benefits of a quack remedy involving zinc.

Multiple studies have found hydroxychloroquine to be effective when taken early:

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial

Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial

Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients

The study that combined hydroxychloroquine with zinc was the most promising, which is why there are more studies in progress (for example). The reason this was looked into in the first place is because zinc inhibits conronavirus replication in vitro, but it needs to get into the cells to work. Chloroquine and its safer relative hydroxychloroquine can facilitate that. But as with any treatment that interferes with virus replication it has to be administered early, best if before symptoms even arise, hence you wouldn't have expected it to be effective in the study that only tracked those who were given it because there were already in desperately poor condition. Hydroxychloroquine is about a dollar a dose to produce, unlike Remdesiver which would be tremendously expensive to acquire if it works out, so I'd prefer the various media outlets stop spreading the type of misinformation you've no doubt read. Their desperation for clicks and the need for Trump to be wrong on this one aren't important enough to justify attempts to undermine public support for research into what may very well be a cost effective and relatively quite safe treatment.

Also:

In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

He's an absolute master troll who belongs on 4Chan. Announcing he's taking the drug as a prophylactic? Masterful. I'm pretty sure the slightly hopeful research was as a treatment for symptoms

He was almost certainly advised to do so, because that is how it's most likely to work. Unless he's lying or bragging about breaking the law, it had to have been prescribed to him.

EDIT: A more detailed explanation (text from the third linked study):

Several medications are under investigation for the treatment of COVID-19. Despite limited and conflicting data, the U.S. Food and Drug Administration authorized the emergency use of hydroxychloroquine for the treatment of COVID-19 with or without azithromycin. Chloroquine analogues are weak bases that concentrate within acidic endosomes and lysosomes. Once intracellular, chloroquine analogues become protonated and increase pH resulting in prevention of endosomal trafficking, dysfunctional cellular enzymes, and impaired protein synthesis[7]. This inhibits viral replication through interference with endosome-mediated viral entry or late transport of the enveloped virus. Further, this results in interference with the terminal glycosylation of ACE2 receptor expression which prevents SARS-CoV-2 receptor binding and spread of infection [8]. Hydroxychloroquine, a hydroxy-derivative of chloroquine, has also been proposed based on in vitro activity against SARS-CoV-2 with a three-fold higher cytotoxic potential compared to chloroquine [9]. However, clinical data in humans has yielded mixed results[10-12]. The anti-viral and anti-inflammatory effects of chloroquine have been suggested to account for its potential utility in preventing COVID-19-related pneumonia. Soon current studies will answer whether hydroxychloroquine is effective as monotherapy or in combination with azithromycin. In the case that hydroxychloroquine is found to be ineffective, it may still have a role to play when combined with zinc sulfate. Zinc inhibits RNA dependent RNA polymerase, and has been shown to do this in vitro against SARS-CoV[13]. However, it is difficult to generate substantial intracellular concentrations of zinc, therefore prophylactic administration of zinc alone may not play a role against SarCoV-2[14]. When combined with a zinc ionophore, such as chloroquine (hydroxychloroquine), cellular uptake is increased making it more likely to achieve suitably elevated intracellular concentrations[15]. This combination is already being tested as a prophylactic regimen in a randomized clinical trial.

As New York became the epicenter of the pandemic, hospitals in the area quickly adopted investigational therapies, including the use of hydroxychloroquine and azithromycin. Given this proposed synergistic effect of zinc with hydroxychloroquine, practices at NYULH changed and the addition of zinc sulfate 220 mg PO BID along with hydroxcychloroquine 400 mg once followed by 200 mg PO BID with azithromycin 500 mg once daily became part of the treatment approach for patients admitted to the hospital with COVID-19.

[Cyclops]

...

He was almost certainly advised to do so, because that is how it's most likely to work. Unless he's lying or bragging about breaking the law, it had to have been prescribed to him.

EDIT: A more detailed explanation (text from the third linked study):

I stand corrected, thank you for that. I assume his opponents have been falling over the facts to criticise his garbled announcement?

[Cope]

I stand corrected, thank you for that. I assume his opponents have been falling over the facts to criticise his garbled announcement?

The president's opponents have been spreading misinformation about hydroxychroloquine and its clinical trials since Trump first mentioned it. We know it isn't unusual for elements of the media to print misleading health advice, but it's rare for them to contort their medical journalism to prop up a particular political narrative (ie. that the president's alleged "self-medication" is yet another example of his irrationality). At this point they're simply running along with a hobby horse again. Sumskilz has provided a more rounded explanation of what's going on than you're likely to find in the media.

[sumskilz]

I stand corrected, thank you for that. I assume his opponents have been falling over the facts to criticise his garbled announcement?

I'll give you an example. Several media outlets have published this article:

Drug promoted by Trump as coronavirus ‘game changer’ increasingly linked to deaths

There's a lot of BS in there, but I'll focus on the headline claim. In the body of the text, they write:

Alarmed by a growing cache of data linking the anti-malaria drug to serious cardiac problems, some drug safety experts are now calling for even more forceful action by the government to discourage its use. Several have called for the FDA to revoke its emergency use authorization, given hydroxychloroquine’s documented risks.

So just what is this growing "cache of data" they cite? Well, it's easy to find because they hotlink to yet more misinformation, a Washington Post titled "Anti-malarial drug Trump touted is linked to higher rates of death in VA coronavirus patients, study says".

This is what the study actually says:

Baseline demographic and comorbidity characteristics were comparable across the three treatment groups. However, hydroxychloroquine, with or without azithromycin, was more likely to be prescribed to patients with more severe disease, as assessed by baseline ventilatory status and metabolic and hematologic parameters. Thus, as expected, increased mortality was observed in patients treated with hydroxychloroquine, both with and without azithromycin.

In other words, those who were believed to be more likely to die, were more likely to be given hydroxychloroquine, so the study's authors were unsurprised that more of them died.

They did try to control for various factors, and found that for those who weren't treated until after they were on ventilation the negative association persisted. Nevertheless they write:

Our study has certain limitations including those inherent to all retrospective analyses such as non-randomization of treatments. We did, however adjust for a large number of Covid19-relevant confounders including comorbidities, medications, clinical and laboratory abnormalities. Despite propensity score adjustment for a large number of relevant confounders, we cannot rule out the possibility of selection bias or residual confounding.

Although it wouldn't be really surprising. Based on what's known of the mechanism, the drug is unlikely to be able to do anything for someone who is already on the verge of death, and probably at that point wouldn't be anything more than an additional stress on their already severely weakened system. So anyway, there's the "growing cache of data" that "several" are concerned about.

Hydroxychloroquine is well studied, there are people who have been taking it daily since the 1940s. Here's what typical non-politicized information about the drug looks like:

Side effects

In some people, HCQ may cause gastrointestinal problems, such as nausea, vomiting, upset stomach, cramps, or diarrhea. These may occur for the first few days a person takes the drug while the body adjusts to the medication. Loss of appetite, tiredness, weakness, or headache are uncommon side effects and typically go away over time.

Rare complications

The greatest concern people have when taking hydroxychloroquine is related to vision. Individuals beginning HCQ therapy should be informed of the possibility, although extremely rare, of retinal toxicity, and told that periodic monitoring can lead to early recognition of some symptoms. Hydroxychloroquine is the most commonly used AM, specifically because it has a lower risk for retinal toxicity than chloroquine. This may be because CQ crosses the blood-retinal barrier and HCQ does not.

[conon394]

@Sumkilz

really!

https://www.medrxiv.org/content/10.1....22.20040758v3

Really 62 people I'm rather underwhelmed if you have full access I like the stats and the health status of the subjects on preexisting conditions and are thay still being monitored for the hallucinogenic long term effects of the drug? I not particularity impressed.

the 20 person French study really the FDA would laugh you out the door and hopefully it still will no matter what the fool in chief says.

No credible study has shown it to be effective.

[sumskilz]

@Sumkilz

really!

https://www.medrxiv.org/content/10.1....22.20040758v3

Really 62 people I'm rather underwhelmed if you have full access I like the stats and the health status of the subjects on preexisting conditions and are thay still being monitored for the hallucinogenic long term effects of the drug? I not particularity impressed.

the 20 person French study really the FDA would laugh you out the door and hopefully it still will no matter what the fool in chief says.

No credible study has shown it to be effective.

I wouldn't say preliminary studies lack credibility simply because they are preliminary. They're enough to warrant a proper trial, and that is what's happening. Although double blind would be better.

I actually doubt hydroxychloroquine does much on its own, but I find the zinc ionophore hypothesis persuasive because of the in vitro evidence plus this:



Look at the P values.

But that's not the entirety of my point. Due to the circumstances, almost every thing that is being reported on is based on preprints of low N preliminary studies, but hydroxychloroquine is the only potential treatment being researched that I see the media widely spreading misinformation about. An accurate understanding of reality is not ascertained by simply putting a negative sign in front of anything Trump says. Although there are possibly other sources of misinformation, seeing as how nobody stands to make a fortune if hydroxychloroquine turns out to be an effective COVID-19 treatment.

[Genava]

If you are interested, there is a blog on Science by Derek Lowe
https://blogs.sciencemag.org/pipeline/

He made a few posts about hydroxychloroquine.

[sumskilz]

If you are interested, there is a blog on Science by Derek Lowe
https://blogs.sciencemag.org/pipeline/

He made a few posts about hydroxychloroquine.

I don't agree with him about the Carlucci et al study. It's statistically quite strong. There's a good reason to exclude the ICU patients, but even without doing so, the HCQ/azithromycin+zinc group still have almost half the negative outcome rate as the HCQ/azithromycin group (P<0.0001). Maybe there is something else going on, but it's not chance. Being an observational retrospective study there may be unidentified confounds, but if so, they just happened to line up with what you'd expect theoretically based on the in vitro studies.

[RedGuard]

I have first hand experience taking this drug. Took it as a malaria preventative in Cambodia. It caused me to violently everywhere and caused me to be cold to the touch and dizziness. I had a friend who also took it and experienced stomach pains like he couldn't believe. He wasn't a wimp either. It was so bad after a week almost everyone I knew stopped taking it and would rather risk malaria instead

[mongrel]

I'll park this here.


https://www.thelancet.com/journals/l...817-5/fulltext

[sumskilz]

I have first hand experience taking this drug. Took it as a malaria preventative in Cambodia. It caused me to violently everywhere and caused me to be cold to the touch and dizziness. I had a friend who also took it and experienced stomach pains like he couldn't believe. He wasn't a wimp either. It was so bad after a week almost everyone I knew stopped taking it and would rather risk malaria instead

That's the most common side effect, which usually goes away after the first few days.

[Cyclops]

...
There's a lot of BS in there..

So that's reasonably consistent with my contention that all Trump has to do is blurt something out and his media opponents fall over contradicting him even if he's actually repeating the truth he heard somewhere? His opposition for the most part is no better than he is.

[Gaidin]

So that's reasonably consistent with my contention that all Trump has to do is blurt something out and his media opponents fall over contradicting him even if he's actually repeating the truth he heard somewhere? His opposition for the most part is no better than he is.

Look, it's one thing for CNN or MSNBC to drop their jaws at what Trump says. But when Fox News full on spit-takes at it and starts hammering at the idea of what is being done. Not hammering Trump mind you. But just telling the public that taking the drug for this is a hilariously bad idea and the FDA recommends against it, it's a bit hard to say that "media opponents" are falling over themselves to "contradict" him.

Look. Get your ducks in a row before you post. At least find a blog or a breitbart article.

[sumskilz]

Look, it's one thing for CNN or MSNBC to drop their jaws at what Trump says. But when Fox News full on spit-takes at it and starts hammering at the idea of what is being done. Not hammering Trump mind you. But just telling the public that taking the drug for this is a hilariously bad idea and the FDA recommends against it, it's a bit hard to say that "media opponents" are falling over themselves to "contradict" him.

Look. Get your ducks in a row before you post. At least find a blog or a breitbart article.

According to this New York Times article, Fox News has been generally supportive other than Neil Cavuto.

This is what Cavuto said:

It was a test on patients there, and those who took it in a vulnerable population, including those with respiratory or other conditions, they died. I want to stress again: They died. If you are in a risky population here, and you are taking this as a preventative treatment to ward off the virus or in a worst case scenario you are dealing with the virus, and you are in this vulnerable population, it will kill you. I cannot stress enough: This will kill you. So again, whatever benefits the president says this has — and certainly has had for those suffering from malaria, dealing with lupus — this is a leap that should not be taken casually by those watching at home who are assuming, well, the president of the United States says it's OK. Even the FDA was very cautious about this unless in a clinical trial safely and deliberately watched. I only make this not to make a political point here, but a life-and-death point. Be very, very careful.

There is some hyperbole in there, and some misunderstanding of the VA study I addressed in post #204, but it doesn't look like deliberate misinformation.

To be fair, the hyperbole comes from a credible (or at least credentialed) source - Michael Ackerman. Quoting from the Lancet article Mongrel posted:

“What I know for sure as a cardiologist is that these powerful medications have important side-effects including rarely sudden cardiac death”, said Michael Ackerman, a genetic cardiologist and director of Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic. He said that at least 1% of patients will be at increased risk for a hydroxychloroquine or chloroquine QT reaction capable of triggering drug-induced sudden cardiac death (especially if used in combination with azithromycin). Although such reactions are rare, if millions of people receive the drugs, thousands of lives could be at risk from medications that were supposed to help them to recover from the virus, he said. Ackerman believes such dire consequences can be avoided easily if physicians carefully evaluate vulnerable patients.

Ackerman says that 1% of patients taking hydroxychloroquine will be at an increased risk of triggering drug-induced sudden cardiac death. Ackerman's claim is based on weaker evidence than the evidence supporting hydroxychloroquine being effective for treating COVID-19:

In a brief report published today in JAMA Cardiology, a team of pharmacists and clinicians at Beth Israel Deaconess Medical Center (BIDMC), part of Beth Israel Lahey Health, found evidence suggesting that patients who received hydroxychloroquine for COVID-19 were at increased risk of electrical changes to the heart and cardiac arrhythmias. The combination of hydroxychloroquine with azithromycin was linked to even greater changes compared to hydroxychloroquine alone.

"While hydroxychloroquine and azithromycin are generally well-tolerated medications, increased usage in the context of COVID-19 will likely increase the frequency of adverse drug events (ADEs)," said co-first author Nicholas J. Mercuro, PharmD, a pharmacy specialist in infectious diseases at BIDMC. "This is especially concerning given that that patients with underlying cardiac co-morbidities appear to be disproportionately affected by COVID-19 and that the virus itself may damage the heart."

Hydroxychloroquine and azithromycin each can cause an electrical disturbance in the heart known as a QTc prolongation, indicated by a longer space between specific peaks on an electrocardiogram. QTc prolongation denotes that the heart muscle is taking milliseconds longer than normal to recharge between beats. The delay can cause cardiac arrhythmias, which in turn increases the likelihood of cardiac arrest, stroke or death.

In this single-center, retrospective, observational study, Mercuro and colleagues evaluated 90 adults with COVID-19 who were hospitalized at BIDMC between March 1 and April 7, 2020, and received at least one day of hydroxychloroquine. More than half of these patients also had high blood pressure, and more than 30 percent had diabetes.

But even if it causes QTc prolongation in those 1% of patients, that doesn't necessarily mean they're at an increased risk of drug-induced sudden cardiac death:

Drug-induced QT prolongation has long served as a surrogate indicator for increased risk of drug-associated torsades de pointes (TdP), a potentially lethal polymorphic ventricular tachycardia. However, the relationship between QT prolongation and risk of TdP is imperfect and complex. The risk of TdP is not a linear function of QT duration nor the extent of change; some drugs which prolong QTc are not associated with increased arrhythmic death.2,3

Okay, but has that ever happened with hydroxychloroquine? Evidently, no:

Chloroquine, and its more contemporary derivative hydroxychloroquine, have remained in clinical use for more than a half-century as an effective therapy for treatment of some malarias, lupus, and rheumatoid arthritis. Data show inhibition of iKr and resultant mild QT prolongation associated with both agents.

Despite these suggestive findings, several hundred million courses of chloroquine have been used worldwide making it one of the most widely used drugs in history, without reports of arrhythmic death under World Health Organization surveillance.4

So when Ackerman says that 1% of patients taking hydroxychloroquine will be at an increased risk of triggering drug-induced sudden cardiac death. It's more accurate to say that some preliminary research suggests the possibility that 1% of patients taking hydroxychloroquine might be at an increased risk of drug-induced sudden cardiac death, although this has never been recorded to have actually happened among the several hundred million people who have taken it over the last seven decades.

So Michael Ackerman seems to be exaggerating a bit. According to his own account, he went crazy in the car when he heard Trump's briefing, to such an extent his wife repeatedly told him to "settle down". I suppose his dispassionate critical approach to the science is what has made him the media's go to expert on the topic.

[Cope]

So when Ackerman says that 1% of patients taking hydroxychloroquine will be at an increased risk of triggering drug-induced sudden cardiac death. It's more accurate to say that some preliminary research suggests the possibility that 1% of patients taking hydroxychloroquine might be at an increased risk of drug-induced sudden cardiac death, although this has never been recorded to have actually happened among the several hundred million people who have taken it over the last seven decades.

This is the key fact for me. That the drug is commonly used to treat arthritis and prevent malaria indicates that, despite Cavuto's alarmism, it isn't dangerous for the vast majority of people (hence why Trump hasn't keeled over yet). Whether or not it is effective at preventative of C-19 is a different matter, but, as per your post even, Ackerman noted that the allegedly fatal side effects could be avoided if physicians took care with prescribing the medicine to vulnerable groups.

[antaeus]

We really don't need to debate this. There are plenty of extensive trials in various different formats going on around the world right now, so if someone is concerned about it, then wait for the trial results to come in.

On the other hand, if you can get your doctor to issue it to you for something that it is not yet proven to be useful for, then that's on you and your doctor. I'm sure their insurer is rubbing their hands together in glee.

Next up... Have we started trials on disinfectant rinsing the lungs yet?

[Cyclops]

Look, it's one thing for CNN or MSNBC to drop their jaws at what Trump says. But when Fox News full on spit-takes at it and starts hammering at the idea of what is being done. Not hammering Trump mind you. But just telling the public that taking the drug for this is a hilariously bad idea and the FDA recommends against it, it's a bit hard to say that "media opponents" are falling over themselves to "contradict" him.

Look. Get your ducks in a row before you post. At least find a blog or a breitbart article.

I don't really base my assessment on the emotional reactions of the media, I have my own emotions. Trump's a turd but a lot of what he says is completely or partially misrepresented.

I'd like him hammered for the things he does, like when he flirts with racism for the lulz or gives Putin the benefit of the doubt over his own people's objections or hung out with the Clintons or has significant brain fades or think aeroplanes are invisible. Pasting him for stuff he didn't say or do? That's not just a waste of time, it makes him a martyr for the loony right.

Trump has shown he is pretty ignorant about medical issues, and his gormless gabbling about injecting light etc is a dumb guy mouthing off, he didn't suggest you inject anything. The drug he's now injecting? Apparently its being trialled on a lot of people (as in front line healthcare workers) as a preparatory measure, but you'd know that if you had your ducks in a row .

[Cope]

There is a certain amusement in the press gasping in shock that Trump is taking a drug which is being tested on tens of thousands of medical staff (ie. exposed persons). It's almost as if there is reason to believe that hydroxychlroquine might act as a C-19 preventative and that it isn't that dangerous for the overwhelming majority of people to take. Strange that. I thought the orange man was a psychotic tyrant who was ordering people to inject bleach and drink fish tank cleaner.

[PointOfViewGun]

There is a certain amusement in the press gasping in shock that Trump is taking a drug which is being tested on tens of thousands of medical staff (ie. exposed persons). It's almost as if there is reason to believe that hydroxychlroquine might act as a C-19 preventative and that it isn't that dangerous for the overwhelming majority of people to take. Strange that. I thought the orange man was a psychotic tyrant who was ordering people to inject bleach and drink fish tank cleaner.

He could be taking a simple aspiring and it would still be equally wrong. He's not a random man on TV. He's the president of the United States. Throwing around medical treatments in a nonchalant manner is irresponsible at best. If that's your standards, sure, you can live with that. On the other hand, if it was Obama even hinting at such a drug we'd already have a lot of conspiracy theories from the Republicans.

[RedGuard]

But that's my point sumskillz. I can't imagine getting the worse end of the side effects of that drug on top of the already life threatening COVID-19 side effects