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Re:Open letter from Italy to the international scientific co... by jennyyang on Saturday March 14, 2020 @08:47PM (#22580069)
Drugs are not a solution in the next 2-3 months. There's no way a drug can be tested and ensure safe and scaled up to the tens/hundreds of millions of doses you would need. It's impossible so don't even bother considering it.

Quarantining is the only thing that will help in this situation. There's no other solution we have as a society to slow down the pace of infections. People who normally wouldn't die will die because of the lack of medical care.

The problem we face in the US is lack of testing, which makes it impossible to do anything except a quarantine.

Re:Open letter from Italy to the international scientific co... by lbeltrame on Saturday March 14, 2020 @08:53PM (#22580110)
> Quarantining is the only thing that will help in this situation.

The question is, for how long? Until the infection curve goes down? Until there is not a single infected cases in the whole country?

While you can't know when this will happen (especially the former, most models are inaccurate because too little is still known about this virus), I don't believe it is sustainable to keep an extended lockdown on a whole country (as opposed to "just" Hubei, which however has almost the entire population of Italy) more than a few months.

Re:Open letter from Italy to the international scientific co... by kadoban on Saturday March 14, 2020 @09:29PM (#22580331)
The purpose now of social distancing and quarantine is to spread out the infections so that the hospitals are not overrun by everyone being sick at once.

A significant proportion of infected need hospitalization to survive. If we all get sick at once, there simply aren't enough hospital beds to go around, not to mention other supplies. If the hospitals go far beyond capacity, the fatality rate will be _far_ higher than otherwise.

As to how long, I haven't seen good models. In the US we don't have very good data either, because we're testing basically noone.

Re:Open letter from Italy to the international scientific co... by lbeltrame on Saturday March 14, 2020 @09:38PM (#22580386)
The press reports several models which say between next week and the end of April for the so called "peak" (I don't think the press understands what it means, however), but at least to me they're useless because the confidence intervals are not given (I can't expect a newspaper to do so, but providing a source to consult in such cases would be beneficial).

Some of these models are also different in nature, which adds to the uncertainty: some are epidemiological models, some are economical (used to evaluate the impact of the measures on the long term).

Lastly, a lot of qualified people speak and try to give estimates. I'd love if they don't, because currently the best answer is "we do not know yet".

That said, I think that going over two months of lockdown will be probably ruinous for the country as whole.

Re:Open letter from Italy to the international scientific co... by shrthnd on Saturday March 14, 2020 @09:46PM (#22580456)
The purpose now of social distancing and quarantine is to spread out the infections so that the hospitals are not overrun by everyone being sick at once.
Re:Open letter from Italy to the international scientific co... by adrianN on Sunday March 15, 2020 @01:52AM (#22581625)
Until we have a vaccine or enough people have been infected to build up natural herd immunity. At least a year is my guess.
Re:Open letter from Italy to the international scientific co... by lbeltrame on Sunday March 15, 2020 @05:11AM (#22582312)
I don't know if the country can hold economically and socially being completely locked up for one year. Probably not.

And I'm not sure if people can hold psychologically being locked up for one year.

Re:Open letter from Italy to the international scientific co... by cameldrv on Saturday March 14, 2020 @09:02PM (#22580175)
Drugs are a solution for mitigation. They already have a preliminary trial result in China that says Chloroquine works. South Korea agrees and I believe is combining it with Zinc. South Korea has the lowest fatality rate of any country.
Re:Open letter from Italy to the international scientific co... by graeme on Saturday March 14, 2020 @09:28PM (#22580319)
This has a lot to do with their age distribution. Their fatality rate by age is similar to elsewhere. A large fraction of the infected cult members were young.

Korea also hasn’t had any hospital breakdown related increase in the death rate.

Chloroquine may indeed work, but the Korean stats are misleading if you don’t adjust for ages.

Re:Open letter from Italy to the international scientific co... by cameldrv on Saturday March 14, 2020 @10:37PM (#22580747)
China’s fatality rate is also way down. Partly of course from less stress on the medical system, but they’ve also just learned a lot about how to treat it, particularly what drugs to use. I believe Chloroquine + Liponavir/Ritanovir + Interferon or Ribavirin is state of the art.
Re:Open letter from Italy to the international scientific co... by copperx on Saturday March 14, 2020 @11:39PM (#22581037)
Chloroquine + Liponavir/Ritanovir may cause fatal arrithmias, in the case anyone out there is self medicating. It's one or the other.
Re:Open letter from Italy to the international scientific co... by cameldrv on Sunday March 15, 2020 @03:36AM (#22581997)
Can you cite a source? Current Chinese treatment guidelines allow it.

Also very important to quantify side effect risks, even if it's a rough estimate. For example, if a 70 year old patient has already progressed to dyspena, they might have something like a 20% mortality rate from COVID. Even if there is a side effect profile for the treatment that normally would be considered very dangerous, it may be well worth it to administer it.

We see the same thing with chemotherapy or radiation treatment. The side effects are terrible and fairly often fatal, but they are safer than the disease. This is the situation in which we find ourselves.

Re:Open letter from Italy to the international scientific co... by copperx on Sunday March 15, 2020 @03:58AM (#22582072)
I can't find the original source, but you can easily verify that both drugs increase the QT/QTC and PR interval, which is a high-risk interaction AFAIK (I'm not a doctor). Some doctors recommend doing an EKG before administering Chloroquine.

https://www.sciencedirect.com/science/article/pii/S088394412...

What you're saying is true, but you're assuming that Chloroquine + Kaletra is better than Chloroquine by itself, and we don't have the data for that yet.

Do you have a source for the Chinese recommendations?

Re:Open letter from Italy to the international scientific co... by cameldrv on Sunday March 15, 2020 @04:39AM (#22582210)
Thanks for the link. Current Chinese treatment guidelines are: https://www.chinalawtranslate.com/en/coronavirus-treatment-p...

They state:

4. Antiviral therapies: Interferon-alpha (adult: 5 million units or equivalent can be added to 2ml sterile injection water and delivered with a nebulizer twice daily), lopinavir/ritonavir (adult: 200mg/50mg/tablet, 2 tablets twice daily; the length of treatment should not exceed 10 days), ribavirin (recommended in combination with interferon or lopinavir/ritonavir, adult: 500mg twice or three times daily via IV, the length of treatment should not exceed 10 days), chloroquine phosphate (adult 18-65 years old weighing more than 50kg: 500mg twice daily for 7 days; bodyweight less than 50kg: 500mg twice daily for day 1 and 2, 500mg once daily for day 3 through 7); umifenovir (adult: 200mg three times daily; the length of treatment should not exceed 10 days).

Pay attention to issues such as adverse drug reactions, contraindications (for example, chloroquine should not be given to patients with heart diseases), and drug interactions. Further evaluate the efficacy of current treatment regimens in clinical applications. Using 3 or more antiviral drugs is not recommended. Corresponding medication should be discontinued should intolerable side effects appear.

Re:Open letter from Italy to the international scientific co... by Cantbekhan on Sunday March 15, 2020 @06:10AM (#22582522)
Same for many EU guidelines

Source as I posted on other submissions

Chloroquine is mostly admitted as a valid treatment now

https://news.ycombinator.com/item?id=22582374

Re:Open letter from Italy to the international scientific co... by ImprovedSilence on Saturday March 14, 2020 @11:25PM (#22580982)
I thought that remdesivir was the drug showing the most promise? What happened with that one? And my big questions are how soon can they spool up world supplying levels of batches?
Re:Open letter from Italy to the international scientific co... by lbeltrame on Sunday March 15, 2020 @05:12AM (#22582318)
It's being tested in a few trials, the earliest one should have data in April, IIRC.
Re:Open letter from Italy to the international scientific co... by bsder on Saturday March 14, 2020 @09:35PM (#22580374)
> They already have a preliminary trial result in China that says Chloroquine works

Chloroquine has a long history with many diseases of "sorta, but not really" working when subjected to actual test.

Please don't spread unsubstantiated info.

Re:Open letter from Italy to the international scientific co... by cameldrv on Saturday March 14, 2020 @10:41PM (#22580773)
This is not unsubstantiated. It is proven in vitro, and this came out the other day: http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con...

I haven’t found the source paper if there is one yet — I can’t read Chinese except with google translate

Re:Open letter from Italy to the international scientific co... by irq11 on Sunday March 15, 2020 @12:20AM (#22581240)
Drugs shown to be effective in vitro routinely fail to show similar effects in vivo.

Chloroquines have a long history of this in viral studies.

Re:Open letter from Italy to the international scientific co... by cameldrv on Sunday March 15, 2020 @03:38AM (#22582004)
The point is that according to what the official Chinese medical line is, it works in vivo. This is apparently confirmed by Korean experience. I understand the skepticism, but you go to war with the data you have, and the data we have indicates Chloroquine works.
Re:Open letter from Italy to the international scientific co... by irq11 on Sunday March 15, 2020 @02:17PM (#22585369)
The “data” is anecdotal, not even close to the standards of an effectiveness trial.

That said, it’s an approved drug, so it will be applied and we’ll see how it goes. But don’t spread rumors about its effectiveness, because the truth is, we don’t know.

Re:Open letter from Italy to the international scientific co... by bsder on Sunday March 15, 2020 @07:44PM (#22588016)
Bleach or a handgun also work "in vitro".

Relevant XKCD: https://www.xkcd.com/1217/

Chloroquines will be tried since they already pass the "safe" bar.

However, I suspect that if they worked "in vivo", we would have compelling data on that from China already. The fact that we don't have such data suggests that they don't.

We seem to have much better data about the effectiveness of standard anti-virals already.

Re:Open letter from Italy to the international scientific co... by stjohnswarts on Saturday March 14, 2020 @09:53PM (#22580487)
They can fast track drugs if that drug has been tested for other things. It happens all the time. I mean like all the time doctors do it for other cases, there's not reason it couldn't happen for cov19
Re:Open letter from Italy to the international scientific co... by tim333 on Saturday March 14, 2020 @09:02PM (#22580173)
There are some existing drugs that help with the treatment but they don't really stop the infection spreading. Chloroquine / hydroxychloroquine are maybe the most useful.

Probably if they handed some out and told people to take a few as soon as they got a cough + some temperature it would help things. (http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con...)