What are you talking about? The severe side effects are known and are usually associated with chronic usage of that drug. Chloroquine is taken for prophylaxis against malaria (daily) in many places in the southern hemisphere. Usual regimen is at least for 8 continuous weeks!
EDIT: Toxicity here: as you can see it's very well tolerated. https://eyewiki.aao.org/Hydroxychloroquine_toxicity
What health authorities want to do is to allow physicians to use the drug if the patient agrees, but only in a controlled setting in which data is collected and there is a control group. So at least afterwards we could draw conclusions about whether it killed more people or helped saving people. Does that not make sense to you?
First is prophylaxis for front line health care workers, who are suffering grave infections likely exacerbated by long hours and low morale. Long term use of chloroquine or alternatives is a concern for this audience. There were fatalities last time, just like this time.
The second is for the patients themselves, who will otherwise endure uncontrolled viral replication for up to two weeks until the adaptive immune response recognizes the pathogen. Reducing transmission requires an earlier end to this stage.
Is the data from the previous studies worthless for these goals?
No. Likely needs to be given closer to onset of symptoms.
"The suggestion was to massively prescribe it."
No. The suggestion is to generate more evidence as fast as possible since it looks promising.
Cannot wait for full clinical trials. 1500+ deaths per day in the mean time.
Why are you fighting it so hard? If this is a useful treatment, don't you want us to find out? Let the doctors do their thing.
Doctors have the authority in many countries to prescribe it off label based on their own review of the evidence and their patient's consent. That's the best we can do right now without risking something much worse.
The goal here is to get enough evidence the treatment works or doesn't work. Conducting double blind studies is not the most efficient and fastest way to do that when you already have a lot of preexisting knowledge about both the patients not receiving any drugs and the safety profile of the drug in question.
This is again a situation where statisticians should be asked for help as medical professionals very often operate on very simplistic model (double blind or gtfo) which we just don't have time for this time around.
And yet trials for new medication against these diseases always include a control group.
It does, but why can't one can have the control groups at the same as blanket prescribtion? In times like this when the health care apparatus is overwhelmed, is it a good alternative to do that, since side effects are well-known and given the fact that the drug might be ineffective if used late in the infection cycle [0]?
And you just described the reason for a control group. We simply do not have that information. Things are moving too fast and treatments have not been standardized yet, not to mention the built in variability between locations. If you want to know if a treatment is effective, you must have to comparable groups. The point of the control group is to gather that information. Just because there are many, many, global cases doesn’t mean you actually have been able to capture the data for a control. Things are moving that fast.
> But if a doctor wants to prescribe all its patient with it, he should be allowed to
And what about the supply of these drugs? There are people who do need these drugs for other conditions (I’ve read Lupus patients sometimes need it). These patients need the drug and the supply is getting scooped up by people who don’t know (a) if they have the virus and (b) if the treatment is effective. And if it is effective, is it effective for treatment of infection or prophylactically? Just because a drug is widely used does not mean that there is enough supply to distribute it to anyone who wants to try it.
These are major issues that can be answered with proper clinical trials. We know how to do this and they can (and are) being done as fast as possible.
I’d suggest we need to get it to people before they end up in the hospital to try to keep the resources available.
See https://www.drugs.com/sfx/hydroxychloroquine-side-effects.ht...
If the discourse become authoritative and biased, we shut it, disregard it pointing out the flaws. But we have to be careful not to be authoritative ourselves when we don't even give the chance for the writer to be wrong because he lacks the right credentials.
Basically, I've seen my share of unqualified people (not that I'm qualified myself) building ridiculous models of exponential growth and predicting catastrophes, commenting on drug research protocols without necessarily understanding the details and so on.
Nor on the basis of panic; we should be able to manage this pandemic as long as people stick to the measures in place. Stay at home, limit your shopping, don't take the piss. I mean panic right now is causing more problems - e.g. hoarding and people trying to make a quick buck.
This thing is mainly a big problem because people can't keep calm and rational. Or they think they're rational, as in, "I should buy enough toilet paper because I should stay indoors for a while".
These are very real concerns for which no one has answers. People are stockpiling because of the uncertainty, which could be seen as a very rational stance in hindsight if this goes on for quite some time.
To clarify, hydroxychloroquine has far fewer side effects than chloroquine.
Hydroxycholoquine is very safe and is prescribed to lupus patients daily. The Korean recommended dose (400mg/day) is the same as what is prescribed to lupus patients. Chloroquine is a bit more dangerous, but only in high doses and over long periods of time. Patients would be on either for 10-20 days maximum which is much less than what it takes to be dangerous.
Both are less toxic than Tylenol.
The drug is 90 years old, has been used by millions, has relatively modest side effects, is relatively well-understood, has shown efficacy against coronavirus in vitro.
And it's not just for drugs. It's also why DDT continues used in some countries but is illegal in others.
I would only want this drug given to me if there was no hope of recovery.
Advil has probably killed more people than hydroxychloroquine.
> if there's no suscipicion this drug could cause new problems, we should have people massively use it
That's not how evidence-based medicine works. The drug is known to cause new problems because of the side effects. Clinical trials are needed to determine whether these are outweighed in patients by positive health effects.
You do not prescribe medicine on the basis of hunches.