Is Hydroxychloroquine a Potential Treatment for COVID-19?

Disclaimer: I am not a medical professional whatsoever. My only contribution here is to assemble some links to primary sources from medical professionals, and provide what I hope is a useful and accurate summary. I hope this is of value to some, and I sincerely hope that I am not accidentally adding to the tide of misinformation out there. Be safe.

For the past 5 days or so I have been tracking a low-level rumbling that there may be a drug that has significant benefits for the treatment of COVID-19. Perhaps it was a complete coincidence, but when I woke up this morning there were three adjacent tweets in my timeline that mentioned the therapy that I have been following. So in case there is a lot of sudden interest in this topic I thought it would be helpful to pull together some links to articles written by medical professionals which are believable and relevant. It is clear that there is no “cure” for COVID-19, (possibly excepting a future vaccine) and I am definitely not suggesting that this is one. But anything which mitigates the damage by measurable percentages is going to help at scale.

Hydroxychloroquine (HCQ) and chloroquine (CQ) were originally developed over 60 years ago for the treatment and prevention of malaria. The compounds are used today primarily for the treatment of arthritis and autoimmune disorders. They are both on the WHO Model List of Essential Medicines, medications considered to be most effective and safe to meet the most important needs in a health system. They are potentially promising in the mitigation of the COVID-19 pandemic for a number of reasons.

1. They appear to help reduce the COVID-19 viral load in measurable ways.
2. They are available now.
3. They have been safely used for decades for both the treatment and prevention of malaria and other disorders.
4. The patents have long expired, so the cost per dose is low.
5. The patents have long expired, so production is not controlled by any one company and can therefore be ramped up quickly.

From the sources I show below these drugs are already listed in the COVID-19 standard treatment guides for at least three countries: China, South Korea, and Belgium.

On the negative side, as they are no longer effective for the treatment of malaria I speculate that the available quantity is currently limited, but as stated above, presumably supply could be ramped up quickly. There can also be negative side effects in large doses and when people are already seriously ill.

Note that most of the sources cited below state that it is believed that HCQ is more effective than CQ for the treatment of COVID-19. Several articles also discuss combining these drugs with others for improved outcomes. Some of those combinations are with newer antiviral drugs. In the French clinical study referenced in #1 below in cases where it was clinically indicated they combined HCQ with azithromycin, a widely used generic antibiotic. They speculate that there could be synergistic effects from the combination.

One possibility that I find particularly intriguing is that it may be possible that these compounds could (highly speculative, please see #3 and #4 below) be used as a prophylaxis for medical staff. Both HCQ and CQ were safely used for many years as a prophylaxis for the prevention of malaria. Anything that helps to keep our medical professionals healthy throughout this pandemic could dramatically improve the potential outcomes.

Below are articles that are written by medical professionals. This list is not exhaustive, but they are the most authoritative ones that I have found to date. I note with interest that with a little searching you can find that China has prioritized the manufacture of chloroquine, and the UK just banned its export. So it seems like some folks are taking it seriously. It is also mentioned as a promising therapeutic in the WHO report from their mission to China. I would add that you can also find some sensationalized reports of a “cure”, that in my humble opinion are not helpful at this point.

1. A new (March 2020) clinical trial in France demonstrates the utility of hydroxychloroquine, relative to a control group. I believe that this is deeply significant as it is a current, properly constructed clinical trial.
   
   Key quote: “We show here that hydroxychloroquine is efficient in clearing viral nasopharyngeal carriage of SARS-CoV-2 in COVID-19 patients in only three to six days, in most patients. A significant difference was observed between hydroxychloroquine-treated patients and controls starting even on day3 post-inclusion. These results are of great importance because a recent paper has shown that the mean duration of viral shedding in patients suffering from COVID-19 in China was 20 days (even 37 days for the longest duration)”

2. The Belgian COVID-19 treatment guide published March 16, 2020.
3. An article entitled “An Effective Treatment for Coronavirus (COVID-19)” from March 13, 2020 from Stanford, UAB, and researchers from the US National Academy of Science that is partially based on the published treatment guidelines established in China and South Korea. It also asserts that Chloroquine may serve as a prophylactic (preventative) measure against COVID-19.
4. A Reddit article that discusses the efficacy of using chloroquine as a COVID-19 prophylaxis for medical staff. (There is as much interesting content in the comments as in the article itself.)
5. This article from China indicates that hydroxychloroquine is more effective than chloroquine. It concludes that “…a loading dose of 400 mg twice daily of hydroxychloroquine sulfate given orally, followed by a maintenance dose of 200 mg given twice daily for 4 days is recommended for SARS-CoV-2 infection...”.
6. A letter to the editor of Nature published February 4, 2020.
7. A 2004 article on the efficacy of using chloroquine to treat the original SARS. I speculate that it may have been research such as this that motivated clinicians to try HCQ to treat COVID-19 in the first place.

 

Plummer’s Lodge Fishin’ Story

 

Last July I went with my two sons and a couple of friends to Plummer’s Lodge on Great Bear Lake in the North-West Territories. This was the trip of a lifetime. If you are into fishing, this place has got to be on your bucket list.

Ben and Nick wrote up what has got to be one of the best brotherly fishing stories going….they each caught a 48lb lake trout on the same day.

---

 

For us, fishing trips have been a part of the family DNA since we were young. A lot of our fondest memories growing up come from family fishing trips with our father. So for Ben, it was an obvious choice to pick a fishing trip as a university graduation gift. With the world as our oyster, Ben chose the one place that few people would – the Arctic. The world-class fishing and uniqueness of the setting would result in incredible family memories that were too good to pass up.

Once Nick heard that the family was going up to Great Bear Lake he made plans to join – making the trip all the way from South Africa. It made the journey from Ottawa seem miniscule!

Our travels to and from Plummer’s itself was memorable as the nights spent in Yellowknife allowed us to try local cuisine that we would never experience normally. We were met at the airport by a Plummer’s representative who made us feel comfortable and made sure we got to our hotel safely and with all our gear.

After 2 years of planning, the last night before actually going to Plummer’s felt like an eternity! Not only because we were all so excited to get on the world renowned water, but because we got to experience the midnight sun in Yellowknife. Even come 1am we were still looking out our windows to see some of the best scenery we had ever witnessed.

After getting only about 2 hours of sleep, we were back at the airport with 30 other excited anglers, and some even more excited guides. We had picked the opening week so many of the guides hadn’t even gotten there yet themselves. We got all the gear and people loaded onto the plane and we were off. The views from the plane were something I will never forget as you fly over some of the most beautiful, yet barren landscape you will ever experience.

On the ride itself, we were lucky enough to sit beside one of the guides and pick his brain early about strategies and spots and what works and what doesn’t. It was his third year here and he was literally shaking he was so excited to get there.

The landing itself is something you will never forget. Landing a large jet on a dirt runway with no airport is something I was always interested in seeing. You would never even be able to tell as it was one of the most seamless landings I have ever had.

Stepping off the plane and breathing the freshest air you ever have is one of the greatest feelings you will ever have.  After taking some quick photos of the plane and the runway we quickly grabbed our gear and hurried down to the boats they had waiting to taxi us to the lodge.

When we arrived at the lodge they had a top notch lunch waiting for us with our licenses and everything ready. It was a quick meet and greet for everyone to meet the lodge crew and go over the rules and then we were assigned our cabins.

We quickly brought all of our belongings to the cabin and tossed them on the beds and starting rigging rods. Our three guides came by and went over what we would need and brought us lures that we should use. Luckily for us, the guide we sat beside on the plane was one of our three guides so we were off to a quick start!

We were the first to hit the water that afternoon and it was a perfectly calm day. The water was like nothing I had ever seen before as it was clear, calm, and perfectly blue. It looked like a Caribbean oasis more than an Arctic lake but to me it was perfect.

For both of us, the goal going in was to get a 20 pound lake trout. The guides assured me it would happen and I should get many more. We were beyond excited to finally have our lines in Great Bear Lake after so long of imagining it.

The action was steady right from the start as my father and I each got a few 12-15 pounders the first afternoon. Needless to say, we were quite ready for 5 more days of fishing like that!

Our first night at the lodge was fantastic. The food the chef prepared was absolutely incredible and really hit the spot after a day on the water. The bartender was great as well, somehow already memorizing everyone’s names and stories.

The next morning we woke up ready to go and after a quick breakfast we were on the water again. The morning started off great with plenty of action and we had more than enough for lunch by 10am. The lunches the guides prepared were something you would expect from a 5-star restaurant, not something they can whip up on the shores of a lake in the Arctic. We had lake trout 9 different ways over our time there and each and every one was fantastic. Even the non-fish fans in our group were amazed with how good the lunches were.

By day 3, the promise of 20-pounders had yet to be realized. However, Our father caught a 32 pounder the second day which was deemed ‘The Miracle Fish’ as they thought they were snagged and ending up getting completely spooled before hand-lining the fish in! I thought to myself if a 32 pounder feels like a rock, imagine a 50 or even 60 pounder!

The 5^th day of the trip our group did a fly out to ‘The Inlet’ which is where the world record Lake Trout was caught some 40 years ago. Going to bed we all had dreams of catching the big one.

We were out early and the plane ride was short and smooth. If you closed your eyes you never would have been able to tell when you took off or when you landed. All the pilots were extremely professional and talented.

We got going quickly in The Inlet but didn’t have much luck for the early part until about 11am we got into a school of Butterfly Lake Trout. We caught about 15 in a 25 minutes span ranging between 8-15lbs. The monster still eluded us.

At around noon Nick decided it was time for a sandwich. A couple minutes later he had his rod in one hand and sandwich in the other when all of a sudden his line started flying. A few minutes into the fight we finally got a glimpse of the fish and all it took was one view of its tail and the whole boat flew into action – we knew we had our 20 pounder and then some. In a matter of seconds it was utter chaos in the boat.  With Nick battling the fish, our guide working the boat and the net, and Ben videotaping and balancing the boat it truly was a team effort. After about an additional 15 minute fight at the boat (would have been longer but we were in shallow water so it could not dive deep) we wrangled the fish into the boat. It was by far the largest fish I had ever seen and weighed in at an astounding 48lbs!

After about 10, ok 20, minutes of celebrating we looked around the boat and it looked like a bomb had gone off. The sandwich my brother was eating was everywhere, boxes were overturned, and lures everywhere. We couldn’t help but laugh.

After we cleaned up the boat we got back to it. Now it was Ben’s turn. With renewed hope and a healthy dose of sibling rivalry – the afternoon was all about getting Ben’s trophy. We chatted with our guide and decided to focus on “hunting monsters” as he put it.

A few more hours of fishing had gone by and we had gotten a few nibbles but nothing big. The plane was coming at 5pm to pick us up so at 4:30 our guide said the famous fishing line: “one more cast”.

Ben threw his spoon back in the water for one more pass across a drop off. As he was conceding defeat and reeling in his last cast at The Inlet , WHAM! A hit like no other hit Ben had ever felt and suddenly he was in battle like never before. Once again chaos overtook our boat. This time we were in much deeper water so the fish was able to run a lot more. After about 10 minutes we saw this fish and thought it was even bigger that the first. 20 more minutes passed and the fish was still diving with ease. Finally, at about the 40 minute mark it was tiring and coming closer and closer to the surface.

After what seemed like an eternity, our second “fish of a lifetime” of the afternoon was in the net. Ben almost collapsed from sheer adrenaline and excitement overload. The guide got the scales out and to our surprise, it was another 48 pounder. After the best day of fishing in our lives, we had come out tied!

We each had our 20 pounder, and then some! To this day our smiles are just as big when we talk about our day at The Inlet and our time at Plummer’s. We also wouldn’t have been able to have the experience we did without the heroic efforts of our guide throughout the day. Boating two 48lb fish in an afternoon is really a team effort and his quick thinking, boat manoeuvring, encouragement, and photography skills were a key ingredient to the day of a lifetime.

It was an incredibly unique and special opportunity for us to each be able to battle a beast and to share that experience and memory with each other. In our long history of family fishing memories, this is definitely one that will never be topped.

Plummer’s is truly a special place. From the staff, to the scenery, to the water, and of course the fishing, Plummer’s is a place where memories and stories of a lifetime happen.

Ben & Nick Milinkovich

P.S. The boys’ old man did sort of okay that day as well. A 34-pounder is still a pretty nice fish!

P.P.S. Thanks to Alex, Brandon and Carl for a fantastic week on Great Bear. The guides at Plummer’s are all great, but these young men really made our week.

Ich liebe Berlin

I love Berlin.

This week was my second visit to the city, and the first time that I really had a chance to play tourist. You can find some of my favourite pictures over on Flickr.

The first time I visited the city I knew I liked it, but I really couldn’t articulate why. I had just recently been in Paris and the way I explained it was “Paris is chic, Berlin is cool”. Which is true.

But after looking over the pictures from this week, I realized a least part of the reason why I love Berlin is that it goes past the other major European cities in revealing its past. London, Paris, etc. make a point of showing off their history. Berlin puts the burden of its history front and centre. From the statue of a scowling Soviet soldier, to the unrepaired bullet holes, to the Holocaust Memorial, Berlin gives equal time to its unpleasant past whereas the other cities only reveal their glories. The whole history is there to find on public display, not just the victories.

That’s not to say that Berlin is sombre. The public art is incredible with a very cool mix of classical and modern. The street scene is hopping with some of the best buskers I’ve seen anywhere.

If you haven’t thought of Berlin as a travel destination, think again. It is a very walkable and lovely city with great hotels, restaurants and bars. I will definitely be going back. Next time I hope to be able to spend some significant time visiting the museums. From all reports they are incredible.

Some random thoughts on what to do or see:

• If you go the Holocaust Memorial don’t just look at it. Walk through it. If you haven’t been disoriented in the middle of it, you’re missing the point.
• I can highly recommend both the Westin Grand and the Intercontinental hotels. Especially the latter, as its location close to the Tiergarten, Zoo and Breitscheidplatz are hard to beat. They’re certainly not cheap, but they are both excellent.
• If you have the legs for it, the view from the top of the Victory Column (Siegessäule) is pretty incredible. But your legs will be burning by the time you walk to the top.
• The public transit is outstanding. I used the ICE to get there and the U-Bahn, S-Bahn and buses in the city. Clean, reliable and on-time.

US-Canada Hi Speed Rail

I travel a lot in Europe and love the high speed rail system. In fact, I am sure that I am one of the very few Canadians that hold a Deutsche Bahn 50 frequent rail traveler discount card.

So I thrilled to see that the Obama administration’s announcement today that they’re pushing for a quite complete high speed rail system for the United States. But I got really excited when I noticed the little northern leg on this map. I poked around a little bit, and yes it seems that a high-speed rail corridor is on the plan from Boston to Montreal.

I wonder what this means for a Canadian high-speed plan? If that linked to the often-rumored Toronto-Ottawa-Montreal rail link, that would be very cool.

Update: There is also a link in the Pacific Northwest that goes up to Vancouver. Boy, I bet Bombardier is licking their chops on this opportunity.

No Surprise There…

The Politics Test is set up for Americans, but it seems to work for me too 🙂

You are a Social Liberal (78% permissive) and an… Economic Conservative (65% permissive) You are best described as a: Libertarian Link: The Politics Test on OkCupid.com: Free Online Dating Also : The OkCupid Dating Persona Test

Berlin Impressions

Ian Skerrett, Ralph Mueller and I are in Berlin this week for the OSGi Community Event. We haven’t had too much time for touring, but I did manage to take a couple of quick photos.

The happy shot of Ian, Ralph and Naci Dai was taken at a Greek restaurant where we watched Greece play Sweden in the Euro Cup. It was good fun to soak up their enthusiasm for the game. But the crowd got pretty quiet as Sweden scored two quick goals in the second half.

I really like Berlin. It has a very nice, relaxed urban vibe. It’s a lot more colourful than Frankfurt. I would definitely like to come back and play tourist here some day.

Unbelievable

Last week I read that the CRTC (the Canadian Radio-television and Telecommunications Commission) is studying the possibility of regulating the internet. Like that is even remotely possible. Or desirable.

With the increasing popularity of online broadcasters such as Joost, Hulu and even YouTube, the CRTC has grown concerned that traditional broadcasting regulations outlining required levels of Canadian content are threatened.

Jeez, did it ever occur to these folks that the very reason people use these services is so they can watch what they actually want to watch, rather than what government regulators think is good for them?

Then this week I read that the Canadian, US and other governments are seriously talking about turning border inspectors into “copyright regulators” with the authority to inspect laptops, iPods, cell phones and the like to determine whether they have illegal copyright materials. And if they do find something which the inspector (in their sole judgment) determines to be an illegal copy of copywritten material, they can detain you, fine you and/or destroy your device.

Oh my. It really does seem that there are going to be some major political and regulatory battles over the next couple of years. But these ideas are just such utter nonsense it staggers me that policy makers would even consider them.

All I can keep thinking of is the time I sat beside a Canadian federal court of appeals judge on an airplane. He told me that he mostly adjudicated patent and copyright cases. He also told me that he had never used a computer in his life and had no idea how they worked.

It ain’t gonna be pretty.

Paris Walkabout

I took the Nikon to Paris on my trip there this week, but unfortunately had very little time for playing tourist. Ralph and I had one free evening to walk around, and the light was only so-so.

We were staying in Montparnasse, which was definitely my favourite location so far in my trips to Paris. The hotel was right across the street from the Gare Montparnasse train/metro station, so getting everywhere was very simple. And its a great Paris neighbourhood. Real people live there, with some great local bistros to enjoy.

I’ve posted some pics, including a few that I took out of my hotel window.

It was great to see that at least one person in Paris has great taste in cars 🙂

My New Role Model

I’ve grown and changed a lot as a coach over the past 12 years. A lot of it has to do with experience and maturity. But having role models to help define your approach to the game and how to interact with the kids is also huge.

Meet my new role model: Coach Jules

Turning a Short

You learn a lot about a city by watching how its taxis work. New York: annoying but efficient. Chicago: dirty and surly. Paris: clean but impossible to find when you need one.

San Francisco Airport: maniacs.

Nowhere I travel do they have a rule like the one in San Francisco, where “turning a short” is the excuse used by cab drivers to find their inner Schumacher. If you are in a cab coming out of SFO that is doing 90 miles per hour, it’s because the driver is attempting to get you to your destination and return to the airport in less than 30 minutes. Because if they’re back in less than 30 minutes they get to jump the queue and pick up another fare immediately. Maybe someday the Freakonomics guys can use this to explain why more cabbies die in accidents in San Francisco than anywhere else 😉

SFO to downtown and back in 30 minutes is not humanly possible if you drive anywhere even close to the speed limit. We are talking some serious velocity requirements.

The good news is that when it is 1:30am according to your body clock, there is nothing like being in a cab doing 90++ weaving through traffic on the 101 to keep you awake.