Hydroxychloroquine And Wuhan Flu-- April 12, 2020

Updates

April 18, 2020: lately I wrote, whatever happened to the hydroxychloroquine story? If it's the silver bullet, one would think we would be hearing more about it. A quick google search suggests .... well, I'll let others sort this one out. Israel apparently puts study on hold; a French study says it doesn't work.

A reader replied that where the hydroxychloroquine trials failed with regard to coronovirus, the reader noted that only hydroxychloroquine was used. In fact, the "hydroxychloroquine" advocates suggest the regimen must include azithromycin (and perhaps zinc).

April 13, 2020: despite my early skepticism, there is more and more evidence that chloroquine really does help fight Wuhan flu. The CDC knew about it since at least 2005. The CDC completely missed it. From the article:

As most know, the media/Democrat politicians/FDA want the use of the hydroxychloroquine/azithromycin/zinc combination to be restricted until late in the course of the infection, when the patient’s infection is well-advanced. As a physician, this baffles me. I can’t think of a single infectious condition — bacterial, fungal, or viral — where the best medical treatment is to delay the use of a anti-bacterial, anti-fungal, or anti-viral until the infection is far advanced.

Original Post

Not ready for prime time. Idle chatter regarding hydroxychloroquine. 

This is a throw-away post, nothing to do with the Bakken or with oil. It refers to an article regarding Wuhan flu over at iceagenow. A reader asked me my thoughts on the article. When I read the article, I was a complete skeptic -- not that hydroxychloroquine might work -- but that the mechanism for action has been discovered (seemingly overnight) and that hydroxychloroquine is the silver bullet for which we've been looking. I learned a lot along the way. It's really quite fascinating. I had forgotten a lot since medical school, especially with regard to esoterica associated with hemoglobin.

In a long note like this there will be content and typographical errors. Facts and opinions are interspersed and may be difficult to tell the difference. 

This is the link to the article with this headline: "Covid-19 had us all fooled, but we might have found its secret." Author: "an RN and a Nutritional Biochemist in former times."

The author explains why "azithromycin or Zithromax, works as does the Quinine derivative chloroquine!" The author bases the explanation on another article, at this link, "Covid-19 had us all fooled, but now we might have finally found its secret." The article was apparently posted April 5, 2020, by an author who goes by the pseudonym, "libertymavenstock." Clicking on "people" at that blog/site provides a look at the folks behind the site, I assume, even though that is questionable. Be that as it may.

Two things bother me about the article posted at the second link:

• the author publishes under a pseudonym; which always concerns me;
• the article itself, a "scientific" article of sorts, has no links to any other scientific articles (unless I missed them)

It reminds me a lot of the young man in middle school who first suggested we need to give up plastic straws after he telephoned a plastic straw company to find out how many plastic straws are manufactured every year.

Both articles, let's call them the "original article" and the "derived article," are filled with factoids: things that look like facts but are not necessarily factual and in some cases outright falsehoods.

The first factoid that caught my attention and which pretty much is critical for the "theory" to work, from the "original article" and carried forward in the "derived article":

This leads to damage and inflammation, which leads to all that nasty stuff and damage you see in CT scans of COVID-19 patient lungs. Ever noticed how it’s always bilateral? (both lungs at the same time) Pneumonia rarely ever does that, but COVID-19 does… EVERY. SINGLE. TIME.

That is 1000% absolutely wrong.

Once I read that, I questioned the entire article. That's a pretty basic mistake. The grammar, punctuation, all caps, etc., are also concerning.

But this is what I find most amazing. I have spent much of the morning looking for articles on the mechanism of action of chloroquine and hydroxycloroquine. Do it yourself. Google it and look at any ten mainstream, peer-reviewed, scientific articles. They all say the same thing: no one knows for sure how chloroquine/hydroxychloroquine works.

There are three major groups of "germs": viruses, bacteria, and parasites. There are others, but these are the ones we usually think of when talking about "germs." Coronavirus is a virus, and malaria is a parasite. "Strep throat" is bacterial.

Among the parasitic diseases, and among all infectious diseases, malaria is one of the most studied. Others would include tuberculosis. Likewise, drugs used to treat those two diseases are among the most studied, including hydroxychloroquine.

A precursor of the drug has been used at least since the 17th century, see wiki.

In 1633, this herbal medicine was introduced in Europe where it was given the same use and also began to be used against malaria. The quinoline antimalarial drug quinine was isolated from the extract in 1820, and chloroquine is an analogue of this. Chloroquine was discovered in 1934 by Hans Andersag and coworkers at the Bayer laboratories, who named it Resochin. Ignored initially, it has been studied, along with malaria, for decades. The eradication of malaria has been a cause célèbre for Bill Gates as just one example. And we still do not know how hydroxychloroquine "works" in fighting malaria.

And that's the second problem. After decades of study, and centuries of being used, "no one" knows for sure how hydroxychloroquine works, and now we have an "RN and dietician" and an unidentified "journalist" who have come up with the mechanism.

Links, hydroxychloroquine, mechanism of action:

• why scientists are studying if chloroquine could treat coronavirus;
• drugbank;  
• chloroquine, COVID-19, cutting through the hype; The New Scientist;

If I did not know better, I would suggest "libertymavenstock" is a pseudonym for AOC.

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How Chloroquine Works

Most of the scientific articles discuss lysosomes when talking about the mechanism of chloroquine (I use chloroquine and hydroxychloroquine interchangeably). I talked about that at an earlier post, March 21, 2020.

I have not been able to find a peer-reviewed, scientific source for this new theory at the link in the "original article" linked above. I'm sure it's out there somewhere but for the life of me I couldn't find it. I found vague allusions to the theory but nothing explicit.

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The Hemoglobin Hypothesis 

or

The Carbon Monoxide Analogy

Having said all that, what is the basis for the article suggesting there may be another mechanism for the toxicity/severity of Wuhan flu? I will call it the "hemoglobin hypothesis", and it's a pretty good hypothesis. I can't deny that it's very, very possible.

Links suggesting hemoglobin hypothesis:

• Thailand Medical, April 9, 2020:  
• Jewish Press, April 10, 2020:
• CNN, April 10, 2020:

If the hemoglobin hypothesis is correct, the analogy would be carbon monoxide poisoning. And, yes, if an individual with carbon monoxide poisoning is ill enough to be unable to breathe on one's own, a ventilator is used. However, if caught early enough, carbon monoxide poisoning only requires 100% oxygen by mask, and not by ventilator.

Carbon monoxide poisoning produces symptoms much like those described in COVID-19.

But COVID-19 also causes viral pneumonia -- direct damage to the lung tissue. And carbon monoxide poisoning, if not treated in time, kills the victim before one develops (chemical) pneumonia.

In medicine, researchers live and die by Occam's razor.

It's possible that the "hemoglobin hypothesis" has some validity, but it cannot explain everything. And I still come back to the problem that for decades, modern science, has not been able to describe (or at least agree on) the mechanism of hydroxychloroquine, and all of a sudden overnight, we have the "explanation."

Bottom line for me:

• there is much more to Wuhan flu than just an analogy to carbon monoxide poisoning (the hemoglobin hypothesis);
• the coronavirus clearly causes tissue damage, lung disease, and viral pneumonia, not seen in carbon monoxide poisoning;
• the hemoglobin hypothesis could explain why ventilators have not been a chokepoint in the treatment of Wuhan flu yet, at least not yet in the US;
• the admonishment by "libertymavenstock" the "RN/dietician" is ill-placed. Intensivists (ICU specialists) use ventilators only when indicated; it is not a trivial decision to place an individual on a ventilator; 100% oxygen by mask is more than sufficient in most cases of carbon monoxide poisoning
• what frustrates me most: tens of thousands of cases severe enough to result in hospitalization and there have been no numbers presented by the CDC: how many of those cases were treated with hydroxychloroquine and outcome; I've not been following the news or listening to the daily task force briefings, so I may have missed something; but it seems pretty clear that we should have something by now;
• does anyone even know if the UK PM, Boris Johnson, received hydroxychloroquine? I would be shocked if hydroxychloroquine had not been used, but I don't know.

For me, the silver bullet remains:

• a vaccine; or, failing that,
• a medicine that interrupts the virus's ability to glom on/enter human cells in the first place. 

Treating the oxygen-starvation problem buys one time but that is neither prevention nor cure.