COVID-19 Knowledge Exchange: spread, prevention, treatment, hacks

My collected knowledge about COVID-19

This whole coronavirus pandemic is quite confusing, as there are a lot of different opinions and recommendations, including from institutions. I spent quite some hours sifting through the mess, and the resulting knowledge is in the file you can view below. It’s mostly links and quotes, with some own ideas and conclusions mixed in. For legal reasons, I do not offer this as medical advice.

COVID-19_Knowledge.v2020-04-23.mm.html (298.8 KB)

When you are offered the file for download, choose to open it in your browser. You can then fold and unfold the hierarchy of nodes by clicking the + and - buttons.

I might update the file here as I add more knowledge. The current version is from 2020-04-06.

Chloroquine as a potential treatment for COVID-19

Note: After the recent incidents with people dying from chloroquine (probably from overdoses, I think) in an attempt to protect against COVID-19, I think it’s better to move this discussion a bit outside the focus. So I moved it here.

Personally I’m not against self-medication in a situation like this where time-tested medical solutions are lacking. But as with any hacks, people must know and understand what they get themselves into. In my view, anyone who did not invest tens of hours of reading and understanding about an unproven treatment and its risks should not attempt it.

Here are some random thoughts from my side. Don’t take it as medical advice, but apart from that, do with it whatever you want :blush:

If this becomes a proper pandemic, then it can be expected that 60-70% of the population will become infected, at which point the pandemic will run out of fuel as each case will result in less than one infected new case (since everyone else is immune already). For those who think that the pandemic will come, it’s a matter of deciding if they want to really be part of the 30-40% uninfected (which is extra hard work for the next 6-24 months) or if they want to accept the risk of going through the infection and then being immune.

For young people (like us :slight_smile: ) in my opinion there is a fairly limited risk to worry about when going through the infection. Of course I’d follow the recommendations re. hand hygiene etc. to avoid it if possible. But case fatality rate is <0.5% for the age group <50 y/o, while 8% for the age group >70 y/o, and even higher for those with pre-existing conditions. These numbers do not account for asymptomatic cases, which seem to be half of all infected (judging from one of the cruise ships, where everyone got tested, unlike the usual practice where only people with symptoms get tested). So <0.25% for our age group maybe? It’s not nothing of course – up to your judgment if you’re ok with this in a foreign country.

Personally I’m super careful around old people I like, though. For that, I think John took the right approach, i.e. self-quarantine when returning from travels in epidemic areas.

Oh and: like I hoped, chloroquine seems to work against this stuff (see this advance publication note from a clinical study in China). WHO etc. did not publish about this yet, though – but they’re slow. So if you take chloroquine as anti-malarial to Indonesia anyway, keep in mind this double use. Proper dosage against COVID-19 has to be higher than for malaria prophylaxis and is not simple due to toxicity at higher doses, but possible (details). Anyway, there will be more information about this when you might eventually need it.

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Thanks, much appreciated.
It looks like you’d have to take 500mg, which is double the usual dose you’d get (need to double check).
Will keep informed. Self medication, what a crazy thing.

Yes, crazy times :slight_smile: So you really looked into dosage already :hushed: Here are some more notes about chloroquine:

  • Antivirals are best taken early in the course of a disease. But mindless use may also induce resistance over time (just like antibiotics abuse – which is a societal problem, not a personal one). So probably it’s not a good idea to take it when the COVID-19 disease takes a light form (= not having to be in the hospital). Also being in the hospital seems a good idea if something about this off-label use of chloroquine would go wrong.

  • In HIV therapy (which is the only major source of experience with antiviral therapy), usually 2-3 drugs are combined to prevent the emergence of resistance. In the case of COVID-19, it would mean combining chloroquine and remdesivir, the only other effective drug. But where remdesivir is not available, chloroquine alone is also effective. Also, that combination therapy has not been tested with these two drugs, and there may be undesired side effects from that combination. Which means, I’d go with chloroquine alone until there is a clinical study saying the combination is safe.

  • Chloroquine is easy to overdose, but what exactly is an overdose seems to depend a lot on the individual. Ideally cell-level concentrations of chloroquine would be measured until reaching the right dose. If that’s not possible, probably calculate the dose based on body weight and then take the pills gradually as long as there are no serious side effects. For example if the calculated full dose would be 500 mg, one would take 250 mg on day 1, 125 mg on day 2, 125 mg on day 3. But that’s just my own estimate – please check for official guidance once you might need it.

  • I have no idea about how long the treatment should be, or in what interval to repeat taking the pills. Just note that for malaria prophylaxis, chloroquine is not to be taken daily, as it keeps around a long time in the body. When taken against malaria, it’s one pill of 250 mg per week.

That’s everything I know so far. There will be better information available online in a few weeks when you might eventually need it.

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There is new information concerning medication, at the moment only peer-reviewed and without clinical studies.
https://www.dpz.eu/de/startseite/einzelansicht/news/die-vermehrung-von-sars-coronavirus-2-im-menschen-verhindern.html (link to an english version at the end of the press release).

But most of the infected recovered without special mediacation.

Here’s a little update on the chloroquine situation, which has become much more messy since I last looked. There’s a lot of hype right now. Trump mentioned it. Somebody heard it, took chloroquine for fish and died. There are several studies underway of which we don’t have the results. And so on.

Articles I found helpful:

That one has a detailed overview of everything going on with the current chloroquine hype, and why there is reason to be careful.

And this one is valuable because it tries to put into perspective the recommendation of Indian Council for Medical Research about high-risk groups using hydroxychloroquine for prophylaxis. It does not fail to talk about the side effects and dangers of that medicine. I have to look more into into it, but it probably means that prophylaxis is not a good idea for anyone who can expect a light course of COVID-19.

My hope is still that chloroquine or the (less toxic) hydroxychloroquine will prove effective in treatment and chemoprophylaxis of COVID-19. That, or the same with other drugs, would certainly be the most comfortable way of going back to near-normal before vaccines arrive 12-18 months from now. We will find out in the next few weeks. Until then, please, nobody does anything dumb with any kind of chloroquine. Just stay home, it’s reasonably safe :wink: I will update this space with relevant info as I come across it.

(Fun fact: Chloroquine is a synthetic derivative of quinine, the first anti-malarial ever, which has a weird and colorful history.)

(cc @noemi and @alberto)

https://insilico.com/ncov-sprint/ Here are some molecules generated by artificial intelligence. Hope it can help to gain time and advance researchs for new drug discovery.

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One more update on this: the pandemic prediction tool by Gabor Vattay says that in European countries the situation during the first wave of the COVID-19 epidemic will not spin out of control completely, but new cases will be minimal basically everywhere within 3 weeks. (The U.S. is a different story – not enough data about that yet.)

So for Europe, the scenario where self-medication with an experimental drug is the only remaining option because there are no respirators and ICU beds left … it won’t happen. Means, I don’t recommend to consider (hydroxy)chloroquine anymore for that purpose. I still think it can be proven useful in larger studies and will then be officially recommended as a treatment option – that will be later in the year, which will be early enough. Also to note, due to the possibility of serious side effects, (hydroxy)chloroquine should be taken only under medical supervision – esp. in the higher-than-usual doses that treatment for COVID-19 would require.

But for now, the situation is enough under control to not require this improvisation anymore. Stay safe, everyone! :blush: (cc @noemi )

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I am concerned about India’s ‘expert advice’ and Trump’s word dropping which could spiral into who knows what reckless behaviors…

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Tingbo LIANG - Handbook of COVID-19 Prevention.pdf (23.6 MB) this handbook could be very helpful :slight_smile:

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Some more updates on the chloroquine situation: here is a long-winded article that explores how the struggle around using chloroquine for COVID-19 is political, with a lot of ego and bickering. You get the impression that not exploring the potential of chloroquine as fast as possible is a massive political failure. Instead, we have to make do with the most ancient and most damaging epidemics control tool: lockdowns. It’s certainly interesting to watch how this unfolds …

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Jez. This. It’s really incredible. Thanks for sharing it.

Raoult noted caustically that it was not impossible that the discovery of a new therapeutic utility for a drug that had fallen into the public domain long ago would be disappointing for all those hoping to win a Nobel Prize thanks to the breakthrough discovery of a new molecule or vaccine… Not to mention the prospect of tens of billions of dollars in revenue to be made, whereas chloroquine costs literally nothing.

Made this topic a bit more general now, so that I can add my own collected knowledge about the coronavirus pandemic. Hope its useful to somebody:

COVID-19_Knowledge.v2020-04-06.html (185.1 KB)

(When you are offered the file for download, choose to open it in your browser. You can then fold and unfold the hierarchy of nodes by clicking the + and - buttons. I added the same file also in the very first post above.)

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To whom that might be interesting: I uploaded a new version of my note collection regarding COVID-19 (also updated in the first post above now).

COVID-19_Knowledge.v2020-04-23.mm.html (298.8 KB)

From what I remember, relevant new material includes new and better letality estimates (0.4 - 0.6%); good estimates about true asymptotics (18% of cases); obscure and so-far unproven hunches about quercetin and luteolin as prophylactics (and where to get these as supplements); my analysis and calculations about the hypothesis that ~75% of people might have cross-immunity from seasonal coronaviruses; in which case a common cold from coronavirus could be administered as a vaccination; studies on infection risk per day of close contact (~2.5%); and more on drugs and treatments (“proning” etc.) that you might have to tell your hospital or just practice when the need might come.

Stay safe everyone :slight_smile: