[redis_mlc]

"Indeed, in our experience, no medicine was particularly useful. Instead, the most effective solution was oxygen. For around 60% of our patients, oxygen saturation was improved by using oxygen masks with a reservoir bag. In more severe cases, we would also use a nasal cannula and an oxygen mask to increase the volume of oxygen."

[Leary]

"One of the first things we noticed was that our COVID-19 patients had a higher tolerance for hypoxia, a kind of oxygen deprivation, than typical viral pneumonia cases."

Definitely heard that from doctors in NYC as well. [1]

[1]: https://www.medscape.com/viewarticle/928156

[neuronic]

Non-medical view: this sounds a bit like a sudden switch is happening at one point.

In COVID-19 cases, large areas of the lungs (article states 60% as an example) may be affected and only mild symptoms experienced until some point in time. Then comes the switch and you have sudden deterioration into critical condition.

In other viral pneumonia cases, more serious symptoms are subjectively experienced earlier, when much less area of the lungs is affected (article says 20% for H1N1).

As if the problem causing breathing trouble is strong in H1N1 from the beginning and suddenly switches on in the affected area for COVID-19 which had time to grow large beforehand.

[djsumdog]

> though many of our patients experienced severe side effects and couldn’t continue the treatment

I took chloroquine years ago as a preventative anti-malaria when I was in India. I didn't get the weird dreams, but I got the harsh bowl movement, heart palpations, etc. I had to stop taking it and so did someone else on the trip. Had I got malaria I knew it would be worse, but I could start taking them again as a treatment drug as well.

Others on the trip didn't have any issues so I'm sure it's individual, but it is a very serious drug that can be hard on your system. I don't think that's been made clear.

[BiteCode_dev]

Just out of curiosity, how long ago was it?

Malaria nowadays is very easy to prevent and treat with a course of atovaquone/proguanil, which have low side effect on the short run.

I want to know if doctors are still prescribing chloroquine despite of that. I know they do sometimes in the army.

[Mediterraneo10]

> I took chloroquine years ago as a preventative anti-malaria when I was in India. I didn't get the weird dreams

The weird dreams and other neurological consequences that some unlucky travelers report when taking antimalaria prophylaxis, typically come from mefloquine (Lariam) and not chloroquine.

[chvid]

COVID19 hits patients with health problems and old age harder; those patients are probably also more sensitive to the side effects of chloroquine or other drugs.

[BiteCode_dev]

So basically, our best chance now is not to cure them, but to help them survive until their immune system fight it off?

[redis_mlc]

It's more subtle than that. Here's some background before I answer your question.

One doctor has said that corona patients should be treated like altitude sickness patients, not like viral patients (and this Wuhan article implies that.)

All doctors say that ventilator intubation is the equivalent of major surgery, requiring anesthetics for the duration of ventilation and a long recovery period. High air pressure damages lung tissue, so afterwards you won't be walking or talking much for weeks or months.

So when you put those together, the best US approach today so far is to provide supplemental oxygen with face masks or cannula until the patient faints repeatedly (turns blue or purple), then make a decision to intubate. (China learned and published this in Jan. or Feb., but we learned it in Mar. or Apr.)

The only problem there is that mouth-breathing patients aerosolize corona virua and infect staff and other patients, so they should be moved out of the hospital to a quarantine facility or sent home. I don't think we are doing this yet, and it's an important step to stopping lockdown since we'll have thousands of new patients to monitor and help breathe.

The US mistakes made pre-Apr. 1 were early intubation based on traditional oxygen level monitoring (and to prevent aerosolization to protect staff.) That had a 66% - 90% mortality rate and consumed too many ventilators.

> out best chance now is not to cure them, but to help them survive until their immune system fight it off?

There is no plan, cure or pattern except we give them oxygen and see what happens next. We have no diagnostic tools that tell us cause and effect. For example, X-rays can show corona virus lung congestion, but there's no measurement or inference we can draw from any image. All we know is that ventilators are a one-way trip for most patients. It is what it is.

[fragmede]

In a less political time with more open societies, we could confirm earlier research started by the Chinese, giving us lead times for our doctors to confirm their theories, which would help get to a scientifically proven and recommended course of action. (Like the pre-print that discusses COVID-19 attacking hemoglobin which then inhibits the ability for the blood to hold oxygen.)

Unfortunately, nationalism has kicked in, and there are rumors that China is censoring any papers that discuss a possible origin, hindering progress.

So now all we can do is give oxygen and hope for the best.

[rjsw]

One thing that might help for the general population could be iron supplements. Not to prevent infection but to help the body to respond to low oxygen levels if you become infected.

[fragmede]

Maybe. There's a pre-print, not-(yet?)-peer-reviewed paper[0] that theorizes that SARS-Cov-2 directly inhibits the ability of red blood cells to carry oxygen by binding in the place of iron (approximately)[1].

If this is true, then iron supplements could be dangerous, as too much iron is toxic, possibly fatal.

[0] The paper's abstract explicitly calls out the status of the research: "This paper is only for academic discussion, the correctness needs to be confirmed by other laboratories. Due to the side effects and allergic reactions of drugs such as chloroquine, please consult a qualified doctor for treatment details, and do not take the medicine yourself."

[1] https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...

[rjsw]

I was thinking more that our response to low oxygen levels at altitude is to make more red blood cells and you need iron to do that.

Plus if you are having problems shopping for food then green vegetables may not be your top priority.

[Gibbon1]

Welcome to Viral Pneumonia, population hopefully not us.

If any of the antiviral drugs they are trying actually work it'll be the biggest stroke of luck in medicine.

[lagadu]

It's like that for the vast majority of viruses.

[asdfasgasdgasdg]

Because of my priors, I believe this is true. My prior being that we should not expect any given random drug to be efficient against a particular virus. But this doesn't count as strong evidence against these medicines any more than the French studies count in favor. (They both count, just very little.)