Treatment of Covid patients in England

[LilacTree1]

Does anyone know if UK patients are being treated with Hydroxychloroquine?

I’m getting the impression that newer drugs with less data, are favoured. But I’m not sure.

ashmts The outcome would be they're not dead. These are extraordinarily circumstances of a global pandemic.

It's very good a lot of trials and research is going on. Longer-term that's the best way.

We all have different views. I prefer the approach some countries, or at least individual doctors with more freedom than in the UK, have taken of trying anything to prevent Covid progressing to a serious stage and/or trying anything to save lives if it's got to hospital stage.

Others clearly disagree with that approach.

@ToffeeYoghurt yeah, others like the MHRA... Hopefully the link @TimothyTerrible posted will clear things up.

And outcomes aren't as clear cut as that. They may want to record data on symptom severity, duration etc. Who would trawl the records to check who got prescribed the drug and survived? Pandemic or not, the data and evidence needs to be good quality.

The outcome may be that they are dead, because of the treatment rather than Covid.

Hydroxychloroquine can cause fatal cardiac arrhythmias. For example, in a patient who may have survived Covid. The only way to find out if the benefit outweighs the risk is to use it within a clinical trial.

I can understand the desire to want results now but if it makes anyone feel any better, medical staff are recruiting anyone eligible for the trial so the numbers are rising rapidly. And they're monitoring the data constantly, so if something is having an obvious benefit they'd try to roll it out ASAP.

All drugs have potential serious side effects. Including the one currently recommended to patients for Covid. Paracetamol.

I'm not talking about trials. I was thinking about treatments given to patients when there's currently no alternatives.

When there's a serious accident or somebody's taken seriously ill in an isolated place without easy or quick access to equipment or drugs, people (including doctors) improvise. Which is what some doctors in other countries have been doing with Covid patients.

When there's such a high mortality rate there's little to lose by trying a known drug that's generally well tolerated. The serious side effects are rare. Many people take it daily for inflammatory conditions like rhematoid arthritis and lupus. In fact one of the problems would be protecting their supply. Given the potential worldwide demand.

Why not make it patient choice? Inform them of the potential but uncommon side effects and let them decide if they want to risk it or would rather the risk of dying from Covid.

Of course it's rather irrelevant debating this. For now we don't have enough of any of the drugs to try them as mass treatment.

Perhaps by the time trial results are ready more will have been manufactured. It's good a primary care trial is starting as it's more than possible the hospital one will fail. With hydroxychloroquine at least. It's most effective given before hospital stage. Perhaps remdesivir will be the hospital stage option. We'll see.

@ToffeeYoghurt It is irrelevant debating, as 1. The MHRA have already made the decision and 2. You don't seem to actually understand the processes. There are people on this thread explaining to you why what you suggest doesn't make sense. Maybe you could learn from us.

There are several trials involving hydroxychloroquine ongoing at the moment:
Eg.

In primary care patients:
www.phctrials.ox.ac.uk/news/national-priority-covid-19-trial-recruits-first-patients

There is also an older trial of hospital based treatments where one of the arms was hydroxchloroquine.

www.recoverytrial.net/

I believe that some french doctors are using it. It was left to their own discretion i think, but i read this some time ago and that could have changed.

ToffeeYoghurt I don’t think you understand what a clinical trial is.

I understand perfectly what a clinical trial is. Which I wasn't really speaking about.

I was talking about trying something (during a global pandemic) that's shown some effectiveness to save lives. When there are no other alternatives and when there's a very high mortality rate. I also spoke of informed consent re patient choosing to whether to take the risk of a drug that might work. Or risk dying.

What you actually mean is I have a different opinion to you. Just because the MHRA has said no, doesn't mean they made the right decision. After all, with the UK having more deaths and the one of highest death rates in the whole world, it's not unreasonable to think just perhaps other countries (with lower death rates) made the more sensible decision.

That's my view. Which clearly differs from yours. There's nothing yet to prove which one of us is right.

Clearly not in this case (in the UK) but doctors can and do prescribe drugs normally used for something else off licence.

This isn't about trials. This is about over 44,000 people dead. Whilst other countries with much lower numbers of deaths tried to treat patients with any drug that could potentially save the patient's life. Something a drug trial result months later will be too late for. The uncommon side effects are well-known since most of the drugs being used in other countries are not new drugs and they are used with no problems daily by many people for other conditions.

The real truth is as I as I've said. There isn't enough to go around. There's worldwide demand. And I suspect the UK was at the back of the queue for the drugs. Just like we were for the PPE, etc.

There are over 10,000 patients recruited into the recovery trial in the U.K. now, one arm of which is hydroxychloroquine 🤷‍♀️

This isn't about trials. It's about doing, as other countries are, something to try to save lives. Like a PP says prescribing off licence at doctor discretion.

When faced with a patient who has a high risk of joining the 44,000 already dead, some doctors might wish to be allowed to choose to try something to save that patient. There's very little to lose when the alternative is so often death. 🤷

The UK trial seems designed to fail. It's on hospitalised patients?
The worldwide evidence suggests hydroxychloroquine (and several others) are most effective when given early - before it gets to hospital stage

@ToffeeYoghurt oh my goddd, how do you think trials are carried out? (Clue - yes, by prescribing off-licence. But under controlled conditions. So it's absolutely about trials) Out of curiosity, what dose of hydroxychloroquine do you suggest? For how long? Based on what data?

The worldwide evidence says nothing, there's such a limited evidence base. There's also a theory that giving treatment too early could be counter-productive as you'd want to give it after the immune response has kicked in.

Out of curiosity, what dose of hydroxychloroquine do you suggest? For how long?

^Just ask Donald!

(joke btw)

It would be extremely irresponsible to advise on dosages, etc here. I wouldn't recommend taking anything without medical supervision.

People should lose the fixation with Trump. He's irrelevant here. This drug (and several others) was being used in several countries (with lower number of deaths than the UK) at least a month before he first mentioned it.

So far none of the drugs have proved to be miracle cures but they're shown promise. Particularly when given early. When the alternative is so often death there's little to lose by trying one of the potential treatments. Whether hydroxychloroquine, remdesivir, or any of the others being used. Better to try something that might help than just let people die. That's my view. Which you disagree with. We'll have to agree to disagree.

Meanwhile in the UK 44,000 people are already dead. We clearly need to do something. If not early drugs treatment, we certainly need to get more PPE for frontline staff, more testing, masks for the public, etc.

Looks like the NHS sees the potential.

www.standard.co.uk/news/world/nhs-staff-to-be-given-hydroxychloroquine-drug-touted-by-donald-trump-in-clinical-trial-a4446671.html

Like I've been saying on various threads for a couple of months. There's evidence to suggest it works as a prophylactic.

As I also said and noted in article, the real issue is about shortage of supply. There's concern to protect access for the people taking it for other conditions. It's a difficult dilemma. I don't know whether they have alternative options?

If trials continue to go well hopefully more can be manufactured fairly quickly. And other drugs also continue to show promise so we shouldn't need to rely on only this one.

Toffeyogurt, I have never heard that off-licence use of existing drugs made the differences among different countries' fatality rates.

I haven't read any reports suggesting that either. It's something I wondered. It might be just one of several reasons why. It might not but it's plausible.
Not necessarily the anti-malarials. Like I've said other drugs have also shown potential.
Japan's been using a flu drug (not tamiflu) with seemingly reasonably good success. That's just one example.

Tom Hanks and Rita Wilson received hydroxychloroquine in Australia a few months ago. So they must be using it there?

Yes Australia was using it.
I sympathise with rheumatoid arthritis and lupus patients. The potential shortage is a real concern. If it turns out to be as successful as evidence suggests. I hope more can be manufactured asap and also that we have success with the other potential drug treatments. That would ease pressure and give us more options.

100% agree with you @ToffeeYoghurt.
Here in the UK people still think they know best despite the high death rates. It's bloody frustrating. People are dying. There is no time for your stupid clinical trials. Learn from what other countries with better outcomes are doing and copy them. Invest in building factories that provide all the necessary PPE, all the drugs in a short amount of time.
The inefficiency and bureaucracy is unbelievable! Quite a few politicians have blood on their hands but, as always, they will all get away with it.

Better late than never.
The good news is we're finally moving forwards. (Perhaps because they've realised the longer-term economic costs of letting Covid run through).

We're starting to increase testing, the plan for track and trace is coming together, drugs have been ordered. We're getting there. Slowly but surely. Hopefully we're also getting on top of the PPE issue. That needs to be the priority.

It should've been done two months ago but there's no point looking back. We can do better from now onwards.

The drug treatments, even if they're successful, are not a panacea. Not yet.
It's not possible to get enough to satisfy global demand immediately. But it's positive progress. It gives us hope.

In the meantime, I read yesterday of studies showing public mask wearing reduced infections by 75%. So that's something easy that we can implement very quickly.

@ToffeeYoghurt
I think India sent mass quantities over to the US. It’s made there.

Here the drug became politicized. Trump mentioned it (I think after the French trials were showing some success) and then governors like the one in NY started banning the use of it.

It’s been so strange to watch the hysteria because politicians never before were able to dictate the use of medications. (In my memory).

It’s contraindicated for people with any heart issues, but our news was promoting the myth that it was unsafe for everyone and killing people and should not be used at all.

Meanwhile I read that 1 in 4 doctors worldwide are using it now. I don’t have heart issues. I’d rather take my chances with a drug that has shown some promise than die with nothing at all.

Study just published in the Lancet showed increased mortality in hospital patients given hydroxychloroquine alone and in combination with a macrolide.