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Coronavirus certainly will cause inflammation and thus causes swelling. The therapeutic role of the Hydroxychloroquine is not from virus killing, but it is in the original therapeutic function of decreasing the inflammation and swelling to reduce the damage and long-term complications on certain organs or tissues as that of the purpose of the treatment for arthritis; which has been a great contribution as a cheaper old drug; but the ignorant people are still asking for more and angered without getting they greedy desired.

Frank May 15, 2020, in Waterloo, Ontario, Updated in May, 16, 19, 21, 25, 27, 2020

http://www.kwcg.ca/bbs/home.php?mod=space&uid=61910&do=blog&quickforward=1&id=13736

Double-blind clinical trial is a questionable way that encourages people killing innocents legally by the pretext of unscientific or unproven. A small pill of hydroxychloroquine is the examiner for the quality and soul of people; and their developed civilization human or inhuman under such a soul.”

French Professor Didier Raoult who happily announced that the hydroxychloroquine is effective treatment to cure COVID-19 patients in decreasing the virus carriage duration; however, the work did not get appreciation to inspire more people to consider how to properly use of the effective medication, but it triggered many people into manic state to work hardly to prove the Professor Didier Raoult is a liar; which has far beyond the issue in technology.

The sadness is that the most of the active players in the arguments are from academic circle; which show that the higher level of education and higher level of IQ scores cannot ensure the person in high quality human nature.

The arguments caused WHO and many governments banned the use of the hydroxychloroquine; which was truly in killing people. Those active players who fight against the use of hydroxychloroquine are the killers actually.

Some reports on the clinical trial of hydroxychloroquine did not introduce the exact dosage and the times of daily administration; besides a high amount number. I once sent emails to request this issue and asked them that why they made such a treatment design, but no one answered my request.

Finally, there rational people did a rational job, July 2, 2020, article Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients reports that in a large-scale retrospective analysis of 2,541 patients hospitalized between March 10 and May 2, 2020 across the system’s six hospitals, found 13% of those treated with hydroxychloroquine alone died compared to 26.4% not treated with hydroxychloroquine. None of the patients had documented serious heart abnormalities.

They used Hydroxychloroquine was dosed as 400 mg twice daily for 2 doses on day 1, followed by 200 mg twice daily on days 2-5. The dose was quite less in comparison with the use of the most of others. Obviously, above report was a reliable, the Hydroxychloroquine is effective for curing Covid-19 in the lower safe dosage.

In the treatment of Professor Didier Raoult, “Twelve-lead electrocardiograms (ECG) were performed on each patient before treatment and two days after treatment began. All ECGs were reviewed by senior cardiologists. The treatment was either not started or discontinued when the QTc (Bazett's formula) was >500 ms.

Invites senior cardiologists to sure the life of patients showed high quality of the Professor Didier Raoult in both professional ethics and noble sentiment with qualified human soul.

In contrast, many other researchers seem never care about the death of the patients, they seem purposefully made the number in death for showing their high quality of the loyalty for scientific. In compared with humanized consideration of Professor Didier Raoult, some people seem have totally lost human nature.

The small pill of Hydroxychloroquine is acting as a mirror for reflecting the beauty or ugly of human soul.

In China, the most of doctors never use hydroxychloroquine in single or simply combined with other synthetic drugs; but follows Daoism to carefully restore the physical condition of patients by multi-integrated medications, especially by combining the assistant of the TCM, thereby ensure the lives of patients, and then use hydroxychloroquine in safe dosage.

An important note:

1.. The serum of the recovered patients is ineffective for treating patients in COVID-19.

In Shanghai, China, for some patients whose virus cannot be eliminated, doctors treated by the serum of the cured person and some of the patients did turn negative, but they regained positive after three days.

2.. Need to learn the effect of hydroxychloroquine whether it is immunosuppressant or anti-virus

26 May 2020, a report from China Ruxolitinib in treatment of severe coronavirus disease 2019 (COVID-19 said that ruxolitinib recipients had a numerically faster clinical improvement with significant chest CT improvement, a faster recovery from lymphopenia and favorable side-effect profile.

Actemra is a drug for rheumatoid arthritis, but approved for treating "cytokine storm" in 2017, and it is testing in China for treating Covid-19. Seattle Dr. Ryan Padgett contracted with COVID19 relying on ventilator, his lungs, kidneys and heart started failing in a day or so to live, the doctors tried Actemra and saved him.

There were reports that immunosuppressant effect of Ruxolitinib caused infections on several organs. But in this study, it effectively cured patents in Covid-19; which inspires us to learn the effect of hydroxychloroquine whether it is immunosuppressant or anti-virus.

Contents

1.. The initiation of the arguments about the use of hydroxychloroquine

2.. The reports of opposition on the use of the hydroxychloroquine

2.1.. France: Hydroxychloroquine should not use in patients who require oxygen

2.2.. China: Hydroxychloroquine did not result in positive but negative for mild to moderate covid-19

2.3.. Canada: Hydroxychloroquine is ineffective for postexposure prophylaxis for Covid-19

2.4.. Frencce stops use of Hydroxychloroquine for the treatment for COVID-19

2.5.. FDA issues hydroxychloroquine warning as studies show risk in using drug for COVID-19

2.6.. Health Canada issues warning against use of hydroxychloroquine for COVID-19

2.7.. The chloroquine is safe and effective in the treatment of COVID-19

3.. China, the use of hydroxychloroquine is combined with TCM

3.1.. Relieve fear psychology, improve sleep, immunity and physical strength

3.2.. The process of understanding for the effect of hydroxychloroquine

3.3.. The stop use of glucocorticoids and antibacterial drugs

3.4.. The gamma globulin is ineffective, thymosin has somewhat effect

3.5.. The serum of the recovered patients is ineffective for treating patient

3.6.. The standard for patients discharge and nucleic acid test

3.7.. The medical experts of China in western medicine reject the use of TCM

3.8.. The use of TCM in the treatment of COVID-19 patients in Shanghai, China

3.8.1.. Chinese medicine has no strong side effect were observed in treated patients

3.8.2.. There is about 93% of local patients used Chinese medicine in cure rate of 97.5%

3.8.3.. The doctors put equal emphasis on Chinese medicine and Western medicine

3.9.. The simple inference for the therapeutic effect of hydroxychloroquine

1.. The initiation of the arguments about the use of hydroxychloroquine

According to available information, especially the attacking target, the arguments on the use of hydroxychloroquine may be triggered by the researches that led by French infectious disease expert Professor Didier Raoult, which proved that hydroxychloroquine is an effective treatment to cure COVID-19 patients in decreasing the virus carriage duration.

1.1.. March 17, 2020, Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial.

International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag. 2020. 105949

https://www.ncbi.nlm.nih.gov/pubmed/32205204

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

Abstract

BACKGROUND:

Chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2, and reported to be efficient in Chinese COV-19 patients. We evaluate the role of hydroxychloroquine on respiratory viral loads.

PATIENTS AND METHODS:

French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16^th, to receive 600mg of hydroxychloroquine daily (200 mg, 3 times/day) and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point.

RESULTS:

Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.

CONCLUSION:

Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.

Percentage of patients with PCR-positive nasopharyngeal samples from inclusion to day6 post-inclusion in COVID-19 patients treated with hydroxychloroquine only, in COVID-19 patients treated with hydroxychloroquine and azithomycin combination, and in COVID-19 control patients.

1.2.. Apr. 11, 2020, the researchers from France published article Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study indicates that “We need an effective treatment to cure COVID-19 patients and to decrease virus carriage duration.”

The treatment design was based on the carefully consideration.

“Patients with no contraindications (Supplementary document) were offered a combination of 200 mg of oral hydroxychloroquine sulfate, three times per day for ten days combined with azithromycin (500 mg on D1 followed by 250 mg per day for the next four days). For patients with pneumonia and NEWS score≥5, a broad spectrum antibiotic (ceftriaxone) was added to hydroxychloroquine and azithromycin.”

Set up experts and monitors to monitor patients for stopping treatment timely.

“Twelve-lead electrocardiograms (ECG) were performed on each patient before treatment and two days after treatment began. All ECGs were reviewed by senior cardiologists. The treatment was either not started or discontinued when the QTc (Bazett's formula) was >500 ms.”

“The risk benefit ratio of hydroxychloroquine and azithromycin combination was estimated by the infectologist and agreed with the cardiologist when the QTc was between 460 and 500 ms.”

“The treatment was not started when the ECG showed patterns suggesting a channelopathy (i.e. lonq QT pattern, Brugada pattern, malignant early repolarisation pattern) and the risk-benefit ratio was discussed when it showed other significant abnormalities (i.e., pathological Q waves, left ventricular hypertrophy, left bundle branch block).”

“In addition, any drug potentially prolonging the QT interval was discontinued during treatment. Symptomatic treatments, including oxygen, were added when needed. An ionogram and verification of serum potassium levels in particular, was systematically performed upon admission. When needed, standard blood chemistry was checked.”

Results

“80 relatively mildly infected inpatients treated with a combination of hydroxychloroquine and azithromycin over a period of at least three days. A rapid fall of nasopharyngeal viral load was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% of patients at Day5. Consequently patients were able to be rapidly discharged from IDU with a mean length of stay of five days.”

Obviously, the work of Professor Didier Raoult and he led team has achieved their goal: We need an effective treatment to cure COVID-19 patients and to decrease virus carriage duration.

This work has lightened the dark nightmare of so many people being killing by virus helplessly. However, it is not get appreciation to inspire more people to consider how to properly use of the effective medication, but it triggered many people into manic state to work hardly to prove the Professor Didier Raoult is a liars. Even, some people wrote for personal attacking.

2.. The reports of opposition on the use of the hydroxychloroquine

2.1.. France: Hydroxychloroquine should not use in patients who require oxygen

May 14, 2020, Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University,, Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data

181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care; 84 patients who received hydroxychloroquine at 600 mg/day within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine at 600 mg/day more than 48 hours after admission.

In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment.

Conclusions: Hydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.

But the report did not mention the key point of the dosage of the administration of Hydroxychloroquine.

May 17, 2020, I email to author to ask about how the Hydroxychloroquine administrated to the patients in detailed dosage and times in daily base; and the concern for the distribution. But, until May 22, 2020, I did not get reply.

In comparison with that of led by Professor Didier Raoult in Hydroxychloroquine 200mg, 3 times per day, this report did not mention the amount of dosage in single time; which is vital important. Small dose in more times administration may be more positive and less negative.

The different practice revealed different in personal quality, the purpose of Professor Didier Raoult was in focusing on saving lives under quality human nature, but the work of others were just in the opposite. Their purpose was for proving the result of Professor Didier Raoult was wrong.

2.2.. China: Hydroxychloroquine was no positive but negative for mild to moderate covid-19

May 14, 2020, Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial.

150 patients admitted to hospital with laboratory confirmed covid-19 were included in the intention to treat analysis (75 patients assigned to hydroxychloroquine plus standard of care, 75 to standard of care alone).

Patients in the treatment group were given hydroxychloroquine within 24 hours after randomisation, with a loading dose of 1200 mg daily for three days followed by a maintenance dose of 800 mg daily for the remaining days (total treatment duration was two weeks for patients with mild to moderate disease and three weeks for those with severe disease).

The probability of negative conversion by 28 days in the standard of care plus hydroxychloroquine group was 85.4% (95% confidence interval 73.8% to 93.8%), similar to that in the standard of care group (81.3%, 71.2% to 89.6%).

The difference between groups was 4.1% (95% confidence interval –10.3% to 18.5%). In the safety population, adverse events were recorded in 7/80 (9%) hydroxychloroquine non-recipients and in 21/70 (30%) hydroxychloroquine recipients. The most common adverse event in the hydroxychloroquine recipients was diarrhoea, reported in 7/70 (10%) patients. Two hydroxychloroquine recipients reported serious adverse events.

Conclusions Administration of hydroxychloroquine did not result in a significantly higher probability of negative conversion than standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19. Adverse events were higher in hydroxychloroquine recipients than in non-recipients.

As same as above report of France, this report also did not mention the amount of dosage in single time.

May 17, 2020, I email to author to ask about how the Hydroxychloroquine administrated to the patients in detailed dosage and times; and concern for the distribution. But, until May 22, 2020, I did not get reply.

2.3.. Canada: Hydroxychloroquine is ineffective for postexposure prophylaxis for Covid-19

June 3, 2020, researchers from several Universities of Canada jointly published report A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19.

Abstract

BACKGROUND

Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days.

RESULTS

We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was −2.4 percentage points (95% confidence interval, −7.0 to 2.2; P=0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported.

CONCLUSIONS

After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.

2.4.. Frencce stops use of Hydroxychloroquine for the treatment for COVID-19

April 8, 2020, French Hospital Stops Hydroxychloroquine Treatment for COVID-19 Patient Over Major Cardiac Risk

Ahospital in France has had to stop an experimental treatment using hydroxychloroquine on at least one coronavirus patient after it became a "major risk" to their cardiac health. Professor émile Ferrari, the head of the cardiology department at the Pasteur hospital in Nice, said the side effects had already been identified, with some patients having to stop treatment because of the risk posed.

April 14, 2020, French Drug-Surveillance Specialist Highlights Hydroxychloroquine Risks

Government monitoring authorities in France have seen a jump in reports of serious side effects from hydroxychloroquine used to treat patients with Covid-19. Since March 27, the center in charge of tracking hydroxychloroquine has received notifications about 54 Covid-19 patients who developed serious heart problems while taking the drug. Four died.

I did find the detailed treatments that can show the doctors in carefully avoiding patients from death.

2.5.. FDA issues hydroxychloroquine warning as studies show risk in using drug for COVID-19

APRIL 24, 2020, FDA issues hydroxychloroquine warning as studies show risk in using drug for COVID-19: Hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19, it caused serious heart-related adverse events and death. Its side effects range from mild — such as dizziness, nausea and diarrhea — to severe — including sensitivity to light, bleeding, muscle weakness, hair loss and convulsions.

2.6.. Health Canada issues warning against use of hydroxychloroquine for COVID-19

April 26, 2020, Health Canada issues warning against use of hydroxychloroquine for COVID-19: Health Canada is warning the public of the possible side effects of a chloroquine and hydroxychloroquine, because they can lead to dizziness, fainting, seizures, liver or kidney problems, and a potentially fatal irregular heart rate. Chloroquine and hydroxychloroquine are approved in Canada to treat malaria, lupus and rheumatoid arthritis, but are not approved medications for COVID-19, though both are currently under clinical trial.

To date, data from clinical trials are limited, and the results have not conclusively shown that any specific medications are effective against COVID-19.

2.7.. The chloroquine is safe and effective in the treatment of COVID-19

May 28, 2020, the Oxford Academic (Oxford University Press) Preliminary evidence from a multicenter prospective observational study of the safety and efficacy of chloroquine for the treatment of COVID-19 .

Abstract

Background

Effective therapies are urgently needed for the SARS-CoV-2 pandemic. Chloroquine has been proved to have antiviral effect against coronavirus in vitro. In this study, we aimed to assess the efficacy and safety of chloroquine with different doses in COVID-19.

Method

In this multicenter prospective observational study, we enrolled patients older than 18 years old with confirmed SARS-CoV-2 infection excluding critical cases from 12 hospitals in Guangdong and Hubei Provinces. Eligible patients received chloroquine phosphate 500 mg, orally, once (half dose) or twice (full dose) daily. Patients treated with non-chloroquine therapy were included as historical controls. The primary endpoint is the time to undetectable viral RNA. Secondary outcomes include the proportion of patients with undetectable viral RNA by day 10 and 14, hospitalization time, duration of fever, and adverse events.

Results

A total of 197 patients completed chloroquine treatment, and 176 patients were included as historical controls. The median time to achieve an undetectable viral RNA was shorter in chloroquine than in non-chloroquine (absolute difference in medians -6.0 days; 95% CI -6.0 to -4.0). The duration of fever is shorter in chloroquine (geometric mean ratio 0.6; 95% CI 0.5 to 0.8). No serious adverse events were observed in the chloroquine group. Patients treated with half dose experienced lower rate of adverse events than with full dose.

Conclusions

Although randomised trials are needed for further evaluation, this study provides evidence for safety and efficacy of chloroquine in COVID-19 and suggests that chloroquine can be a cost-effective therapy for combating the COVID-19 pandemic.

3.. China, the use of hydroxychloroquine is combined with other medications

Firstly, we need to learn the initiation of the use of Traditional Chinese medicine – TCM in the treatment of COVID-19.

In China, the epidemic control has been under a medical expert team, the officials in all level governments work as assistants. At the start, the members of the medical expert team were all in the background of western medicine, they deadly resist the experts in TCM to join the treatment of COVID-19. Until enforced by a special meeting of the top leaders of China.

The fact is clear; the Reductionism of western medicine has deadly distorted the human nature of some people. What is gratifying is that, after saw the magic curative effect of TCM in curing COVID-19 patients, some of them have been convinced and turned to promote the use of TCM.

Zhang Boli, 72, an academician of the Chinese Academy of Engineering, and the principal of Tianjin University of Traditional Chinese Medicine, in Jan. 27, 2020, he arrived Wuhan city for epidemic control on call of the central government of China. Below is his photo from a TV interview. In the interview, he introduces some details of TCM used in the treatment of COVID-19 patents. When talking about the hard situation in hospitals when he just arrives in Wuhan, he is still tearful in two months later.

Mar 23, 2020,专访中央指导组专家组成员中国工程院院士张伯礼：把“胆”留在武汉 | CCTV

^{https://www.youtube.com/watch?=eNnc4TkkPQI&fbclid=IwAR1_bsM2VDWeZQ5DpEoizsNgBBQ2OGln1DJ-GqbEsp5o_g97Gt_1YVK6Aaw}

In Wuhan hospital, he found that patients in COVID-19 or general diseases and health families are overcrowded in the waiting room, they are in quickly infecting of each other. In such a situation, for the epidemic control is as same as that of cleaning the water on floor by the water tap opening. So the medical team decided to isolate the potential patients in COVID-19 together in the hotels and school dormitories.

The principal Zhang worried about that isolation may cause the nervousness and fear of being isolated people, so he suggested making the soup of Chinese medicine to the isolated people as psychological comfort. He prescribed a formula in TCM and tried make a phone call to a company of Chinese medicine. Contrary to his expectations, the company agreed happily, while asked him that how much? He said 3 thousands packages in first day, and 10 thousands in the following days.

Maybe due to people closely contacted of each other between health and infected, at the start, the ratio of suspects confirmed as COVID-19 in 90%, after use of TCM 4 days, the ratio dropped to 30%, and a longer time dropped to 3%. The tests show that there several kinds of immune cells were increased in the blood of recovered people.

The treatments in following report are based on combined treatment in TCM; but it did not mention that.

Mar. 22, 2020, a Mandarin article Full of expectations, Shanghai plan takes hydroxychloroquine as special drug for reversing COVID-19 said that:

Hydroxychloroquine ranks the first therapeutic drugs in Treatment Plan of Shanghai, China. As of Mar. 15, the clinical study of hydroxychloroquine in the treatment of COVID-19 has accumulatively enrolled 184 patients; the results show that hydroxychloroquine treatment is effective and safer.

Shanghai adopts the methods of concentration in patients, experts, resources and treatment; all diagnosed patients are treated in Shanghai Public Health Clinical Center with below measures.

3.1.. Relieve fear psychology, improve sleep, immunity and physical strength

For preventing patients into severe, we advocate the use of antiviral drugs, oxygen therapy, and good maintenance of immune function and physical strength.

Some patients have severe panic psychology in insomnia; we relieve their fear psychology, improve their sleep, help to improve their immunity and body's strength, the stability of the internal environment; we found that the large doses of vitamin C in 10g ~ 20g are effective.

3.2.. The process of understanding for the effect of hydroxychloroquine

Below was excerpts translated from Mandarin reports.

At the start, the antiviral drugs were used in the treatment, we found that the AIDS drug Krizine (Lopinavir ritonavir tablets) and the broad-spectrum antiviral drug Abidor has the same effect as the blank control group. Abidor seems to have somewhat effect. But Krizine side effects are more obvious, especially digestive tract reactions, which may affect immune function.

While, we more and more felt that, after the use of hydroxychloroquine, it is significantly reduced patients from mild developing as severe and reduced the proportion in severe developing as critical ill. Especially hydroxychloroquine has fewer side effects.

In the chloroquine series, the side effects of hydroxychloroquine are relatively low. For safe concern, we specially consulted the experts of rheumatology, they thought that hydroxychloroquine is relatively safe under normal circumstances. Therefore, we used it at the maximum dose of the instructions, that is, 400mg per day.

We compared the differences between patients in the first and second stages, and the proportion of patients with severe and critical illness in the first stage was very high. In the second stage (after Feb. 5 treated by HCQ), the proportion of patients in severe and critically ill decreased significantly. We believed that is the greatest contribution of the use of hydroxychloroquine.

3.3.. The stop use of glucocorticoids and antibacterial drugs

The use of glucocorticoids and antibacterial drugs is strictly controlled in Shanghai. The use of hormones needs by a small dose of short course of treatment. The data showed that (patients using glucocorticoids) detoxification time was significantly longer. We have noticed that in the pharyngeal swab test, the detoxification time of the hormone group and the non-hormone group was 15 days and 8 days. The detoxification time of fecal nucleic acid was the same, one was 20 days and the other was 11 days. So that we restrain the desire to use hormones.

With the understanding of this disease, the use of antimicrobial is also significantly reduced; we boldly stopped all antibacterial drugs, and the effect was good.

3.4.. The gamma globulin is ineffective, thymosin has somewhat effect

For the immune function support and maintenance, we advocate that thymosin should be used, especially for the young patients with low CD4 +, early use seems there is somewhat effect. The gamma globulin, we used more in the first stage, but, we gave up in the second stage, because of we found that the effect of gamma globulin is not ideal.

3.5.. The serum of the recovered patients is ineffective for treating patient

For some patients whose virus cannot be eliminated, we treated by the serum of the rehabilitation person and some of the patients did turn negative, but they regained positive after three days. Therefore, we need to accumulate more experience in the use of the serum.

3.6.. The standard for patients discharge and nucleic acid test

Discharge standards of the national guidelines of China:

1. Body temperature returned to normal> 3d;

2. Respiratory symptoms improved significantly;

3. Pulmonary imaging examination showed significant improvement in acute lesions;

4. Two consecutive negative respiratory tract nucleic acid tests (sampling interval at least 1d);

Increased standards of local Shanghai:

5. After the nucleic acid test of the respiratory tract specimen is negative, the nucleic acid test of the fecal pathogen must be also in negative;

6. The total course of disease exceeds 2 weeks.

Compared with the national discharge standards, the discharge standards of Shanghai city have increased by two.

The first added is that besides negative respiratory specimens, fecal specimens are also negatively before discharge. The expert group of Shanghai believes that if the stool is positive for more than 4 weeks, the infectivity may not be strong; of course, there is no data support for the guess. Therefore, if the stool is positive for more than 4 weeks, we allow the patient to be discharged with suggestion of patients taking care for the pollution.

The second added criterion is to require a course of more than 2 weeks. In the past, I thought that many viruses may be infectious within 2 weeks. Some viruses are self-limiting; they may more weaken after 2 weeks. Even if there is no treatment of drugs, they can heal by patients themselves, so these two additional standards were set at that time.

Shanghai has stricter control over discharge standards than the national one. We also focused on controlling the imaging evaluation before discharge and performing nucleic acid recheck. Only when the pharyngeal swab and stool check are negative at the same time can be discharged.

We also found that the positive sustained time of fecal nucleic acid was much longer than throat swab nucleic acid.

April 1, 2020, the researchers from China reports that Malaria Drug Helps Virus Patients Improve, in Small Study said that “A group of moderately ill people were given hydroxychloroquine, the cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group.

3.7.. The medical experts in western medicine reject the use of TCM

Above practice of Shanghai are from the speech of Hu Bijie, professor, doctoral tutor; the director of the Department of Infectious Diseases, Zhongshan Hospital, Fudan University. Professor Hu is the member of the medical expert team for epidemic control of China.

As talked of professor Hu, the use of glucocorticoids and antibacterial drugs stopped, the use of gamma globulin stopped, the thymosin has weak effective, the serum of the recovered patients is useless for treating patients, then besides hydroxychloroquine, what medications did play the role in curing patients, it is Chinese medicine.

It is Chinese medicine to help patients maintained immune function, relieve the fear psychology, improve the sleep quality, and maintained body's energy and the stability of the internal environment. It is Chinese medicine reduced the side effect of the hydroxychloroquine, and promoted its positive effect.

The decisive medication of Chinese medicine did not mention in such an important speech, the reason, as my view, is from the distorted mentality by the harm of the philosophy of the Reductionism of western medicine to be deeply addicted in so called scientific, thereby rejects experience based TCM.

In China, the conduction of epidemic control was under the medical expert team and the officials in all level governments work as assistants to support to carry out the plans of medical expert team. At the start, the medical experts in the list were all in the background of western medicine, due to that they deadly resist the use of TCM, On Jan. 25, the top leasers of China held a special meeting to have reorganized the medical expert team and replace team leader, and add some experts in TCM to the list.

It is just the special meeting of the top leasers of China made chance for the principal Zhang Boli being able to go to Wuhan city as the team member of medical experts.

I guessed that Professor Hu was one of the people who strongly oppose the use of TCM.

3.8.. The use of TCM in the treatment of COVID-19 patients in Shanghai, China

This section is from YouTube videos of the speeches of Zhang Wenhong, professor, doctoral tutor, the director of Infection Department, Huashan Hospital Affiliated to Shanghai Fudan University, and the leader of Shanghai Medical Treatment Expert Group of New Crown Epidemic.

3.8.1.. Chinese medicine has no strong side effect were observed in treated patients

YouTube video, Apr 5, 2020, 张文宏:中药疗效难评估

https://www.youtube.com/watch?v=G6nAyLRerFM&fbclid=IwAR3hkdFLuZkl4fc2yGxHFo4QFp3Y_2ImzmhJzTQVqnkP4DpXHKgAlZ99Lfg

At 18:00 on April 4, 2020, Beijing time (at 12:00 on April 4, Paris time), the Chinese Embassy in France invited Professor Zhang Wenhong made online communication with overseas Chinese and Chinese students in France, answering "Which one in Chinese medicine or Western medicine has the greatest anti-epidemic effect."

Actually, in China, as myself, we also used a lot of traditional Chinese medicine together with western medicine. You know that, China has used traditional medicine herbs practice for thousandths of yeas, long before the western medicine entered China. Therefore, Chinese doctors are very experienced use it to treat patients.

However, in this pandemic in Shanghai, not separately use traditional Chinese medicine and western medicine, usually, we use integrated strategy of combining western medicine and Chinese medicine in treating patients.

So far, I can tell you that Chinese medicine has no strong side effect were observed in our treated patients here.

The efficacy of traditional Chinese medicine, currently, I think, very difficult for us to evaluate, because we do not take mono-therapy of the drug to treat patients. In future, we need a lot of work to do in evaluating the efficacy of Chinese medicine and the combined use of Chinese medicine with western medicine.

3.8.2.. There is about 93% of local patients used Chinese medicine in cure rate of 97.5%

YouTube video, Apr. 18, 2020, Quotes of Pro. Zhang Wenhong: TCM works well on fighting COVID19 张文宏：中医“威力”显现上海本土病例近93%用了中药

https://www.youtube.com/watch?v=nvbdWipc-uI

Among the local cases of COVID-19 in Shanghai, nearly 93% of the patients used treatment of traditional Chinese medicine, the cure rate was about 97.5%, the cure rate was also very high. This is a good result of the combination of Chinese medicine and Western medicine.

Then, people ask that what is the effect of traditional Chinese medicine? Since 93% of the cases are used in combination with Chinese medicine and Western medicine, it is difficult to say the single treatment effect of Chinese medicine.

We should have a tolerant attitude and allow both Chinese medicine and Western medicine to develop equally and develop independently. If necessary, we should make up for each other's shortcomings and achieve the maximum effect of treatment for patients.

3.8.3.. The doctors put equal emphasis on Chinese medicine and Western medicine

YouTube video, Apr 18, 2020, Quotes of Pro. Zhang Wenhong: TCM and western medicine COVID19 张文宏：中西医就像不同“武功” 救治中合作融洽

https://www.youtube.com/watch?v=5YbCxygcprY

In the process of treatment in (COVID-19), the strength of traditional Chinese medicine is slowly revealed, just like martial arts, some may be faster. Some may be slower, but is more durable. Every morning we view rounds patients in Wards, after the doctors in Western medicine are done, the doctors in Chinese medicine continue. Our working mechanism is to put equal emphasis on Chinese medicine and Western medicine. The cooperation between two professional doctors is very harmonious.

3.9.. The simple inference for the therapeutic effect of hydroxychloroquine

In May 25, 20202, a report said thet WHO has paused the trial of hydroxychloroquine that listed as one of four hopeful medications in the globalized study of SOLIDARITY trial. But in China, as mentioned above, the clinical cases show that the effect of hydroxychloroquine is satisfactory with less side effect in the treatment of COVID-19 patients with saved more lives by avoiding them into ICU of the place where is not only finish patients in 50%, but also is in crowning patients with bad complications.

As immunosuppressive agent, if the Hydroxychloroquine is used in single or combined with other antiviral drugs, its effect may be offset by the harm on immune function, but once it is used by combining with physical enhancing or immune enhancing medications, its effect may be able to well played while reduces the risk of cytokine storm that is the one of main reasons that caused sudden death when patients are in hopeful condition.

In China, it is in the collaborative team, the HCQ played its unique role to contribute own contribution in the effort of saving human lives.

I think HCQ played the role of anti-inflammatory and anti-swelling as originally designed for treating arthritis.