Chloroquine shows promise against COVID-19. Quinine? Not so much

The recent buzz surrounding chloroquine and hydroxychloroquine as potential treatments for COVID-19 has caused some to mistakenly assume that quinine shares the same therapeutic benefits. Consequently, there's been a suggestion that people could use stock quinine to combat the virus. This assumption is incorrect; despite their related historical origins and similar-sounding names, these are entirely different compounds, and there's no concrete evidence suggesting quinine has any effect on COVID-19. Chloroquine and hydroxychloroquine, on the other hand, show considerable promise. These drugs, traditionally used as antimalarials and for certain autoimmune conditions, appear to hold potential in treating COVID-19. Our coverage began as early as February, highlighting initial case reports and noting that chloroquine seems to alter the cell surface chemistry rather than directly targeting SARS-CoV-2. Since those early reports, further evidence has emerged, including additional in vitro studies, more case reports, and a non-randomized Chinese clinical trial with compelling findings. In this trial, all patients treated with chloroquine and azithromycin tested PCR-negative within seven days, compared to the majority of the non-randomized control group who remained positive. However, the study's results were based on an as-treated population, which could introduce bias, and persistent rumors suggest that randomized trials expected in April might confirm these drugs' efficacy in reducing mortality and shortening the duration of severe cases. While the non-randomized trial results aren't definitive, and randomized data will require time, it's becoming increasingly plausible that these antimalarial treatments might offer some benefit against COVID-19. Consequently, medical authorities in countries like South Korea and Japan have authorized limited use of chloroquine and hydroxychloroquine in severe cases, typically through 500mg chloroquine or 400mg hydroxychloroquine tablets taken orally once daily. Reports indicate that China is moving to establish this therapy as standard care. In contrast, U.S. medical authorities have adopted a more cautious stance, advising physicians to await trial outcomes before prescribing chloroquine analogues for COVID-19. Despite this, some U.S. doctors have reportedly used chloroquine analogues in life-threatening cases of the virus, according to the CDC. It's crucial to exercise caution. Some individuals eager for a solution have disregarded medical advice, leading to tragic consequences. Hospitalizations due to chloroquine overdoses have occurred in Nigeria, and a couple in an unspecified U.S. state died after ingesting chloroquine phosphate meant for fish tanks. The cause of their deaths remains unclear—whether it was an adverse reaction, overdose, contamination, or unrelated to COVID-19. Regardless, such actions should not be replicated. The president's enthusiasm for these drugs, particularly on social media, may have contributed to their scarcity in certain markets. Thankfully, this shortage won't persist long. Unless we see tens to hundreds of millions of cases, global supplies will likely suffice. Millions of people worldwide already take chloroquine for malaria, and major pharmaceutical companies like Bayer and Sanofi have committed five million tablets. Teva and Mylan have also announced plans to boost production. These medications, if proven effective, will primarily serve those already infected with COVID-19 and critically ill. They might lower the fatality rate and alleviate pressure on healthcare resources like ventilators and ICU beds. However, they are unlikely to prevent most infections, as the majority occur before symptoms manifest or during non-critical stages. Moreover, these drugs probably won't be needed for the majority of mild cases, except perhaps in surplus situations. Even under optimistic assumptions, where they prove highly effective and become globally available, they will assist but not single-handedly end the pandemic. The Prepared encourages readers to stay informed about updates on chloroquine and related drugs. As for quinine, it’s best reserved for mixing with gin, lemon, and ice—it’s the perfect tonic for your spirits, but not your immune system.

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