This is my Hydroxychloroquine rant. I am wigged out by the scientifically lacking propmotion of Trump and his minions and near equally upset at the negativism of those who wouldlikely take it if they got #COVID19 -No one want to be the smartest person in the cemetery #covid4MDs

HCQ is an intriuging drug but prophylaxis against viral acquisition is its least attractive properties- pre-emtive use in chikungunya and other models have not been encouraging ( differences between alpha viruses and COVID noted)

Its endosomal properties could afford it antiviral properties but I doubt this is its main potential MOA in #COVID19- Previous studies ie HIV reveal no antiviral properties but + effects on reducing immune activation @mmlederman1 This I hope/suspect is where HCQ may help

It also has been used for ever in rheumatic disease with an incredible margin of safety save for high dose long term tox and thus short term Rx is likely VERY safe - most TOX is combining it with other drugs ie AZITHRO which has QT effects- thus study it MONO Rx

Another problem with negative studioes is its lack of effect in severe disease- this is not unexpected for it is not an ACTIVE IMMUNOSUPPRESSIVE- not in theleague of anti-IL6/TNF/IL-1 etc - failure in these ptients is expected in my model

The ideal patient population is high risk ( older/co-morbid/ no active cardiac disease) - not hypoxic etc- these people do not need AZITHRO as they uniformly have nl troponins. Waiting too long is death literally to the pt and the drug

Giving HCQ to such a population before becoming serious ( defined anyway you want O2sat/chest imaging, cytokine biomarker) but with clinical risks will allow powering of study for non progression and wont take a large number of pts- most will be out pts- it will also minimize tox

In summary
Not to early ( could compromise early adaptive immune response and lessen viral control ( thepretic)
Not too late where there is emerging Cytokine Relapse Syndrome and other therapies are attractive
For now haven't seen the study I hope to @MaxKonigMD @EBRheum

Want to share with many for their reactions @PhilipGardiner @psufka @DrBhana @JYazdanyMD @CCalabreseDO @cappelliMD @ELittlejohnDO @AdamJBrownMD @RheumNow @PaulSaxMD @medicalaxioms