[The VFM Addict]

Ed P wrote:

Did you manage to buy your chloroquine? Out of interest I looked on line and Lloyds Pharmacy stated it was prescription only!

No Lloyds are wrong.   Plain Chloroquine Phosphate is most definitely not a ‘POM’.    Although some combination products are POM, IIRC.    I ordered some Avloclor (the most common brand of plain CP) through my local pharmacy and will be picking it up this afternoon.    The pharmacist who I have known for over 20 years would have told me if it needed a ‘script.    I haven’t checked but I suspect it may be a ‘P’ medicine meaning it can’t be sold except when approved by a qualified pharmacist for the patient.  So perhaps Lloyd’s are playing totally to the book online where plainly they have not seen the patient.   However, there are dozens of pharmacies out there online in the UK that will ship ‘P’ classed medicines without a second’s hesitation or once an automated questionnaire is completed.

As far as I know no anti-malarial whatsoever is on the NHS drug tariff for prophylactic use.   So GP’s can only ever write a Private Script for such preventative treatments.

Just checked Avloclor is indeed a ‘P’ see here.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[Ed P]

When I attempted to order Avloclor I received a stiff lecture on using drugs for purposes for which they are not licensed, I’m still not too certain whether the ordered tablets will ever arrive.

If others decide to go down the same route and do not have a good working relationship with their pharmacist then a little lying may be required such as a forthcoming trip to Peru (choose your country carefully as Avlocor is only licensed for a few central/south American countries.)

Lying aside, my small experience does raise potential issues. Chloroquine is no longer easy to obtain and has restrictive licensing. It is NOT currently licensed for Covid-19 so your GP will not be able to prescribe it, and your pharmacist may not release it unless you are able to do some fast talking while coughing up your lungs.

I’m going to email my MP and point out the problem and I suggest that other old pharts do the same.

[Ed P]

In case others want to do it, I emailed my MP (giving my name and address – they will ignore you without it). My letter roughly said the following:

Dear XXX,

I’m sure that you are aware of the latest information from the Chinese Centre for Disease Control in which they released the devastating impact that covid-19 will have on your elderly voters see https://www.bbc.co.uk/news/world-asia-china-51540981, however you probably are not aware of the fact that the Chinese recommend the use of chloroquine phosphate an inexpensive antimalarial to ameliorate the disease see  http://www.xinhuanet.com/english/2020-02/17/c_138792403.htm. Unfortunately although this is licensed for holidays in Peru it is a Pharmacist prescription drug and licensed only for that purpose. I recommend that urgent steps are taken to make this an OTC drug to allow self help as well as making it possible for Pharmacists and GPs to prescribe it. Yours etc.

My recommendation is always to give an MP ‘face’ even if like my MP they as as thick as Pig Carp,

 

[The VFM Addict]

I am quite lucky as my pharmacist knows my background and training hence knows that I only ever make personal medical calls based on best available science and never rashly.

Yep, my envisaged use on this occasion is not licensed use.   So one truly does have to check that neither one’s pre-existing conditions or concurrent meds would make its use dangerously unsuitable if one was visiting a malaria hotspot.   Of course if it would be deemed safe for one if visiting a malaria hotspot then it is as safe for one period as is reasonable and is highly unlikely to do one any harm provided one sticks to the standard malaria dosage.   In other words it is to all intents a relatively risk free strategy.   For me the use trigger would be symptoms highly suggestive of Covid-19 in circumstances where the NHS was already too overburdened to provide care reasonably promptly.

If your pharmacist would dispense, as he or she is able to do without script, if you were going to a malaria hotspot, then that pharmacist is deeming that the compound would do you no harm at the malaria dosage.

Any Forumite going down this route might, as you suggest, find it useful to pose the request to the pharmacist as a request for Avloclor to provide protection from malaria during an overseas trip.    But would do so at their own risk.   I am not advocating this strategy for them rather I am just informing them of my own last resort self-care strategy to cope with the unusually dangerous circumstances that may very well arise.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[Ed P]

The beginnings of a global pandemic can be seen in Japan:

“(Japanese) Authorities have said the virus is now being transmitted locally and have asked citizens to avoid crowds and non-essential gatherings.”

Bang goes chances of watching the Carling Cup from the stands!

[Ed P]

If the worst comes to the worst and other treatments are not available, then a very large bag of liquorice all-sorts might help. (Black Spanish liquorice would be even better)!

No joke – ACS Link

[The VFM Addict]

Death rates in China appear to be 2.3% at best estimate.    Over 80% of deaths occur in those of 60 years of age or over.     It follows quite logically that both the Covid-19 care burden and the death rates are likely to be substantially greater, as the pandemic develops, in countries with older populations.

Cutting to the chase – The 12 most vulnerable countries in the world appear to be the in rising order the USA, Australia and 10 European countries.   We, the UK, are the sixth oldest population in the world.   Greece sits at number 1 and Germany at number 2.    If we take China as the baseline death rate at 2.3%, the UK rate could, using this crude but nonetheless plausible modelling, be China times approx 2.5, in other words 5.7%.   Greece could be over 9%.    I hope to god that such is not the case.

There are of course far more than a few caveats regarding this very basic and crude model.    Most are tendered in the full thread and they are all food for thought    See here includes graphic.   But the bottom line is surely that the threat we are facing is very substantial indeed and many orders of magnitude greater than the very worst (normal) flu year which only has at worst a death rate of 0.1%.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[The VFM Addict]

I truly am not generally into conspiracy theories but looking at the graph linked to in the above post it is impossible not to notice who would be most vulnerable to a Severe Flu-Like viral attack weapon given that in all flu epidemics it is typically the old that fall.   Sitting right behind the top 12 at 13 is Russia which also would be very vulnerable to such a weapon.

If we can see and spot this it is very far from implausible that China might previously have spotted it and researched the development of such a weapon which then inadvertently escaped captivity.   I am, I must admit, increasingly receptive to this, albeit unlikely but nonetheless genuine possibility.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[Ed P]

All things are possible. However I favour a non bio-weapon theory.

Most importantly, a bio-weapon that attacks the non-productive parts of an enemy’s economy and culls the burdensome  part  is a pretty poor weapon and one more likely to have come out of Porton Down than China!  Second, the latest gene tracking indicates a  bat->pangolin->human ancestry, As a result, I think it more likely that this originated in the evil areas of the Wuhan Wet Market . It is possible that  a newly captured pangolin was suffering from a bat crap virus (fruit bats dropping fruit and  defecating onto the ants nest where the pangolin was snuffling). This then infected the human butcher of the animal.

The actions of the Chinese seem to bear this out – my guess is that the Wet Market area was quickly identified due to the early victims all working in the market. The mayor atypically fell on his sword in this respect and eventually took the blame for not acting early enough and closing down the market.. If he could have blamed a minion/ or the People’s Army research you can bet that it would not have been him that made a public confession.

I therefore favour human cock-up versus conspiracy.

[The VFM Addict]

I never can fathom the virus ancestry argument.   To me it is without logic.   One can take existing viruses and splice their DNA or RNA sequences, in the main, as one desires.  Taking sequences from other already in existence sequences to construct a new entity makes sense.    The splicing techniques are those used in gene therapy.  Take a virus and splice in what you want delivered by that virus which is usually a gene sequence from a healthy person to correct a deficiency in a patient.

As for the usefulness of such a bio weapon, as might remotely be the case here; to me it seems to offer numerous advantages.   Yes, it attacks predominantly the non-productive sector of a populous but it burdens the productive sector massively in providing care for the rest.   Moreover, using a construction Lego-style that assembles sequences that might have occurred by chance means it has utterly perfectly credible deniability.    You can’t never use conventional weapons deniably.

All that said I do still lean predominantly in the same direction as you and tend not to think this was manufactured as weapon or even as a stepping stone to a weapon; although it could have been constructed wholly innocently for research purposes.    This information about the profiling of nations merely means that my lean in the same direction as yours is a little less marked than it was before.

BTW way hope your Avloclor arrives.   Picked my Avloclor up yesterday afternoon – 20 tabs – and it goes into my last resort bundle.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[The VFM Addict]

This study of a young symptomatic Thai lady published in the Lancet is very interesting.   Her blood profile during hospitalisation is in the main unremarkable and her chest x-rays equally so.   The later is not unusual because symptoms often significantly lead radiological findings.  Equally her C-Reactive Protein (CRP) was not elevated such as to even suggest infection.

Her treatment was pretty much that used to treat a suspected lower respiratory tract bacterial pneumonia – i.e.  a cephalosporin antibiotic, paracetamol and saline drip.   No reason to suspect the cephalosporin antibiotic would have aided her body’s fight against this virus.    It is clear that after an initial minor struggle her own immune system relatively rapidly won the fight.    No idea what her blood Oxygen saturation was or if it her arterial blood gases were assayed.   But given there is no mention of her needing oxygen or the concentration used I assume her SATS were far from cause for concern.

A patient such as this is (and in this case was not) at serious risk but nonetheless took up a bed, microbiology and histology lab resources and medical time (albeit that the latter would not have been huge), for 9 days.   In other words even those with moderate symptoms levy a significant burden on a state’s care resources if they occur in numbers.    Little more than a couple of thousand or so of such moderate cases in the UK would alone begin to dent NHS capacity significantly.    Scary.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[The VFM Addict]

Travellers from the far east all quite naturally provoke consideration by the authorities of their potential for bringing Covid-19 un-trackably to us.

But are the authorities truly considering incoming from North America where there have been 37 positives; Australia where there have been 15 and EU states where the total is already 35 confirmed positives across 7 western EU states plus Finland.    As the number of states with confirmed cases grows one has to consider almost every plane or ship passenger and every Eurostar passenger as a possible entry vector.    The number of EU lorry drivers alone entering each day would be impossible to vet and such a driver could alone spread the virus across the UK.

The public believing that we can keep free of any significant and un-trackable outbreak to me is an utterly preposterous state of affairs.   I find it amazing how many I meet who are clinging to this forlorn hope and such individuals seem to currently be in the overwhelming majority at present.

Panic when it occurs is usually the result of people facing a situation for which they have not prepared.   Having prepared and having a plan ready to action when the situation arises is probably the greatest inoculation there is against panic.    As the military and Emergency services say –  One’s training just kicks in.   Just a thought, folks.    Don’t be caught with your pants down.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[The VFM Addict]

THIS HAPPENS SO FAR TODAY – 20 new cases in South Korea (51 total) – 10 new cases in Japan (84 total) – 79 new cases on Diamond Princess (621 total) – 3 new cases in Singapore (84 total) – First 2 presumptive cases in Iran (2 total) – 1 new case in Hong Kong (63 total)

and worst of all numerous reports of a Honduran woman today exhibiting full blown Covid-19 symptoms on landing home by plane.   During January she visited China and Taiwan transiting via LA airport on her return flights.   If tests are positive for the virus there is a high probability that she infected many at LA airport.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[Ed P]

An early article I read stated that the researcher thought covid-19 had all the hallmarks of a natural recombinant virus. i.e bat to another host to human.  It looks like this is a fairly common way that the normal flu virus mutates in such an irritating fashion. This link is for research done on a recombinant bird flu. i.e gene splicing in nature.

[Ed P]

I wanted to add that like you there are areas I just do not understand, but in particular I do not understand the Government’s efforts to talk down the issue. Almost every day a captive shill will say SARS-Covid-19 isn’t that bad and only a mild disease, while totally ignoring the implications of an R0 of 2.3 (only 1.3 million deaths compared with the 800000 that featured in the BBC Pandemic simulation). Maybe the evil Dominic Cummings favours the US Far Right view that a cull of the non-productive is overdue.

There is much that could be done without frightening everyone – just installing alcohol gel stations at the entrance to each food supermarket would have a major benefit in buying time to get the NHS ready.

[The VFM Addict]

I expect the NHS per se is as ready as it could be given its limited manpower and real estate.    The only further thing may be to stockpile drugs and other supplies and that will be down to the availability of supplies.

The big problem may well be in areas other than dealing with this virus.  The vast majority of the world’s medical supplies including pharmaceuticals are now produced in China or India with the latter being reliant on base compounds with which to produce pharmaceuticals normally being sourced from China.    The lost production time in China already means we are currently relying on our own stockpiles or on arrivals that were in transit before China shut down.   So if you are critically reliant on medications then irrespective of whether you ever catch this virus you are already more likely than not to some degree be in imminent jeopardy.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[The VFM Addict]

The two patients positively tested today in Iran have died of the condition.   Most unusual to die so quickly of Covid-19 and very fortunate for Iran because if one dies and is incinerated almost immediately then the risk of infecting others approaches zero.    Can’t help but wonder if this virus is more deadly and clever than we ever thought and has now learned how to use an AK-47.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[The VFM Addict]

The virus is starting to get a significantly increasing foothold in South Korea and Japan; both in circumstances where it is probable that the identified infected also infected significant numbers themselves.    Both countries are reaching levels where full potential onward tracking will soon be impossible.    Can’t help but wonder what the situation is in NK?    Guess we all know that Fat Boy Kim will take extraordinary measures with probably a far higher fatality rate than the virus itself if it ever begins to spread there !!!

Taiwan also looks on the brink of losing control.  1 new case in Taiwan, bringing the total to 24 but the source of infection for this latest case has not been traced.   It would appear this case may have been community acquired.   However, it would seem probable that she herself spread the virus extensively.  She is a 60-year-old woman with no travel history abroad in the last two years.   She had a fever and cough on Jan. 22, went to the clinic four times and was diagnosed with common cold and other diseases.    Her symptoms worsened with shortness of breath and she was diagnosed with pneumonia on Jan. 29, hospitalized on Jan. 30, transferred to the intensive care unit on Feb. 10.  As she is only just a new case we must assume she would have been previously tested but false negatives occurring until now.

Singapore is competing with Japan also with 84 cases fior third place after South Korea (104) and China.

Net conclusion is surely that anyone who goes anywhere near any Far East country at present needs not only their blood tested on their return but also their brains.

PS.  After the two very recent positives in Iran who both quickly died, there are today three more positives there; two in Qom and one in Arak.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

[Ed P]

The quick deaths in Iran are not that unusual. Looking at the pathology in the Lancet which was linked earlier, SARS-covid-19 starts with 6 days of a dry cough and chills (the cough continues to the end) This is followed by 3 days of fever and chills, then 5 more days of coughing before death.

If your number is on the ticket, half of your 14 days of remaining life are taken up by something that could look like a bad dose of flu, so I can quite imagine someone only being recognised as a covid-19 victim at a very late stage.

[edit] One late thought, all old pharts can get the pneumonia vaccination. If you somehow have missed out on this, then now is the time to get it!

[The VFM Addict]

I agree 100% re the pneumonia jab.   It reduces the chance of getting a bacterial pneumonia by just over 40% which is worth doing; and the chances of developing a secondary bacterial pneumonia during a viral Covid-19 pneumonia are quite high.    Don’t forget to get one’s flu jab as well because a normal flu can probably co-exist with Covid-19 making matters worse.

Free access to both jabs on the NHS is not merely limited to OAPs; numerous medical conditions entitle one to those jabs irrespective of age.   Even if you are normally healthy with no illnesses you are also entitled to such free if you are someone’s Carer.    Lastly, even if you fit none of those categories you can still get both jabs at a pharmacy OTC; for a combined free of about £100 IIRC.

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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.

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