What price Johnson+ Johnson has found a successful vaccine Fire and Ice?

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https://www.leadersleague.com/en/news/johnson-johnson-scores-456m-coronavirus-contract

Thanks for posting something optimistic Lapsy

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Fire and ice has got 3 tonne of it in a skip in his back garden,tenner a tonne.

He does coincidentally own shares, but it's probably just that he gambled on something he was told by some quacksalver and wanted to look genius if it had been proven true.

Article from the British Medical Journal.

Rapid Response:
Re: Chloroquine and hydroxychloroquine in covid-19
Dear Editor,

The fundamental correctness in this piece cannot be disputed. Trumpian calls for wider use of chloroquine cannot be heeded until efficacy and safety are appropriately assured. That of course is what clinical trials are for.

Nevertheless, I suggest that at such a particular moment in our time, even a professional submission such as this is, should at least acknowledge the necessary influence of urgency. The speed of a convoy is the speed of the slowest ship. PHE, together with the author here, are on the bridge of that ship.

That studies to date have all employed drug doses that err on the side of plenty (although the South Koreans moderated the doses somewhat) is not surprising when the goal is to realise a clear clinical effect. But that of course raises the likelihood of poorly tolerated side effects. This, together with the author's overly pessimistic worries that chloroquine may accelerate illness progression (as per previous trials against other viruses), leads to skewed viewpoint on the emerging facts.

The author is really saying "Whoa!... not so fast! This thing has nasty side effects and might make the disease worse. Let's stick with our tightly controlled trials and see what they throw up in 12 months."

An alternate, more helpful approach might be to acknowledge what we already know about chloroquine and this SARS-CoV-2.

We know that the in-vitro studies suggested efficacy could be achieved with 500mg chloroquine phosphate per day. Yet the authors acknowledged that didn't take account of the particularly heavy sequestration of the drug in lung, liver and spleen. With such a lengthy half-life there is good reason to believe that a lower daily dose is more likely to be optimal for effect, tolerance and safety. Those trials indicated a role for the drug as prophylactic agent and early treatment.

So, whilst acknowledging that in vivo studies to date have been suboptimal in terms of construct and data reporting, there is still enough coming back to us to build reasonable confidence that there’s no evidence of disease exacerbation under studied conditions. This is important.

Certainly, trials should continue. I suggest that the evidence to date (such as it is) is largely positive for the use of chloroquine against SARS-CoV-2.

What’s needed is a large cohort study using chloroquine in dosage which brings good potential for clinical effect but with minimal risk. Surely the most elegant plan for optimal repurposing of this inexpensive drug is to employ doses already known to be universally safe.

That elegant plan indicates a prophylactic dose of 500mg Chloroquine phosphate taken once weekly (same as existing antimalarial chemoprophylaxis). For early treatment, chloroquine phosphate 500mg is taken on day 1, 3, 5 and then only on day 7 and 9 if clinical symptoms endure. The maximum total chloroquine load is 2.5g, taken over 9 days. This equates to the total dose used to safely treat non falciparum malaria over 48 hours (25mg/kg of chloroquine base equals 40mg/kg chloroquine phosphate).

These are overwhelmingly safe doses and yet still respect the values suggested from in-vitro trials.

In 2006, Dr Christopher J M Whitty (then consultant physician, now a Professor and Chief Medical Officer (Eng) and Chief Medical Adviser to UK Gov) had his paper published in the BMJ: "Malaria: an update on treatment of adults in non-endemic countries."
Therein Dr Whitty describes the 'non-falciparum' malaria treatment dose of chloroquine phosphate (40mg/kg over just 48hours):

"This works rapidly and reliably where there is no resistance, is safe in usual doses, and is well tolerated. It is considered safe in pregnancy.
Side effects—It can cause gastritis and mild abdominal pain. It can cause itching in some people of African ethnicity (mechanism unknown)."

Just so we agree, "safe in pregnancy" means very safe.

With such in mind, this week I surveyed 43 clinical colleagues using WhatsApp groups. These were GPs and secondary care clinicians. I asked whether they’d be willing to volunteer for an NHS-wide cohort study, using chloroquine as a medical countermeasure against COVID 19 (prophylaxis and treatment in the doses already advised). I received 37 replies. All 37 stated yes. The most frequent reason given was "potential benefit outweighs minimal risk."

That 86% of doctors would wish to take chloroquine as a medical countermeasure should not come as a surprise. Unlike the author, those doctors do acknowledge the presence of urgency:

We are faced with a fast-moving pandemic with an unacceptably high mortality and morbidity. Unfortunately, front line clinicians will be hugely over-represented in those statistics. They also understand the nature of clinical trials and the concept of risk versus benefit.

So, with written permission from Nominet-UK, I have launched a petition/campaign from my not-for-profit website (for patient information purposes): http://thevirus.uk
There is also a link there to the campaign at change.org http://chng.it/h64H785wCB

This petition is aimed at PHE and Gov Dept Health & SC. I request the creation of a large NHS cohort study with chloroquine being offered as medical countermeasure for all front-facing NHS staff. The control cohort selects itself (staff who decline or who have contraindications, not including those with CV contraindication).

This study should be created with speed. There is minimal due diligence required to repurpose a drug for trial use with doses already proven to be safe ... especially when the trial participants are cognizant of the nature of such a study and stand to benefit directly from any positive therapeutic impact.

In the long grass, several months down the line, we may learn that chloroquine wasn't the optimal anti-viral drug for COVID 19. Perhaps one of the more targeted agents will ultimately take that crown. But if chloroquine delivers on its early promise and prevents mortal disease progression in our brave front-line colleagues, then who gets the crown doesn't matter.

So people, don't panic. But acknowledging the urgency in this predicament is important. PHE need to seize the nettle and offer something that might just save our families and friends at the front-line.

Dr Philip L Davies
MRCGP

the man is a coward he wouldnt take any drug that he thought had any chance that it could harm him in anyway

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