Of Quinine And Chloroquine

Guest Post by Willis Eschenbach

After all the people saying we shouldn’t take chloroquine because of the side effects, let me take the opportunity to say some words about that curious drug.

I moved to the Solomon Islands, north of Australia near the Equator, in 1984. I ended up living and working there for nine years. The Solomons host all four kinds of malaria—Plasmodium falciparum, P. ovale, P. malariae, and P. vivax. Unlike most parts of the world, at the time the four kinds of malaria in the Solomons were not chloroquine-resistant.

So I took chloroquine prophylactically once a week to prevent the disease. 500 mg (300 mg base), one pill every seven days.

After I’d been there maybe three years, I thought “I don’t want to take this forever. If I get malaria, I’ll cure it, that’s what medicine is for”. So after having taken well over 100 doses of chloroquine, I gave it up.

Of course, after stopping chloroquine, I got malaria. It is a most curious and devious houseguest. Malaria has a bunch of forms, all with different shapes and different abilities, and it changes form like we change shirts. When it hits your bloodstream, it streaks for your liver as fast as it can. Along the way, it is shedding parts of its skin layer. These skin bits occupy and distract a large number of antibodies, which recognize enemies by their skin surfaces. This allows more of the malaria parasites to make it to the liver. When it gets to the liver, it changes form.

After living for a bit in the liver in that new form, it changes form again and goes back out into your bloodstream and gets inside the red blood cells. Where, of course, it changes into another form.

Unlike the other forms, this latest form can reproduce. It starts to produce thousands and thousands of descendants, which eventually rupture the red blood cells and re-emerge into your bloodstream.

Until that point, you don’t even know the tiny criminals have invaded your corporeal mansion. But when they rupture the red blood cells, your body gets the full-blown malarial crisis, shaking and sweating, chills and fever at once. I’d always thought stories about people’s teeth chattering in sickness from the chills were exaggerations.

I was very wrong.

Now, at the time we were living on a 280 acre (110 ha) coral atoll island called Liapari Island, way out in the outback. Here’s the island, on the right …

The Solomon Islands are in the middle of nowhere, north of Australia below the equator. Western Province in the Solomon Islands, with the Western Province capital at Gizo Island, is even more nowhere. And Liapari Island, 17 miles (27 km) by water from Gizo, is the very heart of nowhere.

Fortunately, my gorgeous ex-fiancee is a family nurse practitioner. The doctors there advised quinine. So she took the company outboard skiff, drove it seventeen miles to Gizo, and brought back the quinine. I took the prescribed dose. Horribly bitter pills.

Well, I’m here to say that the damn quinine cure is far worse than the disease. It adds bad pain and weakness on top of chills and fever. I recall that at one point it took me about thirty seconds of hard work just to sit up in the bed. When I laid down, I thought “I can’t be that weak! I just can’t be! It can’t take that long just to sit up!”

So I tried it again.

45 seconds that second time. Crazy weakness and pain. I’d never felt anything like the combination of malaria and quinine, and I definitely don’t recommend it no matter how bored you are.

After that, I never took quinine again. I would take its chemical cousin, chloroquine, instead. But this time I was taking it curatively, not preventatively. It was not fun in the high doses, but it beat the malaria back, and it was much more tolerable than quinine.

Finally, after suffering a couple more bouts of malaria over the next couple years, my mad mate Mike told me that when you feel malaria coming on, and you can definitely can feel it coming on, to take three weekly doses at once (1500 mg, or 900 mg of base), then the same thing 24 hours later, then the same thing on the third day. He swore it fended off the malaria.

So I started using his plan, and I never got full-blown malaria again. Just take nine weeks worth of chloroquine in three days, it aborts the onset of the chills and fever, no problem.

In addition, at the time, I knew dozens and dozens of expatriates in the Solomons and maybe half or more of them used chloroquine for either prophylaxis or cure of malaria.

In summary: yes, as with any medicine, some people suffer side effects from chloroquine. But it is widely tolerated. In addition, it’s cheap because it’s been used since the 1930s, so it’s been off-patent for decades, and the side effects are well known

Do we know scientifically if it works for COVID-19? Nope. But I’ll guarantee you that if I get the ‘rona, I will take chloroquine and azithromycin and zinc. Nothing to lose, everything to gain, and Fauci is both mad and destructive to argue against it.

And to close out the story of the madcap transformations of the malaria parasite, we left it swimming in our bloodstream after rupturing the red blood cells. From there, a mosquito removes it from your body with its magic hypodermic needle, and it moves into the mosquito’s stomach where … yes, you guessed it, it transforms itself once again into a new kind of malarious being. And when the mosquito bites another person, it injects that form into your bloodstream, whereupon it starts racing for their liver to start the cycle again.

There is one final oddity of this most odd of life forms. Sometimes, P. falciparum vivax malaria can … yep, you got it … change into yet another form. It does this in the liver, and after changing forms it promptly falls asleep for maybe a year. Or two. Or more. This form goes by the absolutely wonderful name of a “hypnozoite”, after Hypnos, the Greek god of sleep. Hypnozoites are the source of the world-famous recurrence of malaria years, occasionally decades, after leaving the malarial zones.

When one of the hypnozoites wakes up after a two-year nap, I assume it stretches, yawns, looks at the other still-sleeping hypnozoites, and of course, it being malaria and all, just for fun it changes form. No longer a hypnozoite, it jumps into the bloodstream, reproduces inside the red blood cells until they burst … and that is how after I’d left the Solomons and had been living in Fiji for a couple of years, I suddenly felt that awful familiar feeling.

And being an honest man I must confess, at that moment I said very bad words. Not only that, but I engaged in needless and ultimately pointless vituperation, casting unpleasant but extremely satisfying aspersions as to the ancestry of the whole tribe of mosquitoes and malaria in all their evil blood-sucking cell-destroying forms.

I had been convinced at the time that I was done with malaria, but nooo … my main medical squeeze had to go hunt for chloroquine, there’s no malaria in Fiji. And once I got cured of the immediate malarial relapse, I took another drug that in theory kills the remaining hypnozoites, and me and malaria, we parted ways for good. At least I sure hope so.

And that’s my story of chloroquine and the reason why I say that anyone who gets the virus should at least try it. 

My best to all, stay well, wash hands, don’t invite any strange bats to dinner, don’t touch your face, or your bat’s face for that matter, wear a mask, avoid crowds, you know the plan …

w.

PS- Regarding schools as centers of infection, the Solomons uses the British system of boarding schools. Grade school kids go from their villages to the local boarding school, which is often on another island, where they spend the entire semester.

And we always had to gird our loins and break out the mosquito repellent when the kids all returned at semester break, because invariably they brought a surfeit of malaria back with them …