In looking for something else in Journal-Lancet, the long defunct journal of the South Dakota State Medical Society, I came across this article in the 1919 volume, written by Dr. Morton Field of Northfield, Minnesota. The Spanish Flu epidemic was still raging and he decided to treat some of his patients with quinine. Lo and behold, it helped. In the paper, he also observed that those patients being treated with aspirin did poorly, which he blamed on the excessive acid load to his patients’ systems, which is one of the things that happens with high dose aspirin. He aimed to keep the patients’ urine pH neutral, even adding urea to get there. I don’t know if this became standard practice. I don’t recall reading about it in John Barry’s excellent 2005 book The Great Influenza. I don’t think President Harding called quinine a “game changer”. But even in medicine, everything old can be new again. And Dr. Field may be on to something with that pH thing. One thing quinine, hydroxychloroquine, and chloroquine do is accumulate in the endoplasmic reticulum, a transport system within the cell were virus replicate, and raise the pH, making it less comfortable for Mr. flu and Mr. corona. You can read further details on my March 20 post “How Plaquenil might work”. Of course, there are many other things the quinine derivatives do.
The aspirin thing is interesting to me in light of concerns, yet to be fully substantiated, that COVID-19 patients taking non-steroidal anti-inflammatory drugs, like ibuprofen (Motrin), do worse. Again, many chemical and immunologic effects from these drugs, but one thing they all do is suppress fever. Fever is an evolutionarily primitive but important and effective component of the host response to any infection. Cold blooded animals infected in the laboratory will take themselves to the warmest possible part of the cage in an attempt to raise their body temperature. Animals deprived of access to the warm areas die at much higher rates than those allowed to roam. So if, God forbid, you get sick with COVID, let your body burn as it tries to kill off that virus.
I took a screenshot of Dr. Field’s paper. Let’s see how it looks: