The Key to Defeating COVID-19 Already Exists. We Need to Start Using It

[Auburnfan91 1,407]

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The Key to Defeating COVID-19 Already Exists. We Need to Start Using It 

Opinion

HARVEY A. RISCH, MD, PHD , PROFESSOR OF EPIDEMIOLOGY, YALE SCHOOL OF PUBLIC HEALTH 
ON 7/23/20 AT 7:00 AM EDT

As professor of epidemiology at Yale School of Public Health, I have authored over 300 peer-reviewed publications and currently hold senior positions on the editorial boards of several leading journals. I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines. As a result, tens of thousands of patients with COVID-19 are dying unnecessarily. Fortunately, the situation can be reversed easily and quickly.

I am referring, of course, to the medication hydroxychloroquine. When this inexpensive oral medication is given very early in the course of illness, before the virus has had time to multiply beyond control, it has shown to be highly effective, especially when given in combination with the antibiotics azithromycin or doxycycline and the nutritional supplement zinc.

On May 27, I published an article in the American Journal of Epidemiology (AJE) entitled, "Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis." That article, published in the world's leading epidemiology journal, analyzed five studies, demonstrating clear-cut and significant benefits to treated patients, plus other very large studies that showed the medication safety.

Physicians who have been using these medications in the face of widespread skepticism have been truly heroic. They have done what the science shows is best for their patients, often at great personal risk. I myself know of two doctors who have saved the lives of hundreds of patients with these medications, but are now fighting state medical boards to save their licenses and reputations. The cases against them are completely without scientific merit.

Since publication of my May 27 article, seven more studies have demonstrated similar benefit. In a lengthy follow-up letter, also published by AJE, I discuss these seven studies and renew my call for the immediate early use of hydroxychloroquine in high-risk patients. These seven studies include: an additional 400 high-risk patients treated by Dr. Vladimir Zelenko, with zero deaths; four studies totaling almost 500 high-risk patients treated in nursing homes and clinics across the U.S., with no deaths; a controlled trial of more than 700 high-risk patients in Brazil, with significantly reduced risk of hospitalization and two deaths among 334 patients treated with hydroxychloroquine; and another study of 398 matched patients in France, also with significantly reduced hospitalization risk. Since my letter was published, even more doctors have reported to me their completely successful use.

My original article in the AJE is available free online, and I encourage readers—especially physicians, nurses, physician assistants and associates, and respiratory therapists—to search the title and read it. My follow-up letter is linked there to the original paper.

Beyond these studies of individual patients, we have seen what happens in large populations when these drugs are used. These have been "natural experiments." In the northern Brazil state of Pará, COVID-19 deaths were increasing exponentially. On April 6, the public hospital network purchased 75,000 doses of azithromycin and 90,000 doses of hydroxychloroquine. Over the next few weeks, authorities began distributing these medications to infected individuals. Even though new cases continued to occur, on May 22 the death rate started to plummet and is now about one-eighth what it was at the peak.

 

A reverse natural experiment happened in Switzerland. On May 27, the Swiss national government banned outpatient use of hydroxychloroquine for COVID-19. Around June 10, COVID-19 deaths increased four-fold and remained elevated. On June 11, the Swiss government revoked the ban, and on June 23 the death rate reverted to what it had been beforehand. People who die from COVID-19 live about three to five weeks from the start of symptoms, which makes the evidence of a causal relation in these experiments strong. Both episodes suggest that a combination of hydroxychloroquine and its companion medications reduces mortality and should be immediately adopted as the new standard of care in high-risk patients.

Why has hydroxychloroquine been disregarded?

First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed. We must judge this medication strictly on the science. When doctors graduate from medical school, they formally promise to make the health and life of the patient their first consideration, without biases of race, religion, nationality, social standing—or political affiliation. Lives must come first.

Second, the drug has not been used properly in many studies. Hydroxychloroquine has shown major success when used early in high-risk people but, as one would expect for an antiviral, much less success when used late in the disease course. Even so, it has demonstrated significant benefit in large hospital studies in Michigan and New York City when started within the first 24 to 48 hours after admission.

In fact, as inexpensive, oral and widely available medications, and a nutritional supplement, the combination of hydroxychloroquine, azithromycin or doxycycline, and zinc are well-suited for early treatment in the outpatient setting. The combination should be prescribed in high-risk patients immediately upon clinical suspicion of COVID-19 disease, without waiting for results of testing. Delays in waiting before starting the medications can reduce their efficacy.

Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects.

But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in theAmerican Journal of Medicine by established cardiologists around the world fully agrees with this.

In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence. But for now, reality demands a clear, scientific eye on the evidence and where it points. For the sake of high-risk patients, for the sake of our parents and grandparents, for the sake of the unemployed, for our economy and for our polity, especially those disproportionally affected, we must start treating immediately.

https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535

[savorytiger 182]

Very interesting. This opinion piece got me googling around and I ran into a counter argument: https://www.statnews.com/2020/07/08/a-flawed-covid-19-study-gets-the-white-houses-attention-and-the-fda-may-pay-the-price/

Basically, most of the evidence towards usage of the drug come from non-randomized trials with mixed usage of medication. For example, the first study that's referenced in this piece is I think this one: https://www.immunology.ox.ac.uk/covid-19/literature-digest-old/hydroxychloroquine-and-azithromycin-as-a-treatment-of-covid-19-results-of-an-open-label-non-randomized-clinical-trial. While it does support the OP's hypothesis, the first research highlight is: Hydroxychloroquine seems to promote viral clearance (arguable as data acquisition lacks scientific rigor).

I looked for a study from the American Journal of Medicine that supports his claims but instead found 3 that does not:

https://www.nejm.org/doi/full/10.1056/NEJMoa2016638

https://www.nejm.org/doi/full/10.1056/nejmoa2012410

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014?query=featured_home

The latest one was published on July 23.

I think I'll go on continuing to believing that it's unlikely to be harmful nor helpful for recovery unless told by my personal physician or actual peer reviewed randomized trials show otherwise.

[AUFAN78 3,894]

1 hour ago, Auburnfan91 said:

https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535

This should not be happening. Politics should not enter into life saving measures. Who do you blame? How do you correct it?  Sad state of affairs.

[AUDub 11,147]

tl;dr the **** is this a**hole talking about?

https://respectfulinsolence.com/2020/07/24/harvey-risch-defends-hydroxychloroquine/

[SaltyTiger 7,794]

54 minutes ago, AUDub said:

tl;dr the **** is this a**hole talking about?

https://respectfulinsolence.com/2020/07/24/harvey-risch-defends-hydroxychloroquine/

Interesting

https://respectfulinsolence.com/who-is-orac/

Also note that, although he has distinct political opinions of his own, Orac is nonpartisan. He is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical

[SocialCircle 570]

2 hours ago, Auburnfan91 said:

https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535

Amen! And I am going to my doctor soon and seeing if she will prescribe this treatment to me as a proactive measure. 

[savorytiger 182]

I think I found the article from the American Journal of Medicine that the OP mentions. From https://www.amjmed.com/article/S0002-9343(20)30445-9/fulltext:

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In summary, we recommend that health care providers restrict their prescriptions of hydroxychloroquine and chloroquine to compassionate use for patients with COVID-19 until the results of randomized trials that provide sufficient evidence.

Maybe it supports the OP's premise that hydroxychloriquine isn't harmful to patients, but that doesn't mean it helps, and the paper definitely does not support widespread usage of the drug.

[AUDub 11,147]

9 hours ago, SaltyTiger said:

Interesting

https://respectfulinsolence.com/who-is-orac/

Also note that, although he has distinct political opinions of his own, Orac is nonpartisan. He is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical

"Medical commentary is not medical advice" is a stock indemnity statement.

Weigh what Dr. Gorski actually says. Like him, I'm trying to figure out what madness has infected Dr. Risch.

[AUDub 11,147]

12 hours ago, AUFAN78 said:

This should not be happening. Politics should not enter into life saving measures. Who do you blame? How do you correct it?  Sad state of affairs.

I mean, it's not hard to see why HCQ is so politically charged. Rumor started with China, who thought patients with RA prescribed HCQ didn't seem to be getting the virus and integrated HCQ in their standard of care anecdotally, then some silly doctor in France thought he had managed to reinvent the wheel with it, then the tech-bros noticed and it got to Trump from there, who touted it a game changing wonder drug.

In truth, its efficacy is about as well established as ear-candling or chiropractic. Results from various studies are starting to finally see the light of day and they show pretty much no benefit.

I'm at a loss as to the article posted in the OP. A first year epidemiology student could tear it to pieces.

[SocialCircle 570]

16 minutes ago, AUDub said:

I mean, it's not hard to see why HCQ is so politically charged. Rumor started with China, who thought patients with RA prescribed HCQ didn't seem to be getting the virus and integrated HCQ in their standard of care anecdotally, then some silly doctor in France thought he had managed to reinvent the wheel with it, then the tech-bros noticed and it got to Trump from there, who touted it a game changing wonder drug.

In truth, its efficacy is about as well established as ear-candling or chiropractic. Results from various studies are starting to finally see the light of day and they show pretty much no benefit.

I'm at a loss as to the article posted in the OP. A first year epidemiology student could tear it to pieces.

Asking speaking with several doctors who are currently treating Covid-19  patients; I believe almost everything these doctors said in this video. 
https://www.breitbart.com

 

[AUDub 11,147]

23 minutes ago, SocialCircle said:

Asking speaking with several doctors who are currently treating Covid-19  patients; I believe almost everything these doctors said in this video. 
https://www.breitbart.com

 

Well there's a Breitbart link but no video.

You're welcome to believe whoever you want, but is that belief held on the basis of ideology or evidence? There's very little evidence out there. Sure, you can find plenty of anecdotes, but the hard data on efficacy is dubious at best.

[SocialCircle 570]

2 minutes ago, AUDub said:

Well there's a Breitbart link but no video.

You're welcome to believe whoever you want, but is that belief held on the basis of ideology or evidence? There's very little evidence out there. Sure, you can find plenty of anecdotes, but the hard data on efficacy is dubious at best.

It is based on doctors who have and are currrently treating patients with Covid-19. 

[McLoofus 35,182]

Hahaha. Breitbart. This dude.

[AUDub 11,147]

8 minutes ago, SocialCircle said:

It is based on doctors who have and are currrently treating patients with Covid-19. 

Yes, anecdotes. Those are as common as needles on a pine, with evidentiary value roughly equivalent to them regarding whether or not HCQ is an effective treatment.

Remember, the plural of anecdote is not data. 

[McLoofus 35,182]

8 minutes ago, AUDub said:

Yes, anecdotes. Those are as common as needles on a pine, with evidentiary value roughly equivalent to them regarding whether or not HCQ is an effective treatment.

Remember, the plural of anecdote is not data. 

It reminds me of the folks saying their ENT in some backwoods hamlet somewhere east of Atlanta knows more about masks and COVID reporting than literally everyone else except a few other ENTs in a few other backwoods hamlets. And Breitbart. 

[SocialCircle 570]

18 minutes ago, McLoofus said:

Hahaha. Breitbart. This dude.

The video is of real doctors currently treating real patients. I have also spoken to several doctors I know who have personally treated patients with great success using this treatment. The issue is because Trump touted this medicine, those against him will not cover doctors who have effectively treated patients with it. One of the doctors on the video has treated over 300 patients with the treatment and not one has died. I try to listen to all sides and then make up my mind. 

[SocialCircle 570]

8 minutes ago, McLoofus said:

It reminds me of the folks saying their ENT in some backwoods hamlet somewhere east of Atlanta knows more about masks and COVID reporting than literally everyone else except a few other ENTs in a few other backwoods hamlets. And Breitbart. 

Your logic isn’t sound. Breitbart simply covered an event and published the video unedited. Meanwhile Facebook took it down after I posted it as did other platforms. 

[AUDub 11,147]

30 minutes ago, SocialCircle said:

The video is of real doctors currently treating real patients. I have also spoken to several doctors I know who have personally treated patients with great success using this treatment. The issue is because Trump touted this medicine, those against him will not cover doctors who have effectively treated patients with it. One of the doctors on the video has treated over 300 patients with the treatment and not one has died. I try to listen to all sides and then make up my mind. 

Are you referring to Stella Immanuel? I looked her up.

Get a load of this:

And her Twitter is a flaming ball of insanity.

In fact, that whole organization,  America's Frontline Doctors, looks to be a corporate backed astroturf filled with crazy people that happen to be MDs. 

[SocialCircle 570]

11 minutes ago, AUDub said:

Are you referring to Stella Immanuel? I looked her up.

Get a load of this:

And her Twitter is a flaming ball of insanity.

In fact, that whole organization,  America's Frontline Doctors, looks to be a corporate backed astroturf filled with crazy people that happen to be MDs. 

There are a number of doctors on the video. She is one of them. What you posted misrepresents what she saidon the video, so it is possible it also misrepresents her in other ways. I have personally spoken to several doctors who have used the treatment involving  hydroxychloroquine with much success. A couple of them I have known since elementary school and I trust them. 

[AUDub 11,147]

2 hours ago, SocialCircle said:

There are a number of doctors on the video. She is one of them. What you posted misrepresents what she saidon the video, so it is possible it also misrepresents her in other ways

I didn't assert anything about what she said in the video. I did, however, call her credibility into question. She has a history of saying crazy stuff.

And the other doctors featured in the video have a history of saying stupid bull**** too. 

I'd be extremely careful about wielding these doctors' words as a cudgel. The further I look into them, the more red flags I see. I mean, hell, if you look hard enough, there are still doctors out there that deny the causal link between smoking and high BP,  lung cancer and arteriosclerosis. Not hard to find idiots among 9 millionish doctors. 

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. I have personally spoken to several doctors who have used the treatment involving  hydroxychloroquine with much success. A couple of them I have known since elementary school and I trust them. 

Don't know if you are aware of what I do, but I work closely with doctors and have for well over a decade now. Right now it's nephrologists, but in the past it's been GPs, intensivists, pulmonologists, psychs, neurologists, dermatologists, surgeons. s***, name a specialist, I have at least one acquaintance that has walked the walk.

I get wanting to bring the "argument from authority" to bear, but that doesn't hold much weight with me. 

[SocialCircle 570]

https://www1.cbn.com/cbnnews/us/2020/july/new-hydroxychloroquine-study-proves-trump-right-says-it-significantly-cuts-death-rate
 

Many elites from both sides are taking this right now as a preventative measure BTW. 

[savorytiger 182]

13 minutes ago, SocialCircle said:

https://www1.cbn.com/cbnnews/us/2020/july/new-hydroxychloroquine-study-proves-trump-right-says-it-significantly-cuts-death-rate
 

Many elites from both sides are taking this right now as a preventative measure BTW. 

This is the same study I already talked about here: https://www.statnews.com/2020/07/08/a-flawed-covid-19-study-gets-the-white-houses-attention-and-the-fda-may-pay-the-price/

Stop using highly biased sources to justify your beliefs. Dig a little deeper.

[AUDub 11,147]

21 minutes ago, SocialCircle said:

https://www1.cbn.com/cbnnews/us/2020/july/new-hydroxychloroquine-study-proves-trump-right-says-it-significantly-cuts-death-rate
 

Many elites from both sides are taking this right now as a preventative measure BTW. 

You didn't read my link. Dr. Gorski addresses this in another post. 

https://respectfulinsolence.com/2020/07/09/henry-ford-hospital-hydroxychloroquine-trial-covid-19/

[AUDub 11,147]

4 minutes ago, savorytiger said:

This is the same study I already talked about here: https://www.statnews.com/2020/07/08/a-flawed-covid-19-study-gets-the-white-houses-attention-and-the-fda-may-pay-the-price/

Stop using highly biased sources to justify your beliefs. Dig a little deeper.

No idea why he's so invested in this random antimalarial drug.

s***, how many possibly better options have we delayed or flat out not studied because we decided to direct our resources to tilting at windmills?

[SocialCircle 570]

12 minutes ago, AUDub said:

You didn't read my link. Dr. Gorski addresses this in another post. 

https://respectfulinsolence.com/2020/07/09/henry-ford-hospital-hydroxychloroquine-trial-covid-19/

This article is very misleading. Nobody is saying only use hydroxychloroquine. It is like he is taking an argument nobody is making and then debunking it. It is meaningless. The 3 studies he links in the body didn’t even use the medicine regiment that the doctors I have been referring to and that the doctors I personally know have successfully used in real life (not in tests).