Coronavirus News (196)

The Key to Defeating COVID-19 Already Exists. We Need to Start Using It | Opinion  .......  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. ............  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. ........... renew my call for the immediate early use of hydroxychloroquine in high-risk patients .......  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...........    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. ..............  a classic example of how extra-scientific factors overrode clear-cut medical evidence ......... 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......  Harvey A. Risch, MD, PhD, is professor of epidemiology at Yale School of Public Health.

Hydroxychloroquine Is Not a Key to Defeating COVID-19   On July 15, Oxford University reported in a randomized and controlled study that hydroxychloroquine did not reduce 28-day mortality after randomly allocating 1,561 patients to receive hydroxychloroquine and 3,155 patients to receive standard care. On July 23, The New England Journal of Medicine published a study of 667 patients, who were randomly given hydroxychloroquine, hydroxychloroquine and azithromycin or standard care, with a 1:1:1 ratio. This study found that the use of hydroxychloroquine, either alone or with azithromycin, did not improve outcomes. Cardiac side effects, however, were more frequent in individuals receiving hydroxychloroquine. Other well-designed studies published earlier have all shown that hydroxychloroquine has no benefit in managing COVID-19. Earlier observational studies have also pointed out the lack of benefits and safety profile when treating COVID-19 patients with hydroxychloroquine.............  Considering the replicable evidence from multiple studies showing no benefits but safety concerns, it is not surprising to see health authorities all around the world, as well as the World Health Organization, halt hydroxychloroquine studies and recommend against its use. .........  Some also draw conclusions from a study done in Brazil, available only in Dropbox and on WordPress. This work not only had no formal research design, but did not even confirm whether enrolled patients actually had COVID-19. Many other studies used by hydroxychloroquine supporters should all be taken with multiple grains of salt because they are all poorly designed, inconclusive and outdated. ..............   The keys to defeating COVID-19 are solidarity, leadership, transparency and collaboration. Hydroxychloroquine is not one of them, and wrongfully promoting this drug is not protecting our lives........ Jon Zhou is a doctor of pharmacy, a practicing health care professional and a graduate of master of public health/global health from Yale School of Public Health.