Posted by Jeff Id on July 3, 2020
Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19
A new study of over 2000 hospitalized patients reveals that Hydroxychloroquine works very well in treatment of COVID. The reason I’m so excited about this one is because unlike the poor studies that I’ve written about already, this study controlled the dosages, use the correct levels of HCQ and Azythromycin per other studies, and matched patients to each other by their own health situations. This matching of health condition is the proper method to control the confounding factors in a situation where testing cannot be double-blind. The health of the patient is what the frustratingly fake studies didn’t correct for, but certain political pressures made them popular.
This is absolutely the most conclusive research produced to date by anyone, due mostly to the quality of the approach. No one has published this quality level of work on HCQ on humans prior to this.
HCQ reduced deaths by half from the untreated patients.
Of note, this was a very large study:
The results of this study demonstrate that in a strictly monitored protocol-driven in-hospital setting, treatment with hydroxychloroquine alone and hydroxychloroquine + azithromycin was associated with a significant reduction in mortality among patients hospitalized with COVID-19. In this study, among one of the largest COVID-19 hospital patient cohorts (n = 2,541) assembled in a single institution, overall in-hospital COVID-19 associated mortality was 18.1% reflecting a high prevalence of co-morbid conditions in COVID-19 patients admitted to our institution.
And Safe:
To mitigate potential limitations associated with missing or inaccurate documentation in electronic medical records, we manually reviewed all deaths to confirm the primary mortality outcome and ascertain the cause of death. A review of our COVID-19 mortality data demonstrated no major cardiac arrhythmias; specifically, no torsades de pointes that has been observed with hydroxychloroquine treatment.
My bold of course. That means that HCQ is still not dangerous folks!!
Look at this powerful result:
The Cox regression result for the two propensity matched groups (Table 4) indicates that treatment with hydroxychloroquine resulted in a mortality hazard ratio decrease of 51% (p = 0.009). The resulting Kaplan-Meier survival curves within the propensity matched setting displayed significantly better survival in the hydroxychloroquine treated group, with the enhanced survival persisting all the way out to 28 days from admission (Fig. 2).
Also:
I found it very interesting that the Azythromycin didn’t work as well in combination with HCQ but it did better by itself than no treatment. I also found it a little overly deferential in its recognition of the bad papers which others have produced, but those who know me probably aren’t surprised by that.
I want to thank all of these researchers who did their job so well. Saving lives the right way.
Samia Arshad, Paul Kilgore, Zohra S. Chaudhry, Gordon Jacobsen, Dee Dee Wang, Kylie Huitsing, Indira Brar, George J. Alangaden, Mayur S. Ramesh, John E. McKinnon, William O’Neill, Marcus Zervos, Henry Ford COVID-19 Task Force<ce:author-group id=”aug0010″>, Varidhi Nauriyal, Asif Abdul Hamed, Owais Nadeem, Jennifer Swiderek, Amanda Godfrey, Jeffrey Jennings, Jayna Gardner-Gray, Adam M Ackerman, Jonathan Lezotte, Joseph Ruhala, Raef Fadel, Amit Vahia, Smitha Gudipati, Tommy Parraga, Anita Shallal, Gina Maki, Zain Tariq, Geehan Suleyman, Nicholas Yared, Erica Herc, Johnathan Williams, Odaliz Abreu Lanfranco, Pallavi Bhargava, Katherine Reyes, Anne Chen
Well done!
hard to believe!
3 Jul: CNN: Study finds hydroxychloroquine helped coronavirus patients survive better
by Maggie Fox, Andrea Kane, and Elizabeth Cohen
(CNN) A surprising new study found that the controversial antimalarial drug hydroxychloroquine helped patients better survive in the hospital.
A team at Henry Ford Health System in Southeast Michigan said Thursday its study of 2,541 hospitalized patients found that those given hydroxychloroquine were much less likely to die…
https://amp.cnn.com/cnn/2020/07/02/health/hydroxychloroquine-coronavirus-detroit-study/index.html?__twitter_impression=true
of course, it didn’t take long for the above CNN headline to change to:
2 Jul: CNN: Study finds hydroxychloroquine may have boosted survival, but other researchers have doubts
By Maggie Fox, Andrea Kane, and Elizabeth Cohen
Updated 1731 GMT (0131 HKT) July 3, 2020
https://edition.cnn.com/2020/07/02/health/hydroxychloroquine-coronavirus-detroit-study/index.html
headline is changed at the first link as well. here is the original headline elsewhere:
2 Jul: WREG News: Study finds hydroxychloroquine helped coronavirus patients survive better
by: CNN Wire
Posted: Jul 3, 2020 / 08:15 AM CDT/ Updated: Jul 3, 2020 / 07:49 AM CDT
https://wreg.com/news/study-finds-hydroxychloroquine-helped-coronavirus-patients-survive-better/
behind paywall:
2 Jul: WSJ: Hydroxychloroquine Given Early Helped Coronavirus Patients, Study Finds
Analysis suggests certain Covid-19 patients could benefit from taking antimalaria drug early in their illness, though further research is needed
By Jared S. Hopkins
https://www.wsj.com/articles/hydroxychloroquine-given-early-helped-coronavirus-patients-study-finds-11593729664
3 Jul: ThePostMillennial: CNN reports ‘surprising’ positive hydroxychloroquine study results after pushing negative stories about drug for months
by Libby Emmons
https://thepostmillennial.com/cnn-surprising-hydroxychloroquine-study
3 Jul: Outkick: CNN ‘Surprised’ By Success of Hydroxychloroquine, Drug Originally Suggested by Trump
by Joe Kinsey
CNN slipped a tweet into the public record early Friday morning that is getting plenty of attention…
https://outkick.com/cnn-surprised-by-success-of-hydroxychloroquine-drug-originally-suggested-by-trump/
New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19?
The multiple molecular mechanisms by which chloroquine can achieve such results remain to be further explored. … preliminary data indicate that chloroquine interferes with SARS-CoV-2 attempts to acidify the lysosomes and presumably inhibits cathepsins, which require a low pH for optimal cleavage of SARS-CoV-2 spike protein
Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture
Add AZ to address opportunistic pathogens. Both the mechanisms and toxicity of theses chemicals are well established. They do not reverse disease progression, but rather enhance normal body functions and reduce viral viability.
I have used hydroxychloroquine years because of arthritis rheumatoides. It did not work well against rheuma. Wonder where those tablets are now.
Kari: Right next to the memory tablets.
Frustratingly, this study still didn’t address the most likely optimized use of HCQ…namely using it Early in the disease process and along with Zinc supplements.
There are 5 known HCQ mechanisms that impart antiviral actions and HCQ also has anti-inflammatory effects that could be efficacious in the treatment of Covid-19. The 5 antiviral actions would all argue for the early treatment and also for Zinc supplementation to inhibit viral replication. The resultant lowering of viral loads increases survivability. That is best done BEFORE viral loads get high.
The FDA’s insane advisory to use HCQ only in Hospital settings was ostensibly to minimize cardiac arrhythmia complication. That was a ridiculous advisory…and it also (purposefully) eliminated the use of HCQ when it is most effective and when it’s most safely administered. HCQ has about as high a Therapeutic Index as any drug if used properly (extremely safe in low doses for a few days as is the case in Covid treatment).
It was criminal (and I believe politically purposeful) for the FDA to conspire to reduce HCQ use when the risks were so very very low and the benefits potentially very high. In an epidemic, that is what you do. Use low risk high potential benefit approaches. There isn’t time to be certain.
As this study confirms (Zero cardiac rhythm disruption in thousands of patients), all the Press and FDA talk about the dangers of HCQ were outright lies….lies that have now killed many thousands of people. The Press has that blood on their hands. So does the FDA. I’d love to see a huge Class Action Law Suit…big enough to bankrupt the Press….and to deconstruct the FDA. Justice demands it.
Great comment. Also, they should study the prophylactic efficacy of taking it (with extra Zinc of course, and extra C would also be a good idea). The president has said he takes it, though whether with Zinc or C we don’t know (probably not). In particular, healthcare workers, who are exposed to CV on a daily basis need more protection, and this could be it. The PPE they use help I’m sure, but there are certainly many failures.
I seems you don’t have to go full commy to start к;11ing people. It’s a parabolic function.
Trump is the boss of the FDA. If it’s as bad as you say, why doesn’t he fire the director and bring FDA back to reality?
The swamp is deep. First he would have to find a qualified replacement who did not have bureaucratic TDS. Next, he would be pilloried by the press, and then quickly investigated by House Democrats. And who knows how long it would take Congress to approve the replacement. Sometimes it is better to play the cards you are dealt than to wait for the next deal.
Actually the incidence of side effects in sick people taking HCQ is several times higher than the overall death rate of covid infected patients.
So it is simply hogwash and utterly false to say the risk is minimal compared to the possible benefit.
The opposite is true.
No good evidence of benefit, plenty of possible harms.
It is becoming clear the death rate of those infected is less than 1%, and may be far less than 1%, overall, if it is true that only one tenth of infections have been diagnosed by testing.
right on.. zinc is the key
Confusion is the right word to describe this situation.
There appears to have been NO attempt to consider the claims for HCQ (with or without supplements) and create appropriate test protocols. Instead, there has been intense political pressure to either present the drug as a ‘miracle game-changer’, or as an evil attempt by a far-right American President to gain benefit out of people’s misery. I do not know how to explain trials which included over a gram of HCQ a day – perilously close to the known lethal dose, and well within the range at which side effects are experienced.
I am reminded of Kuhn’s description of the progress of Scientific Revolutions – where he points out that breakthrough discoveries are initially ignored or explained away – frequently illogically. The requirement for humans to cling to an existing paradigm is a strong one. and overwhelming when, as Upton Sinclair commented, ‘your job depends on it’.
Current HCQ trials show how powerful political correctness is, and how easily it can damage all aspects of human endeavour – even those which are claimed to exist solely to discover truth…
‘But again, the outcome is just strange.’
But then again,that is the data.There always is a problem with working out loading in statistics.
It could be that the white racial population of Urban Detroit, after the collapse of its economy, is prone to the diseases of the poor.
The retrospective trial was looking for comorbidity caused by cardiac arrhythmia, caused by the treatment, ie looking for iatrogenic disease.Without saying so, it looked at a white potentially young,drug affected population, as well as the survivors in the aged population.
These survivors from Detroit could not be compared to the aged here in Australia, because of medicare,open to all.
Whatever one’s view of the present US President, it would appear that his prophylactic use of an antmalarial, on himself, when those around him had Covid 19, was a rational choice.
What is really exiting about this limited aim trial, is the hope that these patients be more thoroughly ‘reviewed’ for bacteria and viruses that may be treated with other drugs, such as augmentin, at least in a non hospital setting.
Targeting Diplococcus,if found, would be high on the list for the aged.
The hospital could be full of MRSA anyway, reducing the likelihood of survival once admitted.
https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336
This paper does not delve into this.
The paper assumes both treatment have been absorbed.
It would be useful to do blood levels to see if in fact the drugs have actually reached the target organs.
If not then i/v support would be warranted.
Maybe there‘s a missprint of the median age in the HCQ agegroup in the Ford study?
53 (64 – 74)
Yes, same error in the pre-print (table 1):
https://www.mediterranee-infection.com/wp-content/uploads/2020/07/Arshad-IJID-2020.pdf
As was pointed out in Climate, Etc., this isn’t a good study because the administration of steroids wasn’t matched across treatment groups. See Table 1: https://www.ijidonline.com/action/showFullTableHTML?isHtml=true&tableId=tbl0005&pii=S1201-9712%2820%2930534-8
It could’ve been the steroids.
Maybe someone should test the exact Zelenko protocol, exactly as written, looking for the exact results described by Zelenko instead of trying to find out if such a protocol kills every last viral particle, which is not what Zelenko claimed.
Corticosteroids use can be “filtered” for analysis through this study due to the large number of subjects. Why wasn’t that done?
It would be fairly trivial to do that retrospectively if the record keeping was well done. It’s hard to imagine that information about drug administration and dosages was not recorded at each dose given (since that happens with every patient every time).
Big Pharm. does not like out of patient drugs. .
As usual its all about money. Lots of it.
VK5ELL MJE
Coincidentally, just moments ago.
“ Dear Editor, I will not use Facebook or any site that censors its would-be users. For now I am pleased with GAB and PARLER and Yippy search-engine.
I believe that ALL of our current troubles are due to the overweening influence of the Social Justice Networks.
I have used this tag-line for a decade and more, “The conspiracy of ignorance masquerades as common sense,” never imagining how appropriate it might become. My neighbors, fellow intellectuals, might study up on epistemic trespass.”
Were the Write Brothers guilty of epistemic trespass?
Hi Jeff, thank you for the link and discussion. Many of the comments have been interesting and helpful as well.
From the NIH Covid Treatment Guidelines: https://www.covid19treatmentguidelines.nih.gov/whats-new/
“June 16, 2020, Update: On June 15, The Food and Drug Administration revoked the emergency use authorization (EUA) that permitted the use of chloroquine and hydroxychloroquine donated to the Strategic National Stockpile to treat certain patients with COVID-19. In light of this announcement, the following sections of the COVID-19 Treatment Guidelines have been updated to remove the information regarding the EUA:
Antiviral Drugs Under Investigation
Chloroquine or Hydroxychloroquine
Table 2b”
“Chloroquine or Hydroxychloroquine
The Panel recommends against the use of chloroquine or hydroxychloroquine for the treatment of COVID-19, except in a clinical trial (AII).”
It will be interesting if this papers findings has sufficient credibility with the NIH to result in a change in treatment protocol recommendations.
Anyone here now who/how/when the NIH changes/reviews the NIH publishes changes to the Treatment Guidelines?
Ethan Brand
There was an op-ed in the WSJ this past week by an academic virologist regarding the efficacy of the Sabin oral polio vaccine (OPV) and its boosting the immune system. This tablet has been in use since 1962 and is very cheap. Does anyone have any information regarding the advisability of taking this as a preventive? My doctor is constrained in recommending this due to standard of care issues but would probably write a prescription for it if I insisted.
While I totally support HCQ as one aspect of infection treatment, the problem in the real world is that the number of things which we can all do to meaningfully increase immune function and overall health is vast with many overlapping pathways. Further, there are differences between people (e.g. for capability to absorb zinc) which are not all understood or measured. Immune function is supported by many things (e..g hormones, vitamins, minerals, sun exposure, heat shock proteins, thymus gland products, and dozens more) so in the real world, we all need to be doing everything we reasonably can, not just for the current infection but permanently. The body is a high complex, interdependent system and we will never have the luxury of knowing exactly what is doing what. This is one of the flaws in modern western medicine that relies on “a pill for an ill” approach.
It’s probably safe enough. Why take the risk though (however small), when extra Vitamin D and C would keep the immune system healthy and vibrant? You’d presumably have to keep taking the vaccine every so often, as the immune-boosting effect wouldn’t last. The vitamins, at least, are something the body can probably benefit from anyway.
1.) If you or a loved one gets sick enough to be hospitalized, how do you get the treatment if the state, county, facility or doctor doesn’t provide for it?
2.) Why aren’t people age 60 and older on a prescribed daily regiment of HCQ, Vitamins C & D and Zinc?
May I suggest that all experts do review of all respiratory viruses!
Comparisons would be interesting and perhaps we all regain our perspectives away from the “devils” like gates et al who wish to gain control of our lives.
Not joking!
Right on! Try WIKI for a start. Get deeper into it and find that vastly more under 60 died in HxNx flue pandemics than in the current ‘pandemic’.
It is immoral to screw the mid-career and young to protect people like me over 70 and secure on a pension.
There is a misprint in the ages given for the sample. ThomasF above is right – 53 (64-74). The line below giving proportions above and below age 65 is presumably correct.
The regression uses statistical adjustment for variables on which the groups differ. It shows essentially the same results as for the subsequent analysis in which two matched groups of 190 with and without HQ are compared. The excess risk for white race is puzzling in light of epidemiology so far, but it probably results from admission of white patients when they were sicker – ie, expecting poorer outcome for blacks admitting criteria different.
Note also that 53% of the whole sample had BMI>30, 64% had chronic lung disease, 38% Diabetes, hypertension 65% and 43% chronic kidney disease – adds up to multiple comorbidities. Interestingly, cardiovascular disease was only 9%. These factors produce the high mortality in a younger group, and presumably are the same factors that lead to high death rates in care home patients.
This study is going to be a real problem for those with Trump Derangement Syndrome. Expect all sorts of efforts to take it apart.
Due to the potential for a high degree of multicollinearity within the data set, this will result in unstable and less than reliable estimates of the coefficients, hence the “strange” results as some have put it. Although the authors do not report the degree of multicollinearity in the data (which they should have), the covariance of BMI, diabetes, and other comorbidities is extremely likely. I expect they did not report the multicollinearity because it was so high. All of this can be addressed by a true random controlled experimental design, with proper sample sizes.
Two interesting observations regarding this study which others, especially those who dispute its value because of discrepant statistics, fail to mention:
1. The study population is compose largely of a Detroit area cohort. Thus the population is 55% black. That the HR is 1.7 for white people in the study is not so surprising, perhaps, as people think because it is quite possible that the white population in this region is actually of poorer health than the black population. The authors specifically mention that all HRs employed pertain to this hospital system’s service population.
2. The study may have involved 2,000+ people, but the very important part of the study is the 190 pair subgroup who were propensity matched. There is no point bickering over the fact that the median age of the control was 71 while the HCQ group was only 53, when there was propensity matching to control for confounders.
This study may or may not prove to be correct, but they seem to have carefully thought through problems with their data, and they recognize the many problems with other trials.
Roy Spencer had an article on his blog in Mid-March showing that nations with the highest malaria rates, where HCQ usage was high, had extremely few COVID deaths.
I sure would like to see an update of that article.
The Irish Times has just posted that WHO has stopped hydroxychloroquine trials for hospitalised Covid patients because results little or no efficacy. https://www.irishtimes.com/news/science/who-stops-hydroxychloroquine-trials-for-hospitalised-covid-19-patients-1.4296597 What the hell is WHO doing …..are they in big pharma’s pocket????
They used data from a proper clinical trial.
As did the FDA last month.
BE very double blind randomized trial has shown no benefit from malaria drugs or antibiotics, either used as a treatment or for pre exposure prophylaxis.
A retrospective study is not comparable.
The confounding variables in the headline article study here shows some of the reasons why such studies are problematic at best.
The properly done clinical trials show no benefit.
Why is that so hard for some people to comprehend?
Steroids seem to hekp.
Remdesivir is shown to help.
Believing malaria drugs are useful requires, at this point, a willful ignorance of the whole body of evidence, and mind boggling selective attention and confirmation bias.
Be very = Every
Autocorrect, sorry.
Thank you. With a true random experimental design (double-blind), multicollinearity becomes a non-issue.
Is the “Empire Fighting Back”? Of course, it’s a rhetorical question; they, the WHO and etc, are always and relentlessly fighting back.
The WHO just released news, somewhat contradictory to this article — I did not compare the exact pharmaceutical and procedural protocols — where it is announced that the WHO is halting and perhaps terminating, due to less than positive results, their HCQ testing. Among others, providing details regarding this news release, here are some of the articles, linked below, released 04 July at approx 16:00 EST:
[1] WHO halts hydroxychloroquine, HIV drugs in COVID trials after failure to reduce death: https://www.reuters.com/article/us-health-coronavirus-who-drugs-idUSKBN2450OJ
[2] WHO says trials show malaria and HIV drugs don’t cut Covid-19 hospital deaths: https://www.theguardian.com/world/2020/jul/04/who-says-trials-show-malaria-and-hiv-drugs-dont-cut-covid-19-hospital-deaths
[3] WHO halts trial of HIV drugs as possible treatment for patients hospitalized with coronavirus: https://www.cnbc.com/2020/07/04/coronavirus-who-halts-trial-of-two-hiv-drugs-lopinavir-ritonavir.html
… and etc.
Was the WHO timing a random coincidence, relative to the one referenced in this article [per the International Journal of Infectious Diseases], or, otherwise?
There are results coming out all the time, one of several every week.
Hundreds of trials have been ongoing.
Many are and have been winding down and posting results.
The study discussed above in headline article is a retrospective anakysis, not a clinical trial.
All of the various clinical trial results show the same thing: HCQ does not provide any benefit when used to treat covid.
The total body of evidence at this point is overwhelming.
By the end of the year, HCQ, with and without various added compounds, will be the most studied drug in history that he never been shown to help anyone with the target condition via actual scientific evidence.
How to you spell M U R D E R by these government entities. Unfortunately it seems to continue at all costs.
WUWT needs to keep its eye on the ball and not be posting irrelevant nonsense posts that distract. Ie this post is still number one otherwise I love WUWT cheers sent in good jest
The paper reports:
“Hydroxychloroquine was dosed as 400 mg twice daily for 2 doses on day 1, followed by 200 mg
twice daily on days 2-5.”
Here in Quebec, it’s impossible to get any variant of quinine without a medical prescription, and for most of us, there’s less than a snowball’s chance in hell of getting one.
So how much Tonic Water would one have to drink to get the equivalent of 800mg of hydroxychloroquine?
I understand that the FDA limits the quinine content of Tonic Water to 83mg per liter. Here they don’t list the amount on the label, but probably follow the FDA lead sheepishly.
So assuming quinine has the same efficacy for Clovid-19 purposes as hydroxychloroquine, one would have to drink 10 liters on day one, and five liters a day for the next four days.
I don’t know the precise answer, but from my readings I recall it to be an impossible amount to drink.
If it was strong enough we would be drinking it instead of bothering trying to get pills.
In the report of the Zelenko protocol, linked below by David L. Hagen , (thanks David) the “low dose HCQ” used was only 400 mg per day (200 mg twice daily), for 5 days.
So if quinine is as potent as HCQ, then one only needs to drink 5 liters a day of tonic water to get the same dose of 400mg. Seems doable to me, assuming you can find the tonic water. I cleaned out one big grocery store of the two liter bottles some weeks ago, and haven’t seen any since. The 330ml cans have now disappeared from the shelves too.
Searching via duckduckgo on “health risks of excessive water consumption, I found no scientific reports, but I did find the following at:
https://www.healthhype.com/excessive-water-intake-drinking-too-much-effects-dangers.html
“…. As a general rule, a person should not drink more than 4 liters (approximately 135 ounces) in a 24 hour period but the dangerous level is consuming more than 6 gallons of water per day repeatedly¹. This is the maximum capacity that healthy kidneys could pass out excessive fluid.”
I’ve no previous experience with this site or with “Dr. Chris” who posted this, and the only reference for the content is to the Merck Manual (where I couldn’t find the above information), but if it’s correct, then 5 liters per day should be safe for five days, and maybe one could even get away with 10 liters on day one.
Some information on maintaining correct electrolyte levels for this amount of hydration would be helpful. But maybe Dr. Chris is saying that at 4 liters spread over 24 hours, there is no risk of dangerous electrolyte loss.