I have decided to use today's post to pass on some research I've done (via google) about the possibility that a combination of two drugs, Hydroxychloroquine & Azithromycin, might be effective against the COVID-19 virus. This is a confusing story which I have already done a tiny bit to spread on facebook. It has several dimensions, and at this point, I do not know what to think about it, but I think I can shed some light on what is going on.
To begin with, a team of French doctors has written and is about to publish a study arguing that a small sample trial showed effectiveness for these drugs. I quote from their summary.
"French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point.
"Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms.
"Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.
"Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin."
The study lists 18 different authors with French names (including two with Vietnamese or Arab roots) and I checked some of them to verify that they are indeed French doctors and medical scientists. The study also includes some caution about the use of these drugs. They have side effects and can be serious for patients with certain pre-existing conditions--which are, of course, exactly the patients most at risk from COVID-19.
Now the CDC has posted comments about the use of these drugs for treatment. Here is what it says:
"Hydroxychloroquine and Chloroquine
"Hydroxychloroquine and chloroquine are oral prescription drugs that have been used for treatment of malaria and certain inflammatory conditions. Chloroquine has been used for malaria treatment and chemoprophylaxis, and hydroxychloroquine is used for treatment of rheumatoid arthritis, systemic lupus erythematosus and porphyria cutanea tarda. Both drugs have in-vitro activity against SARS-CoV, SARS-CoV-2, and other coronaviruses, with hydroxychloroquine having relatively higher potency against SARS-CoV-2 [1,4,5]. A study in China reported that chloroquine treatment of COVID-19 patients had clinical and virologic benefit versus a comparison group, and chloroquine was added as a recommended antiviral for treatment of COVID-19 in China . Based upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently recommended for treatment of hospitalized COVID-19 patients in several countries. Both chloroquine and hydroxychloroquine have known safety profiles with the main concerns being cardiotoxicity (prolonged QT syndrome) with prolonged use in patients with hepatic or renal dysfunction and immunosuppression but have been reportedly well-tolerated in COVID-19 patients.
"Due to higher in-vitro activity against SARS-CoV-2 and its wider availability in the United States compared with chloroquine, hydroxychloroquine has been administered to hospitalized COVID-19 patients on an uncontrolled basis in multiple countries, including in the United States. One small study reported that hydroxychloroquine alone or in combination with azithromycin reduced detection of SARS-CoV-2 RNA in upper respiratory tract specimens compared with a non-randomized control group but did not assess clinical benefit . [The footnote cites the French study, above.] Hydroxychloroquine and azithromycin are associated with QT prolongation and caution is advised when considering these drugs in patients with chronic medical conditions (e.g. renal failure, hepatic disease) or who are receiving medications that might interact to cause arrythmias.
"Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19. In the United States, several clinical trials of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection are planned or will be enrolling soon. More information on trials can be found at: https://clinicaltrials.gov/external icon."
Thus, medical scientists in two different countries--China and France--have reported, based on relatively limited evidence, that these drugs have been effective, and broader trials are underway here to test them further. I do not know exactly why Dr. Anthony Fauci, in yesterday's press conference, described the evidence for their effectiveness as "anecdotal." I am not a scientist myself, and "anecdotal" might be a word frequently used to describe the results of very small clinical trials. I will allow the above evidence to speak for itself, and wait for evidence from the additional trials that are going on.
Meanwhile, however, something else is happening.
The Huffington Post now reports that two men are waging a public relations campaign on behalf of this treatment: Michael Coudrey, a Las Vegas marketer with ties to Republican politicians, and Gregory Rigano, who claims to be an adviser to Stanford Medical School, but isn't. Tucker Carlson of Fox News has interviewed Coudrey about this. That's probably how President Trump heard about the drug, and he has plugged the idea that it might be a cure in his last two press conferences, while Dr. Anthony Fauci has replied that any evidence is anecdotal.. Trump is also retweeting Coudrey's tweets about this. Coudrey's and Rigano's motives are unclear.
There is already a run on Hydroxycholoroqine as people beg their doctors to prescribe it, and arthritis and other patients who already relied on it are having trouble getting it. In this as in so many other issues of public policy, we obviously need to proceed cautiously on the basis of real science, while looking for answers as thoroughly and quickly as we can. With Donald Trump at the helm--a man who seizes upon the answers most convenient to him and refuses to study any data--this is not easy. Now, more than ever, we have to try to read beyond headlines and use the tools available to us all to check important information out. That is what I have tried to day. Best wishes to all in these difficult times.