SARS-COV-2 and chloroquine/hydroxychloroquine: We just don’t know, but feds are forging ahead. Let’s hope we get some large case/control studies.

(image courtesy of pixabay.com and TheDigitalArtist)

Novel coronavirus treatment is locked in a cycle of political versus scientific arguments.  The federal government, via the FDA, is distributing millions of doses of chloroquine and hydroxychloroquine to hospitals.  The scientific reports available from France suggest that treatment reduces the time to clearance of the virus dramatically but the studies are small (eighty patients were reported yesterday; one abstract that I accessed today reported statistical significance with only twenty patients).

We will not know for some time what the results will be.  Under the circumstances, randomized, double-blind, placebo-controlled studies are next to impossible because very few people will sign up for a fifty-fifty chance of getting a placebo when they feel like they are dying.

Epidemiologists say that, under these circumstances, the only way to proceed is with large case-control studies.  Patients will be given the drug where it is available and their outcomes will be compared with those in patients who couldn’t or didn’t get the drug.  The absence of placebo controls militates against small studies, and that is all that is available right now.

Although chloroquine has large toxicities at relatively small doses (not much more than is needed to be effective), patients have little to lose when it is offered.  The only problem is that, if everyone gets the drug, how will we know whether it made a difference?

Where is remdesivir?  I think that there is very little of it available, but I could be wrong.

Another unknown is whether our current supply of chloroquine will be restocked.  India has stopped exports of this drug, which is generic and made mostly there and in other Asian countries.  What if we run out?  Then we will have those controls that we needed in the first place.

A final word: what will happen to the news?  Free newspapers will soon die for lack of advertising.  Print newspapers have been dying for years and this will be the final nail in the coffin for most of them.  McClatchy is already in bankruptcy.  Soon we will remember the novel coronavirus as “The Great Winnowing” as only NYT, Washington Post, and a few others remain.  Even the TV networks will not be spared.