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WaPo: ophthalmologist with COVID-19 failed hydroxychloroquine/azithromycin, Kevzara, not eligible for remdesivir due to renal failure; on ventilator for 10 days.

2020-04-01

(image courtesy of pixabay.com and Ri_Ya)

A story in today’s Washington Post describes the tragic tale of a 41-year-old ophthalmologist with three children on Long Island.  He fell ill on March 14 with fever and cough, was hospitalized with dyspnea (shortness of breath), and by March 19 was on a ventilator.  He has not improved with a course of the treatment touted by [redacted]: azithromycin and hydroxychloroquine.  Then he failed to respond to Kevzar, an investigational drug originally intended for rheumatoid arthritis.  His kidneys stopped working.  Now he is ineligible to try remdesivir due to renal failure (kidneys not working).

To be clear, evidence was not presented that renal failure is a contraindication (reason for not using) to taking remdesivir.  These are the criteria set by Gilead, the drug’s maker, to limit the number of patients eligible for trials of this drug.  Presumably, the drug would be less likely to help him under these circumstances.  There is also the issue of supply: over a thousand patients have already been treated with this not-yet-approved drug.

There is no publicly available outcomes data for remdesivir, in part because Gilead holds the patent and can claim that such information would be “proprietary” (a trade secret).  On the other hand, there is widely circulated data on a French study of hydroxychloroquine and azithromycin which looks impressive until one checks the actual numbers.  Only twenty patients were studied.  This is inadequate given that, by now, thousands and thousands of patients have been treated with the drug combination, including people with renal failure and other comorbidities (additional diseases) and those in extremis (clearly dying).

The situation now is so dire that an obstetrician-gynecologist calling himself “The Honest Ob-Gyn” has circulated a video on FaceBook touting the results of the French study.  He told his listeners to “tell your doctor” and by implication, to demand this treatment.  He failed to mention the tiny number of patients in the study, and inaccurately claimed that the results (which he held up on a hand-drawn graph in the video) showed “clearance of virus from the blood”.  In fact, the novel coronavirus doesn’t circulate in the blood in most cases, and is only shed from the respiratory epithelium (the lining of the nose, throat, bronchi, and lungs).

What is worse, hydroxychloroquine is currently unavailable to outpatients due to a run on the supply and the donation of hundreds of millions of doses to hospitals.  There is plenty of azithromycin around, as this is widely prescribed for bronchitis (which is usually caused by other viruses) even though there is no evidence that it is effective even for ordinary, garden-variety acute bronchitis.

This FaceBuck video is now responsible for medical assistants asking their providers (the doctors and physician assistants they work for) why they are not prescribing these drugs!  This in the context of no tests being readily available and the turnaround time for test results stretching out to ten days in routine cases.  It has to be patiently and gently (adverbs of which I am not capable) explained to them what is wrong with this picture.  This is one reason I retired: too many ignorant questions from people who don’t even know what questions to ask.

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