More proof that he doesn’t know what he is talking about and thinks that he knows more than the experts: he cuts off Fauci when asked about unproven drugs for COVID-19. What does the research really say?

EM of sars-cov-2 budding from apoptotic (dying) cells–NIAID

This story from WaPo tells it all.  If anyone was actually listening to the daily update/re-election campaign show by our con-man president, when Dr. Fauci tried to answer a question about treatment of COVID-19 with hydroxychloroquine, the Man cut him off.  He gets defensive whenever reporters ask hard questions, and he can’t get used to the fact that they have a lot of hard questions to ask.

This is what Dr. Fauci said on “Face the Nation”:

“There have been cases that show there may be an effect and there are others to show there’s no effect, so I think in terms of science, I don’t think we can definitely say it works.”

This is what the president of the American Medical Association (AMA) said, when indicating that she would not prescribe hydroxychloroquine to a patient with the virus:

“You could lose your life,” Harris said. “It’s unproven. And so certainly there are some limited studies, as Dr. Fauci said. But at this point, we just don’t have the data to suggest that we should be using this medication for covid-19.”

This Chinese study (full text .pdf) reports positive results with use of hydroxychloroquine.  There were 31 patients treated with the drug and 31 patients not treated; 80 patients were excluded from the study for a number of reasons, including clinically severe infection, kidney or liver failure, possibility of being transferred to another hospital within 72 hours, oxygen saturation less than 93% (indicating severe disease), and retinal conditions or potential heart arrhythmia (irregularity).  The number of patients excluded/included for each of the individual criteria was not specified.

The results were a 2-day lesser duration of fever and cough.  Pneumonia improved in about 81% of patients and about 55% of controls.  Other antiviral drugs were given, but their names were not specified in the report.  The significance levels of each individual result were not specified in the report; a confidence level of 95% (p=0.05), was given overall (this means that, of twenty studies like this, one would falsely give a negative result and one would falsely give a positive result). These results are encouraging but not conclusive.  There may be problems with the study not obvious to the untrained eye.

Given the results of this study, it would be reasonable to try hydroxychloroquine (alone, without azithromycin) in hospitalized patients with mild pneumonia who have relatively normal blood oxygen saturation.  This presupposes that the drug is available, the patient is hospitalized, and there are no contraindications.  Severely ill patients may or may not benefit and it is these with whom we are most concerned.  Note that more than half of the controls improved without the drug within five days.

The problem with the president promoting the use of hydroxychloroquine and azithromycin is that he is not in any sense an expert in any field.  He is “followed” by tens of millions of people on Twitter, many of whom hang on every word.  The doctors who follow him have the power to prescribe these drugs, and they have done so for preventive use in most cases.  This has resulted in a run on hydroxychloroquine and chloroquine which makes the drugs unavailable for their previously intended uses as well as for hospitalized patients (the FDA will address this issue by distributing millions of doses to hospitals, or so they say).

We are rightly scornful of laymen with huge Twitter followings who endorse unproven therapies and cause other laymen to demand treatments that they don’t (yet) need from their doctors.  The problem is that, if he left it alone, doctors would receive the information they need from their regular sources (of which there are good and plenty right now) and laymen would remain blissfully (and rightly) ignorant.

The guy who drank aquarium cleaner and died wouldn’t have done so without His tweets.  His purpose in publicizing these studies is not to relieve the suffering of others but to pump himself up and get people to vote for him.  He doesn’t care who (ignorantly or accidentally?) dies as a result of his behavior, as long as it’s not blamed on Him.

We are, however, interested in further evaluation of hydroxychloroquine in particular.  Formal studies and collection of anonymous data from hospitals that can record this information under the stress of an overwhelming pandemic are needed.