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Veterans Hospital Study Finds Slightly Increased Risk of Death from Taking Hydroxychloroquine versus no drug in COVID-19: why [redacted] is no longer “flogging” this drug since April 16.

2020-04-23

Here is the relevant portion of the abstract (from MedRxiv dated April 16):

RESULTS: A total of 368 patients were evaluated (HC, n=97; HC+AZ, n=113; no HC, n=158). Rates of death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively. Rates of ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively. Compared to the no HC group, the risk of death from any cause was higher in the HC group (adjusted hazard ratio, 2.61; 95% CI, 1.10 to 6.17; P=0.03) but not in the HC+AZ group (adjusted hazard ratio, 1.14; 95% CI, 0.56 to 2.32; P=0.72).

Note that, while the death rate in the HC (hydroxychloroquine) group was more than double that in the no HC group, the statistical significance of this finding was only P=0.03.  This is slightly better than the usual standard of significance, P<0.05, but only slightly.  To find significant significance, I personally have a standard of P<0.01.  This is because, if a finding is to be really significant, I think it should be better than 100 to 1 rather than 20 to 1.  Just a personal thing.  So there weren’t enough patients studied to find this really significant.

What is most important is that this study didn’t find any benefit in death rates from taking hydroxychloroquine (HCQ) or the combination of azithromycin (AZ) and HCQ.  So the president is barking up the wrong tree, as usual.  There are more beneficial drugs out there, particularly remdesivir, which interferes with replication of the virus RNA.  The apparent mechanism of action for HCQ is to lower the pH of vesicles created by the fusion of the host cell membrane with the virus cell membrane, not a very specific or potentially highly active way to stop the virus theoretically.

For these theoretical reasons, as well as the poor showing of HCQ in this early clinical study (not yet peer-reviewed), I do not support the use of HCQ in patients with COVID-19, even if it is readily available.  I do support the use of remdesivir for theoretical reasons, although its early clinical studies showing benefit are so far of poor quality and probably manipulated by the company producing it (Gilead).

Coincident with this finding, the (now former) director of the Biomedical Advanced Research and Development Authority, Richard Bright, released a statement through his lawyers claiming that he was transferred for resisting the White House push for the use of HCQ and AZ.  This statement can be found in an NPR article dated April 22:

Bright was director of the Biomedical Advanced Research and Development Authority and a deputy assistant secretary with the Department of Health and Human Services until, he says, he was removed on Tuesday. Bright said he has been transferred to “a more limited and less impactful position” at the National Institutes of Health.

The president should stop “flogging” the use of HCQ and AZ, and stick to what he is in office to do (and is authorized to do by law).  He should invoke the Defense Production Act to commission private companies to produce urgently needed supplies of all kinds: testing swabs, reagents, test kits, ventilators, N95 face masks, gowns, gloves, and so on.  In addition, he should be leading the development of a large force of contact tracers to find everyone who has been exposed to SARS-COV-2.  Those exposed should be tested and urged to isolate themselves for two weeks until it is clear whether they have developed symptoms or tested positive.

These are critical elements of a five-fold plan to fight the virus: physical distancing, contact tracing, testing, isolation, and treatment.  With this plan, countries like South Korea are showing that they can get the upper hand against the virus.  Until this country gets with the program, we will continue to be behind the eight-ball and we will have more infections and more deaths than we should have had.

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