Thursday, May 14, 2020

Success in Italy reported in early treatment of COVID-19 using hydroxychloroquine.

Copyright 2020 Robert Clark

 It is becoming abundant clear that antiviral treatments for COVID-19 are most effective when given early. Drs. Raoult and Zelenko have stated this repeatedly in regards to HCQ yet in the U.S at least studies keep being done with HCQ on patients who are already under severe disease condition.

The importance of early treatment with HCQ is illustrated by a recent news article from Italy.
From Google Translate:

SCIENCE Coronavirus - From North to South 1039 patients treated with hydroxychloroquine at home. The point on experimentation: "Collapse of hospitalizations".
"I am a doctor and, positive for Covid19 , I immediately took hydroxychloroquine : in 3-4 days the fever and other symptoms disappeared ". This is how Paola Varese , head of cancer medicine at the Ovada Hospital in Piedmont , begins . "I applied the same protocol on myself that I planned for 276 patients at home," continues Varese , stressing that "timely intervention by family doctors in patients' homes is essential, with hydroxychloroquine associated with heparin (and if necessary the ' antibiotic ). It is presumable - he says - that the collapse of the hospitalization is due to the immediate use of the drug : we only had 7 hospitalizations: according to the projected expectations of the ISS we should have had 55 ".

 So the hospitalization rate dropped by a factor of 8 for the cases seen by this doctor. This fact would be extremely important to know in infection clusters such as New York, which was close to being overwhelmed by the number of hospitalized cases.
 According to this article, in New York only 20% of COVID-19 patients put on ventilators survive, so an 80% mortality rate for those on ventilators:

A bridge between life and death: Most COVID-19 patients put on ventilators will not survive
John Bacon

 Imagine if the Italian numbers of HCQ prevention of hospitalizations held true in New York. The number of hospitalizations and subsequent deaths could have been cut by a factor of 8.
 Also important is it could have dropped the death rate by an larger factor than 8.
 The death rate might have dropped by an even larger number than just by a factor of 8 because it seems likely that for those cases that were admitted to hospital the severity would also have been reduced. Indeed that was what was noted by doctors quoted in the Italian article.
 This fact about the reduced hospitalizations also shows why even small studies can be important. The HCQ studies done so far have been criticized because they were small in number, or wasn’t randomized, or without controls. But imagine a situation like in New York where a hospital may have seen in the range of 200 HCQ admissions in a week, imagine that being dropped to in the range of only 25. The doctors in that hospital wouldn’t care that this is only a small sample or it wasn’t randomized or didn’t have a control group. They would only care their case load was radically reduced, which allows them also to focus more on the patients they already have.
 So you don’t need to have a randomized controlled double-blind trial with thousands of cases costing tens of millions of dollars and taking months to complete. If every hospital that tried the policy of giving HCQ once someone tested positive prior to severe symptoms or any symptoms appearing, and all those hospitals within a matter of days saw their new cases dropped by a factor of 8, that would be powerful evidence for the effectiveness of HCQ.
  Another doctor in Italy even advises giving HCQ on the first signs of symptoms even before a positive test comes back. The reason is it takes days to get the test results back during which time the disease is getting worse. So give the medication as soon as possible:

Coronavirus, the method that avoids the massacre: "No patient has died"
Piacenza flooded with infections. The first dead. Then the idea of ​​Dr. Luigi Cavanna: home-to-home care. "So patients heal"
Giuseppe De Lorenzo Andrea Indini -Fri, 08/05/2020 - 07:55

 This shows another important fact about the drop in hospitalizations using HCQ early. A criticism of the small studies with HCQ is that most patients get better anyway so you would need a large sample size to show a statistically important difference in death rates when using HCQ.

But because the drop in hospitalizations is by such a large factor over not using early HCQ you can see easily the effect of using the HCQ.

 Moreover, since most patients who will need hospitalizations develop the serious symptoms within a matter of days, doctors in hospitals could see the reduction in the number of admissions within a matter of days. This is a key distinction over just looking at death rates because a patient could be treated for weeks in hospital before it is finally known if he will fully recover or not.
 It should be noted though that not all the Italian doctors quoted in the article agree with the effectiveness of HCQ in early treatment. From the English translation:
However, some of the scientific community remains cautious. According to the director of the infectious diseases department of the "Sacco" of Milan, Massimo Galli , "this drug (hydroxychloroquine) is used as an antimalarial prophylaxis , but it is not useful as a prophylaxis against this virus , and can cause serious damage to those suffering from heart and those with favism ”.
 It is not clear though whether or not Dr. Galli has treated patients early using HCQ so that he could determine whether or not it reduced hospitalizations. By the way, the “favism” he mentions is a condition that occurs at a higher rate among people of Mediterranean descent that he says HCQ could have bad side effect on. HCQ would have to be given with knowledge of the patients prior health history.
 Also, not all doctors quoted in the article saw the large factor of 8 drop in hospitalizations. Of the doctors quoted using HCQ early, one saw a drop by a factor of 6 and two others saw a reduction by a factor of 2 in hospitalizations. The variation might be due to how early the HCQ is given after infection.

Note: there is a problem with the google translation with the Italian word “sfebbrata”. The original Italian passage is this:
Se prima del trattamento si avevano alterazioni della temperatura fino a 10-12 giorni, dopo l’introduzione sistematica di idrossiclorochina, il 75% delle persone si è sfebbrata entro il 4° giorno e l’85% entro l’8° giorno”.
Google translate gives this in English as:
If before the treatment there were changes in temperature for up to 10-12 days, after the systematic introduction of hydroxychloroquine , 75% of the people choked by the 4th day and 85% by the 8th day “.
The English word “choked” doesn’t fit here since the doctor being quoted is describing positive benefits of HCQ. I did a web search and a better meaning here should be “fever broke”. This fits in the sentence since it is describing high temperatures.
Another minor issue is this with this passage in the original Italian:
“Tra i 169 pazienti trattati non vi è stato nessun decesso. Il 7% dei trattati è stato ricoverato, ma nessuno ha sviluppato complicanze gravi, né ha avuto alcun effetto collaterale durante il trattamento”.
Google translate gives this as:
“Among the 169 patients treated there was no death . 7% of the treaties were hospitalized , but none developed serious complications , nor had any side effects during treatment "..
It would be easy to misread the google translation of the hospitalizations as “.7%”. Instead of the correct 7%. But this is because the “7” comes after the period of the prior sentence.

  Bob Clark

1 comment:

  1. We haven't seen real traceable test results for this yet. Soon we will. Then we'll know.

    The test results for Remdesvir show that it helps, but only somewhat. We can trust that result. More are on the way, just not completed yet.