Copyright 2020 Robert Clark
A recent Chinese study testing hydroxychloroquine for the coronavirus has been badly reported on by the media:
Hydroxychloroquine Use For COVID-19 Coronavirus Shows No Benefit In First Small—But Limited—Controlled Trial.
Tara Haelle Senior Contributor
The headline is highly misleading, but this is how most articles on this research is being presented.
But reading what the article actually says is different than the impression the headline gives. The headline falsely gives the impression the conventional treatment group or control group didn’t get any medicine and all they did was give bed rest and perhaps some inhalers, and that for either testing group or control group there was little improvement. Actually, no.
ALL patients both in the test group and control got antivirals. Plus, most importantly ALL patients showed no virus after two weeks. They were essentially cured!
Here's the passage in the article by Ms. Haelle where it is discussed that all patients received antivirals of some type:
Usual care included bed rest, oxygen inhalation, and antiviral or antibiotic drugs as needed or recommended according to the hospital’s treatment plan. All patients in both groups received interferon alpha with a nebulizer, and umifenovir—an antiviral treatment approved in China for influenza—was administered to 67% of the usual care patients and 80% of the patients receiving hydroxychloroquine. Two patients received lopinavir-ritonavir, an anti-viral normally used to treat HIV infections.
And here it is discussed in Ms. Haelle's article the results showing all patients tests and controls were free of virus in two weeks:
Here were the main findings:
The focus has been so much in the news articles describing this research in disproving hydroxychloroquine, that they completely overlook the fact that hospitalized patients with the disease showed a 100% cure rate after using certain antivirals!
Ms. Haelle has done an admirable job in summarizing in English the results of the original research report written in Chinese. I advise everyone also to read the original research report. It can be downloaded here:
To see an English translation, uploaded it to translate.google.com under the "Documents" option:
Ms. Haelle mentions both test and control group patients temperatures returned to normal at same rate, but in fact it took on average only 1 day(!) for their temperatures to return to normal, a key indicator for lessening in the severity of the disease. Also important in regards to the rapidity of response to the medication, in both test and control groups while all patients tested negative in two weeks for the virus, in about 90% of the cases, they tested negative in only one week. Moreover for the control group, it took on average only 2 days for the patients to test negative for the virus.
A rapid positive response to the medication is extremely important. The longer the disease persists the more damage is done to the lungs. This increases the likelihood the patient will have to be intubated, where a tube is inserted down the throat and a ventilator is used to assist with breathing.
However, doctors treating COVID-19 patients have noted that only 1/3rd to only 1/5th of intubated COVID-19 patients survive. This may be because at that point the damage to the lungs is too severe, or it may be the intubation itself is too damaging. In any case, it is extremely important to stop the progression of the disease before intubation becomes necessary.
In the Chinese study different drugs were given to different patients. But there was a common denominator for all the patients. The common denominator was that interferon alpha, a potent antiviral, was given to ALL patients. An internet search reveals that interferon of all three types, alpha, beta, and gamma, has previously shown success against other corona-type viruses such as MERS and SARS in all of test tube, animal, and human studies.
Then THIS should be the focus of the articles reporting on this research, that there maybe a drug that has a 100% cure rate for hospitalized patients with COVID-19.
Aside, from the effectiveness of interferon alpha, you really can't make any conclusions on the effectiveness of hydroxychloroquine from this study. The reason is the interferon alpha was 100% effective, and it's pretty hard to improve on 100%!
Since interferon alpha was given to even the hydroxychloroquine patients, it's hard to disentangle the hydroxychloroquine effectiveness from that of interferon alpha. It could be 0%, it could be 50%, it could be 100%, just like interferon alpha. You can't tell since it was always combined with the interferon alpha.
Better would be a study that applied hydroxychloroquine and interferon alpha to separate groups of patients. Likely though for this recent study they didn't want to do that since this was for hospitalized patients and it was felt unethical to give patients only an unproven treatment.
Now that hydroxychloroquine has been reported to have some success against COVID-19, such a study could be undertaken that compared it to interferon alpha in separate groups.
By the way, if interferon alpha really is 100% effective, can there be any benefit in using instead hydroxychloroquine? Conceivably there could be. If say HCQ, perhaps with its associated side medications of azithromycen and zinc, proves to be 90%+ effective as a protective against COVID-19 likely you would have to be taking it continually while the virus is considered actively spreading. Then since HCQ is so well characterized over decades for millions of people for long term use, you would have more understanding of its side effects than for interferon alpha under a scenario of long-term use.
UPDATE, April 10, 2020:
UPDATE, April 10, 2020:
In this review article the authors also suggest that interferon can be used to treat COVID-19 with the recommendation it should be used in the early stages of the disease, and perhaps it can also act as a prophylactic(protective) agent:
Available online 7 April 2020, 104791
In Press, Journal Pre-proof
Type 1 interferons as a potential treatment against COVID-19
Erwan Sallard 1, François-Xavier Lescure 2,3, Yazdan Yazdanpanah 2,3, France Mentre 2, Nathan Peiffer-Smadja 2,3
for the C-20-15 DisCoVeRy French Steering Committee
The authors here though argue interferon beta(IFNβ) is a more potent inhibitor of corona virus than interferon alpha(IFNα). Certainly interferon of all three types alpha, beta, and gamma should be tried as treatments.
UPDATE, April 16, 2020:
This research preprint on a trial of interferon also showed it significantly reduced the length of time of detectable virus and lung inflammation:
Qiong Zhou, Xiao-Shan Wei, Xuan Xiang, Xu Wang, Zi-Hao Wang, Virginia Chen, Casey P Shannon, Scott J Tebbutt, Tobias R Kollmann, Eleanor N Fish
This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.