Earlier this week, the news media was abuzz over a study performed by the VA purporting to show that the anti-viral drug hydroxychloroquine (in some cases paired with azithromycin) had no positive effect on Coronavirus patients -- and may have increased the likelihood of patients dying. Others have written about the media's bizarre and sloppy hostility toward any promising developments around this potential therapy, in some cases actively seeking out negative angles and anecdotes to report on instead.
In some ways, this treatment has become a culture war proxy for loving or hating President Trump, who has frequently mentioned the treatment. Hardcore Trump fans often seem too inclined to unduly tout it as something of a miracle cure (he can't be wrong!), while his relentless detractors almost appear to be rooting against the drug working (he can't be right!). Unlike previous embarrassing misfires, the limited VA study at least gives us some actual information to consider:
A malaria drug widely touted by President Donald Trump for treating the new coronavirus showed no benefit in a large analysis of its use in U.S. veterans hospitals. There were more deaths among those given hydroxychloroquine versus standard care, researchers reported. The nationwide study was not a rigorous experiment. But with 368 patients, it’s the largest look so far of hydroxychloroquine with or without the antibiotic azithromycin for COVID-19...The study was posted on an online site for researchers and has been submitted to the New England Journal of Medicine, but has not been reviewed by other scientists. Grants from the National Institutes of Health and the University of Virginia paid for the work. Researchers analyzed medical records of 368 male veterans hospitalized with confirmed coronavirus infection at Veterans Health Administration medical centers who died or were discharged by April 11. About 28% who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone. About 22% of those getting the drug plus azithromycin died too, but the difference between that group and usual care was not considered large enough to rule out other factors that could have affected survival.
This limited study, which the Politico story concedes was not rigorous and had not been peer-reviewed, suggests that among this population, nearly three-in-ten Coronavirus patients who were administered hydroxychloroquine ended up dying from the virus, compared to roughly one-in-ten of patients who received "routine care alone." The cocktail of the malaria drug plus the antibiotic performed better than hydroxychloroquine on its own, but that combination's 'death rate' was still double that of patients receiving neither drug. Some critics are already questioning the usefulness and methodology of this research, and the piece quoted above notes that "the NIH and others have more rigorous tests underway."
Previous analyses of this drug have suggested that it may be more effective in patients with moderate symptoms, and there has been speculation that patients with certain underlying heart conditions may be at higher risk from taking it. I began to wonder if something else might have accounted for the worse death rate among those who received the treatment; for instance, was it more likely to be administered to people who were in worse conditions to begin with, almost as something of a last resort? If so, that could significantly skew the sample and lead to wrong lessons being drawn. If, however, patients with approximately similar symptom severity were given the drug around the same period of the virus' progression, and the death disparity was still significant, that would be more worrisome. And, voila:
Of note: Hydroxychloroquine was more likely to be prescribed to patients with more severe disease, which may help explain why patients who were given the drug were more likely to die. That’s one potential problem with the study, that not everyone was given the drug at the same stage of the illness.
The researchers say they tried to control for those differences, but with such a small sample size, it's difficult to land on any clear conclusions. Also, I'll just note that other small, flawed studies have produced more hopeful results on this front, and I find it difficult to simply discard the ample anecdotal experiences of Coronavirus recoverees who've attributed their own health turnarounds to receiving hydroxychloroquine. I've had a parade of doctors on my radio show in recent weeks, and every single one of them whose work overlaps with COVID-19 care has told me that they've prescribed this drug (or drug combination) to some patients. The results have ranged from positive to neutral. And these doctors are not alone:
"Sixty-five percent of physicians across the United States said they would prescribe the anti-malaria drugs chloroquine or hydroxychloroquine to treat or prevent COVID-19 in a family member," the survey, which questioned 1,271 doctors in 50 states, found. "Only 11 percent said they would not use the drug at all." In addition, a significant number of doctors said they would prescribe the drugs to those exposed to the virus as a preventative measure and would take it themselves if they became sick from the disease. "Thirty-percent of the surveyed doctors said they would prescribe the medications to a family member prior to the onset of symptoms if they had been exposed to COVID-19," they found. "Sixty-seven percent of surveyed physicians said they would take the medications themselves to treat COVID-19. Fifty-six percent said they would take the anti-malarial if they displayed symptoms and another 11 percent said they would take the medications if they got very sick from the virus."
I'm not a doctor, but I find it difficult to believe that nearly two-thirds of America's doctors would become blind, pro-hydroxychloroquine zombies just because the President of the United States has been talking up that particular treatment. (Allow me to digress briefly to say that Trump has probably went overboard in his boosterism, but was relatively disciplined in repeatedly stating that he did not know either way, and that people should consult with their physicians on the matter). Also, Trump -- along with New York's Democratic governor -- didn't latch onto this drug out of thin air. Cuomo didn't approve a massive real-time hydroxychloroquine test among more than 1,000 Coronavirus patients in the state based on nothing. This is my general takeaway:
As a layperson observer who’s watched this battle play out, I wouldn’t be surprised if it turns out that it’s a mixed bag: Helpful for some, neutral for others, potentially dangerous for others susceptible to certain side effects.— Guy Benson (@guypbenson) April 22, 2020
More than anything, I want people to recover. I want the treatment to work for that reason, not because of anything Trump has said. I cannot fathom what it must be like to live one's life in such a way that a drug assisting people recover from a terrible disease might be irksome because that might mean that a politician was right about something. In short, Dr. Fauci has been right on this: Let's wait and see the results of real trials -- because right now both the optimistic and pessimistic information we have remains limited. With dozens of therapies being actively tested, I'll leave you with hopeful information about non-hydroxychloroquine treatments, including remdesivir (Update: Ugh -- or is the 'ugh' premature?)
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