Hydroxychloroquine: The One Chart You Need To See

With conflicting reports over the efficacy of hydroxychloroquine (HCQ) in treating COVID-19, and large-scale studies pending, it would be really great to have a 10,000-foot view of everything we know about the anti-malaria drug that a host of doctors swear by – and which has been standard treatment protocol in some countries but not others.

To that end, Twitter user Gummi Bear has conducted a ‘deep dive’ into virtually everything we know about HCQ – which starts with this must-see chart comparing country-level case-fatality rates (CFR) by HCQ use. Entire thread embedded below:

It’s not perfect as HCQ was also used in Belgium and Spain and later in Italy, but the idea is that Western Europe as a whole never embraced the ‘treat early and often’ strategy. Mostly they tried it with sick patients, didn’t work..moved on

They mainly followed the WHO position

— Gummi Bear (@gummibear737) July 16, 2020

Mainly I want to talk about two types of data:

Scientific Data: lots of studies on HCQ are out and you can find them here https://t.co/A1OhQjPnRC @CovidAnalysis

Countrywide Data: country data is also very important for reasons I will explain shortly

— Gummi Bear (@gummibear737) July 16, 2020

The necessary study to do is testing HCQ with high risk outpatients – treat early and often@zev_dr did this with good results, but unfortunately, it’s not an RCT and small cohorthttps://t.co/SMpJyrlTTC

— Gummi Bear (@gummibear737) July 16, 2020

Quick aside:

Nobody knows HCQ works – antiviral/anti-inflammatory, they are all theories

Zinc – I know the theory and its scientifically plausible but nobody knows the exact mechanism

— Gummi Bear (@gummibear737) July 16, 2020

NYC Study – 6493 patients, laboratory-confirmed C19 w clinical outcomes between Mar 13 and Apr 17, 2020

Kaplan-Meier estimate showed lower mortality in hospitalized patients who received hydroxychloroquine (log rank Pvalue < 0.001)https://t.co/bG3RnACYnj

— Gummi Bear (@gummibear737) July 16, 2020

And for you Zincophiles, there is a study showing that the addition of Zinc does indeed help over just HCQ+AZhttps://t.co/c3ZlEFeIB8

— Gummi Bear (@gummibear737) July 16, 2020

Then came the NEJM study where they
1) did a crazy propensity matching to align two arms which barely overlapped https://t.co/12wEQ30uqY

2) conflated intubation or death into a single outcome but didn’t provide seperate numbers https://t.co/jUeZMdsZ0shttps://t.co/ditCq8Ztpy

— Gummi Bear (@gummibear737) July 16, 2020

The famous RECOVERY RCT trial which showed no benefit in late use. Around 25% died in

There were however some strange dosing issues covered extensively by @JamesTodaroMD https://t.co/Vijr1fX5d1https://t.co/y5zBuL1HNj

— Gummi Bear (@gummibear737) July 16, 2020

For country data there are two types of analysis

1) differences caused by the introduction of HCQ into a population previously not receiving it

2) early treatment protocols in countries that significantly outperform other countries with similar age pyramids

— Gummi Bear (@gummibear737) July 16, 2020

Brazil: I covered it in this tweethttps://t.co/rKYdf4A4U8 pic.twitter.com/JgDBOA4KVP

— Gummi Bear (@gummibear737) July 16, 2020

Morocco – Also started treating in late March

Again, almost immediate results

Fun fact: more people have died of COVID in the Moroccan diaspora than in Morocco! Think about that for a second…

I tried to find that article where I read that but couldn’t pic.twitter.com/BmxpTmV3wp

— Gummi Bear (@gummibear737) July 16, 2020

Ukraine, similar to Russia, has a low CFR of 2.5% CFR but unlike Russia it has 1/10th the testing of the UK

This was hard to find, but here are Ukraine’s treatment protocols – immediate treatment upon suspicion of Covidhttps://t.co/5ydBdJu1P5https://t.co/J6AGSfrmmM

— Gummi Bear (@gummibear737) July 16, 2020

Conclusions:

HCQ Studies are overwhelmingly positive

Negative studies get lots of attention but have some serious flaws

Country data offers some convincing arguments

Need to wait for RCTs to be proven

If you liked this deep dive please RT the first tweet in this thread!

— Gummi Bear (@gummibear737) July 16, 2020