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The Lancet HCQ study claims to include 63,315 hospitalized COVID-19 patients from N. America by April 14.

By Apr 14, total COVID-19 hospitalizations for USA, Canada & Mexico was only ~67,000.

There's no way Surgisphere collected data on nearly every covid patient in N. America.
If just a handful of North American hospitals confirm that they did NOT share data with Surgisphere, then the Lancet study numbers cannot possibly be true.
Lastly, the Lancet study claims to have collected patient data from 559 hospitals in N America.

There are 6,146 hospitals in the USA, and >12,000 hospitals in USA, Mexico & Canada.

Was there really 63,315 COVID-19 hospitalizations in a fraction of the total hospitals by Apr 14?
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James Todaro, MD
@JamesTodaroMD
1/ My thoughts on the NY study on HCQ published in NEJM.

First, use of a "composite endpoint" of death + intubation is strange. Composite endpoints are reserved for studies with rare endpoints. However, death wasn't rare in this study, occurring in >10%.

nejm.org/doi/pdf/10.105…
2/ Moreover, the authors fail to provide number of deaths or intubations in the propensity-score matched control group (n=274)—leaving us unable to calculate our own mortality rate comparison. (Authors omit this from the supplementary table below.)
3/ Secondly, the study does not address the fact patients in respiratory distress treated w/ HCQ had better outcomes.

Assuming intubation indicates severe resp distress, intubated patients treated w/ HCQ had a 68% probability of surviving (compared to only 35% in no-HCQ group).
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James Todaro, MD
@JamesTodaroMD
1/ Cuomo’s office says NY trial results on hydroxychloroquine will be released April 20.

Few details are available, but it seems HCQ was primarily used in hospitalized patients.

With the current state of NY hospitals, it's likely only the sickest #COVID19 patients received HCQ.
2/ Treatment of advanced stage COVID-19 w/ HCQ will likely show minimum to no benefit. (Bear in mind it can take ~2 days for HCQ to reach therapeutic levels.)

First, the benefit of viral load reduction from HCQ may no longer be important once the cytokine storm path is activated
3/ Secondly, although HCQ has anti-inflammatory/immunosuppressive properties, it is probably minimally effective at inhibiting cytokine storm/CRS in late stage COVID-19.

Alternative agents such as the anti-IL-6 monoclonal antibody Tocilizumab may be more effective in late cases.
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James Todaro, MD
@JamesTodaroMD
A tale of two drugs by the Washington Post.

Both articles refer to studies without randomized control groups.

I wonder how the Washington Post decides which drugs are “hopeful” and which are a “false hope”?

#hydroxychloroquine #Gilead #Remdesivir #COVID19
Also, of course, the Remdesivir study was funded by Gilead and the NEJM manuscript written by a Gilead employee...Weird that the conflict of interest wasn't mentioned by the Washington Post.
Source: nejm.org/doi/pdf/10.105…
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