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My Hydroxychloroquine Deep Dive - long thread

Gotta start with this chart many of you have seen by now

In early June after months of following articles, treatment protocols, declarations, etc. I was curious about how the countries lined up. For the most part, it's accurate
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
I wanted to address the chart first, because its not a work of great science. It was meant to provoke thought and discussion.

Along the way, some saw it as proof. It's not, but it does make you say "hmm.."

In this thread, I'm going to try and go much deeper into the data
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 c19study.com @CovidAnalysis

Countrywide Data: country data is also very important for reasons I will explain shortly
The problem with proving that HCQ works is that 99.5% of people who get Covid do not die

The problem with Dr Raoult's early findings is that his patient base was fairly young so while his results were excellent, it was hard to evaluate them without a control
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 cohort

preprints.org/manuscript/202…
The NIH is currently conducting one such large scale RCT which should give us a pretty definitive answer, but so far I know nothing of its progress

If anybody knows more, please share

clinicaltrials.gov/ct2/show/NCT04…
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
Here are some of the positive studies of note:

Michigan 2,541 patients retrospective

Treatment with HCQ cut the death rate significantly in sick hospitalized patients, no heart-related side-effects. HCQ decreases mortality from 26.4% to 13.5% (HCQ)

ijidonline.com/article/S1201-…
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)

link.springer.com/article/10.100…
Portugal Study
Results: 77 (0.29%) of 26,815 C19 positive patients and 1,215 (0.36%) of 333,489 negative patients were chronically treated with HCQ (P=0.04)

Conclusions: data suggest that chronic treatment with HCQ confer protection against C19 infection
medrxiv.org/content/10.110…
And for you Zincophiles, there is a study showing that the addition of Zinc does indeed help over just HCQ+AZ

medrxiv.org/content/10.110…
Negative Studies:
This is the infamous VA retrospective study where the HCQ arm was significantly sicker

This got huge headlines

medrxiv.org/content/10.110…
Then came the NEJM study where they
1) did a crazy propensity matching to align two arms which barely overlapped

2) conflated intubation or death into a single outcome but didn't provide seperate numbers

nejm.org/doi/full/10.10…
Then there was the Lancet study which was based on the implausible Surgisphere database compliments of Sapan S Desai, MD

WHO recommended an end to HCQ use based on this study which later had to be retracted, because the data was allegedly fake

thelancet.com/journals/lance…
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



medrxiv.org/content/10.110…
Overall, there are more positive than negative studies

The negative studies are mostly about treating very sick patients with HCQ which is known not 2 work

I believe there is some amount of bad faith involved here

It has been 4 months and we do not have one proper RCT study...
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
Country data is important because it allows you to resolve the 99.5% will live problem

If comparing countries with similar age pyramids and testing, significant differences can indicate that treatment is a significant factor
Algeria - Started using Chloroquine in late March. Results came very soon

According to one infectious disease specialist, "near-total effectiveness."

translate.google.com/translate?sl=f…
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
Russia - has an incredible CFR of 1.6% and does fewer tests per million than the UK which was a CFR of 15% percent. That's a 10 fold difference

Russia's treatment protocol: Treat early and often with HCQ

translate.googleusercontent.com/translate_c?de…
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 Covid
translate.google.com/translate?hl=e…

translate.googleusercontent.com/translate_c?de…
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!
So this happened, the only RCT which could settle the debate on early use HCQ was shut down because they only have 20 subjects since May

Draw your own conclusions

I hear there are plenty of volunteers to populate (30k) Moderna’s mRNA vaccine trial
Missing some Tweet in this thread? You can try to force a refresh.

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