Here are some notes from the groundbreaking interview of Professor Didier Raoult of April 28 which covers the evolution of the epidemic, including its slowdown in various countries / regions; what we know today about the disease and its different phases; what is known about early treatment with hydroxychloroquine, including the risks; what is the role of medical doctors; and the progress made in France for intensive care treatment.
In the interview, Professor Didier Raoult, ranked number 1 among the world’s infectious disease experts, comments on the media treatment of the early treatment he recommends.
“Hydroxychloroquine, chloroquine, these are incredibly used drugs … I don’t even know how the media could have gone mad around this story. It is a real madness disconnected from reality … It was just needed to speak to any doctor to know that the plaquenil is harmless … All of a sudden, we learn it’s a toxic product . It is appalling, it is completely delusional … We must return to reason, reason must regain its rights, and we must stop considering that this drug, which was discovered 80 years ago, and which has been used since, became toxic in 2020.”
For Professor Didier Raoult, the majority of doctors reacted very well to the need to treat the disease. However, concerning doctors who do not intervene quickly and let the disease progress without treating it, he says that it goes against the principles of medical practice since … Hippocrates.
Professor Raoult also commented on treatments in intensive care units, in intensive care in France: “Something has happened that is quite remarkable, absolutely extraordinary, it is the quality of care in intensive care units.”
(note: these are notes taken quickly and then translated into English – please refer to the original interview in French)
Evolution of the Epidemic
In this new interview, the Professor first discusses the evolution of the epidemic.
- that the COVID-19 epidemic follows the typical bell curve for epidemics
- that epidemics are disappearing, that humanity has not disappeared because of an epidemic, and that we do not know why epidemics disappear
- that ecosystem phenomena, that are not understood, are at the basis of the transmissibility of viruses
- he presents some graphs, where we can see the bell shape for Italy, Turkey, Germany, France
- he cites a study officially recognized in France which predicts that 99% of cases will have occurred by around May 19
- he thinks that at that time, in May, the transmissibility of the virus will be lower
- he doesn’t think there will be a rebound, a second wave
- he doesn’t think 70% of the population should be immune to control the epidemic
- he thinks that these last two elements are kind of virtual, that they do not emanate from facts, from actual observations
The Phases of the Disease
Professor Raoult then comments on treatments for the coronavirus. He insists that now we know this disease well, and that there are several phases.
He first gives some figures:
- 25,000 people who have been tested at the IHU in Marseille;
- positivity rates peaked at 22%,
- it’s now down to 5 or 6% positive;
- among staff, about 3% have been infected, as this is equivalent to what is happening in the general population
- approximately 4000 patients were followed
- 3300 were followed in day hospital as outpatients
- 630 were hospitalized
- 1500 strains have been identified; 1300 are under culture
- 1900 low dose chest scans were performed,
- chest scans are very important because they show lung damage in people who are apparently not symptomatic
- 7,500 electrocardiograms were performed and supervised by cardiologists
- 434 genomes have been sequenced and 309 analyzed
- approximately 1400 dosages of hydroxychloroquine, 500 dosages of azithromycin and 300 dosages of zinc were carried out to understand the drugs and to avoid any overdose (Important to note here the appearance of Zinc in the dosages carried out)
Treatment of the Disease
Thanks to considerable experience with treatment and a database of 3,500 patients, here are Professor Raoult’s comments.
- there are several stages to the disease.
- the first phase, which they call the incubation period, is between when the patient catches the virus and when he is symptomatic;
- the only thing at that the time of this incubation period is the virus, and sometimes people don’t even realize they have the virus
- the next period is the clinical period. There, the patients are sick, they have a fever. It’s the most common manifestation.
- from a therapeutic perspective, the virus is then the target, but needs to be treated relatively early.
- he says it’s known for the flu for example. Tamiflu works for the first, second day of the flu, and then it doesn’t work.
- we know that for viral infections, it is at the beginning that it is necessary to treat,
- after, the response against the virus is so strong that the problem is no longer the virus
- gradually, there is no longer a correlation between the viral load (the number of viruses) and the severity of the disease, and in the end, there are no more viruses.
- so there is a real sequence / evolution for the the disease, which is first a viral disease, then it becomes both viral and an immune response, and then it’s just a disease related to the immune response
- once the patient is healed, there is another risk, that of pulmonary fibrosis, which can make the lung no longer work at all, even when we thought the patient was cured
- each phase of the disease corresponds to a therapeutic phase
- in order to be able to treat people at the start, I always said, you have to deal with drugs that have anti-viral efficacy and are not toxic. There should not be too significant risks compared to the expected benefits.
- this is one of the reasons why drugs such as Remdesivir cannot be prescribed for this because their toxicity is too great;
- regarding Remdesivir, you can see it very well with the study which quickly disappeared from the WHO website …
- (note that this randomized study, which found that “remdesivir was not associated with statistically significant clinical benefits” is now public – see our article)
- the toxicity of Remdesivir means that it cannot be given for a disease which at first is mild
- what you can do is to give harmless drugs, and the Chinese have done it too. the first study led the Chinese to decide to choose hydroxychloroquine over Remdesivir,
- why hydroxychloroquine? Because it is not toxic, it is cheap and it is available, which was a reasonable choice if we thought that it was necessary treat people early.
- then things get worse, and there it’s the immune response that becomes important. there are no more viruses. There is no longer any need for antivirals at this point. Because antivirals no longer work. There are no more viruses.
- the problem at this point is the immune response, even if there probably remains a place for hydroxychloroquine, which is a modulator of immunity.
- Hydroxychloroquine, chloroquine, these are incredibly used drugs.
- I do not even know how the media could have gone mad around this story. It’s real madness out of touch with reality. They are sick. It would have been simple to speak to any doctor to know that plaquenil is harmless and that people are given that.
- before the crisis, 1.2 million boxes of plaquenil were sold in 2019, so 36 million tablets of plaquenil.
- and all of a sudden, we discover that plaquenil is a toxic, appalling product – it’s completely delusional.
- a recent study of people using plaquenil for arthritis shows an absence of heart problem
- how this madness took the world is something that is mysterious
- always be careful: chloroquine and hydroxychloroquine, if taken in sufficient doses, you can kill you
- we must return to reason: it is a drug that can be used if we respect the right dosage.
- as for azithromycin, it is the drug that has been most prescribed for respiratory infections, including those that are viral, because often there are secondary bacterial infections
- luckily azithromycin is particularly effective in combination with hydroxychloroquine
- we have already treated more than 3000 people with this. things are going very well. there have been no medication related accidents.
- we must return to reason, reason must resume its rights, and we must stop considering that this drug, which was discovered 80 years ago, and which has been used since, became toxic in 2020
- people ate 36 million pills, just in the cities, because I’m not talking about those from the hospital, and it would have suddenly become a deadly thing?
- just ask your GP. everyone has already prescribed plaquenil. it’s not possible, it’s just an implausible thing that it suddenly become a deadly thing.
- what we forget is that this disease (COVID-19) causes damage to the heart – myocarditis. There are fatal myocarditis. Whether or not you are taking treatment, watch out as they can cause rhythm disturbances and death.
- we live in an era where we seek maximum safety, and it is legitimate to look at the things that are possibly associated with torsades de pointe: potassium base, co-medications, the length of the ECG QT interval,
- all of these are things you can do, and if you do that, you have no trouble; all this is very simple.
The Role of Medical Doctors
Regarding the role of medical doctors today in the crisis, here are the comments of Professor Didier Raoult.
- I found that generally speaking, medical doctors react very well.
- I think I am in tune with most of the practitioners, who see the sick and who say: listen, something has to be done.
- A lot of people react like this, so we give azithromycin, we give macrolides, we treat patients like that.
- The idea that we can leave people until they have respiratory failure without giving them anything … medicine has never done that.
- Medical doctors treat people. We give them something. At least to reassure them, to say that we take care of them.
- You can’t say: people are sick, they are left in a bed until they can’t breathe, and there they go to the hospital.
- This is against all principles of medical practice since … Hippocrates. We can’t do that. We can’t validate that.
- He comments on the situation of Paris versus that of Marseille: they use more hydroxychloroquine and azithromycin in Paris than in Marseille.
- Perhaps the media, but Parisian doctors and patients, they are no crazier than the others: they want the medications.
- It’s a story of Parisian media. But Parisians are normal humans, and when they are sick, they want to be treated.
- And Parisian doctors, when their patients are sick, they want to treat them. These are humans – not aliens.
About Treatment in Intensive Care
- something quite remarkable, absolutely extraordinary, has happened: the quality of care in intensive care units.
- I know it’s like that in Marseille. In Paris, my friends tell me the same thing. When there are these forms of respiratory distress, in general the mortality is more than 20 or 25%.
- In the American data series, what we see are absolutely considerable mortalities.
- what friends and colleagues tell us is that we have a much lower mortality: 9 or 10%. A colleague in Paris told me the same thing: 9 or 10%.
- this is because they have a network of intensive care specialists and they exchange information that they have as they go, and which are not yet published, in particular regarding coagulation
- there are big coagulation issues. They changed their therapeutic approach. They adapted it by giving anti-coagulants as soon as possible, to avoid pulmonary embolism, which can be a cause of sudden death.
- they also used “outside protocol” medication to control the immune response.
- when this immune response goes crazy, you have to control it, and there are drugs for that;
- such drugs should be used, even if there are no randomized studies, because this is about saving the lives of people in a situation that is compassionate;
- these tools must be used: when you have such severe situations, you have to use whatever you can to save people’s lives
- this approach there and the French ICUs amount to an incredible reaction, because the ICUs were overflowed, there are units that were installed in conditions that are almost war conditions – yet the result is quite exceptional.
- we could have had 30% more deaths, if it had not been for the quality of care in the ICUs.
- I think that is very good and that many people have been saved thanks to high quality ICU treatment.
- regarding the last phase, after intensive care, there are real questions, and pulmonologists will take care of that, for how to detect pulmonary fibrosis
- pulmonary fibrosis happened with people treated in ICU who have had this terrible inflammatory reaction, but also in other situations, which pose a real question for the future.