How Could a Treatment-Based Strategy to “Covexit” Work?

Here is a preliminary discussion about how a treatment-based strategy could help us to fight the pandemic and progressively “covexit” the crisis.

This analysis is based on the latest scientific developments, which show that effective treatment for COVID-19 exists, in the form of hydroxychloroquine-based medication administered early to patients. There are various possible combinations, yet the one that was subject to the most extensive research combines hydroxychloroquine and azithromycin.

In the most recent study by Professor Didier Raoult and his team in Marseille, there was just a 0.47% case fatality rate among the treated patients. The fatalities were all older than 71 in the context of that study that encompassed 1061 patients. The vast majority of treated patients recovered within 10 days. Only 10 out of 1061 patients required to go to the ICU. See details of the study here.

There are indications that the treatment could be even refined, with Zinc now seen by some researchers as playing a key role in improving the efficacy hydroxychloroquine. See details here.

Of course, other treatments are being tested and may also become available. What’s important for this analysis is that effective treatment exists, and that treatment-based strategies can now be designed to “covexit” the crisis and progressively return to normal economic and social life.

An hydroxychloroquine based treatment-based strategy to fight the pandemic has considerable implications. To be effective, research has demonstrated the medication has to be administered early.

This is NOT an end-of life, a compassionate treatment. It’s a treatment to be administered to patients before severe symptoms.

This means that mass testing, and mass early treatment are needed.

Large scale hydroxychloroquine-based treatment is not new for COVID-19. There are already several countries that are using hydroxychloroquine-based treatment on a substantial scale, including Italy, Spain and the US. What happened so far in those countries is that treatment has often been provided at a late stage, because of the emergency situation and because the need to treat early was not yet clear.

Fortunately, the three key molecules at stake for the various formulations of the treatment: hydroxychloroquine, azithromycin and zinc, are extremely cheap and can be mass produced. The US already has stockpiled millions of doses of hydroxychloroquine.

In the short term, in the US and elsewhere, there are shortages, but pharmaceutical groups such as Novartis, Bayer, Mylan, Teva, Sanofi and others have pledged to boost production.

Let’s remember, for about 80% of the people contracting the virus, there will only be mild symptoms, or no symptoms at all.

Approximately 20% of the infected people develop serious symptoms and need medical care.  It’s on those 20% that early hydroxychloroquine based treatment needs to focus.

This would be a large scale implementation of a three pillar approach, relying on testing, isolation and treatment. 

1. People must be diagnosed via testing. 
2. Infected people must be isolated, not to infect others. 
3. Infected people must be treated.

See here for background.

The Considerable Advantages of an Early Treatment Strategy

An early hydroxychloroquine-based treatment strategy, which can be implemented immediately, has numerous and considerable advantages.

1. Wide-scale early treatment will save countless lives. If administered under medical supervision, treatment is extremely low risk, yet is anticipated to be life-saving in many instances. Saving those many lives alone should be a sufficient argument to adopt the strategy immediately.
   
2. Treating early is also critical to avoid long-lasting consequences of COVID-19 infection. Lung function impairment, due to lung fibrosis, is the main issue. When later treatment is provided, there is a higher risk of permanent reduced lung function.
   
3. With early treatment, much fewer patients will need long hospitalization or intensive care. In Marseille, the mean hospitalization duration is 5 days. For sure, some patients recover without treatment, but those patients need a longer hospital stay, and their therapeutic outcome is more uncertain. The more one waits, the less effective the treatment is.
   
4. Early treatment could be implemented in many instances through telemedicine. People take the treatment home, but they are closely monitored through telemedicine. This is a key element of the strategy recently decided by the Canadian province of New-Brunswick. This provides further relief on hospitals and other medical facilities, which focus on those developing complications.
   
5. Wide-scale early treatment is anticipated to considerably relieve pressure on the medical systems and on health care workers. By now, everyone knows about the urgency of flattening the curve. This can be even more effectively achieved with  early treatment of those diagnosed with the disease.
   
6. The isolation of contagious patients, that comes with wide-scale early treatment, will contribute to reduce the spread of the disease. Let’s keep in mind that herd immunity will not be achieved any time soon in the population. Isolating sick patients, and giving them therapy, is a key to reduce the spread of the disease. 
   
7. Wide-scale early treatment is cheap to implement. The medications are cheap – less than US$20 per person for the full treatment – and when needed, most hospital stays will be short and will not require much medical staff involvement. Very few patients will require intensive care treatment.

There are still numerous unknowns about this virus. Yet what we already know is that early treatment works and countless lives can be saved right away.

Contrast this with a vaccination strategy, for which it’s impossible to say at this point if there will be a safe, effective vaccine, and when. Compared to an early treatment strategy, vaccination is clearly a much more uncertain course of action. 

It’s very likely this virus will be with us for a number of years. But once the current crisis is over, there should be enough medical knowledge about how to deal with it. It will likely not disappear, but it should be manageable, through early hydroxychloroquine-based treatment and possibly other therapies, yet to be found or perfected.

From an economic and social perspective, an early treatment strategy will have considerable benefits.

Thanks to immunity gained by a growing number of people, and the declining number of infectious people, the strategy will progressively allow for economic activity and normal social life to safely resume.

All of this can happen in a much shorter and realistic timeframe than if one needs to wait for a vaccine.

 © 2020 Jean-Pierre Kiekens. All Rights Reserved.