“Available evidence of efficacy of HCQ+AZ has been repeatedly described in the media as “anecdotal,” but most certainly is not.”
A new article to be published by Oxford University Press, on behalf of the Johns Hopkins Bloomberg School of Public Health, calls for hydroxychloroquine and azithromycin to be made widely available and promoted immediately for physicians, to be prescribed for early outpatient treatment.
The article, titled “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis,” is authored by Professor Harvey Risch, MD, from Yale University.
Dr. Harvey Risch is Professor of Epidemiology in the Department of Epidemiology and Public Health at the Yale School of Public Health and Yale School of Medicine. Dr. Risch received his MD degree from the University of California San Diego and PhD from the University of Chicago. He was a faculty member in epidemiology and biostatistics at the University of Toronto before coming to Yale. Find his complete bio here.
We Cannot Afford the Luxury of Perfect Knowledge
Professor Risch recognizes that, in an ideal world, randomized double-blinded controlled clinical trials are preferable, yet, regarding ongoing randomized trials with HCQ+AZ, he notes:
“For the earliest trial, between now and September, assuming a flat epidemic curve of 10,000 deaths per week, I estimate that approximately 180,000 more deaths will occur in the US before the trial results are known.”
“In this context, we cannot afford the luxury of perfect knowledge and must evaluate, now and on an ongoing basis, the evidence for benefit and risk of these medications.”
The author describes various studies. He also compares the case fatality rates typically observed without treatment to those with HCQ+AZ treatment.
For example, he notes that there was 12-13% mortality of hospitalized patients receiving placebos in the remdesivir trials both by Wang et al and in the ACT trials sponsored by NIH.
Professor Risch also discusses the issue of adverse events, which brings him to conclude that:
“the FDA, NIH and cardiology society warnings about cardiac arrhythmia adverse events, while appropriate for theoretical and physiological considerations about use of these medications, are not borne out in mortality in real-world usage of them.”
“It would therefore be incumbent upon all three organizations to reevaluate their positions as soon as possible,” writes Professor Risch.
It is Our Obligation Not to Stand By
The analysis by Professor Risch brings him to the following concluding remarks.
“Some people will have contraindications and will need other agents for treatment or to remain in isolation. But for the great majority, I conclude that HCQ+AZ and HCQ+doxycycline, preferably with zinc can be this outpatient treatment, at least until we find or add something better, whether that could be remdesivir or something else.”
“It is our obligation not to stand by, just “carefully watching,” as the old and infirm and inner city of us are killed by this disease and our economy is destroyed by it and we have nothing to offer except high-mortality hospital treatment.”
“We have a solution, imperfect, to attempt to deal with the disease. We have to let physicians employing good clinical judgement use it and informed patients choose it.”
“There is a small chance that it may not work. But the urgency demands that we at least start to take that risk and evaluate what happens, and if our situation does not improve we can stop it …”
“… but we will know that we did everything that we could instead of sitting by and letting hundreds of thousands die because we did not have the courage to act according to our rational calculations.”
See summary in American Journal of Epidemiology.
See original unedited manuscript at this link.
See also this segment of our video interview with Professor J. Varon about early therapies for COVID-19.