Hydroxychloroquine-Gate: A Lament
October 3 2020: A search for meaning in this unfolding public health debacle
The debate over Hydroxychloroquine (HCQ-Gate from hereon in, because why not) has been excruciating to watch: take it from someone who has spent a lot of time — almost certainly too much time — watching it unfold.
I can tell you, firstly, that HCQ is not a miracle cure for COVID-19, as it has been unhelpfully if sincerely advocated by certain individuals. But I can also tell you that, despite much of the current popular opinion, this previously harmless and uncontroversial anti-malaria drug has been shown to be an effective and safe treatment for newly-infected COVID-19 patients. Here is a selection of findings from recent academic studies on the drug:
“The randomized clinical trials performed to date demonstrate that hydroxychloroquine use in outpatients, safely reduces the incidence of the composite of COVID-19 infection, hospitalization and death” (Source).
“Early treatment with HCQ on the first day of admission is associated with a reduced risk of 53% in transfer to the ICU for mechanical ventilation” (Source).
“Use of hydroxychloroquine alone and in combination with azithromycin was associated with a significant reduction in-hospital mortality compared to not receiving hydroxychloroquine” (Source).
“Among all treatment modalities, antimalarial hydroxychloroquine ranked the highest cure rate. Therefore, this drug is considered as the first‐line of COVID-19 treatment” (Source).
“HCQ administration is safe for short-term treatment for patients with COVID-19 infection regardless of the clinical setting of delivery” (Source).
The best site for understanding the current research on HCQ is this aggregating page. While it cannot be guaranteed to be without editorialisation and agenda, it nonetheless offers the most comprehensive attempt to map out the combined findings of the HCQ research base. A clear majority — almost 75% in fact — of the 126 current studies (76 of which have been peer reviewed) report a positive effect of HCQ when treating COVID-19 patients, with an average of a 34% decrease in symptoms that rises to 64% with early treatment. It also finds no evidence of significant risk from taking HCQ, which shouldn’t be surprising given its safety as a treatment for malaria — as well as other chronic diseases such as lupus and arthritis — is well established, including for all age groups along with pregnant and nursing mothers.
Not surprisingly, the drug now finds a place in numerous treatment protocols, typically in combination with both zinc and the antibiotic Azithromycin. The combination of zinc in particular is crucial to the effectiveness of HCQ: zinc has been found to be a coronavirus inhibitor, and chloroquine a zinc ionophore that increases its uptake into cells. It now seems beyond doubt that if it had been used in this way from the start of the pandemic, HCQ would have saved potentially hundreds of thousands of lives.
This is a big call, I know — how could we have possibly gotten to this stage? Let me try and walk you through it. I present HCQ-Gate: a lament.
It all started off so promisingly for HCQ — a drug that has been proposed as an inhibitor of coronaviruses since this academic study into its derivative chloroquine in 2005. Back at the beginning of the pandemic, in February, chloroquine was found to show promise in treating COVID-19 patients, leading Chinese authorities to unanimously declare it to be the most promising treatment for COVID-19 out of tens of thousands of available drugs. At approximately the same time, South Korean disease experts began recommending HCQ along with HIV drug Kaletra.
So what happened? You know what happened: Donald Trump happened. The US President first came out in support of HCQ in combination with Azithromycin on the 21st of March, citing promising results from a small French study. With Trump picking a side, the now surely undeniable phenomenon of Trump Derangement Syndrome kicked in, as Trump’s political and media detractors swiftly got to work in their denouncements.
So yes, TDS has an inescapable role in HCQ-Gate. However, in fairness to the detractors of the drug, at least in the early stages of the debate, they had what appeared to be legitimate science to support their arguments. For we must now turn to these notorious studies that every HCQ-hating news article tells you have proven beyond any doubt the ineffectiveness and even danger of this drug.
First we have a study originally released in April, whose negative findings were immediately leaped on by mainstream news outlets to discredit HCQ (which, it should be remembered, was at this early stage still being widely prescribed). This was despite the fact that the paper had not yet been peer reviewed — although, as we will soon see, this peer review process also failed to pick up other glaringly flawed studies. As it turns out, the study never really gave HCQ a chance, given it was prescribed mainly to late stage patients with severe pre-existing conditions. Thus, not only were these patients actually the ones already likely to die, the study did not follow now accepted treatment advice that HCQ be administered early. This is one of the key points to keep in mind about HCQ-Gate: the drug must be administered early after infection to be effective. Studies that are not designed with this fact in mind are not going to accurately portray its clinical effectiveness.
Then we have a paper from New York, published in May, which was also criticised for making the same mistake of prescribing HCQ primarily to late stage at-risk patients (neither study also used the correct combination of both zinc and azithromycin). Nonetheless, the paper concluded: “Among patients hospitalized with COVID-19, treatment with hydroxychloroquine, azithromycin, or both was not associated with significantly lower in-hospital mortality.” Except, it wasn’t. When re-analysed based on the now accepted recommend treatment protocol for the drug, the data showed that HCQ “significantly and dramatically improved patient survival”: survival rates for hospitalized patients who received the drug approached 85%, rising to 90% when combined with azithromycin, but falling to as low as 53% with neither drug.
However this relatively innocent error in clinical procedure pales in comparison to the flaws found in several of the other notable HCQ-negative studies.
We have, for example, the Lancet study, which coincidentally (?) was released just days after Trump announced he was taking HCQ himself. Coming from one of the most respected medical journals in existence, it was immediately cited by mainstream media to advance their attacks on both the drug and the President. It also acted as the catalyst for World Health Organisation trials of the drug to be halted and for the drug to be pulled from use in many countries. What a shambolic episode of ‘science’ this was: the dataset used for the study was quickly questioned, an open letter from experts in dissent was written, the publisher offered a minor correction, the publisher retracted it and apologised.
Such farce is perhaps only surpassed by the now infamous RECOVERY (Randomised Evaluation of COVid-19 thERapY) study — with a tortured acronym like that, did it ever stand a chance? Certainly not, when the researchers inexplicably decided to give patients doses of the drug at poisonous levels: 2400 mg over a 24 hour period instead of the recommended 490mg. The study has been lambasted on various parts of the internet, perhaps most savagely but not unfairly as “The Marx Brothers doing Science”. A similar dosage was also used for the international Solidarity trial, with many arms of this study halted as a result of the negative outcomes that were inevitable from such a high dose.
With these studies now firmly established in the collective consciousness, the debate was for all intents and purposes settled — despite the outspoken work of fringe Doctors such as Didier Raoult and Vladimir Zelenko. It would take something truly dramatic to turn things on their head — for HCQ-Gate to truly take off.
For this, we have America’s Frontline Doctors to thank, not least the truly remarkable figure of Dr. Stella Immanuel. This group of contrarian Doctors held a press conference on July 27th in Washington DC — highlighted by Dr Immanuel’s impassioned advocacy of HCQ as a a cure for COVID-19, along with her fiery take down of her silent colleagues. As divisive as this press conference was — given further spice when Immanuel’s past views on human sexual intercourse with demons and alien manipulation of our DNA were uncovered — it undoubtedly opened the flood gates for further, more palatable dissenting voices to come forward and be heard.
Central among these voices has been Dr. Harvey Risch. Risch is a respected Professor of Epidemiology at Yale School of Public Health, having published hundreds of articles in peer-reviewed establishment journals, who to the surprise of many broke into the mainstream bubble with this Newsweek article. The article is well written, balanced (he notes that there are still some risks that come with taking HCQ) and ultimately highly convincing — it served as my own personal wake up call to how skewed the mainstream narrative surrounding this drug had become. He followed up with this article in the Washington Examiner defending himself against his newly emerged critics, before pulling out all stops in this interview with Fox News:
“I conclude the evidence is overwhelming, there is no question that for the people who need to be treated and are treated early, it has a very substantial benefit in reducing risk of hospitalisation or mortality… the science is so one-sided in supporting this result that it’s stronger than anything else I’ve ever studied in my entire career. The evidence in favour of Hydroxychloroquine benefit in high risk patients treated early as out-patients is stronger than anything else I’ve ever studied. So scientifically there is no question whatsoever ever.’’
This really isn’t hyperbole, once you actually sit down for yourself and look at what the now substantial research base for the effectiveness of HCQ for treating COVID-19 is saying — research that has only continued to pile up in a positive direction since Risch’s interview.
But in the end, we don’t actually need to bore ourselves with the science most of us aren’t qualified to understand. All we need to do is look out into the real world: one that isn’t lost in the hubris and naval gazing of the United States and its similarly-compromised Western allies.
Because the real story, the real evidence for the effectiveness of HCQ, lies virtually everywhere else in the world: where health professionals not constrained by egos and/or conflicts of interest have repeatedly made up their own minds that their doctors should have access to HCQ to treat their citizens.
Along with the aforementioned Chinese authorities and South Korean disease experts, the drug has been recommended for early-stage treatment and for prevention in India, along with the Malaysian Health Director General; plus Bahrain, Turkey, Jordan, the United Arab Emirates, Morocco, Algeria, Nigeria, Senegal, Cuba, and Costa Rica have all used the drug and claimed some degree of success. You can find a full summary of the adoption and effectiveness of HCQ around the world at this excellent twitter thread, along with a comprehensive account of how the debacle played out across the world in this piece.
Yet despite this mounting evidence — despite graphs like this showing differences in case fatality rates between countries with widespread and limited HCQ use — health agencies in many Western nations, not least the Therapeutic Goods Administration in Australia, continue to restrict the rights of doctors to prescribe this drug. Only a fool would believe that heads will not soon roll because of this.
Adjusted deaths per million from COVID-19 across countries categorised by extent of early use of HCQ (Source)
A final, astonishingly obvious proof of the consequences of restricting HCQ use comes from Switzerland. Following the release of the soon to be retracted Lancet study, the World Health Organisation suspended trials into HCQ and advocated for bans on its use. Switzerland restricted use on the 27th of May, before lifting these restrictions on the 11th of June, a week after the Lancet study was retracted. If HCQ has no effect on COVID-19 patients, this two week period of restriction would of course have made no difference (and, if we are to take on face value these dire warning of its dangers about the drug that many have made, would actually improved the situation somewhat).
Regrettably, it did not.
The graph below illustrates the indexed Case Fatality Rate in Switzerland. It shows a clear two week ‘wave of excess lethality’ between June 9th and June 22nd, a statistically significant rise from a low of 3–5% up to a peak of 10–15%. This represents a lag of around 12 days when compared to the two week period when HCQ use was suspended, due to the delay in time between prescriptions being stopped and un-treated patients succumbing to the virus. 13 days after HCQ prescription was resumed, the index again displays a statically significant drop to 3%.
Indexed Case Fatality Rate of Switzerland showing the statistically significant spike in COVID-19 deaths following the two week ban on HCQ prescription (Source)
It is always important to find the silver linings within these situations. At least in this case, the faulty Lancet paper and the resulting decision to restrict use of HCQ in Switzerland (among other places) provides us with such definitive evidence of its effectiveness. It provides some sort of reassurance that the truth will always find a way to come to the surface.
Of course, this would be of little solace to the families of those many individuals who lost their lives as part of this Case Fatality Rate spike, not to mention the many thousands of families around the world who have lost family members to this virus in other HCQ-restricted areas. The preventable loss of their lives is to be mourned, and the debacle that is HCQ-Gate that contributed to their deaths is to be greatly lamented. Surely, however, these emotions will be the catalyst for changes in our health system that ensure such a scandal is never again to occur.