By Dr. Liji Thomas, MDApr 19 2020Posted on 04/19/2020 7:24:59 PM PDT by SeekAndFind
The COVID-19 pandemic is still spreading around the world and affecting nearly 2.4 million people, with over 164,000 dead so far. With neither vaccine nor proven therapeutic drug being available so far, the need of the hour is for effective treatment. Now, a new study reports the potential usefulness of a combination of hydroxychloroquine and azithromycin as a treatment in mild cases of COVID-19 infection and urges the need for further evaluation and widespread use if its findings are confirmed.
COVID-19 began in December 2019, caused by a novel coronavirus called SARS-CoV-2, in Wuhan city, Hubei province, in China. It rapidly spread to over 185 countries and territories and was declared a pandemic on the 12th of March, 2020. The overall case fatality rate is about 2.3%, but in older people, this is 8% and 15% in those aged 70-79 years and 80-plus years, respectively. The fact that up to 80% of cases are asymptomatic or mildly symptomatic means that the actual fatality rate may be much less.
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This scanning electron microscope image shows SARS-CoV-2 (round gold objects) emerging from the surface of cells cultured in the lab. SARS-CoV-2, also known as 2019-nCoV, is the virus that causes COVID-19. The virus shown was isolated from a patient in the U.S. Credit: NIAID-RML" width="674" />
Novel Coronavirus SARS-CoV-2: This scanning electron microscope image shows SARS-CoV-2 (round gold objects) emerging from the surface of cells cultured in the lab. SARS-CoV-2, also known as 2019-nCoV, is the virus that causes COVID-19. The virus shown was isolated from a patient in the U.S. Credit: NIAID-RML
However, the need remains to contain the spread of the virus, which can be done by limiting the duration of virus carriage. Repurposing older drugs for use against the virus is a highly regarded strategy because these drugs are already approved for use in humans. Their safety, tolerability side effects, and drug interactions are established. Among these drugs, antibiotics similar to azithromycin, and the immunomodulatory drug hydroxychloroquine, have gained widespread attention.
Over a third of physicians already prescribe or believe they should prescribe hydroxychloroquine or azithromycin for COVID-19 infections. This makes it urgent to find out if these are indeed effective.
Preclinical studies have shown that chloroquine phosphate and hydroxychloroquine sulfate inhibit viral activity in vitro. The current study authors report that another of their studies show a synergistic effect when both azithromycin and hydroxychloroquine are used on cells infected with the SARS-CoV-2, at levels similar to the probable concentrations in humans dosed with these drugs. Some studies have also shown that chloroquine reduces fever and leads to an improvement in the CT signs on imaging, as well as delaying the progression of symptoms. This has led some Chinese researchers to recommend a chloroquine-based treatment for COVID-19, of all severities.
The virus is shed for a median of 20 days in survivors (8-37 days), but until death in fatal cases. Treatment is thus required to shorten this period and produce clinical cure without a progression to severe symptoms.
A small pilot study on 20 cases showed a 100% resolution with hydroxychloroquine 600 mg per day. On day 6, the viral carriage was reduced, and nasopharyngeal swabs were negative in 70% of cases, in contrast to 12.5%. Another study failed to show any significant difference, but this study tested several other drugs as well.
The current study is an uncontrolled observational study in 80 COVID-19 patients with mild infection. All were treated with the two drugs, hydroxychloroquine, and azithromycin for three or more days. The researchers assessed the clinical outcome, the degree of transmissibility as measured by the PCR and viral culture, and the period of patient stay in the infectious disease unit.
The median age of the 80 patients with confirmed COVID-19 was 52 years. 57% of them had one or more chronic medical conditions, which are considered a risk factor for severe COVID-19. Patients were hospitalized five days on average from the onset of symptoms. The most common symptoms were lower respiratory in 54%, and upper respiratory symptoms in 41%. Fever was present in only 15%. 92% of them were assessed as low-risk for progression. About 54% had CT findings suggestive of pneumonia.
Most patients started treatment either on the day of admission or the next day. Almost all of them were treated daily for a maximum of 10 days. One patient stopped treatment early due to the risk of drug interaction with another medication. Safety and tolerability were acceptable.
In 65 patients, that is, 81%, patients were discharged with a good clinical outcome. Oxygen therapy was required for 15% during their hospital stay. Intensive care admission was required for three patients, of whom two improved and returned to the ward. One patient died in the ward, and one was still in the ICU.
The administration of hydroxychloroquine and azithromycin brought about an improvement in all but one patient (who was elderly, had severe symptoms, and had an irreversible disease). The improvement appeared to be better than that described in other hospitalized cohorts.
The viral load in the nasopharynx reduced rapidly as per qPCR, with 83% and 93% of patients having a negative swab by day seven and day eight, respectively. The number of contagious patients was two by ten days, and zero by day 12, but had declined markedly by day 6.
In over 97% of patients, respiratory swabs proved negative on culture by day 5. Only two cultures were still positive after day 5, one by day 8 and none by day 9.
Most patients stayed in hospital for five days on average before being discharged.
In 65 patients, that is, 81%, patients were discharged with a good clinical outcome. Oxygen therapy was required for 15% during their hospital stay. Intensive care admission was required for three patients, of whom two improved and returned to the ward. One patient died in the ward, and one was still in the ICU.
The researchers point to the rapid symptomatic improvement, with the parallel reduction in viral DNA load, both by PCR and by culture, as evidence for the potential of these drugs to produce a favorable outcome. The safety of these drugs is not in question, at the recommended doses, but ECG monitoring is recommended since hydroxychloroquine has occasionally been reported to cause heart block in patients with underlying heart conditions.
The researchers are planning a larger trial in their institution to validate their early findings. They summarize, “We have provided evidence of a beneficial effect of co-administration of hydroxychloroquine with azithromycin in the treatment of COVID-19 and its potential effectiveness in the early reduction of contagiousness. Given the urgent therapeutic need, and the negligible cost of both hydroxychloroquine and azithromycin, we believe that there is an urgent need to evaluate this strategy further.”
Gautret, P., Lagier, J.-C., Parolam P., Hoang, V. T. et al. (2020). Clinical and Microbiological Effect of a Combination Of Hydroxychloroquine And Azithromycin In 80 Covid-19 Patients With At Least A Six-Day Follow Up: A Pilot Observational Study. Travel Medicine and Infectious Disease (2020), doi: https://doi.org/10.1016/j.tmaid.2020.101663.
for those who want to delved deeper, a PDF version of the study can be found here:
TITLE:
Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study
STUDY PARTICIPANTS:
Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L, Sevestre J, Mailhe M, Doudier B, Aubry C, Amrane S, Seng P, Hocquart M, Eldin C, Finance J, Vieira VE, Dupont HervéTissot, Honoré Sté, Stein A, Million M, Colson P, La Scola B, Veit Vé, Jacquier A, Deharo J-C, Drancourt M, Fournier PE, Rolain J-M, Brouqui P, Raoult D
BACKGROUND OF THIS ARTICLE’s AUTHOR:
Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.
Speaking to Daily Mail, Gao Yu, a Chinese journalist, said that he spoke to the virologist who revealed that she was ‘muzzled’ by the Chinese authorities. “We learned later her institute finished gene-sequencing and related tests as early as January 2 but was muzzled,” revealed the journalist.
Thanks for the article. But we don’t have time for IN VITRO studies anymore. We need REAL LIFE PATIENT studies and treatment. We are not living in normal times.
Two observations
- wonder why zinc not mentioned
- the glacial speed of medical studies while on a wartime footing
The underlined part does not mean the virus is like HIV. It refers to a method used.
I read the Indian article when it came out. It was an embarrassing crock. They knew nothing about biology and their findings were nothing.
won’t do any goo-d a bogus study from china declared there was no benefit to HCQ- so that is all the msm care about reporting on-
well we always knew what side the us libtard media would be on.
Unless Bill Gates funds it and approves it, it’s anecdotal
/s
I am becoming convinced that many severe cases would not become severe cases if patients did not put off seeking professional treatment, family doctors could always get a Wuhan Virus test quickly, and mitigating treatments like Hydroxychloroquine could be administered before the progression of the illness, that does not start out with damage to the respiratory system directly.
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