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I have some issues with their patient selection criteria. I am not sure that all of them were Covid-19 positive.

Just read the following from the paper:

STUDY POPULATION

Patients enrolled in the study were residents of the city of Sao Paulo, Brazil, after the pandemic was officially declared in this city.

Positive epidemiology for COVID-19 was defined as living in a city with more than 100 confirmed cases of COVID-19. Consecutive outpatients with persistent flu-like symptoms (suspected COVID19 infection), persisting for a period equal to or greater than 2 days, were first evaluated by the telemedicine team or by the emergency department medical doctor.

All physicians had access to medical records of all subjects, such as clinical history, laboratory parameters, images exams and electrocardiograms.

Those who had no immediate need for hospitalization and no contraindications for treatment were invited to participate in the study. Treatment with hydroxychloroquine associated with azithromycin was suggested and prescribed if consented from patient.

The swab laboratory was not mandatory and chest computed tomography was performed according to medical judgment.

Lung injury criteria for COVID-19 were defined as the computed tomography scans with the presence of ground glass opacities in multiple lung lobes with bilateral predominance and peripheral localization (which may evolve to the central region).

Definitions of the severity of lung injury according to tomographic aspects were: Mild (<25% of lung involvement), moderate (25% to 50% of lung involvement) and high (>50% of lung involvement).

All patients were part of the same health care provider, with access to the same network of hospitals, outpatient clinics and diagnostic clinics in the city of São Paulo-Brazil.

In case patients needed to be referred to hospital, they were evaluated, admitted and treated by medical staff advised to follow the standard protocol from the institution.

The main hospitalization admission criteria were:
● Worsening general condition
● Oxygen Saturation < 90%

INCLUSION CRITERIA:

● Patient over 18 years old and flu-like persistent symptoms > 3 days, with a probable diagnosis of COVID-19 and no immediate indication for hospitalization.

EXCLUSION CRITERIA:

● Severe related retinopathy
● Severe liver disease
●Myasthenia Gravis
● Known QT enlargement
● Pregnant
●Severe Renal Failure

MY COMMENT: To me, it looks like not all of the patients were actually tested for Covid-19. They were simply ASSUMED to have it based on symptoms. What if they had the Flu or Pneumonia unrelated to Covid-19?

Am I wrong in what I understand?

MY COMMENT: To me, it looks like not all of the patients were actually tested for Covid-19. They were simply ASSUMED to have it based on symptoms. What if they had the Flu or Pneumonia unrelated to Covid-19?

Am I wrong in what I understand?

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Could be you’re correct. And could be that the med package is known to work against a wide variety of virus and bacterial infections.

Known to work.

Already tested to the nth.

And known for decades.

Am I wrong in what I understand?
= = = = = = = = = = =

Be careful....too many people start THINKING like that and the whole plan will blow up in everyone’s face.
Can’t have people thinking not EVERYONE has died from the beerflu these past couple of months...

To me, it looks like not all of the patients were actually tested for Covid-19.

It appears that they did not have a direct test, but used a population of symptomatic people. If COVID-19 infections were randomly distributed in the groups then the improvement in outcomes would still be valid. If, for example, the people who declined the medication had some kind of increased likelihood to have COVID-19 then the results could be skewed. But absent any evidence that does not seem to be likely.

Am I wrong in what I understand?

I think you are correct. I also suspect that Dr. Zelenko's results can be criticized on the same basis. On the other hand, Dr. Raoult tested all his patients for COVID-19, and kept repeating the PCR tests during the period of treatment.

Here's the thing (a little Joe Biden lingo): If your goal is just to save patients, it is reasonable to give possibly-effective, generally safe medications (HCQ+AZ±Zn) to people who appear to have COVID-19, without verifying that diagnosis with a PCR test. If your goal is also to convince physicians that your drug treatment is effective against COVID-19, it would help considerably to have at least an initial positive PCR test.

My guess is that both Dr. Zelenko and these Brazilian docs saved lives.

It could still be said to test the efficacy of CHQ and Zythromycin against persistent flu-like symptoms. But this is not a definitive study of CHQ protocol’s efficacy against Covid-19 imho fwiw.