RE: To prescribe hydroxychloroquine (or chloroquine) to hospitalized patients with COVID-19 pneumonia if all of the following apply: a) shared decision-making is possible, b) data can be collected for interim comparisons of patients who received hydroxychloroquine (or chloroquine) versus those who did not, c) the illness is sufficiently severe to warrant investigational therapy, and d) the drug is not in short supply,
MY COMMENT:
1. Condition B. Looks like a double blind study to me. They are going to compare the results of patients who take HCQ with those who don’t.
2. Condition C. above is the most troubling to me. They want to wait until the symptoms are “sufficiebtly severe” before giving HCQ to the patient. They never define “severe”. What does it mean? Are They going to wait till the patient needs to be on a ventilator before starting this treatment? By that time,the lungs are probably already damaged.
It looks like they aren’t following the protocols presented by successful doctors like Dr. Raoult and Dr. Zekenko.
Both these successful doctors give HCQ to patients who exhibit symptoms earlier in the disease, not later. This is where the greatest success in significantly shortening hospital stay occurred.
It doesn’t have to be double-blind to compare the results of patients taking HCQ with those who don’t, but it does have to be controlled. The purpose of double-blind is to decrease bias from investigators and subjects. There is a whole lot of risk of bias from people touting HCQ. Controls are necessary to make such a study legitimate. What if the people receiving HCQ were mostly 30 year olds?
Sufficiently severe to warrant investigational therapy does not have to mean waiting until they’re on a ventilator. It could just mean that they’re sick enough to be in the hospital, or have severe sepsis (sepsis with organ dysfunction, not the same as organ failure). It also doesn’t have to mean they’re just going to put people on these medications and then wait and see who dies. Institutional Review Boards (IRBs) review proposed studies to protect the public and keep tabs on them. If it’s noticed during the study that people not receiving HCQ are being harmed by not receiving it, they will stop the study early so the control group can be treated too.
D. short supply is a big one. If everyone who was concerned about COVID-19 or had a cough got a script for HCQ, you could easily have shortages affecting the sickest patients.