Use hydroxychloroquine combo early, urges Yale professor

Yale Epidemiologist Dr. Harvey Risch is calling for hydroxychloroquine and the antibiotic azithromycin to be made widely available and promoted immediately so physicians can prescribed them for early outpatient COVID-19 treatment.

The Professor of Epidemiology in the Department of Epidemiology and Public Health at the Yale School of Public Health and Yale School of Medicine has authored a soon-to-be-published article arguing that in an ideal world, randomized double-blinded controlled clinical trials are preferable, but exceptions should be made due to the unprecedented nature of the COVID-19 pandemic.

The article will be published by Oxford University Press, on behalf of the Johns Hopkins Bloomberg School of Public Health titled “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.”

“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.”

“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,” he urges.

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.

He discusses ongoing randomized trials with hydroxychloroquine (HCQ) and azithromycin (AZ), arguing, “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.”

“Available evidence of efficacy of HCQ+AZ has been repeatedly described in the media as “anecdotal,” but most certainly is not.”

Professor Risch describes various studies in the article, comparing the case fatality rates typically observed without treatment to those with HCQ+AZ treatment.

He points out the 12-13% mortality of hospitalized patients in the remdesivir trials both by Wang et al and in the ACT trials sponsored by the National Institutes of Health (NIH).

Professor Risch also discusses the issue of adverse events, contending 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.

“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,” he notes.

“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,” Professor Risch concludes.

During a CNN interview on Wednesday, National Institute of Allergy and Infectious Diseases Director Anthony Fauci insisted that hydroxychloroquine lacks “efficacy” as a treatment for coronavirus.

A study published in The Lancet last week was “unable to confirm a benefit of hydroxychloroquine or chloroquine . . . on in-hospital outcomes for COVID-19.”

The study also stated hydroxychloroquine drug regimens were “associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.”

President Trump has relentlessly promoted the use of at great political risk in order to save lives and reduce the COVID-19 death toll.

He even announced last month that he had been taking hydroxychloroquine as a prophylactic for “a couple of weeks,” along with zinc and azithromycin.