
Chronic treatment with hydroxychloroquine and SARS-CoV-2 infection - drocer88
https://www.medrxiv.org/content/10.1101/2020.06.26.20056507v1
======
blakesterz
"After adjustment for age, sex, and chronic treatment with corticosteroids
and/or immunosuppressants, the odds ratio of SARS-CoV-2 infection for chronic
treatment with HCQ has been 0.51 (0.37-0.70). Conclusions: Our data suggest
that chronic treatment with HCQ confer protection against SARS-CoV-2
infection."

Assuming this really does help protect against one virus, I wondered does that
mean it would help protect against ALL or ANY other virus as well? There's no
small number of people that have been taking this for a long time already, do
they tend to catch colds or the flu or other virus caused illness less than
other folks?

~~~
LyndsySimon
> After adjustment for age, sex, and chronic treatment with corticosteroids
> and/or immunosuppressants [...]

Interestingly, I didn't see from the summary that they were controlling for
the conditions for which individuals were being treated with HCQ and the
impact they had on their lives.

If people with Lupus are treated with HCQ (they are) and people with Lupus are
often forced to make behavioral changes like staying indoors and out of the
sun and avoiding physically demanding activities - which they are - doesn't it
seem reasonable that those lifestyle changes would result in fewer SARS-CoV-2
infections?

FWIW, I'm very much open to the idea that HCQ may be a viable treatment for
COVID-19. I've not kept up with the clinical results since it became a
political issue, but it originally seemed to be a promising avenue of
research. Once Trump started talking about it, it became all but impossible to
find data about its effectiveness that wasn't obviously politically motivated.

This paper doesn't appear to be politically motivated... but it also doesn't
appear to provide strong evidence one way or another.

~~~
pariahHN
I was also wondering about this. No discussion of the likelihood of someone
who knows about their condition and is being treated for it being exposed in
the first place. If they had a lower likelihood in the first place then it
would also look like HCQ had the desired effect.

I am interested by a couple of their references, specifically regarding the
possibility of HCQ only working as a prophylactic after a sufficiently long
period of exposure. That could be a contributor to difficulty in replication.

------
giardini
2005 article (on an _in-vitro_ study) also:

 _" Chloroquine is a potent inhibitor of SARS coronavirus infection and
spread"_

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/)

------
brodouevencode
Consider
[https://news.ycombinator.com/from?site=medrxiv.org](https://news.ycombinator.com/from?site=medrxiv.org)

Of all the nearly 160 posts from this domain, only three are flagged. Three
that have, through various sociological and political reasons, become toxic or
divisive to a large degree. The content/conclusion itself shouldn't be
political, but that's where we are at.

------
drocer88
Articles like this don't need the "flagged" treatment.

HCQ studies need serious review and discussion.

The theory has always been that HCQ increases Zinc in the cell which blocks
viral replication ,might have a small effect and might help with early
infection.

Research like this does not need the heated politics.

We need good clinical trials and reproduced studies.

~~~
tumetab1
Agree and what does "flagged" in HN mean? :\

The FAQ and Guidelines doesn't explain it.

I was following this post to see if more knowledgable people would comment if
this study seems good or not (since I have no idea).

~~~
gridlockd
It means that enough people flagged it, so it got flagged.

The motivation for flagging is probably something along the lines of "this
surely will promote poor quality discussion".

Less visibility means less discussion.

------
cliffy
This hasn't even been peer reviewed yet. Don't expect that _you_ , the average
HN reader, knows better than reviewers with relevant backgrounds.

~~~
lbeltrame
Peer review, while extremely useful in bringing out some, or many warts of a
work, is not a substitute for quality control, which depends only on the
authors.

> Don't expect that you, the average HN reader, knows better than reviewers
> with relevant backgrounds.

After what happened with the Surgisphere paper, where the first problem was
the statistics (caught by post-publication comments) and only later there was
the problem of fake data, the mere presence of a secret review does not mean
the work is up to anything.

P.S: yes, I work in the fields of biology and pharmacology and have written
and reviewed a number of papers myself.

~~~
dekhn
I still think it's a fair comment that most Hacker News readers are not the
audience for pre-prints. It's simply not possible for people untrained in the
art of reading papers in a specific field to make reasoned judgements.

------
acqq
There must be a prize for this kind of work.

"\- 360,304 patients with suspected SARS-CoV-2 infection

\- Of these 360,304 cases, 26,815 were confirmed by a positive PCR test. The
rest had negative PCR tests.

\- In the set of patients with case definition, 1,292 received HCQ (at least 2
grams per month)

\- The proportion of HCQ chronic treatment was higher in negative patients
(0.36% vs. 0.29%, P = 0.04)

\- We were able to show that patients taking HCQ have had reduced odds of
SARS-CoV-2 infection"

No joke, that is the basis for their claim. Just like "compared to those that
we suspected could have tested positive, it turned out that among those that
weren't positive there were more people proportionally receiving HCQ." I don't
understand how that can actually prove something. One can surely find a lot of
things that are proportionally more present in those tested negative, but
without any meaning.

~~~
gridlockd
That's how screening for drug treatments often works. You look for those kinds
of correlations. You move on from there. With many drugs, we don't even know
how or why they work for certain things, but we prescribe them anyway.

There's nothing wrong with the claim, it seems to be factually accurate. The
authors are not claiming that HCQ is an effective treatment, they say _the
data suggests_ that HCQ is protective.

~~~
acqq
> they say the data suggests that HCQ is protective.

Only, I fail to see that the data does that. And their explicit claim is,
which I specifically quoted directly from the paper:

"We were able to show that patients taking HCQ have had reduced odds of SARS-
CoV-2 infection"

It's not different than "there were more people believing in Santa Claus
proportionally in those negatively tested, so that means that Santa Claus
belief reduced odds of SARS-CoV-2 infection."

It just doesn't.

Even if A is true, in such a construct B doesn't follow. Like it was already
noted, those treated could have been also less willing to do risky things. Or
it could have been a mere coincidence, like in the Santa Claus example.

~~~
gridlockd
> It's not different than "there were more people believing in Santa Claus
> proportionally in those negatively tested, so that means that Santa Claus
> belief reduced odds of SARS-CoV-2 infection."

If people who believe in Santa Claus have a 0.5 hazard ratio of contracting
HIV, that _suggests_ that belief in Santa Claus is protective against HIV. If
we flip "belief Santa Claus" for some random drug, it would be the same, you
just couldn't obviously tell that it is implausible.

Just because data suggests one thing or another doesn't mean that whatever the
data suggests is true. It's still just a correlation, but you _always_ start
with a correlation.

You're simply not used to the jargon but feel entitled to criticize the
authors for just doing their work. Please don't do that.

~~~
acqq
I claim that their statement

"We were able to show that patients taking HCQ have had reduced odds of SARS-
CoV-2 infection"

is not true. It's not jargon. It's a false statement given the data that they
presented. To "show" that the "odds" are reduced compared to something they
have to show the reasonable odds of that something. I don't see them showing
that at all, or that their paper actually demonstrated "odds."

~~~
gridlockd
I just realized you're the guy from the other thread. You have a rather
hostile way of interpreting other people's writing.

Please, consider:

[https://en.wikipedia.org/wiki/Principle_of_charity](https://en.wikipedia.org/wiki/Principle_of_charity)

