
Effect of hydroxychloroquine and azithromycin in 80 Covid-19 patients [pdf] - m0zg
https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf
======
asdfasgasdgasdg
Still no control group, though. Isn't the author of this study the same
individual whose history of faking data was discussed on Twitter earlier
today?

[https://forbetterscience.com/2020/03/26/chloroquine-
genius-d...](https://forbetterscience.com/2020/03/26/chloroquine-genius-
didier-raoult-to-save-the-world-from-covid-19/)

Yep, it's him. I'll wait for a reproduction from an independent group before
believing this.

If I may say: be especially wary of people who tell you that what you want to
believe is true. It's not necessarily that they're more likely to lie. It's
that your guard is more likely to be down against mistakes in their reasoning.
Doubt is the province of the wise.

~~~
vikramkr
I don't understand why there wasn't a control - placebo effect would matter
here and 1/80 dead could just simply be an effect of these patients being more
closely monitored in the study, it doesn't sound too far off from the 1.2%
death rate you see cited in some publications. This just isn't a confidence
inducing paper.

~~~
lone_post
It's important to note the 1.2% case fatality rate includes all patients,
including the 80% or so who do not require hospitalization.

This study was performed on a group requiring hospitalization, so a 1.2%
mortality rate would appear extremely promising in that context.

~~~
asdfasgasdgasdg
Where in the study does it say that those with a low NEWS score were omitted?
The only selection criterion I saw is pcr-positive for sars cov 2.

"Patients with PCR-documented SARS-CoV-2 RNA from a nasopharyngeal sample were
admitted to our infectious diseases (ID) ward."

Doesn't list any other criteria. This is a small part of why control groups
are so important.

~~~
vikramkr
It's also a really well written paper. Isn't it impressive how people just
read into it and assume that there must be all these criteria that make the
data better without them being detailed or a control group? Not many academic
papers can communicate things (of differing levels of veracity) that they want
to communicate but can't say explicitly so well.

~~~
asdfasgasdgasdg
There seem to be a huge number of people reading about this topic online who
just want to be comforted and are willing to throw all critical thinking out
the window to that end. That's the only way I can figure why all these
optimistic but poorly designed papers are being cheered on places like HN and
/r/covid19, not to mention the news.

~~~
vikramkr
Theres a reason even the language of scams - snake oil - has an origin in
health panacea. Health and money have ways of getting people to believe things
that they should be quite a bit more sceptical of.

------
fernly
> [On patient died but] For all other patients in this cohort of 80 people,
> the combination of hydroxychloroquine and azithromycin resulted in a
> clinical improvement that appeared significant when compared to the natural
> evolution in patients with a definite outcome.

Note patients were excluded based on an extensive list of contra-indications,
and there was care taken to avoid one of the known side-effects, heart
arrhythmia; EEGs were taken before and during treatment and reviewed by
cardiologists.

Also note that this treatment is not preventive, but rather would be used to
treat people with serious illness, to shorten the illness. Given that, and the
lengthy list of contra-indications and potential for serious side-effects, it
could be useful in reducing deaths among infected people, but not in reducing
infections, nor -- given you need to be pretty sick to justify the risks -- in
reducing hospitalizations.

------
peppery
Lest others also experience HN's hug-of-death of the original source, Google's
cached version
([https://webcache.googleusercontent.com/search?q=cache:bkjo_-...](https://webcache.googleusercontent.com/search?q=cache:bkjo_-
CYAegJ:https://www.mediterranee-infection.com/wp-
content/uploads/2020/03/COVID-IHU-2-1.pdf+&cd=1&hl=en&ct=clnk&gl=us)) works as
interim alternative version of the original PDF before the link returns or
e.g. Wayback Machine has a chance to archive it.

(This aside, heed @asdfasgasdgasdg's very prudent note of caution; other
independent and more reputable replications are essential.

As of this writing there are at least 19 such hydroxychloroquine trials in US
([https://clinicaltrials.gov/ct2/results?term=Hydroxychloroqui...](https://clinicaltrials.gov/ct2/results?term=Hydroxychloroquine&cond=COVID-19))
and more beyond (though WHO clinical trial site listing them is also
apparently under critically-heavy load).)

------
lone_post
The lack of a control group is frustrating, but the comparison to outcomes in
untreated groups documented in China still makes me feel this treatment holds
promise:

"For all other patients in this cohort of 80 people, the combination of
hydroxychloroquine and azithromycin resulted in a clinical improvement that
appeared significant when compared to the natural evolution in patients with a
definite outcome, as described in the literature. In a cohort of 191 Chinese
inpatients, of whom 95% received antibiotics and 21% received an association
of lopinavir and ritonavir, the median duration of fever was 12 days and that
of cough 19 days in survivors, with a 28% case-fatality rate (18). The
favourable evolution of our patients under hydroxychloroquine and azithromycin
was associated with a relatively rapid decrease in viral RNA load as assessed
by PCR, which was even more rapid when assessed by culture."

------
fmjrey
I find it too easy for people not on the front line to criticise those who
are.

1\. Chloroquine has been used since 1949 for treating a range of diseases
including malaria, and is therefore a well known drug which causes
complication only in rare cases because its side effects and use are well
known, it's even given in prevention to healthy people travelling in certain
parts of the world

2\. Pr Raoult has demonstrated 13 years ago its effectiveness against
coronaviruses

3\. The current CV19 pandemic is killing people at an alarming rate

4\. In Europe hospitals are stretched beyond capacity meaning more are dying
for lack of space/equipment/attention/treatment, and not because of CV19
itself

5\. As a world renown specialist Pr Raoult has been in contact with doctors in
China who were the first to use it to treat CV19 and observe its effectiveness
in greatly reducing the viral load

6\. As director of a research hospital Pr Raoul is on the front line for
handling CV19 patients and is responsible for making life and death decisions
not just for his own life but for all patients arriving in mass to his door

7\. There is no other alternative treatment to date for CV19, some other drugs
are promising but are either much newer and less known, or heavier on side
effects and cost

Now take into account the above facts, imagine yourself in Pr Raoult shoes,
and realise that withholding the use of chloroquine in such dire situation,
where the luxury of a full study cannot be afforded and the drug is very well
known, can be considered not only immoral but also criminal. In other words
when the choice is either to let people die with a "wait and see" attitude, or
to save lives by significantly reducing the viral load and infection with a
well known drug, the choice is clear. Another way to view the situation: you
are a policeman stopping an ambulance not respecting the driving code and
driving too fast, and then learn there is a dying patient in the back, what do
you do?

Also Pr Raoult does not claim he has done a full study. Those that get finicky
and still want to have a full study before allowing its use are irresponsible
people who have no idea of what's it's like on the ground. Those that
criticise him as a lone advocate are really out of touch with reality: he is
definitely not alone, he's got 200 staff under his responsibility, 80 of which
are researchers, he has been on the forefront of his field worldwide (see his
wikipedia page), knows very well how to perform perfect academic studies, and
is and has been constantly talking with specialists and doctors around the
world since the earliest time of the pandemic.

~~~
vikramkr
Chloroquine has side effects and the drug might not work. It'd make the front
blinds a hell of a lot worse if we start giving people whatever without any
scientific basis just because one charismatic scientist has been pushing for
it. Ignoring the science is what got us here. Staying blind to science to
pursue false hope isn't going to get us out of here. Remember how during Ebola
we were all convinced that drug by Gilead was going to work since it seemed to
have an impact on the mechanism of action etc etc? Remember how it failed
after rigorous studies? Imagine if we'd just decided it worked without testing
it on preliminary data and given it to people on the front lines to protect
themselves.

These regulations are written in blood. Dengue vaccines are another example.
Ignoring science got us here. Ignoring science again will keep us here.

~~~
jamesblonde
Today France authorized the use of hydroxychloroquine for the treatment of
covid-19 - based on this study. So the study has had impact on policy already.

