As an aside, I do feel like the mean age of poor clinical outcomes, 69, feels a bit low relative to my expectations.
sigh COVID-19 is associated with low fatality rate in patients. It's not clear this combination of drugs does anything other than not kill people any faster.
> As an aside, I do feel like the mean age of poor clinical outcomes, 69, feels a bit low relative to my expectations.
I'm confident that has to do with top of funnel.
I think you're probably correct. But, frustratingly, it's equally possible that the HCQ increased the likelihood of negative outcomes for younger patients. Or, that HCQ decreased the likelihood of negative outcomes without regard to age, resulting in fewer bad outcomes for really old people.
China never claimed HCQ was very effective. Chloroquine was considered an experimental viral treatment and the side effects were notable.
HCQ was used more commonly in South Korea.
> As a conclusion, based on our experience, we consider reasonable to follow the recommendations made in Asian countries for the control of COVID-19, notably in Korea and China
did you read this "A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years – range 14–95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). "
> l, this is not a controlled study,
You can retrospectively get the control data for same time frame. This won't br same as placebo but still good.
AND, death rate in france for closed cases is around - 15-25% .
Death rate with HCQ+AZ is 0.75%
If I got crona. I will take the HCQ+AZ
No you can't and no it won't. Clinical study protocol documents are often thousands of pages long because they need to describe mundane procedures down to how doctors and nurses are supposed to draw the subjects' blood so that there aren't significant variations between participating hospitals. The point of a control group is to control as many variables as possible and placebos are only a small part of that. Selecting control groups is an entire subfield of modern medicine.
Many drugs with much more promising early results that were gathered under nearly ideal conditions (instead of the chaos of a pandemic) have failed hard in third phase trials.
You can take the entire case cohort and filter out all of the people who we don't have robust data for. Then find a control cohort who do have all of the things we're looking at and then analyze the data. Yes it would've been better to do a grade A trial from the get go, but these kinds of studies can be done.
I'm not arguing with the validity of the statistics, I'm saying it's not enough to fulfill the medical standards for demonstrating drug efficacy. An actual clinical trial protocol needs to be properly designed and coordinated across participating facilities - otherwise it's simply garbage in, garbage out, no matter the quality of the statistical method.
Edit: The exception is cases like this where the drug is approved for some uses and doctors in some countries are legally allowed to prescribe it off label using their own judgement of statistical analyses like the one above. However, the issue becomes liability and most doctors will fall back to FDA recommendations that are based on controlled clinical trials.
I was just mentioning that things can be learned from this study retrospectively by creating a control group from an EHR.
It has validity in the short term for MD's who might begin using this treatment under our fast track system we're using for COVID stuff.
If this trial was done at my institution and my team already had all of the paperwork out of the way with regards to the data access we could have something useful in a week or two out the door. So I hope this will be done by someone somewhere, just to save lives in short term.
What is the fast track system for COVID? I've seen the emergency use authorizations for clinical testing but not any for new treatments other than the usual off label use.
Or are you making the much less useful statement that a proper study is possible?
I think that's pretty typical in untreated patients. Average recovery period is about two weeks. 
> Death rate with HCQ+AZ is 0.75%
The death rate of COVID-19 in the general population is less than 1% (0.25%-1% depending on the study). Even New York, the worst city (by case count, and fatalities) in the worst country in the world is ~0.7%. All this study shows is that HCQ+AZ doesn't kill people faster than not taking HCQ+AZ.
> AND, death rate in france for closed cases is around - 15-25%.
Not worth re-hashing CFR vs. IFR (and the associated adverse selection risk) but you won't get anything approximating your risk without referencing serological studies. I can't stress how this number is not representative, and treating with HCQ+AZ does not by any means get the number from 15-25% down to 0.7%
Pretty sure this is inaccurate, except perhaps by total number of deaths...
It's probably fine if you want to take the drug, but accurate statistical reasoning is not the driver of that decision.
Right there in the discussion section:
> In our analysis, which is not a RCT
AFAICT, they suggest taking HCQ early on during the course of the disease, assuming the patient can take it (they excluded quite a few that might have got bad side effects from it).
Rheumatologist with 30 years of experience who, while skeptical of hydroxychloroquine's benefits for COVID19, has no problem with Trump's "what have you got to lose?" statement: https://www.youtube.com/watch?v=hRCG9RtFJ_Y
I just skimmed through the paper, but what attracted my eye is the mention of severity at admission being a risk factor (but the confidence intervals are huge so I don't know what to make of it).
"Finally, a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers found no evidence that, before ventilation, the use of HCQ either with or without AZ, reduced the need for subsequent mechanical ventilation"
Compared with what the paper actually says:
"In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with
Everyone has to wonder why you would publish results without publication of the sources when you want to convince people with an important subject...
It is quite disturbing, however, to see on French Twitter, the far right, complotists, nationalists, and even bots push Raoult so hard...
I'm confident that the COVID-19 PEP trial by U of Minnesota will help put an end to this polarized debate on the use of HCQ (which for most part has nothing scientific going on).
Yet we have to argue about the ?!@#!$ thing repeatedly, because public figures (we all know who) decided to push this idea irresponsibly as a miracle cure. So now all the people on one side of the discussion have to crow about every positive result as if it vindicates the original rhetoric.
It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not.
This is a really good take on it for those who aren't into reading scientific papers. It's totally plausible HCQ does help a bit. If true, it changes virtually nothing about our current situation. The decision making is all the same.
Honest question: why?
(Note: my background includes pharmacology, so I am more interested in pharmacological options rather than vaccines)
Yes, everyone who has their life saved by this treatment is happy, and it's worth chasing small improvements on the margin... but...
(It's worth noting that the (very) little evidence from controlled trials that we have leans more in the direction of harm than benefit, too. But the same argument holds for e.g. remdesivir where we do have some decent evidence).
Unsure about fatality (the data is a statistically insignificant trend), but the NIAID trial preliminary data points that remedesivir does cut recovery time by 30% (11 days vs 14 days) according to their interim report. I have to dig up the exact definition.
Yes, not HCQ, but data on drugs exist. Too bad it's probably one of the hardest to manufacture.
Even cutting recovery time by 22% doesn't lower peak ICU usage very much-- less than 22% because there's still the effect of the exponential peak.
The point is it doesn't affect policy / the fundamentals of the situation in any way. It's something that individual patients are happy and thankful for, but the overall societal situation is the same. A treatment that reduced the chance of ending up in ICU by 50% would, but this isn't enough to move the needle.
I beg to differ. At least on paper, there is at least one trial (target size 3000 individuals, but they claim they might have enough power with lower numbers):
I am placing the odds of a positive result at around 25%. For vitamin D supplements to people who are deficient, I place the odds at 50%. Not that anyone cares what I think the odds are.