Hydroxychloroquine
$cience
Hydroxychloroquine, HCQ, is a known antimalarial drug with antiviral and anti-inflammatory properties. It is the less toxic brother of Chloroquine, CQ. It is commonly used as a prophylactic or preventative, starting before one goes into a malaria region, or immediately after malaria infection as an early treatment. HCQ is very safe when used as prescribed and it is a cheap drug which is widely available. It is also used as a medicine for treating autoimmune diseases like rheumatism. HCQ and CQ were also repurposed in relation to SARS-CoV and MERS-CoV.
HCQ has been used all over the world since the beginning of the COVID-19 crisis. It is not intended to be a cure for COVID-19, but it has been shown to be effective in reducing symptoms of COVID-19 when used in the correct way. Since its effective use HCQ has become a highly politicized topic and the media are all over it in a very negative sense.
Early treatment
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We believe that the two-phase division is very important: the first immune defense-based protective phase and the second inflammation-driven damaging phase. Doctors should try to boost immune responses during the first, while suppressing it in the second phase.
Boosting immune responses in patients in the early-stage or mild stage of infection is certainly the key to prevent progression to severe disease.
It is used at an early stage in low doses and only with patients without comorbidities, which could be complicated by hydroxychloroquine.*
Hydroxychloroquine is obviously not a panacea for severe cases of Covid-19. Given early, it helps reduce mortality by about half, compared to those not given the drug. It should be noted that conditions apply.*
Although these drugs also have anti-inflammatory effects, the antiviral mechanisms take place at viral entry or early in replication, and indicate that the earlier CQ/HCQ are used in the course of COVID-19 infection, the more likely they could have a clinically useful effect.
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HCQ should be used as preventative or early treatment
South Korea was hit hard by COVID-19 early in 2020 and Korean medical professionals recommended to use HCQ in the early stage of the infection.* Apparently early treatment with HCQ made a difference in the amount of patients ending up in hospital beds and requiring intensive care. Early treatment was also already known from in vitro studies like those of for example Martin J Vincent et al, Manli Wang et al and Xueting Yao et al. From the beginning the recommendation is to use HCQ as a prophylactic or in the early stage of COVID-19 infection, immediately after infection. This is also how HCQ is used as antimalarial. HCQ works by obstructing the novel viral infection from developing into severe illness. It is being used as prophylactic by health care workers all over the world and that would never be the case if health care workers knew that HCQ had no effect whatsoever.
Low dose
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Exposure to chloroquine and hydroxychloroquine was reported in six and five cases of sudden death, respectively. In four of these cases, overdose was listed as the indication. ... Long-term use of chloroquine or hydroxychloroquine may cause myopathy, which may involve cardiac muscle. ... Reported deaths following chloroquine and hydroxychloroquine have been associated with use in overdose. ... There have been no reports of sudden unexplained death suggestive of cardiac arrhythmia at the doses used for malaria treatment.*
Eligible participants were allocated to receive orally or via nasogastric tube high dose CQ (600mg CQ twice daily for 10 days or total dose 12g); or low dose CQ (450mg for 5 days, twice daily only on the first day, or total dose 2.7g). ... The high dosage CQ arm presented more QTc>500ms (18.9%), and a trend toward higher lethality (39%) than the lower dosage.
Although HCQ has had a substantial margin of safety, its use in critically sick patients like those with COVID-19 has caused several instances of serious cardiac events and deaths. These events are more likely to occur under three circumstances: a) with higher doses of the drug; b) with concomitant use of azithromycin, which potentiates the effect on QT interval; and c) in patients who have underlying co-morbid conditions...
The safety of CQ/HCQ is well established in malaria or autoimmune disease. However, some serious side effects (cardiotoxicity, retinopathy and neuromypathy) may occur with long-term usage of high doses or in overdose.
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HCQ should be used in low doses
In 2017 the World Health Organization itself published a paper in which it warned for HCQ or CQ overdose because it was related to cardiac death because of QT prolongation. That same paper also implies that overdose is defined as a dose higher than is commonly prescribed for treating malaria. Common prescription for preventing malaria is 400mg/week starting two weeks prior to entering malaria region, each week on same day until 4 weeks after leaving malaria region.* Prescription for treating malaria immediately after infection is 800mg as initial dose, then 400mg at 6 hr, 24 hr, and 48 hr after initial dose.
On top of that, by April 2020 it was clearly mentioned in scientific literature that using high doses of HCQ on patients with comorbidities, like heart disease, and/or severe illness is very dangerous and can possibly even lead to death. This confirms its use as preventative or early treatment and it also means that these drugs should only be prescribed by medical professionals, which a lot of them succesfully did around the world.
Later we will see that the high profile UK and WHO studies used a very high dose of HCQ or CQ on severely ill patients with comorbidities which basically amounts to intentional murder because the recommended usage of this drug was widely known.
Zinc
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It turns out that zinc inhibits replicase’s activity. An obstacle to the action of zinc is the problem with the penetration of this element into the cell. What is needed here is a substance that causes the zinc to transfer from the external environment of the cell to its interior, where the virus potentially replicates. These substances are so-called ionophores, and their function is to transport ions through the cell membrane. Ionophores include hydroxychloroquine and chloroquine.*
Metal ionophores [like HCQ] have been proven over the years to exert overt antiviral and anticancer properties especially when coupled with enough doses of metal ion additives [zinc] that will galvanize their functions in living tissues.
Chloroquine and hydroxychloroquine reduce the glycosylation of the ACE2 receptor and the viral penetration into the cell, due to the alcalisation of endocytic compartments—when not glycosylated, they will have lower affinity towards the viral spike proteins, which probably impedes the virus—receptor binding, resulting in the inhibition of the infection development.
Zinc inhibits viral replicase when inside the cell. For zinc to enter into cells an ionophore is needed. HCQ is a zinc ionophore.
As zinc deficiency frequently occurs in elderly patients and in those with cardiovascular disease, chronic pulmonary disease, or diabetes, we hypothesize that CQ/HCQ plus zinc supplementation may be more effective in reducing COVID-19 morbidity and mortality than CQ or HCQ in monotherapy. Therefore, CQ/HCQ in combination with zinc should be considered as additional study arm for COVID-19 clinical trials.
A significant, relatively stable, but negative correlation of Zn-deficiency with cases per million for the time period (...) and a steady improvement of covariation with deaths per million (... on 26 May 2020) was observed.
Most of the risk groups described for COVID-19 are at the same time groups that were associated with zinc deficiency. ... Zinc deficiency can probably be added to the factors predisposing individuals to infection and detrimental progression of COVID-19. Finally, due to its direct antiviral properties, it can be assumed that zinc administration is beneficial for most of the population, especially those with suboptimal zinc status.
Patients with coronavirus disease 2019 (COVID-19) had significantly low zinc levels in comparison to healthy controls. Zinc deficient patients developed more complications (70.4% vs 30.0%, p = 0.009). Zinc deficient COVID-19 patients had a prolonged hospital stay (7.9 vs 5.7 days, p = 0.048).
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HCQ should be used together with zinc
Zinc plays important roles in immunity and viral infection. For many years it has been known that Zinc deficiency is common in the elderly, especially those aged over 75. Zinc deficiency is characterized with impaired immune function. It is also known that older people are most at risk with COVID-19 infection. It is shown that zinc deficiency is prevalent among COVID-19 patients with severe illness resulting in higher development of complications and prolonged hospital stay.
So one would expect an organization like the World Health Organization to bring an end to zinc deficiency as soon as possible, zinc supplements are very cheap and easy. But after a search on the WHO COVID-19 information page here's what it provides about zinc...
FACT: Vitamin and mineral supplements cannot cure COVID-19
Micronutrients, such as vitamins D and C and zinc, are critical for a well-functioning immune system and play a vital role in promoting health and nutritional well-being. There is currently no guidance on the use of micronutrient supplements as a treatment of COVID-19.
There's exactly one article about zinc on the WHO website! Of course vitamins and zinc cannot cure COVID-19, but something as simple and cheap as zinc supplements can take away zinc deficiency and therefore this can significantly bring down the development of complications and prolonged hospital stay. But the WHO is obviously not promoting the use of cheap zinc supplements that can make a big difference, because it states there's "no guidance on the use of micronutrient supplements as a treatment of COVID-19". Incredible.
HCQ is a zinc ionophore and may derive an anti-cancer and antiviral action from increasing intracellular zinc uptake. But as we'll see, HCQ is also not very popular at the WHO which most likely has to do with financial interests, certainly not with public health.
Studies (March-June 2020)
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A lot of official statements and scientific papers from medical professionals are mentioned here. The papers are listed mostly in chronological order by (released or published) date. Most papers are available online in PDF format. Below each link to the research paper I put the outcome (positive, neutral or negative) w.r.t. HCQ's effect on COVID-19 and some details.
Jianjun Gao et al - Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies
Positive ... 100 people ... ?mg for ?days ... early treatment.
Philippe Gautret et al - Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial
Positive ... 20 people ... 3x200mg/day for 10 days ... start treatment after infection not sure.
Mehmet Mahir Ozmen - Proflaxis Using Hydroxychloroquine Plus Vitamins-Zinc During COVID-19 Pandemia
Positive ... prophylactic ... 200mg single dose repeated every three weeks plus vitamin C and zinc once a day.
Joshua Barbosa et al - Clinical outcomes of hydroxychloroquine in hospitalized patients with COVID-19: a quasi-randomized comparative study
Negative ... 63 people ... 2x400mg/day for 1-2 days + 200-400mg/day for 3-4 days ... how many days after infection when treatment starts is not sure.
Zhaowei Chen et al - Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial
Positive ... 142 people ... mild symptoms ... 400mg/day for 5 days ... early treatment.
Philippe Gautret et al - Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study
Positive ... 80 people ... mild symptoms ... 3x200mg/day for 10 days ... early treatment.
Sun Hee Lee et al - Can post-exposure prophylaxis for COVID-19 be considered as an outbreak response strategy in long-term care hospitals?
Positive ... 205 people ... mild symptoms ... 400mg/day for 14 days ... early treatment.
Francesco Fontana et al - SARS-CoV-2 infection in dialysis patients in northern Italy: a single-centre experience
Neutral ... 37 people ... all were dialysis patients and had comorbidities ... median dose of 300 mg/day and for a median time of 6.5 days ... doesn't seem like an important study on HCQ.
Mohammad Ali Ashraf et al - COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes
Positive ... 100 people ... ? symptoms ... 2x200mg or 400mg/day(+Lopinavir/Ritonavir) ... early treatment.
J. Emilio Sánchez-Álvarez et al - Status of SARS-CoV-2 infection in patients on renal replacement therapy. Report of the COVID-19 Registry of the Spanish Society of Nephrology (SEN)
Neutral to slightly positive... 868 people ... database study ... "A very high percentage (85%) required hospital admission, 8% in intensive care units" requiring mechanical ventilation ... high percentage of patients with fever, pneumonia and lymphocytopenia ... no information about the dose or the duration use.
Michael J. A. Robb et al - AAPS Letter Asking Gov. Ducey to Rescind Executive Order concerning hydroxychloroquine in COVID-19*
Positive ... letter of two Doctors of Medicine.
See also Coronavirus Conversation With Michael J. A. Robb, M.D. in which he mentions the importance of early usage.
Matthieu Million et al - Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France
Positive ... 1,061 people ... mild symptoms ... 3x200mg/day for 10 days (+AZ) ... early treatment.
Matthieu Mahévas et al - Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data
Negative ... 173 people ... patients with severe symptoms at baseline ... 600mg/day for ? days ... "received hydroxychloroquine within 48 hours of admission to hospital" implies these patients were already pretty sick before getting HCQ ... patients who started HCQ before admission to hospital were not included ... implies late treatment ... long list of "personal fees" from pharmaceutical companies (competing interests).
Philip Carlucci et al - Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients
Positive ... 932 people ... ? symptoms ... 400mg for 1 day + 2x200mg/day for 4 days (+ AZ and zinc) ... early treatment.
Federico Alberici et al - A report from the Brescia Renal COVIDTask Force on the clinical characteristicsand short-term outcome of hemodialysispatients with SARS-CoV-2 infection
Neutral to slightly negative? ... 94 people ... no mention of the dose! ... many comorbidities ... many already with fever and other symptoms ... "The finding of worse outcome of hemodialysis patients with SARS-CoV-2 infection may be explained by a high prevalence of comorbidities, as well as other risk factors." ... "patients who do not require hospital admission experienced a better disease course compared to patients who required hospitalization."
Francisco Javier Membrillo et al - Early Hydroxychloroquine Is Associated with an Increase of Survival in COVID-19 Patients: An Observational Study
Positive ... 166 people ... 800mg+400mg/day for 1 day + 400mg/day for ? days ... early treatment.
Wei Tang et al - Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial
Neutral ... 150 people ... 1200mg for 3 days + 800mg for 11 days (mild to moderate) or 18 days (severe) ... trial was stopped early.
Andrew Ip et al - Hydroxychloroquine and Tocilizumab Therapy in COVID-19 Patients - An Observational Study
Neutral ... 2,512 people ... majority of patients received 800 mg on day 1, and 400 mg on day 2-5 (80%, n=1533) ... "at least one dose" = unclear ... "Patients were included in the database based on the following inclusion and exclusion criteria: ... Were not discharged to home within 24 hours." Hospitalization implies these patients already had serious illness. Tabel 1 shows comorbidity rates, a high percentage of HCQ patients had comorbidities, hypertension, fever, shortness of breath. "The median time from self-reported onset of symptoms to hospitalization was 5 days" which implies these patients were treated in a late stage.
Bo Yu et al - Low dose of hydroxychloroquine reduces fatality of critically ill patients with COVID-19
Positive ... 550 people (48 HCQ) ... mild symptoms ... 2x200mg/day for 7-10 days ... early treatment.
Shailendra Singh et al - Outcomes of Hydroxychloroquine Treatment Among Hospitalized COVID-19 Patients in the United States- Real-World Evidence From a Federated Electronic Medical Record Network
Neutral ... data analysis research via TriNetX database ... no information about the dose or the patients consitions at start treatment ... info in Table 1 implies high comorbidity level.
J. Rogado et al - Covid-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid
Positive ... 1069 medical records ... cancer patients ... HCQ positive, HCQ+AZ better.
Joseph Magagnoli et al - Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19
Neutral to slightly negative ... 807 people ... 400-480mg for 5 days ... unclear when treatment started after infection.
An-Li Wang et al - Comorbidity and Sociodemographic determinants in COVID-19 Mortality in an US Urban Healthcare System
Neutral ... 7,592 people ... no mention of dose ... just summarizes existing studies.
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What can be concluded from the studies so far is that studies which use HCQ in an early stage of COVID-19 are very likely to have positive outcome. Most positive studies use a low dose of around 400-800mg on first day followed by 200-400mg/day for several days. HCQ doesn't seem to have a positive effect on COVID-19 patients with comorbidities and/or severe illness which confirms that it should be used in an early stage of infection. Also higher doses seem to be ineffective. The addition of zinc seems beneficial. These mainly positive outcomes have turned HCQ in a highly politicized topic...
WHO against HCQ (May 2020)
25 May 2020:
The World Health Organization says it is temporarily halting its clinical trials that use hydroxychloroquine to treat COVID-19 patients over published concerns that the drug may do more harm than good. The move comes after the medical journal The Lancet reported on Friday that patients getting hydroxychloroquine were dying at higher rates than other coronavirus patients.*
The paper published by The Lancet on which the WHO based its decision to halt its clinical trials for HCQ was later shown to be a fraud and was retracted. More about this later.
27 May 2020:
Five studies, including 2 controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. ... These medications need to be made widely available and promoted immediately for physicians to prescribe.
29 May 2020:
The Indian Council of Medical Research (ICMR) has written to the World Health Organization, expressing its disagreement with the global health body's advisory against the use of anti-malaria Hydroxychloroquine in treating Coronavirus patients. The ICMR, in the letter, cited the difference in dosage administered to patients and said that international dosages are four times higher than Indian trials.*
This is crucial, HCQ doses prescribed in the West, as recommended by for example the WHO, are much higher than the commonly prescribed optimal doses of HCQ which have shown to be effective in countries like India and many others! Later more about this.
Politicization against HCQ (June 2020)
According to the European Commission:
Disinformation on the coronavirus is thriving. It is important that you get updated information from authoritative sources only. ... We suggest that you follow the advice of your public health authorities, and the websites of relevant EU and international organisations: ECDC and WHO. ... Think twice before sharing any information that you see on social media about treatments and be sure to crosscheck information on new developments with trusted sources. One such example is the discussion around Hydroxychloroquine (a drug used to prevent and treat attacks of malaria), which has received a lot of attention, despite evidence from controlled studies so far showing the that drug is ineffective against the coronavirus.*
Of course it's true that there is a lot of disinformation on the internet of which people should be aware. But the message of the president of the EU implies to only trust information from authorities like ECDC and World Health Organization (WHO) and at the same time it also implies to distrust everything else.
Since its effective use HCQ has become a highly politicized topic. Highly politicized topics are usually also highly suspicious and controversial. That's because politicization usually happens when government officials and high level power elite involved in powerful organizations have (private or corporate) interests in the topic. The COVID-19 crisis shows that globalist organizations like EU and WHO are trying to gain more "control" over information in the world. Despite its widespread use and effectiveness, the authorities oppose the use of HCQ as a treatment of COVID-19 and regard all information that confirms HCQ's effectiveness — including scientific research, official statements of medical professionals and the fact that HCQ has been used worldwide and effectively since the beginning — as "disinformation".
Fraud against HCQ (June 2020)
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In June two studies with very negative results for HCQ were published in well respected scientific papers, one in The Lancet: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19..., and the other in New England Journal of Medicine, NEJM: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. These papers were later retracted because of fraud.
The fraudulent study published by The Lancet resulted in the World Health Organization announcing the halt of the HCQ test for COVID-19 on 25 May 2020 while none of the abundantly available genuine scientific research papers with positive results for HCQ were ever taken into account.
The focus of the media was largely directed at Sapan Desai who owned the company Surgisphere from which the fraudulent data supposedly came. Much less attention was directed at the main author of this fraud, namely "well-respected" Mandeep R. Mehra. Another paper published by Oxford University and authored by Mandeep R. Mehra, titled Conducting clinical trials in heart failure during (and after) the COVID-19 pandemic... contains a section "Conflicts of interest" showing that each researcher gets "personal fees" from pharmaceutical companies. Roughly two pages are neccessary to get all the "personal fee" links listed. Big Pharma and these kind of researches from "high profile scientists" are basically two sides of the same coin.
Then there's a certain Jyoti Mehra who is Executive Vice President of Human Resources at Gilead Sciences*, the pharma company that produces the expensive Remdesivir, a competitor of cheap HCQ. She is married to Uneek Mehra who is currently Chief Financial Officer at PACT Pharma** after having worked for other pharma companies. It's one happy pharma family.
Mandeep Mehra was a participant at an online information session called Update on SARS-CoV2 and COVID-19 in Barcelona which was sponsored by Gilead Sciences*. In for example a 2014 paper titled Right heart failure: Toward a common language he declared consultancies for Gilead Sciences. Etcetera.
It's obvious what's going here. After the fraudulent Lancet paper was retracted the WHO reluctantly continued testing HCQ for a little while to no avail. Of course it never was WHO's intention to finish it or to produce objective results.
Richard Horton is editor-in-chief of The Lancet and has served in various roles with the World Health Organization.** Birds of a feather flock together.
FDA against HCQ (June 2020)
Based on its ongoing analysis of the EUA and emerging scientific data, the FDA determined that chloroquine and hydroxychloroquine are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA. Additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorized use.*
On May 27 France banned hydroxychloroquine to treat COVID-19, after having been used for months. On June 15 the Food and Drug Administration (FDA) revoked the Emergency Use Authorization (EUA) for Chloroquine and Hydroxychloroquine in the United States, after having been used for months. On June 16 Britain's drug regulator suspended hydroxychloroquine trial recruitment after having been used for months.
So all those months that medical professionals used HCQ and CQ on themselves, as a prophylactic, and on patients, as a treatment, was just a completely useless practice without any positive effect? Impossible. The FDA, which was formed in 1906 with the aim of protecting public health, has close ties with the pharmaceutical industry. The result after more than a century of FDA's existence is that there is a very unhealthy American population plagued by obesity and many other health issues. See UNhealth.
Vaccine race (June-July)
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AstraZeneca has reached an agreement with Europe’s Inclusive Vaccines Alliance (IVA), spearheaded by Germany, France, Italy and the Netherlands, to supply up to 400 million doses of the University of Oxford’s COVID-19 vaccine, with deliveries starting by the end of 2020.
The vaccines are being researched by an alliance between the pharmaceutical companies BioNtech and Pfizer as well as the firm Valneva. The new deal is on top of 100 million doses of the Oxford University vaccine being developed by AstraZeneca.
AstraZeneca and many other leading pharma companies have received billions of dollars of public money to develop their COVID-19 vaccines at the earliest. Other companies that are producing COVID-19 vaccines have also signed pacts with governments across the world on different terms.
The U.K. is poised to become the first country to approve Pfizer Inc. and BioNTech SE’s COVID-19 vaccine... The U.K. had long signaled it would move fast on any promising vaccine candidate. ... The government invoked a special rule allowing the U.K. drug regulator to bypass its European Union counterpart...
In July 2020, Pfizer and BioNTech announced an agreement with the U.K. to supply 30 million doses of the BNT162b2 mRNA-based vaccine, once authorized for emergency use. That agreement was increased to 40 million doses in early October. The delivery of the 40 million doses will occur throughout 2020 and 2021, in stages, to ensure an equitable allocation of vaccines across the geographies with executed contracts.
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As early as June governments pre-ordered vaccines on a massive scale. Big business. There's a close relationship between government and pharmaceutical industry. One of the pharmaceutical companies involved is AstraZeneca which is closely related to the UK RECOVERY Trial mentioned later.
Another aspect worth mentioning is that these COVID-19 vaccines were already on the market, only one year after COVID-19 broke out. Normally the development of a new vaccine takes about 10 to 15 years when done correctly. That's because vaccines face a tougher safety standard than most pharmaceutical products. It's impossible to compress 10 to 15 years into only 1 year while maintaining the same safety level. Therefore these pharma companies have nogotiated non-liability with governments in case these vaccines cause future damage.* See also VacciNATION. While we hear very little criticism in the media about this, we do hear a lot about the possible side effects of HCQ which has an extremely safe antimalarial track record around the world for decades, and while any side effects are mainly the result of wrong usage against the safe use guidelines mentioned earlier. "High profile" trials from the UK and WHO will be mentioned later.
Studies (June-July 2020)
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Olivier Paccoud et al - Compassionate use of hydroxychloroquine in clinical practice for patients with mild to severe Covid-19 in a French university hospital
Neutral ... 117 people ... 2x200mg for 10 days ... patients were all hospitalized which implies more advanced stage of disease, not early treatment
Emilie Sbidian et al - Hydroxychloroquine with or withoutazithromycin and in-hospital mortality or discharge in patients hospitalized for COVID-19 infection: a cohort study of 4,642 in-patients in France
Positive ... 4,642 people ... 600mg on day 1, followed by 400mg daily for 9 additional days (+AZ) ... no reduction in mortality but significantly higher rates of discharge home.
Pranab Chatterjee et al - Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19
Positive ... ? people ... mild symptoms ... 2x200mg/day for 7-10 days ... early treatment
Note: HCQ did not offer therapeutic benefits to severe COVID-19 cases, and was associated with increased mortality. But that goes for late treatment.
Jean-Christophe Lagier et al - Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis
Positive ... 3,737 people ... ? symptoms ... 3x200mg/day for 10 days (+AZ) ... early treatment
Jean-Christophe Lagier et al - Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis
Positive ... 3,737 people ... 3x200mg/day for ten days ... early treatment
Takahisa Mikami et al - Risk Factors for Mortality in Patients with COVID-19 in New York City
Positive ... 6,493 people ... A multicenter retrospective cohort study ... "using multivariate regression analyses and the IPTW method, which revealed that hydroxychloroquine use was associated with decreased risk of in-hospital mortality."
Samia Arshad et al - Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19
Positive ... 2,541 people ... 400mg twice daily for 2 doses on day 1, followed by 200mg twice daily on days 2–5 (+AZ)... reduction in mortality ... "our patient population received aggressive early medical intervention"
Marie Lecronier et al - Comparison of hydroxychloroquine, lopinavir/ritonavir, and standard of care in critically ill patients with SARS-CoV-2 pneumonia: an opportunistic retrospective analysis
Neutral ... 80 people ... critically ill, late treatment ... 200mg twice a day versus a loading dose of 400mg twice a day followed by 200mg three times a day ... "hydroxychloroquine ... potential benefit ... in critically ill patients has not been evaluated". "our results cannot confirm or refute the conclusion ... that there is insufficient evidence to issue a recommendation on the use of chloroquine or hydroxychloroquine in critically ill adults with COVID-19-related pneumonia".
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Meanwhile more studies kept confirming what we already knew about HCQ.
UK RECOVERY Trial (July 2020)
At the beginning of July the WHO came with the following statement...
Interim trial results show that hydroxychloroquine and lopinavir/ritonavir produce little or no reduction in the mortality of hospitalized COVID-19 patients when compared to standard of care. Solidarity trial investigators will interrupt the trials with immediate effect. ... The interim Solidarity results are now being readied for peer-reviewed publication.*
So these WHO studies have not yet been peer-reviewed and the authorities already made the decision to stop any further research into HCQ as a remedy against COVID-19. That's peculiar to say the least. The WHO does not mention anything about HCQ's effectiveness in an early stage of COVID-19 as was strongly suggested by scientific research. Mid July Peter Horby et al published their so-called UK RECOVERY Trial paper. Some observations:
1,561 people ... severely ill (hospitalization), 60% were on oxygen, 17% on mechanical ventilation, comorbidities ... number of days since symptom onset 9 days, ... 800 mg at zero and 6 hours, followed by 400mg starting at 12 hours after the initial dose and then every 12 hours for the next 9 days or until discharge. ... A history of diabetes was present in 27% of patients, heart disease in 26%, and chronic lung disease in 22%, with 57% having at least one major comorbidity recorded. ... hydroxychloroquine was not associated with reductions in 28-day mortality but was associated with an increased length of hospital stay and increased risk of progressing to invasive mechanical ventilation or death.
The findings indicate that HCQ is not an effective treatment for hospitalized patients with COVID-19. But this trial tested HCQ on severely ill patients in the late stage of COVID-19 while we know from previous research that HCQ is most effective when used in the early stage in order to prevent COVID-19 from developing into severe illness. This study merely confirmed what we already knew, namely that HCQ most likely does not have any meaningful mortality benefit in severely ill patients hospitalised with COVID-19. On top of that, the dose given to patients was very high, against the safe use guidelines mentioned earlier. Already in 2017 it was shown that high doses of antimalarial drugs are related to sudden death, especially in patients with heart disease. Despite these simple facts, based on this research alone the WHO quickly concluded that HCQ has no effect and interrupted its Solidarity Trial on July 4.
This research was funded by the Medical Research Council, MRC, and National Institute for Health Research, NIHR. MCR has several partnerships with industry.*** Both Peter Horby and Martin Landray, who led this UK RECOVERY Trial, are Professors at the University of Oxford which is partnered with AstraZeneca and funded by for example Novartis and Boehringer Ingelheim, and it collaborates with Merck on vaccine manufacturing.* So there is a strong relation between pharmaceutical industry, academia, and researches like this one. It has conflicts of interest written all over it.
Studies (July-August 2020)
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Caleb P. Skipper et al - Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 - A Randomized Trial
Neutral ... 236 people ... 800mg once, followed by 600mg in 6 to 8 hours, then 600mg daily for 4 more days ... early treatment was aimed for, but experienced limitations ... "Only 58% of participants received SARS-CoV-2 testing because of severe U.S. testing shortages" ... private donors.
Oriol Mitjà et al - Hydroxychloroquine for Early Treatment of Adults with Mild Covid-19: A Randomized-Controlled Trial
Neutral ... 293 people ... many patients with coexisting diseases ... 800mg on day 1, followed by 400mg once daily for 6 days.
Nikolas Bernaola et al - Observational Study of the Efficiency of Treatments in Patients Hospitalized with Covid-19 in Madrid
Positive ... 1,645 people.
Marcus Zervos et al - A sound approach: Hydroxychloroquine reduces mortality in severe COVID-19
Positive ... Letter.
David R. Boulware et al - A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19
Neutral or positive ... conclusion differs from actual measured data because of the method used to interpret the data.
See also letter and article. The conclusion by Boulware et al is most likely the result of bias, perhaps fraud, but certainly misleading and bad scientific practice. Another problem with this study is that it enrolled people through the internet and social media and participants were not all tested for the coronavirus but were diagnosed as COVID-19 cases based on symptoms in many cases. This means that there are a lot of uncertainties. After this study Boulware said:While we are disappointed that this did not prevent COVID-19, we are pleased that we were able to provide a conclusive answer. Our objective was to find an answer.* A "conclusive answer" from such an incomplete study is a very bad scientific practice for a so-called "professor".
It is known that David R. Boulware is sponsored by Gilead Sciences which is a pharmaceutical company that produces Remdesivir, a competitor to HCQ. In another article Boulware promotes Remdesivir despite it being very expensive*. Gilead is not mentioned anywhere in the "Funding and Disclosures" section of the paper while David Baszucki is mentioned as financial sponsor. David Baszucki is also sponsor of other studies with negative outcome for HCQ. A quick search on Google for "David R. Boulware" gives several media appearances.
A reaction to this paper was published saying:However, it would appear that to some extent the media and social forces — rather than medical evidence — are driving clinical decisions and the global Covid-19 research agenda. ... The results reported by Boulware et al. are more provocative than definitive, suggesting that the potential prevention benefits of hydroxychloroquine remain to be determined.
Lucy Catteau et al - Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants
Positive ... 8,075 people ... ? symptoms ... 480mg/day for 5 days ... early treatment.
See Dr. John Campbell - Hydroxychloroquine, evidence of efficacy.
Thibault Fiolet et al - Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
Negative ... meta-analysis ... based on late treatment studies and possibly bias.
Discussed in more detail in the next paragraph.
HIDE CONTENT
Meanwhile more studies kept confirming what we already knew about HCQ.
Meta-analysis Fiolet et al (August 2020)
SciTechDaily reported...
New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin. ... The authors conclude: “There is already a great number of studies that have evaluated hydroxychloroquine alone or in combination and it seems unlikely at this stage that any efficacy will ever emerge. Our results suggest that there is no need for further studies evaluating these molecules, and the European DisCoveRy and WHO international Solidarity clinical trials have already discontinued treatment arms using hydroxychloroquine.”
This article is based on a meta-study by Thibault Fiolet et al which concludes...
Hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients but the combination of hydroxychloroquine and azithromycin significantly increased mortality.
How did this study come to the opposite conclusion and why do these people pretend there is no evidence whatsoever for HCQ's positive effect when used under the right conditions as is extensively documented? The authors of this paper did a selective meta-analysis of existing researches. The reference studies they use for this conclusion are listed by reference numbers...
Studies included 27 articles for hydroxychloroquine [14-19,23,24,36,39-56] and 12 articles for hydroxychloroquine + azithromycin [18,36,41,42,47,48,50,51,57-60].
The first referenced study is paper #14. This paper was already mentioned earlier on this webpage, it supports the use of HCQ. To my surprise it also contains direct criticism of three of the research papers used by Thibault Fiolet et al in their negative meta-analysis. This is what these researchers say:
We also noticed a couple of negative reports about CQ and HCQ (Geleris et al., 2020; Mahevas et al., 2020; Magagnoli et al., 2020). However, based on the results in these studies, it is very likely that they used high doses of HCQ, which might induce cardiotoxicity and death. They might also have used high doses of HCQ as antiviral agents rather than for anti-inflammation. ... Recently, Geleris et al. (2020) reported their observation study, showing that there was no significant association between hydroxychloroquine use and intubation or death. By carefully re-analyzing this report, however, we noticed that in this study, HCQ-treated patients were more severely ill at baseline (even if after propensity score-matched) than NHCQ-treated patients. In addition, the time of treatment for patients is too short (5 days) to show the efficacy of HCQ. Another concern of this study is that about 60% HCQ-treated patients received azithromycin simultaneously, which increases risk of QT-interval prolongation and sudden death.
And criticism from another research team...
Recent observational studies in 1446 consecutive, non-randomized patients suggest that HCQ administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death [Geleris et al]. Still, HCQ-treated patients were more severely ill at baseline than those who did not receive HCQ. More, the toxic side effects were minimal.
So referenced papers #13, #15, #41 have already been criticized. Most of the referenced papers by Fiolet et al have been mentioned in the long list of scientific studies earlier ("Fiolet #"). The remaining papers will be briefly discussed here...
#17:Luis Ayerbe et al - The association between treatment with heparin and survival in patients with Covid-19
This paper talks about Heparin, I don't see any significant information about HCQ.
#18:Eli S. Rosenberg et al - Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State
This paper doesn't even mention the dose of HCQ, nor the duration as far as I can see.
#19:Awadhesh Kumar Singh et al - Hydroxychloroquine in patients with COVID-19: A Systematic Review and meta-analysis.
Positive.
#45:Emma Wilkinson - RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials
This is not a paper or a study, but a letter. It doesn't mention any dose, nor the duration.
#47:Donna R. Rivera et al - Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
This paper is about a test on people with cancer. Cancer is a comorbidity. Nowhere can I find information about the dose. I'm not sure about the duration, it mentiones "primary evaluation of 30-day all-cause mortality within the context of hydroxychloroquine exposure". But without the dose we can't compare.
#49:J. Luo et al - COVID-19 in patients with lung cancer
Again a research involving cancer patients. Cancer is a comorbidity. I can't find information about the used dose, not about the duration of use. It strongly seems that HCQ was not tested intensively since it is merely mentioned on the side.
#52:Paolo Cravedi et al - COVID‐19 and kidney transplantation: Results from the O International Transplant Consortium
Scanned the paper and as far as I could see there's not even mention of the dose, nor the duration of use. Seems therefore not suitable to draw conclusions from this.
#53:Shruti Gupta et al - Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US
Scanned the paper and as far as I could see there's not even mention of the dose, nor the duration of use. After all it's about critically ill patients. Seems therefore not suitable to draw conclusions about HCQ from this.
#60:Guilhem Bousquet et al - ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19
There is no definitive conclusion about HCQ in this paper?
It strongly seems to me that, after scanning the referenced papers, this conclusion does not correctly represent the conclusions and content of those referenced papers. Furthermore, I believe that all the scientific research papers, available at that time, with positive outcomes for HCQ, cannot simply be waved away as insignificant. Most of the neutral or negative research papers either do not mention the dose or they use a higher dose than in positive studies. But more importantly, those researchers used HCQ in a late stage of COVID-19, on severely ill patients, of which we know from previous studies that it's less effective and possibly dangerous according to the safe use guidelines. It even seems that the researchers cherry-picked studies that are negative.
On top of that, Thibault Fiolet is linked to the World Health Organization* and to the World Economic Forum*, powerful organizations run by the power elite and the ultra-rich with a globalist agenda. According to his LinkedIn page* he is a PhD Student in Public Health, food contaminants and cancer at the University of Paris-Saclay of which he says:My PhD at Institut Gustave Roussy is about food exposure to Persistent Organic Pollutants ... and breast cancer risk in the European EPIC Cohort coordinated by IARC/WHO.The European EPIC Cohort is sponsored by the World Health Organization.
Studies (September-October 2020)
SHOW CONTENT
Alexandre B. Cavalcanti et al - Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19
Neutral ... 504 people ... mild to moderate ... 400mg twice daily for 7 days or 400mg twice daily plus azithromycin (AZ) ... "with 14 or fewer days since symptom onset" implies very late treatment. See also criticism of this paper and a reply. This paper was used as reference paper by Fiolet et al who must have used the released paper before it was published.
Tarek Sulaiman et al - The Effect of Early Hydroxychloroquine-based Therapy in COVID-19 Patients in Ambulatory Care Settings: A Nationwide Prospective Cohort Study
Positive ... 7,892 people ... mild to moderate symptoms ... 400mg/day for one day + 2x200mg/day for 4 days ... early treatment
Philip M. Carlucci et al - Zinc sulfate in combination with a zinc ionophore may improve outcomes in hospitalized COVID-19 patients
Positive ... 932 people ... zinc ... low dose HCQ ... late treatment
Radha Rajasingham et al - Hydroxychloroquine as pre-exposure prophylaxis for COVID-19 in healthcare workers: a randomized trial
Neutral to positive ... conclusion differs from actual measured data, dose dependent response measured in Fig. 2
See also letter. The biased conclusion in this paper is likely due to interests other than science. The sponsors of this study were, among others, Jan and David Baszucki who were already involved in other papers (e.g. Boulware et al) with biased conclusions mentioned earlier.
Eleftherios Pelechas et al - Anti-Rheumatic Drugs for the Fight Against the Novel Coronavirus Infection (SARSCoV-2): What is the Evidence?
Positive ... cell theory ... early treatment ... "HCQ blocks viral replication by inhibition of cell entry of SARS-CoV-2 and prevents virus-cell fusion by interfering with glycosylation of ACE2 receptor and its binding with spike protein."
A.J.J. Lammers et al - Early hydroxychloroquine but not chloroquine use reduces ICU admission in COVID-19 patients
Positive ... 1,064 people ... ? symptoms ... 400mg/day for one day + 2x200mg/day for 4 days ... early treatment
Y-X Bai et al - Advances in SARS-CoV-2: a systematic review
Positive ... cell theory ... "As reported, SARS-CoV-2 used ACE2 as a single receptor31,34. Inhibiting the interaction between spike protein and ACE2 is of great signifi-cance for anti-coronavirus therapy. CQ is thought to play an antiviral role by blocking the binding of the spike protein of coronavirus to ACE232. In addition to its antiviral activity, CQ also has immunomod-ulatory activity, which can synergistically enhance the antiviral effect invivo. CQ has been used in clinical practice for more than 70 years, with high safety and low cost.
Raja Bhattacharya et al - Pre exposure hydroxychloroquine prophylaxis for covid-19 in healthcare workers: a retrospective cohort
Positive ... 106 people ... pre-exposure prophylaxis ... dose as per ICMR guidelines
Jacques Fantini et al - Leveraging coronavirus binding to gangliosides for innovative vaccine and therapeutic strategies against COVID-19
Positive ... cell theory ... "A critical step of the infection cycle is the binding of the virus spike S protein to the cellular ACE-2 receptor."
HIDE CONTENT
Meanwhile more studies kept confirming what we already knew about HCQ.
WHO SOLIDARITY Trial (October 2020)
Picture is taken from an article on Thibault Fiolet's webpage*, the author of the negative meta-analysis mentioned earlier. The WHO did a study into HCQ as well, the so-called WHO Solidarity trial, it concluded...
These Remdesivir, Hydroxychloroquine, Lopinavir and Interferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay. The mortality findings contain most of the randomized evidence on Remdesivir and Interferon, and are consistent with meta-analyses of mortality in all major trials.
Incredible. After all the positive results from around the world the researchers at WHO conclude that there is no evidence for any positive effect of HCQ. Let's examine this study further...
The protocol was designed to involve hundreds of potentially over-stressed hospitals in dozens of countries ... Hydroxychloroquine (oral): Hour 0, four tablets; Hour 6, four tablets; Hour 12, begin two tablets twice daily for 10 days. Each tablet contained 200mg Hydroxychloroquine sulphate (155mg base/tablet; a little-used alternative involved 155mg chloroquine base/tablet). ... Neither trial recorded dosage/kg, obesity...
The official WHO recruitment form* states that already hospitalized patients are being used. An official WHO statement* explains what it means to be hospitalized with COVID-19. Severe illness of the HCQ patients is confirmed in Table 1 of the study: 55% were on oxygen at entry and more than 11% already ventilated, 70% with bilateral lung lesions, 21% diabetes, 21% heart disease.
But HCQ is not supposed to be used on severely ill patients in a late stage of disease!
Researchers use a very high dose of 4x200mg + 6 hours later 4x200mg + 6 hours later 2x200mg/day for 10 days. First day in total 2000mg (!) while most previous studies do not exceed 800mg on the first day and most suffice with 400/200mg for a few days starting in the early phase of infection.
But HCQ is not supposed to be used in very high doses!
This study also mentiones "a little-used alternative involved 155mg chloroquine", which can make a big difference because CQ is more toxic than HCQ. This was already concluded in April 2020 by Mayla Gabriela Silva Borba et al. This WHO study does not mention how many patients were given CQ instead of HCQ, neither does it mention different doses for the more toxic variant, neither does it mention the dose/kg body weight of patient which can make a difference.
As expected, the outcome of this study is neutral to negative because HCQ was used completely contrary to how it should be used, it should be used as a preventative in the early stage of infection, not as a cure in a late stage of severe illness! Although this research adds very little to what we already knew about HCQ, it confirms that organizations like the WHO and related "high profile" scientists and governments are involved in strong negative bias against HCQ. More about this later.
Global usage of HCQ
screenshot
Because of the WHO recommendations HCQ is currently not longer used in large parts of the Anglo-American western world. But it was being used for several months prior to this recommendation, also in the United States. And it is still being used in pretty much the rest of the world. This begs the question whether those months of HCQ usage were a total waste of pharmaceuticals, money and false hope... or not. As shown in previous studies there are a lot of positive outcomes of HCQ use on COVID-19 under certain conditions. It would be highly unlikely that so many medical authorities all over the world were using HCQ if it didn't show any positive effect on COVID-19 patients at all.
The conclusions of several high profile studies, by for example the UK and the WHO, simply excluded known preconditions for effective use of HCQ. And given the fact that this knowledge was widely available it is highly suspicious. This must have been done by design because it's impossible that all the intelligent "professors" of these highly esteemed universities are that ignorant of observable reality. That which should have been tested, namely the use of HCQ in an early stage of infection to prevent severe illness as is recommended and proven effective everywhere in the world, was left out intentionally by whoever was in charge of the UK and WHO studies. The ultimate responsibility was with the WHO whose globalist elite are in control of global policy and they were quick to ban HCQ from the western world, based on their own suspicious and incomplete research, while it was being used effectively in the rest of the world.
Studies (October-... 2020)
SHOW CONTENT
Mukesh Kumar et al - Decoding the silent walk of COVID-19: Halting its spread using old bullets
Positive ... cell theory ... "The glycosylation event is thought to be essential for virus attachment to ACE2 and its priming in the endosome for the membrane fusion required for its cytoplasmic entry. Inhibition of the ACE2 glycosylation by CQ can successfully decrease the SARS CoV2 viral load"
Flavio A Cadegiani et al - Azithromycin with nitazoxanide, hydroxychloroquine or ivermectin, with or without dutasteride, for early stage COVID-19: an open-label prospective observational study in males with mild-to-moderate COVID-19 (The Pre-AndroCoV Male Trial).
Positive ... 305 people ... 400mg/day for 5 days (+AZ) ... early treatment
Roland Derwand et al - COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study
Positive ... 141 people ... 2x200mg/day for 5 days (+ AZ and zinc) ... early treatment
Jennifer A. frontera et al - Treatment with Zinc is Associated with Reduced In-Hospital Mortality Among COVID-19 Patients: A Multi-Center Cohort Study
Positive ... 3,473 people ... 2x400mg first day then 2x200mg for four days ... zinc
Silvia Nunes Szente Fonseca et al - Risk of hospitalization for Covid-19 outpatients treated with various drug regimens in Brazil: Comparative analysis
Positive ... 717 people ... 2x400mg first day, 400mg/day days 2–5 ... early treatment
Deba Prasad Dhibar et al - Post-exposure prophylaxis with hydroxychloroquine for the prevention of COVID-19, a myth or a reality? The PEP-CQ Study
Positive ... post-exposure prophylaxis (PEP)
Flavio A. Cadegiani et al - Early COVID-19 Therapy with Azithromycin Plus Nitazoxanide, Ivermectin or Hydroxychloroquine in Outpatient Settings Significantly Reduced Symptoms Compared to Known Outcomes in Untreated Patients
Positive ... early treatment ... vitamin D, vitamin C, zinc ... ACE2 ... less than seven days of symptoms
Sheila Samanta Mathai et al - Hydroxychloroquine as pre-exposure prophylaxis against COVID-19 in health-care workers: A single-center experience
Positive
Iván J. Núñez-Gil et al - Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry
Positive
Wesley H. Self et al - Effect of Hydroxychloroquine on Clinical Status at 14 Days in Hospitalized Patients With COVID-19A Randomized Clinical Trial
Neutral to negative ... very late treatment
I. Simova et al - Hydroxychloroquine for prophylaxis and treatment of COVID-19 in health-care workers
Positive ... letter
Eman Sheshah et al - Prevalence of Diabetes, Management and Outcomes among Covid-19 Adult Patients Admitted in a Specialized Tertiary Hospital in Riyadh, Saudi Arabia
Positive
Gianluca E.M. Boari et al - Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study
Positive ... see "Supplementary data" Fig. 2 Panel 3 and 4
Yi Li et al - Comparative efficacy and safety of current drugs against COVID-19: A systematic review and network meta-analysis
Slightly negative ... late treatment
Hoyt Burdick et al - Is Machine Learning a Better Way to Identify COVID-19 Patients Who Might Benefit from Hydroxychloroquine Treatment?-The IDENTIFY Trial
Positive ... study involving better selection of patients to treat with HCQ because most (negative) studies don't do that.
Karlijn van Halem et al - Risk factors for mortality in hospitalized patients with COVID-19 at the start of the pandemic in Belgium: a retrospective cohort study
Neutral ... late treatment on hospitalized patients
Frederico Scuotto et al - Predictors of QT Interval Prolongation in Critically-ill Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine
Neutral ... confirms what we already knew: do not use HCQ in high doses on patients with heart disease
Abdulkarim Abdulrahman et al - The efficacy and safety of hydroxychloroquine in COVID19 patients : a multicenter national retrospective cohort
Neutral to slightly negative ... very late treatment because HCQ-receiving patients were more severely ill on admission.
David M. Wiseman et al - Effective post-exposure prophylaxis of Covid-19 is associated with use of hydroxychloroquine: Prospective re-analysis of a public dataset incorporating novel data
Positive ... corrects previous studies ... early treatment (within 4 days after infection)
Cheng-Pin Chen et al - A multicenter, randomized, open-label, controlled trial to evaluate the efficacy and tolerability of hydroxychloroquine and a retrospective study in adult patients with mild to moderate coronavirus disease 2019 (COVID-19)
Neutral to negative ... patients "were stratified by mild or moderate illnesses within 4 days of diagnosis." which implies it was not known how many days they already were infected. ... patients with pneumonia were included. Pneumonia is an infection that inflames the lungs due to bacteria. HCQ is meant to prevent the infection from becoming severe, so pneumonia is already late for HCQ ... no mention of zinc
HIDE CONTENT
Meanwhile more studies kept confirming what we already knew about HCQ.
Hierarchy of evidence
The hierarchy of evidence is a standard by which evidence is valued. But it's not the holy pinnacle of science. If for example 100s of observational studies around the globe conclude that a certain medicine or method is effective in treating a certain condition, then one randomized controlled trial with a negative outcome doesn't necessarily undo all previous scientific research and knowledge, it might as well indicate that something is wrong with that trial, as we've seen with for example the large UK and WHO trials.
The results of well-designed observational studies (with either a cohort or a case–control design) do not systematically overestimate the magnitude of the effects of treatment as compared with those in randomized, controlled trials on the same topic.
Well-designed observational studies are a very good indication, there is no need for randomized controlled trials, RCTs, to come to decent conclusions about what works or what doesn't.
More than half of the current recommendations of the IDSA are based on level III evidence only.
So most recommendations are based on observational studies, not on randomized controlled trials. It's common in the medical world.
On average, there is little evidence for significant effect estimate differences between observational studies and RCTs...
RCT results can serve science but are weak ground for inferring ‘what works’.
People like for example Thibault Fiolet et al put much emphasis on the selection of randomized controlled trials, RCTs, over regular observational studies. But many independent observational studies from all over the world which come to similar conclusions is, in my opinion, much better than large clinical trials controlled by huge organizations with ties to the pharmaceutical industry and politics. This study into HCQ made me trust more in the science of many independent observational studies from real life around the globe than in the so-called "science" of "high profile" scientists from "highly esteemed" universities who are paid too much for delivering the kind of incomplete studies with biased conclusions like those of the UK and WHO. For the much hailed peer-review process pretty much the same applies. True science is unbiased and does not exclude possibilities from its research and conclusions, like these overpaid researchers did. The hierarchy of evidence is a nice theoretical standard, but when it is regarded as the holy pinnacle of science, over evidence from real life, then it becomes more like a religion or a tool for the power elite to increase their profit, which brings us to the following topic...
Money, money, money
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Therefore, the results of chloroquine and HCQ so far done against COVID-19, more promising than previous trial in other viral diseases. Moreover, these drugs are of low cost, reasonably safe (...), and widely available in countries where malaria is endemic.
Considering the availability and cheapness of HCQ, it seems worth further investigating the clinical effect of an optimised dosage of HCQ.
As shown extensively on this webpage, which is only the tip of the iceberg, many medical professionals and scientists of different and independent studies around the world suggest to use HCQ not only because it has been proven effective against preventing severe illness after infection with COVID-19 when used correctly, but also because it is cheap and widely available. Zinc and vitamin D are also widely available and cheap and can be implemented immediately and without much cost.
But the bleak reality is that we live in an extremely materialistic world with extreme levels of inequality and corruption. Medicine in general works by treating symptoms instead of causes and the pharmaceutical industry thrives by profits made of diseases. If cheap HCQ can prevent the majority of people with COVID-19 infection from progressing to severe illness when used properly, then the power elite in control of the pharmaceutical industry and globalist organizations like WHO will not make enough profit from very expensive vaccines.
source
EU President Ursula von der Leyen isworried that those behind those claims exploit people's fears about the virus, just to make money.The misinformation about, and the suppression of HCQ and Ivermectine is a crime against humanity supported by criminal clowns like Ursula.