There has been a lot of conflicting studies coming out recently regarding the use of hydroxychloroquine in COVID19 cases. Some showing effectiveness some not. In this article, I would like to review these studies and come to some logical conclusion regarding this potentially beneficial therapy for early onset COVID.
Michigan Study Showed Marked Effectiveness
The most recent study is very pertinent, for it was performed at a regular hospital setting in patients who had started taking the HCQ early on, within 1 day of symptoms for most. The study was performed at Henry Ford hospital in Michigan and it followed 2,541 consecutive patients admitted to their health system in Michigan.
Although it was an observational study looking at patients who had been treated for COVID19 retrospectively, the results are quite amazing. Those patients who had used HCQ starting early in their disease with or without Azithromycin had a 39% reduction in the risk of dying from COVID versus those who did not receive HCQ (16.1% vs. 26.4%).
There are data essentially showed that giving HCQ early saves lives! Doctors should look to the data for insight and the data here clearly shows there is a significant benefit to using HCQ in COVID19 patients. Although an observational study, it was highly analyzed and peer-reviewed. Of note, their dosing was different from other studies, with patient using a higher dose similar to the Wuhan studies using higher doses and showing effectiveness.
No patients had side effects, demonstrating the safety of this drug. We have heard that African Americans have worse outcomes from COVID, but in this study 51% of treated individuals were black, showing benefit to all races. The authors felt that HCQ should indeed be used in outpatient clinics before potential hospitalization is needed.
HCQ Must be Started Early and HCQ Actions
The Michigan study used HCQ during the appropriate time, i.e. early onset. Many other studies have been performed that have shown efficacy of HCQ for decreasing the severity of COVID19, if started early and with adequate doses.
Multiple studies have shown that starting HCQ late, when patients need oxygen and/or ventilators, does not work. Although the news media had stated that these studies showed that HCQ was not effective against COVID19, most of these failed to mention that the HCQ was given late when the disease process has already taken hold and has caused significant damage.
There are several mechanisms of action of HCQ against COVID19. One is that it affects the cell membrane and prevents the virus from entering the cell. Another is that, once the virus enters the cell, HCQ prevents it from attaching onto the membranous system (reticulum) within the cells preventing the virus from getting into the nucleus and causing damage.
HCQ has been thought to increase Zinc levels inside cells by actively transporting higher concentrations of Zinc into the cells. Zinc has antiviral activities and this higher amount of Zinc within the cells is thought to decrease the infectiousness of the virus.
Lastly, HCQ is indeed an antimalarial drug, and it is thought to work with COVID19 in a similar fashion as it does in malaria. COVID19 virus, like the malarial parasite, decreases the oxygenation of red blood cells by dissociating the iron from the protein making hemoglobin, which transports the oxygen to the tissue and brings back CO2 to the lungs to receive more oxygen. Without adequate heme, the bound form of iron forming hemoglobin, this exchange doesn’t happen well in the lungs, resulting in inflammation in the small alveoli in the lungs which also inflames the bronchi. In addition, in malaria you get clotting of the blood, and this happens in a similar fashion with COVID, which can be lessened with the use of HCQ.
Studies Showing HCQ was not Beneficial and Possibly Harmful were Retracted
Several poorly performed studies, on in Lancet and one in the NEJM concluded that HCQ given to patients before or during hospitalization resulted in no benefit from the medication and potentially made severe cases worse.
Both studies were criticized by hundreds of physicians for multiple reasons. Finally, once it was determined that their data could not be substantiated and was questionable, both journals retracted their respective study.
Thus, although these were reputable journals, the review process for COVID19 articles has slacked, and even the journals have admitted to this. Thus, don’t believe everything you hear concerning in this rapidly changing environment.
As we have told our patients from the start of the pandemic, it appears that HCQ is beneficial to decrease the severity and death rate from COVID19 if started early before severe symptoms take over. This study confirms this philosophy and we at TrueMD will continue to help patients if they get symptoms early with this therapy as an off-label use via Telehealth services.
This philosophy is endorsed by the AAPS (American Association of Physicians and Surgeons). Studies showing no effectiveness either gave the HCQ too late or were of poor data. Although further studies need to be done, it still appears to be an effective method to reduce severity.
This philosophy is particularly pertinent for the elderly and those with comorbidities, such as obesity, diabetes, COPD, smokers, severe heart disease, and immunocompromised cancer patients. The severe side effects from HCQ are very rare and it has been used for over 50 years safely. Thus, one has so much more to gain than to lose, why not take the drug in the early stages of the disease?
 Lee TC, et al. An Observational Cohort Study of Hydroxychloroquine and Azithromycin for COVID-19: (Can’t Get No) Satisfaction. Intern. J. of Infectious dis. July 02, 2020DOI:https://doi.org/10.1016/j.ijid.2020.06.095. https://www.ijidonline.com/article/S1201-9712(20)30530-0/fulltext
 Rosenberg ES, Dufort EM, Udo T, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020;323(24):2493–2502. doi:10.1001/jama.2020.8630