On this week's COVID-19 update, Dr. Steven Bishop discussed that hydroxychloroquine video that made the rounds on Tuesday and answered questions on cleaning supplies for college, what needs to happen for more rapid testing availability, the timeline for a vaccine, and more. Watch the video below and read on for a recap.
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We got a lot of questions about the hydroxychloroquine video that made the rounds on Tuesday from a group of doctors calling themselves America's Frontline Physicians. I watched some of it and read the transcript of most of it to get a gist of what they talked about.
They had some valid point, and some points that didn't completely make sense. My first comment is a general one about the way they were talking about COVID-19. Most physicians who are trained well, have a good grounding in a science-based education, or have experience working as scientists (either in a lab, during medical school, doing research, doing trials)...they don't typically talk the way those doctors talked.
You will find, if you have a good physician, that physicians don't talk in absolute terms like the doctors in the video. You won't hear "a cure for" or "this definitely is...". Most physicians, if they have good scientific training, tend to be much more circumspect about disease and treatment. I will let you take that for what it's worth. It is the caveat I will provide about my impression of that group of doctors.
I get concerned when I hear people talking in absolute terms about medical things, because very little in medical science is an absolute, very little is set in stone, and to suggest otherwise is often disingenuous, at best, or nefarious at worse. I don't think the way they presented themselves was the best way to get their message across.
Now, let's move onto some of the things they addressed. The constant controversy over hydroxychloroquine, azithromycin, and zinc continues unabated. I find this fascinating from a lot of angles. It's quite clear from the trials that have been done so far that hydroxychloroquine, whether alone or combined with other things, probably does not work for hospitalized patients. People who are already very sick. The data is fairly clear at this point that it probably does not help much, if at all, in a hospitalized person.
That being said, there's only been a couple of trials done so far, so I'm not even willing to say that definitively. But, I think we do not have strong evidence that it helps the hospitalized person or the person that is already very ill.
Now, that is different from an outpatient or someone who is moderately ill. And I think this is the point that these physicians were trying to make, and I do agree with their point on this. There are a large number of studies, about 65 studies, on COVID patients with hydroxychloroquine. A lot of them are on outpatients, and all of the studies, except for two, have shown a positive impact on viral outcomes when used early in the disease course and when patients are moderately or mildly ill.
I think there is sufficient data to say two things.
First, we need a large-scale trial on outpatients to be done by our major medical institutions (NIH, WHO, CDC) and our large academic institutions. They need to take this data seriously and evaluate it in a trial like it has been done for hospitalized patients. It needs to be done.
Why it hasn't been done? I can't say. I don't know. I think it's a mystery. I think it needs to be addressed, because there are quite a large number of small-scale studies with more than enough evidence to go forward with a large-scale trial. And more than enough evidence for people to say, for the moderately ill outpatient, this is something reasonable to consider, especially if you don't have strong risk factors for having a negative side effect from any of the drugs.
We recommend other treatments and therapies with far less data than what's been presented here. The bottom line is, what those physicians were commenting on with hydroxychloroquine, while I don't agree with the way they presented and I don't agree with them saying its a "cure" for COVID, it deserves a further look and it deserves further evaluation. I think for the moderately ill person who is high-risk for COVID, who is an outpatient, it is a reasonable thing for you and your physician to have a conversation about whether its something for you to try.
I don't think it should be a blanket recommendation. I don't think it should be over-the-counter, like some of the physicians were calling for. I do think there is a space for that drug combination to be used in the right person.
Someone asked a follow-up question about if taking hydroxychloroquine already for an ailment such as rheumatoid arthritis provides protection from COVID-19. The answer is maybe and I don't know. There is some data out there about using hydroxychloroquine for prophylaxis.
But the strongest data is when it's being used in the combination therapy, either with azithromycin, plus or minus zinc, for treatment of active COVID-19 illness. The study results, if you go to the link above, you can divide them up into pre-exposure/prophylaxis. The study results are fairly positive for that, but again, to really get to the bottom of these things, we've got to have a randomized control trial on a large scale.
This is about the point where the video cut off for me. They did go on to discuss the negative impact of the lockdowns in terms of the lockdowns harming people and schools being closed harming people. I think there is a lot of merit to some of these things. I don't think we, and our government officials, have not talked enough about the negative impacts of the way we have managed this virus.
VCU put out a study a couple weeks ago showing there was a large number of excess deaths that occurred in the severe lockdown period that were not attributed to COVID. They were probably a result of the lockdown policies. The lockdowns were always a gamble that we would have fewer people die from the lockdown than die from the virus.
We never knew what was going to happen, because we didn't know what the death rate from the virus would be. At the time, that trade-off made sense. I think it probably does not make sense anymore. Just from a pure numbers perspective, given all the negative outcomes we've seen from the lockdowns, the spikes of suicides, the spikes in severe depression and anxiety. Many studies are coming out showing these lockdowns have had serious detrimental effects on people's mental health, on the economy, on food security.
And of course that doesn't even speak to the issues that are going on with our children in the community. Many of you know that I have advocated for kids to go back to school in some way or another. A lot of that is for their own health. It has had a negative impact on the health of children and adults in our country.
That being said, we have to continue to tread carefully. We've got to do the other things that our public health officials recommend. The social distancing is important. The hand washing is important. The mask wearing is still a good idea in many situations.
The thing to remember is everything is nuanced. There are no cut-and-dry answers for almost any problem in life. Medicine and public health are no different. We have to be careful about how we approach things. We have to investigate this hydroxychloroquine thing a little more.
We have to do many of things our public health officials are recommending, but we should take their recommendations at face value and see what the data is behind them. While the data behind wearing a mask all the time is unclear, it's a pretty harmless intervention. If you can do it, you should, especially if you are out in public around crowds.