It is week 20 of the coronavirus lockdown. For a man of my age, between the pandemic, the sometimes illogical/irrational Government response, and the everlasting urban mayhem, this is clearly the most bizarre time period of my entire life.
Here in Pennsylvania, presumably due to a rise in cases in western Pennsylvania, our governor has re-imposed restrictions on bars and restaurants. The first version of this specified that there could be no bar seating, and customers had to buy food if they wanted a drink.
Understandably, many already struggling taverns created inexpensive food items for patrons who wish to have a libation while sitting at a table. Curiously, Governor Cuomo in New York, imposed the same rules on his state. This occurred despite the fact that the number of new cases in that state were minimal.
Apparently, New York bars and restaurants followed the Pennsylvania practice, and soon there were “Cuomo chips” made available to patrons.
For absolutely no discernible reason, other than perhaps pique, both Governors imposed additional rules requiring that A “substantial meal” be served. Andrew Cuomo made it clear that for instance “chicken wings” don’t qualify, undoubtedly endearing him to western New York voters.
All of this is ridiculous. I think of restaurants that I frequent in places like Sullivan County, Pennsylvania (5 confirmed cases), or Hamilton County New York (same statistics) which were forced to stay closed from March to June, only to have restrictions re-imposed once again for no good reason. No wonder that a recent Yelp survey reported that 53% of their member restaurants were closing for good.
I recently visited an establishment where I sometimes go for lunch on my day off. I usually sit at the bar, talk to friends, have a beer, and a single slice of sausage pizza (I love the crispy texture of re-baked crust). The slices are large and it’s more than enough food for me.
My waitress on that day was unfamiliar. I dutifully sat alone at a table, no friends around. I ordered my usual slice of pizza with a beverage and waited.
She came to the table with the pizza and beer and then informed me that although they would honor my order today, the slice of pizza was inadequate to be considered a meal, and they would not do this again. I was also told that I could not have another beer regardless of whether the pizza was finished. The restaurant, often quite busy on a Thursday, was minimally occupied. I can’t imagine why.
What kind of madness is this? Is the state now determining what I eat for lunch? And how does this protect anybody from COVID? Or is it just meant to add to the general misery? You decide.
I would be remiss if I didn’t discuss the surge in cases throughout the southern US. There are likely multiple reasons for this from the parallel surge in Mexico, to the loosening of COVID restrictions. Spring break activities may well have played a role.
The climate may also have something to do with this. While the Northeast in March April and May were “hotspots”, the South had minimal problems with really no “peak” like we experienced in April. It was a cold spring in the North and for most of us, we were trapped indoors, while people in the South presumably spent more time outside.
Now in summer things have reversed themselves, with those in the South, escaping the summer heat indoors with air conditioning, and those of us in the North are enjoying the outdoors. I do wonder whether HVAC systems are helping to spread the virus. There is some emerging interest in this possibility.
So, let’s talk about hydroxychloroquine. I’ve been writing about the pandemic since March 21st. In that first article, I already noted that there was some evidence that hydroxychloroquine, along with azithromycin might have some efficacy. I also noted that a research-based physician such as Dr. Fauci would culturally be uncomfortable recommending a medication without multiple double-blind studies. This is entirely understandable. But Dr. Fauci doesn’t treat anybody. Practicing caregivers in the middle of a pandemic are sometimes forced to innovate for the benefit of the patients.
Even in March, there was in vitro data suggesting that HCQ inhibited coronavirus replication, and since then, we have come to understand that there perhaps for other mechanisms on a cellular level where the drug may prevent viral contents from entering human cells. There were also non-blinded trials strongly suggesting that the drug was useful. In later articles, I discussed other papers that had been published with similar views. Finally, there was the controlled study from Detroit where HCQ halved the mortality rate of hospitalized COVID patients.
Unfortunately, when Donald Trump mentioned the drug in one of his briefings, all hell broke loose. I think I understood what he was trying to do, namely offer some optimism during frightening times. I honestly believe that another president, at another time might have been given the benefit of the doubt. Not in this case. Hydroxychloroquine became “Trump’s drug” and its use must not be allowed.
On Monday, a group of physicians calling themselves America’s Frontline Doctors held a press event in front of the Supreme Court. There they discussed their experiences using hydroxychloroquine in the treatment of COVID. The most prominent and controversial speaker was Dr. Stella Immanuel, who was apparently a pediatrician, born in Cameroon. She also claims to be a minister. She is convinced that hydroxychloroquine is effective having by her account treated 350 patients with it with minimal morbidity and no mortality.
What she seems to believe is that “Big Pharma” is suppressing information on the drug’s efficacy in order to boost profits from drugs such as remdesivir, as well as from vaccines to be developed. Having dealt with pharmaceutical companies for much of my career, I do not find this idea completely fantastic.
It was her opinion, that if hydroxychloroquine was used more often for prophylaxis and treatment, that no masks or other restrictions would be necessary. She was, to say the least, very fervent in her beliefs.
I saw this video on Monday night. It was interesting, but I’d never heard of the physician group and thus wasn’t sure what to make of it. Nonetheless, if her treatment claims are truthful, it is another data point. I couldn’t really figure an ulterior motive when the drug is off-patent for 40 years.
Tuesday morning, I was perusing Facebook when I noticed that multiple friends of mine had posted the video. They also were reporting that Facebook and YouTube were deleting it. I despise “Big Data” censorship, and thus I shared the video with the comment that I was posting this because it was being removed, but I found the video “interesting”.
I was then beset upon by a young lady of my acquaintance, who works in health sciences who was extremely offended that I would post what she considers to be essentially anti-science. She informed me that either I should take down the post, or undoubtedly Facebook would, as she had already reported the post to their “editors”.
Dr. Immanuel, as it turns out as a somewhat “colorful” online presence and holds some controversial opinions as part of her ministry. Websites like the Daily Beast, eschewing their usual love of diversity, quickly did a “deep dive” in order to debunk her. They claimed that Dr. Immanuel claimed that masks are not necessary, without the qualifier she provided.
Nonetheless, if her claims about her medical practice and her treatment of coronavirus are true, then the information may be useful. Again, it’s information to be processed and then believed or discarded. Information is generally helpful.
Given the significant number of articles that I have quoted in the past, some controlled, some anecdotal, but all supporting hydroxychloroquine as a COVID antiviral (here is a recent one from Newsweek), the virulence of opposition to this video would suggest that there are people who just don’t want to know if the drug works. Logically, it suggests that they may not wish for any chance to see the pandemic brought under control so that the economy can fully reopen. And why would they feel that way? Maybe it has something to do with the presidential election in 3 months or so?
I for one cannot imagine being such a nihilist- so politically driven that I would be willing to discard a potential treatment and prolong people’s physical and economic distress. I do not understand on an interactive forum like Facebook, why people who disagree with a viewpoint, would want to erase it, rather than just to make their case in opposition.
I just want to know what works so I can treat my patients.
And perhaps selfishly… sit at a bar with a beer and eat a piece of pizza.
Jo Lynne Rokita
July 30, 2020 7:40 pmHi Hank. Thanks for posting your opinions. As a scientist, I carry an ethical duty to inform my friends, family, and the public (within my control) when there is false information spreading and thus the reason for my comment, which you are free to keep or delete.
Below, I have cross-posted my response about the use of HCQ to someone else here, along with many key points about financial interest that were omitted from this post. The question was, “why not test HCQ + azithromycin”?
From my limited research, I’ve read that HCQ+azithromycin worked well on patients with no underlying conditions/asymptomatic patients(!), with mild disease (95% of them), and early in the disease course (France: https://www.sciencedirect.com/science/article/pii/S1477893920302179). Probably didn’t need those drugs to get better. I think the hype started because of very early papers which used HCQ for other coronavirus, but those were quickly flagged for improper controls in PCR.
There is an updated FDA timeline of action here (FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems | FDA) along with a report of adverse events (side effects) from HCQ use in COVID-19 patients (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/OSE%20Review_Hydroxychloroquine-Cholorquine%20-%2019May2020_Redacted.pdf) that may be helpful.
The Frontline Doctors group has been deemed a conspiracy theory group, they are funded and promoted by right-wing super PACs (https://apple.news/A25PjbQEbSXSzbdVXVBpW9w ), their website, whose domain was only recently registered on 7/16/20, has been removed the same day their video was released, and they provide no evidence or transparency for claims they make. For all we know, they never used any of these drug combinations on patients. Maybe they don’t even see COVID-19 patients. The argument “it could be a data point” is premature, and spreading misinformation is actually pretty dangerous. Read: the anti-vaccine movement.
The person to whom I responded mentioned the Hippocratic oath. Why, if these doctors have taken the oath, would they lie? Well, you know as well as anyone, there are good apples and bad apples. I would love to believe all doctors and scientists have the best intentions, some actually don’t. Some are mentally unstable and believe unsubstantiated science they preach to be true and some are malicious. The key is deciphering these two types from those who truly want to help people, who have nothing to gain, and who do solid science. It is also up to those of us with integrity and ethics to stand up against falsified data, research, and videos, or we ourselves are amplifying harm by allowing others who may be vulnerable to the persuasion to believe these things. Ask yourself, if a group of doctors called the “Frontline Lung Association” came out with a video saying smoking cures lung cancer, would you spread the video as readily, in the name of free speech? It’s not about freedom of speech or censorship, it’s about not conveying information we know to false.
I’ll try to answer the question, “why aren’t there studies using the HCQ combinations?” A quick search shows there may be a few ongoing trials (https://clinicaltrials.gov/ct2/results?cond=COVID-19&term=Hydroxychloroquine&type=&rslt=&age_v=&gndr=&intr=Azithromycin&titles=&outc=&spons=&lead=&id=&cntry=&state=&city=&dist=&locn=&rsub=&strd_s=&strd_e=&prcd_s=&prcd_e=&sfpd_s=&sfpd_e=&rfpd_s=&rfpd_e=&lupd_s=&lupd_e=&sort=) however, these also have to be vetted (are they reputable doctors?). Sadly, it isn’t easy to rid the practice of doctors who falsify data. I work in pediatric oncology and one of these bad apples is still practicing and still performing clinical trials, even though this person has been reported. Overall, my answer to this is that the reason is probably a simple one- if HCQ alone has such deleterious side effects, why would reputable doctors use it in combination with something? Move onto the next thing. Remdesivir is the next thing. Convalescent plasma is the next thing. Monoclonal antibodies are the next thing. Vaccines are the next thing. CAR-T is the next thing. All of these show much more promise (and to a broader population), hence the efforts there. ALL of these alternatives hold much more promise for treatment (in addition to masking and socially distancing for preventing spread).
Also, remember why Trump, or political groups promote ideas that go directly against expert opinion. Ethical scientists and doctors do not have monetary or political motivation. For heaven’s sake, we were warned of this in January and today, July 30, there is still no unifying message on how to get through COVID-19 in the U.S. Trump’s promotion of HCQ, however, is very likely due to having three trusts in Dodge & Cox mutual fund, whose largest holding was in Sanofi (the company that makes HCQ). This was reported back in April: https://www.washingtonpost.com/politics/2020/04/07/trumps-promotion-hydroxychloroquine-is-almost-certainly-about-politics-not-profits/. He later purchased 500,000 doses of remdesivir: https://fox6now.com/2020/07/01/us-buys-virtually-all-of-worlds-remdesivir-preventing-other-countries-from-acquiring-drug-for-months/. Why would he retweet HCQ now if he believed remdesivir was the answer enough to buy 90% of the world’s supply? I won’t post sources because it’s absurd, but he also suggested that injections of Lysol could help because Lysol was shown to kill the virus on surfaces. The point is – he is not a scientist. He is not a doctor. He doesn’t take their advice unless it makes him look good or he has something to gain. With HCQ, it’s money. Everything he does is politically-motivated rather than for the good of the people. For months, experts have been asking him to rally the country, to invoke the DPA for PPE and N95 masks (he’s only done it for masks to date), to take this seriously and ask people to stay home, and on and on, but it took him 4 months to do the simple thing to wear a mask and ask the country to wear masks – the ONE way we know prevents the spread of COVID-19 for sure (as evidenced by the many countries who have nearly beat this thing). We could have been past this by now, but instead, we are still soaring in cases and deaths.
Finally, I’ll say that there have been 30,000+ articles published on COVID-19 in 4 months, which is unprecedented. Many are accepted within days, so peer review is not *AS* rigorous as it should be and hence we also see more retractions. Information is flowing openly and at such a fast rate, and the scientific community has been amazing as far as sharing, critiquing, and adapting as we keep gaining knowledge. Some of the leaders in the U.S. you can follow on Twitter, if interested in hearing directly from scientists, are @erictopol, @virusesimmunity, @sanjum, @trvrb, and @covid19tracking for daily data. They tend to write many “tweetorials” and make videos to break down the science a bit, so I highly recommend!