So, with the iDJiT-in-chief pushing this new hydroxychloroquine study, I thought I would look at the numbers. Interesting’y, I finally found the “peer reviewed study” in the , along with the news about it. Let’s start with the basics: Who, what, where, why, when , and how.
Who?
Henry Ford Health System (HFHS), with the study contact author being Dr Marcus Zervos
What?
I think the title of the HFHS news release says it all: Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows
Where?
The Henry Ford Health System (HFHS) in Southeast Michigan: large six hospital integrated health system; the largest of hospitals is an 802-bed quaternary academic teaching hospital in urban Detroit, Michigan.
Why?
Pretty much self-explanatory, but there seems to be no political bias involved based on prior history I was able to ferret out (but please correct me if ou find anything).
When?
Consecutive patients hospitalized with a COVID-related admission in the health system from March 10,2020 to May 2,2020 were included. Only the first admission was included for patients with multiple admissions. All patients evaluated were 18 years of age and older and were treated as inpatients for at least 48 hours unless expired within 24 hours.
How?
Finally, the really interesting gem in the study, at least to me (bolding by me):
Patients with a COVID-related admission in the health system from March 10, 2020 to May 2, 2020 were included. Only the first admission was included for patients with multiple admissions. All patients were hospitalized though our emergency department. A COVID-related admission was defined as hospitalization during which the patient had a positive SARS-CoV-2 test. Diagnosis with SARS-CoV-2 was confirmed by a positive reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay from a nasopharyngeal sample. All patients evaluated were 18 years of age and older and were treated as inpatients for at least 48 hours unless they expired within the time period. The primary objective was to assess treatment experience with hydroxychloroquine versus hydroxychloroquine + azithromycin, azithromycin alone, and other treatments for COVID-19. Treatments were protocol driven, uniform in all hospitals and established by a system-wide interdisciplinary COVID-19 Task Force. Hydroxychloroquine was dosed as 400 mg twice daily for 2 doses on day 1, followed by 200 mg twice daily on days 2-5. Azithromycin was dosed as 500 mg once daily on day 1 followed by 250 mg once daily for the next 4 days. The combination of hydroxychloroquine + azithromycin was reserved for selected patients with severe COVID-19 and with minimal cardiac risk factors. An electrocardiogram (ECK) based algorithm was utilized for hydroxychloroquine use. QTc>500 ms was considered an elevated cardiac risk and consequently hydroxychloroquine was reserved for patients with severe disease with telemetry monitoring and serial QTc checks. The clinical guidelines included adjunctive immunomodulatory therapy with corticosteroids and tocilizumab.
Can someone please explain to me why they excluded participants when those same participants were why hydrochloroquine was contraindicated for COVID-19 in the first place? These people have a major risk factor. Looking at the numbers for these types of studies, most are falling into the 16-20 percent mortality rate range v. untreated in the 23-28 percent mortality rate range (from my anecdotal research — too tired to find the real numbers, long day moving). I have been looking for mortality rates associated with the COVID-19 cases, haven’t found any that lists primary, secondary, teriary, etc. causes of death yet, but I am thinking that some unknown number of those who died on ventilators might have had underlying cardiac issues as well and that might skew the study results. All this is just to say we don’t freaking know what exact effect most treatments have. I think their limitations paragraph says a lot, too:
Limitations to our analysis include the retrospective, non-randomized, non-blinded study design. Also, information on duration of symptoms prior to hospitalization was not available for analysis. However, our study is notable for use of a cohort of consecutive patients from a multi-hospital institution, regularly updated and standardized institutional clinical treatment guidelines and a QTc interval-based algorithm specifically designed to ensure the safe use of hydroxychloroquine. To mitigate potential limitations associated with missing or inaccurate documentation in electronic medical records, we manually reviewed all deaths to confirm the primary mortality outcome and ascertain the cause of death. A review of our COVID-19 mortality data demonstrated no major cardiac arrhythmias; specifically, no torsades de pointes that has been observed with hydroxychloroquine treatment. This finding may be explained in two ways. First, our patient population received aggressive early medical intervention, and were less prone to development of myocarditis, and cardiac inflammation commonly seen in later stages of COVID-19 disease. Second, and importantly, inpatient telemetry with established electrolyte protocols were stringently applied to our population and monitoring for cardiac dysrhythmias was effective in controlling for adverse events. Additional strengths were the inclusion of a multi-racial patient composition, confirmation of all patients for infection with PCR, and control for various confounding factors including patient characteristics such as severity of illness by propensity matching.
In the end, it is just another study that shows some promise, and may be narrowing down the search.
(This diary brought to you by my own curiosity
