CoVID19__HCQTreatmentTable__4.26.20__Gov.Ducey
The probabilities of clinical success using
hydroxychloroquine with or without azithromycin +/-
zinc against the novel betacoronavirus, SARS-CoV-2
Physician
Hospital
Academic
institution
Location
Date of data
reporting
Number of
Patients seen
Number
treated with
HCQ +-
azithromyci
n +/- zinc
Improved Died Success
defined as
% of no
mortality or
probability
of
preventing
death, P(D-
)
Qingdao, China
3.16.20
? total unknown
Use 100 at least
since they said
greater than a
hundred were
treated
>100; 100
will be
used
100
assumed
0 Up to
100%
may have
improved
Didier Raoult
3.17.20
26? 16? 15? ? ???
Didier Raoult
3.27.20
80 79 63 1 98.7%
[Didier Raoult
4.7.20
1,061 (may or not
include the 80
from 3.27.20
paper)
1,061 1,040 5 99.6%]
Dr. Didier
Raoult 4.20.20
Million M,
Lagier JC,
Gautret P,
Colson P,
Fournier PE, et
al at
IHU_Mediterran
ee Infection in
Marseille,
France
1,411 1,061
Rx
HCQ+AZ
973 8 (46
with poor
clinical
outcome;
47 with
poor
virologic
al
outcome
91.7%
.754%
Risk of
death in
those tx
with
HCQ
2
Dr. Vladimir
Zelenko 3.30.20
Monroe, New
York
200 (65% of tests
were + in his first
200 patients)
700 seen who
were + or had
clinical suspicion
500 were not
treated with HCQ
Rx
200 were high risk
and treated with
HCQ,
Azithromycin and
Zinc
200 194;
2
intubated;
4 with
pneumoni
a but not
intubated,
improving
0 100%
Dr. Vladimir
Zelenko
Monroe, New
York
4.12.20
1,354 405 399
(6
hospitalize
d of which
4 were
intubated
and then
extubated
and 2
deaths)
2 2/405
99.995%
P(D-)
0.005%
risk of
death
Dr. Stephen
Smith 4.2.20
Smith Center for
Infectious
Diseases
80
Rx HCQ and
azithro
45% 29 % patients
were prediabetic,
47% diabetic and
obese; average
BMI of severely
ill 30.7 obese;
prediabetics are
also at risk
80 80,
20 patients
are
intubated
0!
No
deaths
reported
100%
Dr. Zheng 4.2.20 11 11 0 ? ?
Dr. Rob
Richards
15 14 14 0 93%
Dr. Jeff Colyer,
Overland Park,
KS
14 14 14 0 100%
Dr. Daniel
Hinthorn,
Kansas City, KS
21 21 21 0 100%
Dr. Anthony
Cardillo Mend
Number = ? Rx HCQ +
zinc
All those
treated
0 100%
3
Urgent Care
Sherman Oaks,
Van Nuys,
Burbank, CA
4.6.20
Unknown number
of patients treated;
Contact Mend
Urgent Care for
more info
Sherman Oaks:
818-646-2562 |
Van Nuys: 818-
646-4928 |
Burbank: 818-
843-8555
He did not
use
azithromyci
n
Treated
very sick
patients all
of whom
greatly
improved
within 8-12
hrs
improved
Dr. Marc Siegel
New York, New
York
1 Rx HCQ 1 1 0 100%
Seattle, WA
group; NEJM
publication
? 58% of
COVID-19
patients in
ICU were
diabetic
with
average
BMI of 33,
morbidly
obese
? ? ?
Dr. William
Grace, NewYork
?
Dr. Alex Lechin,
Texas
?
Dr. Joe Mather,
Louisiana
?
Dr. Zhong
Nanshan,
epidemiologist
and
pulmonologist,
discovered
SARS virus in
2003, China
?
Lee SH, Son H,
Peck KR,
Samsung
Medical Center,
211, HCQ 400mg
po qd prophylactic
treatment in long
term care hospital
211;
189
patients
and 22
211
All viral
tests were
negative
0 100%
success0
% death
4
Pusan National
Univ. Hospital
Republic of
Korea
4.20.20
exposures careworker s
Paolo Zanotto
and President
Bolsonaro,
Brazil
? HCQ in use
without significant
debate or delay
?
?
?
?
Dr
s. A. Kapoor,
U. Pandurangi,
V. Arora et al
India
? prophylactic use
of HCQ in
progress
?
?
?
?
University of
Minnesota
Enrolling for a
prophylactic study
pending
University of
Queensland
Centre for
Clinical
Research,
Australia
Chloroquine study
in progress
Univ of
Washington
-
NYU Grossman
School of
Medicine
2,000
Enrolling now
Columbia
University
?
University of
Pennsylvania
?
Rutgers
?
Washington
University in St.
Louis, MO
(WUSTL)
Multicenter
international
trial called
CROWN
CORONATION
or CROWN
CORONA
Dr. Michael S.
Avidan principal
investigator
Hydroxychloroqui
ne prophylaxis,
An international,
multi
-site,
randomized,
double
-blinded,
Bayesian platform
adaptive design
clinical trial
5
Missouri,
Australia,
Canada, Ireland,
South Africa,
United
Kingdom,
Zambia
Washington
University in St.
Louis, MO
(WUSTL)
Barnes-jedi
Hospital
Dr. Rachel M.
Presti,
Dr. Jane
O’Halloran, co-
leaders of the
trial
Chloroquine,
HCQ, and AZ will
be studied in those
with novel
betacoronavirus
infection
Asan Medical
Center, Seoul,
South Korea
Enrolling
comparison study
Kaletra vs.
hydroxychloroqui
ne vs. placebo
?
Chen Z, Hu J,
Zhang Z et al,
Renmin Hospital
of Wuhan
University,
Wuhan, China
Released mid
April 2020
HCQ 400mg / day
62 patients in
study; 31 HCQ,
31 control group
31 tx with
HCQ
25
improved
(vs. 17 in
control
group, p =
0.0476
0 deaths 25/31
80.65%
success
rate
Dr. Mehmet C.
Oz
New York, New
York
2 2 2 0 100%
Dr. Mohammed
A. Arsiwala,
internist, in
Livonia,
Michigan
Dr. Arswiwala
says he has treated
16 patients so far
including Rep.
Karen Whitsett in
MI, data on others
not available yet
1 1 0 100%
(N=1)
6
Mark Campbell,
former Buffalo
Bills football
player, self
report, physician
name ?
1 Treated with
HCQ
1 1 0 100%
(N=1)
Magagnoli J,
Narendran S,
Pereira F, et al.
VA Health Care
System,
Columbia, South
Carolina
368 Veterans 210 with
severe
disease
treated;
Ventilation
in 13.3% of
HCQ group
and 6.9%
of
HCQ+AZ
group
158 52 75.24%
Dr. Idir Bitam
Algeria
4.26.20
170 170 treated
w/ HCQ +
AZ
165
“returned
to health”
? 97%
Others
7
Conclusions as
of 4.26.20
See figures in
bold
Total patients
seen by these
physicians =
3,868
-------------------
Which includes
Dr. Zelenko’s new
data as of 4.12.20
2,065 + 654 =
2,719 + 350 which
includes new
Raoult data from
4.20.20
3,069 + 211 from
Lee Son and Peck
3,280
plus
62+16+1+368 + 2
(Oz) – 31
(duplicate) + 170
(Dr. Bitam) =
3,868
Total
patients
treated with
HCQ, plus
or minus
azithromyci
n and/or
zinc = 2,333
------------
1,533
+205 Dr.
Zelenko’s
series
update =
1,738
1,738 +
211 =
1,949
+
31+1+1+21
0 -31
duplicate
+2 (Oz) +
170
(Bitam) =
2,333
Total
patients
clinically
improved
= 2,137
------------
91.6 %
treated with
HCQ
improved
or never
contracted
CoVID-19
despite
being
exposed
2,137/2,33
3 =
91.6%
Total
deaths in
those
treated
with
HCQ or
HCQ +
AZ +/-
zinc
= 63
63/ 2,333
P(D) =
2.7%
Updated
probabilit
y of
success in
preventing
death,
P(D-),
from
CoVID-19
using
HCQ or
HCQ +
AZ = 91.6
%
This table is provisional and is being updated as new data surface.
Please note that the Veteran’s Administration study conducted by Magagnoli J,
Narendran S, Pereira F, et al. in South Carolina assessed a very sick population and the
hydroxychloroquine was given late the course of the illness. Many patients were
ventilated. We believe the 52 deaths reported in this population are not indicative or
predictive of the average death rate observed in populations diagnosed in the early to mid
stage of the CoVID-19 disease and treated with hydroxychloroquine. Based on the
experienced clinicians observational data summarized above, the death count was only 11
out of over 2,000 patients treated with hydroxychloroquine.
Dr. Stephen Smith’s patients who were treated with HCQ and azithromycin did not
require mechanical ventilation. He reports that severely ill CoVID-19 patients under 70
yrs of age were diabetic or prediabetic with high BMI. He is convinced
8
hydroxychloroquine works for his patients. His level of certainty is very high. –
personally reported on 4.2.20 and again on subsequent dates in April 2020.
Clinicians are natural Bayesians and such philosophical and qualitative statistical analysis
is consistent with our medical training, bedside clinical skills including history taking,
examination, differential diagnosis, probable primary diagnosis, laboratory evaluations
including serologies, EKG, chest X-ray, CT scan of lungs, objective gold standard test
interpretation and clinical decision making. In other words, waiting for fixed randomized
controlled trials during a pandemic when time is of the essence, a Bayesian approach to
the assessment of diagnostic and therapeutic probabilities is wise and efficient and will
save time, money and lives if the physicians are given a chance to retain their autonomy
and practice medicine to the best of their abilities.
Special thanks to Jeremy Snavely and Marilyn Singleton at AAPS and Avery Knapp,
M.D. at the KnappGroup for assisting in the gathering of clinical information, research,
and other data.
Special thanks to the Bayesian statisticians at Arizona State University, University of
Arizona BIO5 and the International Society for Bayesian Analysis for their valuable input
and direction and ongoing assistance.
Disclaimer: these results are preliminary and provisional because observational data from
experienced clinicians are dynamic and may or may not be incomplete or of insufficient
granularity to make more specific associations and interpretations. Moreover, some of the
papers are undergoing the peer-review process, but have been shared with the world to
reduce delays in clinical decision making. Likelihood ratios and Bayes’ factors cannot be
computed yet since fixed randomized controlled trials (RCTs) are just starting around the
world.
A flat prior (0.5 probability where 0 is impossible and 1 is certain) could be used to
represent one’s beliefs about whether hydroxychloroquine (HCQ) would result in clinical
improvement and/or prevention of death from CoVID-19 based on knowledge up to
December 2019 and January 2020. Based on the new observational studies and reports
from several (more than 10) different medical sources in February, March and April
2020, the prior will be updated using Bayes theorem yielding a posterior probability
density when sufficient data to calculate likelihood ratios emerge. At present, physicians
have a significant amount of basic science and human observational data to incorporate
into their baseline knowledge of hydroxychloroquine safety and efficacy plus the current
info included in this table will facilitate the physician as beliefs are updated accordingly.
Based on the current clinical information available, the success rates for a favorable
outcome/clinical improvement are approximately 91.6% using hydroxychloroquine
(HCQ) without or without azithromycin (AZ) and/or zinc and the death rate in this treated
group is approximately 2.7%.
9
In comparison, the probability of death is 0.5-0.85 or 50 to 85% when patients with
CoVID-19 are on mechanical ventilation and the probability of death based on Johns
Hopkins University data worldwide is 206,544/2,971,477 or 6.95% as of 4.26.20.
At this time, the data from 9 observational reports and one controlled trial suggest that
hydroxychloroquine is dramatically more effective at preventing death from CoVID-19
than mechanical ventilation. It is encouraging to note that ventilated patients treated with
hydroxychloroquine have been able to undergo successful extubation and transfer out of
the intensive care unit onto the floor. Moreover, CoVID-19 viral loads have been reduced
to low or undetectable levels after 5-15 days of treatment with hydroxychloroquine.
The NIH initiated a study today to investigate hydroxychloroquine for prophylactic and
active treatment for the novel betacoronavirus, CoVID-19.
Numerous CoVID-19 studies utlizing hydroxychloroquine for either prophylaxis or
treatment are listed on the clinicaltrials.gov site but many of them have not started
enrolling patients yet.
One trial out of Washington University in St. Louis, MO is a Bayesian adaptive design
trial using hydroxychloroquine as a prophylactic drug against CoVID-19.
The table shows several international studies that are underway reportedly but this list is
provisional and no data is available yet from these centers conducting randomized
controlled trials.
As new data surface, we will be able to update the table and make additional Bayesian
inferences that may assist physicians in clinical decision making.
As Ben Carson, MD, pediatric neurosurgeon and HUD Secretary, has recently reminded
us, physicians treating suspected or confirmed CoVID-19 patients should ask themselves
during this pandemic:
What is the best clinical outcome that can happen if I use hydroxycholorquine?
What is the worst clinical outcome that can happen if I use hydroxychloroquine?
What is the best clinical outcome that can happen if I do not use hydroxychloroquine?
What is the worst clinical outcome that can happen if I do not use hydroxychloroquine?
This table is a continuous work in progress.
10
Comments or additional contributions to the data set may be forwarded to the Association
of American Physicians and Surgeons (AAPS) in Tucson, AZ, established 1943,
dedicated to preserving the patient-doctor relationship and liberty in medicine, see
www.aapsonline.org for more information.
Sincerely,
/Michael J. A. Robb, M.D./
Michael J. A. Robb, M.D.
Physician
Practice of Private Oto-Neurology
Past President, Association of American Physicians and Surgeons (AAPS)
Board of Director, AAPS
Arizona State Chapter President, AAPS
source >>
https://drive.google.com/file/d/1w6p_HqRXCrW0_wYNK7m_zpQLbBVYcvVU/view
