The Second Punch

In another Wall Street Journal op-ed Jeff Colyer reports on the progress in the second punch in the one-two punch I mentioned above—the search for an effective treatment beyond supportive care for people with COVID-19:

What is the treatment?

Physicians are using two drugs in combination—hydroxychloroquine and azithromycin, which I’ll abbreviate HC and AZ—to treat patients with advanced Covid-19 symptoms. We use a regimen reported in a recent open-label trial in Marseille, France, which was updated March 26, and which doctors may modify in any given case.

What is the evidence?

For HC, two bodies of evidence support its potential in treating Covid-19: in vitro (test tube) studies and initial clinical reports from the field. After the 2002-03 global outbreak of SARS, a coronavirus related to the one that causes Covid-19, an in vitro study conducted by doctors from the Centers for Disease Control and Prevention identified chloroquine (a relative of HC) as an attractive option for prevention and treatment. If added before the virus was introduced, the drug was highly effective in preventing cellular infection. Even later application markedly inhibited infection. Another contemporaneous study showed similar results. As for Covid, a Chinese study published March 9 showed HC has excellent in vitro effects. Other recent information suggests potential antiviral mechanisms of HC and chloroquine.

The bedrock of all infectious medicine, from developing treatments for specific infections to treating individual patients, is in vitro laboratory testing and patient trials. Covid-19 is no exception. Current laboratory data suggest that HC should work.

Clinical information has also emerged from Covid treatment. During the initial Chinese outbreak, Wuhan doctors observed that patients with lupus—a disease for which HC is a common treatment—did not seem to develop Covid-19. Of 178 hospital patients who tested positive, none had lupus and none were on HC. None of this Wuhan hospital’s dermatology department’s 80 lupus patients were infected with the novel coronavirus. The Wuhan doctors hypothesized that this may be due to long-term use of HC. They treated 20 Covid-19 patients with HC. Their result: “Clinical symptoms improve significantly in 1 to 2 days. After five days of chest CT examination, 19 cases showed significant absorption improvement.”

Second, consider AZ—the antibiotic marketed as Z-Pak—combined with HC. The French study showed that 57% of 14 Covid-19 patients receiving HC without AZ tested negative for the virus on a nasal swab on day six. But 100% of the six patients who received both HC and AZ tested negative on day six. Compare that with 16 infected patients at another hospital who didn’t receive either treatment: only 12% tested negative on day six. These are small samples, but significant.

HC has been approved by the FDA and in use since 1955 and Z-Pak since 1988. Given the field experience in South Korea in using the two in combination to treat COVID-19, I’m not sure why American physicians would be reluctant.

Finding an effective treatment for COVID-19 is the sine qua non for stemming the epidemic. As long as people continue to contract the disease which in my opinion is likely to be forever, new cases will continue to threaten the health care system with collapse.

It should be carefully noted that HC+Z-Pak or any other treatment will not be prophylactic and will not be a substitute for limiting the spread of the disease. Testing will need to be increased by several orders of magnitude, especially epidemiological testing and serological testing.