This is the opening line of an email that I received on Tuesday from a 79-year-old woman, who has been a patient for many years:
Hi Steve,
Just learned that Trump is taking Hydroxychloroquine. Could I take this as a preventative? It doesn’t seem to have side effects. What is your opinion?
This question got me thinking about Mr. Levin, my ninth-grade biology teacher, who opened my mind to the ways of science and the concept of the scientific method. If you want to learn the efficacy of an intervention, say spraying Round-Up on your garden, the best way is to spray Round-Up on half of your garden and compare the outcome of each half. This keeps all of the other variables, like sunlight, fertilizer, and water the same and allows you to control for only one variable: the effects of Round-Up.
In Medicine, when researchers are trying to figure out the efficacy of a medication, they do their best to control variables and isolate the effect of that medication alone on a disease. The most effective design of such a study is called a randomized controlled trial (RCT). An RCT may involve thousands of patients, half of which receive a placebo and half of whom receive the drug. The patients are monitored, and the properties of the drug are determined. (Did it work and did it kill anyone in the process)
The RCT method has led to numerous breakthroughs in the field of Medicine including block buster drugs to treat heart failure, diabetes, cancer, and infections. The RCT method has also proven more accurate than the “Aunt Mabel Method” which is “My Aunt Mabel said she took bicarbonate of soda and it cured her colon cancer.”
So, getting back to the hydroxychloroquine question and the best way to answer it. The most extensive trials on Hydroxychloroquine on the outcomes of the COVID 19 to date have been published in the Journal of the American Medical Association and the British Medical Journal. These studies involve about 1600 patients in total and neither showed an advantage to taking the medication. More patients taking hydroxychloroquine had cardiac arrythmias. There are ongoing trials involving more patients, the results of these will be coming soon to a medical journal near you. To date I have not been able to locate any trials studying the effects of taking hydroxychloroquine as a prophylaxis to prevent getting the disease.
So, the best answer to my patient’s question would be: Scientific evidence does not support that intervention. But you may want to call your Aunt Mabel or in this case the President to see what he thinks.
Moving on. There is some good news in Maryland: Hospitalizations and deaths per day for Covid-19 patients have continued to decline, though slowly. Daily Hospitalization at Anne Arundel Medical Center for Covid patients have declined to 55, from 90 about 2 weeks ago. These trends are similar in cities where Covid cases appeared first, like New York and Los Angeles. Some cities in the Midwest are still seeing an increase in cases but this was expected, as their first cases occurred much later than on the coasts, and these cities are earlier on the curve.
Most states around the country have liberalized their ‘lock down’ procedures especially in regard to outdoor activities. People are still advised to practice social distancing, wearing masks, and hand washing. The results of the slow reopening of the country will be evident over the next few weeks. Most experts are hopeful that the virus will slow down over the summer due to higher temperatures and normal seasonal fluctuations of viral activity.
For those of you skeptical of the efficacy of all of these precautions, I urge you to read Atul Gawande’s recent article on how the Massachusetts General Hospital System prevented virtually all transmission of the Corona Virus between patients and staff despite having over 1000 Covid inpatients admitted to their hospital system. You can read that article here:
Lastly, progress on vaccines has been in the new this week and certainly this is encouraging. I will get more into that subject next week along with some interesting correlations between receiving the MMR vaccine (measles mumps and rubella) and the possible protection against death or severe disease from a Covid infection. A patient forwarded me this article this week on the subject which is fascinating. You can read that here:
https://www.researchgate.net/publication/341354165_MMR_Vaccine_Appears_to_Confer_Strong_Protection_from_COVID-19_Few_Deaths_from_SARS-CoV-2_in_Highly_Vaccinated_Populations We plan to resume a normal office schedule during the first week of June and will resume performing yearly physicals then. Stay safe.