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Hydroxychloroquine can dramatically ease the COVID-19 crisis

Last September 17, 2020, the Concerned Doctors and Citizens in the Philippines (CDC-PH) held a press conference entitled Flatten The Fear. Their goal? To call for the end of all lockdowns and the implementation of a national protocol for early treatment of patients with COVID-like symptoms. [See videos below if you wish to understand the bases for their position.]

Awareness Campaign event video 1 of 2

Posted by Flatten The Fear PH on Friday, September 18, 2020

Awareness campaign video 2 of 2

Posted by Flatten The Fear PH on Friday, September 18, 2020

A day after the event, Dr. Edsel Salvana, described by Esquire Magazine as “an award-winning infectious diseases specialist and molecular biologist at the University of the Philippines and the Philippine General Hospital”1, made public the following post on his social media profile2.

The foundation of Dr. Salvana’s assertions are fraudulent studies which are found to be full of loopholes by the same journals that published them (see more on this below). And because Dr. Salvana plays a key role in COVID policy decisions, it is important that we deconstruct his false claims.

Here is a renowned expert, one who has been working with the Philippines’ Inter-Agency Task Force on Emerging Infectious Diseases (IATF) since the beginning of COVID-19, hoping to close the debate. But several individuals, some lay people and doctors themselves, saw the errors in Dr. Salvana’s position. We shall relate to you later in this article how those exchanges looked like, and how Dr. Salvana reacted.

As we have been researching about SARS-CoV-2 for months now, we also knew that Dr. Salvana was wrong. First, there are numerous evidences showing that HCQ is effective in controlling the spread of the virus. Second, there is reason to believe that HCQ has value in the fight against COVID-19. The fact that the issue of the efficacy of HCQ as treatment for COVID-19 keeps arising (with doctors reviving the call to allow them to prescribe the medication) is proof that the smear campaign against the drug has not succeeded. Let us look at the evidences supporting these two points.

PROOF FOR THE EFFICACY OF THE USE OF HCQ FOR COVID-19 AS TREATMENT AND PROPHYLAXIS

What is the basis for pushing for the use of HCQ for prophylaxis and early treatment? The answer is simple: there is enough evidence for its efficacy.

In an article entitled The Key For Defeating COVID-19 Already Exists. We need to start using it3, Harvey Risch, professor of epidemiology at the Yale School of Public Health said,

I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines.

Risch was referring to hydroxychloroquine and the highly politicized debate for and against it. He says that some doctors he knew have saved hundreds of lives using HCQ, but are now in danger of losing their licenses.

In this same article, Risch introduces us to seven studies (all published after May 2020) that demonstrate the efficacy of the medication. Unlike earlier studies, these seven studies involved hundreds of patients, many of whom were high-risk. To summarize, these studies include the additional 400 high-risk patients treated by Dr. Vladimir Zelenko (no deaths), four studies involving a total of almost 500 high-risk patients (no deaths), a controlled trial of more than 700 high-risk patients in Brazil (reduced risk of hospitalization with two deaths among those treated with HCQ), and 398 matched patients in France (reduced risk of hospitalization).

But these are not the only researches about HCQ. In June 2020, a group of PhD researchers and scientists established the C19study website4 to collate new studies about COVID-19, with particular focus on HCQ use. As of writing, the website has catalogued 103 articles, each one categorized based on the stage at which HCQ was used for treatment.

According to this meta-analysis, in studies where HCQ was used as pre-exposure prophylaxis (PrEP), post exposure prophylaxis (PEP), and as early treatment, the medication proved to be effective. HCQ use as late treatment (for example, in treatment of those who are already exhibiting severe symptoms) showed mixed results. This point has been reiterated by many doctors who have been using HCq for their patients: the medication was most useful when utilized as early as possible. For example, in the highly censored press conference of America’s Frontline Doctors [see Read it yourself:Transcript of the first press conference of America’s Frontliner Doctors], Dr. Stella Immanuel said:

For the past few months, after taking care of over 350 patients, we’ve not lost one. Not a diabetic, not a somebody with high blood pressure, not somebody who asthma, not an old person. We’ve not lost one patient. And on top of that, I’ve put myself, my staff, and many doctors that I know on hydroxychloroquine for prevention, because by the very mechanism of action, it works early and as a prophylaxis. We see patients, 10 to 15 COVID patients, everyday. We give them breathing treatments. We only wear surgical mask. None of us has gotten sick. It works.

Doctors at the Flatten The Fear press conference said the same thing: HCQ is meant to be used EARLY, not for late stage treatment. Those who are already having trouble breathing, or have already developed pneumonia are not supposed to use this drug. It must be noted, however, that there are some doctors abroad (for example, Dr. Ivette Lozano from Texas5 who report the successful resolution of serious or moderate symptoms within 24 hours of taking the drug. This only highlights that HCQ can be effective for COVID-19 treatment.

The goal was to enable patients to self-manage by preventing disease, and hence, reducing the risk of hospitalization and severe complications. HCQ is most beneficial for those belonging to high risk groups like medical frontliners and immunocompromised individuals. Those who have no real need for HCQ, for example those who have no debilitating illnesses, can choose to strengthen their immune systems through a different protocol [an entirely different discussion has to be dedicated to this, as a preliminary read on The significance of host resistance].

To add to this huge list of resources proving the efficacy of HCQ, the website HcqTrial6 looks at deaths in countries vis-à-vis use of HCQ. Their research shows that countries with widespread use of HCQ had 73.9% lower death rate compared to those that did not use the medication.

Is there a benefit to considering the use of HCQ? If we are to look at the overwhelming evidence cited here, then you should already know the answer.

Also, take note that in 2005, a study7 already showed that chloroquine can prevent SARS-coronavirus (SARS-CoV) infection and spread. Hydroxychloroquine, a derivative of chloroquine, shares its chemical properties. Meanwhile, SARS-CoV-2 is 70% genetically similar to SARS-CoV8. There is nothing in the molecular structure of both HCQ and SARS-CoV-2 which suggests that the results of the 2005 study cannot be applied now.

Asking for a “randomized, double-blind placebo controlled trial” in the face of increasing infections (which according to Dr. Salvana is also a cause for concern), when there is enough evidence showing that HCQ can prevent and treat COVID-19, is murder.

HCQ IS SAFE TO USE

Is HCQ safe to use? Just like any drug, HCQ has its side effects. Yes, it can cause arrythmias and serious harms IF USED INAPPROPRIATELY. This is the reason why, in the Philippines, one still needs to secure a prescription before buying the drug. However, there are many countries in the world where HCQ can be bought over the counter. Because the drug has been in circulation since the 1940s, we already have a good grasp of its effects and side effects.

If HCQ wasn’t a safe drug, why would the Food and Drug Administration (FDA) approve it in 1955, and allow it to circulate for many years, before finally preventing doctors from prescribing it? If one asserts that it wasn’t used for COVID-19 before, well, guess what, HCQ has been used for various other purposes different from what it was initially intended for. It has been used to treat rheumatoid arthritis, and systemic lupus erythematosus, among others. Why are authorities suddenly alerting doctors on the side effects of HCQ when these have been known for decades already? A previous article on this website may provide some insights [see Alternative views concerning the COVID-19 vaccine].

The World Health Organization (WHO) added HCQ in the “Solidarity Trials” for a reason, but decided to stop its use in June 2020 due to two researches. The first one, from The Lancet showed that HCQ led to higher mortality and new ventricular arrythmia. The second was from the New England Journal of Medicine (NEJM) which suggested that HCQ made no difference. Both of these researches have been found to be fraudulent and have since been retracted9. But it wasn’t the journals’ peer reviewers and editors who discovered the issue with the data used in the studies. Instead, it was The Guardian10, and several scientists who saw the anomaly AFTER the researches have already been published. This means that either the researches were not reviewed properly, or the editors noticed the error, and for an unknown reason, allowed it printed anyway (which shows us that these journals are not always as upright as we think they are). And though the researches have been retracted, they have already inflicted their damage – the WHO has fully suspended the HCQ trials, the FDA has revoked its authorization for emergency use, and clueless doctors continue to cite HCQ’s supposed negative effects.

Now, remember that article Dr. Salvana was referring to? The one which “proves” that HCQ has no benefit as prophylaxis? Well, that article was published by NEJM. Yes, the same one that published one of the retracted articles on HCQ. Sure, uphold the gold standard, but critical thinking is also necessary here. If that journal can publish a fraudulent article once (whether intentional or not), the same can happen again.

That new NEJM article11 authored by David R. Boulware et al. has its own set of problems. A statistician from Brazil, Mario Watanabe12, used the data in the study and found that hydroxychloroquine actually saves lives! According to their analysis:

when applied as a prophylaxis, it can significantly reduce the relative proportion of symptomatic patients if used from 0 to 2 days after exposure to the virus (71.98% for 0 days, 48.86% for 1 day and 29.33% for 2 days.

Watanabe’s article was submitted to the NEJM on June 24, 2020 and to this day, has not been addressed or published. This is unusual as most researches on COVID-19 are being fast-tracked, and a research as important as this, which can save the lives of thousands of people, deserves priority.

Doctors and regular citizens have also expressed their rebuttal to the Boulware article (see photos below).

According to Dr. Homer Lim, it is important to look at the methodology before copy-pasting conclusions. Dr. Lim cites three reasons why the Boulware study is not conclusive:

(1) Patient recruitment was by social media hence Biased already.

(2) Dose of Hydroxychloroquine was 1400mg on the first day and 600mg/day for 4 days which is way higher than the standard 400mg/day. (hence side effects were very high)

(3) Diagnosis of Covid was by PCR AND assumed infected due to symptoms! (so those assumed to have covid might actually have other forms of virus not Covid)

Meanwhile, Fredda Perez says: “There are three high profile studies done to question the effectivity of HQC for C19. The studies appeared credible until they pass thru the peer-review process.

1. US Veteran Hospital study using 1300 subjects last April.13 They got records of past patients w/o proper authorization. The data were force-fitted to make a pseudo study discrediting HQC. It wasn’t published but leaked to the media, purposely to ignite a scandal.

2. The study of DR Boulware et al published last June in the NEJM was impressive until it was subjected to peer-review process. The attached critical review14 shows the major flaws of this study which was deemed provocative than scientific. As of late, the questions raised remain unanswered.  

3. A Multinational study using over 1.5M+ subjects published in The Lancet. Upon peer-review, the study was scandalously retracted.15

NONE OF THE COVID-19 POLICIES IMPLEMENTED BY THE GOVERNMENT TODAY HAS ACHIEVED SCIENTIFIC CONSENSUS

Doctors who promote the use of HCQ have been accused of experimenting with the lives. And yet, ALL COVID-related policies implemented today were contentious from the very beginning. There have been earlier doubts about lockdowns, mandatory masking, use of face shields and barriers, and even social distancing. We know today that lockdowns were the ultimate experiment. It was NEVER meant to make any fundamental difference in controlling the virus. At best, it gave time for the health care system to catch up with the projected surge of critical cases and death (which never happened), but it was never meant to eradicate the virus. Today, we know of its disastrous consequences, not only to our economy, but also to physical and mental health.

If we only look at Sweden, then one would see immediately how meaningless our sacrifices have been. Perhaps this is the reason why it is difficult for so-called experts to accept that it is now time to re-calibrate our “pandemic” response. The time for lockdowns is over. What we need now is to move forward.

Prophylaxis and early treatment is necessary because it returns to people the control over their bodies and their own lives. HCQ can help us prevent and treat COVID-19, no one needs to die unnecessarily. If you say that HCQ is an experiment on the lives of people, which it is not, well guess what? The lockdown was the real experiment, and look at where it got us.

Our people are STILL in fear, even after almost seven (7) months of living with the virus. We remain clueless of its nature and behaviour, and the way forward is still elusive. Meanwhile, HCQ, with all the studies we have presented here, and the experts that support this approach, is a viable alternative. It is not a dangerous drug, especially when its used is guided by a doctor who teaches his patients on how to use HCQ effectively.

GOING BACK TO DR. SALVANA’S POST

Now our experience in engaging with Dr. Salvana. After seeing his post, and knowing what we know about HCQ, we found it necessary to correct some of his assertions. We posted the following comment:

Have you atleast talked to the doctors proposing to use HCQ? Doesn’t evidence-based medicine work that way? To confer with colleagues, debate, and study, and finally find a conclusion together? 

Also, here are some resources on HCQ I found online:

Country-based studies: https://hcqtrial.com

Treatment analysis: https://c19study.com

The research used by Fauci to debunk HCQ use has been retracted: https://www.thegatewaypundit.com/2020/08/report-study-used-dr-fauci-condemn-hydroxychloroquine-use-debunked-new-england-journal-medicine-will-not-publish-lifesaving-update/

NYU study: https://www.ny1.com/nyc/all-boroughs/news/2020/05/12/nyu-study-looks-at-hydroxychloroquine-zinc-azithromycin-combo-on-decreasing-covid-19-deaths

Case study of 19 subjects: https://pubmed.ncbi.nlm.nih.gov/32205204/

Henry Ford study, 3,000+ subjects: https://www.henryford.com/news/2020/07/hydro-treatment-study

Twitter thread for new studies on HCQ: https://twitter.com/CovidAnalysis

We also said:  

NEJM also recently published a fraudulent study on HCQ. The study has been quietly retracted with no public apology of what they did. NEJM’s reputation as “purveyor of good news”, is not crystal clear. 

This study, which doesn’t subscribe to the mainstream covid narrative, remains under review. But it uses the data on the NEJM study you hold as the gold standard. The conclusions are different: https://arxiv.org/pdf/2007.09477.pdf

As if in response to our question, Dr. Salvana blocked us from his page (hence, the reason why we don’t have a screenshot of our response). Apparently, this is not the first time that this has happened. Jo-Est B. Tan wrote an article in April showing that Dr. Salvana hides replies which are contrary to his opinion.16 Moreover, several individuals who took the time to compose replies on his post either had their comments deleted, or were completely blocked from the page [see examples below].

Dr. Salvana’s actions shows us that he is intolerant of others who question his judgement. While we can forgive a normal person who does not accept his mistake, we cannot condone such action from an individual tasked with making decisions for millions of Filipinos. Dr. Salvana’s actions have shown that he cannot learn from others, because he only wants to hear those who validate his ideas.

We are not health professionals but we found resources that debunks Dr. Salvana’s statements. Many lay people have also found the errors to his claims independently, which only goes to show that you don’t have to be a doctor to learn to read critically, put things together, and to find the pattern. And the patterns we are seeing now is this: Dr. Salvana is censoring information that can help bring us out of this lockdown. He is playing a key role in besmirching HCQ in the Philippines.

We conclude that either he is knowingly purveying lies, or he is ignorant. We know Dr. Salvana’s background. We all know he is not ignorant, so why is he promoting lies when lives are at stake? Does he not know that false information can cause deaths?

Sources

  1. https://www.esquiremag.ph/author/edsel-maurice-salvana-md
  2. The photo below has the following text: The proposal to use hydroxychloroquine for prophylaxis (as a preventive measure) against COVID-19 is UNSUPPORTED by science and is DANGEROUS. A randomized, double-blind placebo controlled trial (the gold standard for effectiveness in science) published in the New England Journal of Medicine has shown NO BENEFIT to its use as prophylaxis. Several randomized controlled trials have shown NO BENEFIT for the treatment of COVID-19 and WHO has discontinued its use in treatment trials. The US FDA has WITHDRAWN emergency use authorization for treatment since June.

    There are currently additional trials looking at hydroxychloroquine’s potential for prophylaxis. Any proposal for widespread use IS NOT JUSTIFIED by the current evidence. Time and again, hydroxychloroquine has FAILED to show benefit in properly controlled scientific trials. It is still being studied but please DO NOT USE IT FOR PROPHYLAXIS at this time.  IF there is any benefit, the current trials will try to find it. In the meantime, DO NOT USE. 

    Hydroxychloroquine can cause arrhythmias in people with heart conditions. Inappropriate use can lead to serious harm or death. Not to mention people recklessly relaxing protective measures because they mistakenly think they are protected. Scientists are constantly studying drugs and checking and double-checking if they are useful or not. There is currently NO REASON to believe that hydroxychloroquine has ANY VALUE in the fight against COVID-19. Thanks for listening.

  3. https://www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535
  4. https://c19study.com/
  5. http://andmagazine.com/talk/2020/05/15/what-if-you-could-start-feeling-better-from-covid-19-in-as-little-as-5-hours/
  6. https://hcqtrial.com/
  7. https://virologyj.biomedcentral.com/articles/10.1186/1743-422X-2-69
  8. https://www.healthline.com/health/coronavirus-vs-sars#molecular-factors
  9. https://www.cnn.com/2020/06/04/health/retraction-coronavirus-studies-lancet-nejm/index.html
  10. https://www.theguardian.com/science/2020/may/28/questions-raised-over-hydroxychloroquine-study-which-caused-who-to-halt-trials-for-covid-19
  11. https://www.nejm.org/doi/full/10.1056/NEJMoa2016638
  12. https://arxiv.org/abs/2007.09477
  13. https://www.airforcemag.com/wilkie-va-didnt-perform-clinical-trial-of-hydroxychloroquine/
  14. https://www.nejm.org/doi/full/10.1056/NEJMc2023617?
  15. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext
  16. https://www.msn.com/en-ph/entertainment/celebrity/bigot-dr-edsel-salvana-caught-hiding-replies-that-contrast-his-opinion-on-testing-and-isolation/ar-BB13bonl

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