The constant battle between pathogens and their hosts has long been recognized as a key driver of evolution

Overall crude mortality rates were 18.1% in the entire cohort, 13.5% in the hydroxychloroquine alone group, 20.1% among those receiving hydroxychloroquine plus azithromycin, 22.4% among the azithromycin alone group, and 26.4% for neither drug

Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4-10 days), median age was 64 years (IQR:53-76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3-53). Overall in-hospital mortality was 18.1% (95% CI:16.6%-19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%-23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%-15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%-30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%-31.0%])​. Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9-3.3]), white race (HR:1.7 [95% CI:1.4-2.1]), CKD (HR:1.7 [95%CI:1.4-2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1-2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4-3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001).

Physicians who have been using these medications in the face of widespread skepticism have been truly heroic. They have done what the science shows is best for their patients, often at great personal risk. I myself know of two doctors who have saved the lives of hundreds of patients with these medications, but are now fighting state medical boards to save their licenses and reputations. The cases against them are completely without scientific merit.
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In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence.

This far into the pandemic, with double-blind, randomized, controlled clinical trials starting to be published and showing, each and every one of them so far, that hydroxychloroquine shows no benefit versus COVID-19 (I’ll discuss them shortly), let’s just say that I am flummoxed to find, in the midst of a crisis, that a seemingly respected epidemiologist is fighting for a drug that almost certainly doesn’t work based on low quality and anecdotal evidence when far higher quality evidence is becoming available and even the bulk of the observational evidence has been negative, with one notable outlier. I am even more flummoxed to find that Newsweek provided this epidemiologist a platform to promote this argument, particularly given how he based it primarily on a commentary and review that he wrote in May, which is basically ancient history as far as the evidence base for hydroxychloroquine goes.

hat being said, it’s amazing how much believers in acupuncture, vitamin C to treat cancer, and hydroxychloroquine to treat COVID-19 have in common. It’s also distressing how much like the villain in a slasher flick the drug is. No matter how many times it appears to have died, it always comes back.

“Was given it the day my test came back,” Fine replied. “Sorry to burst the magic bubble.” ... "I'm over it," Fine texted FLORIDA TODAY from his Holmes Regional Medical Center hospital bed on Monday. "People should be able to use it if they want. But people should stop pretending it is some kind of magic potion as well. If they need proof, look at me."