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0 0.5 1 1.5 2+ Mortality 94% Improvement Relative Risk HCQ  Bernabeu-Wittel et al.  EARLY TREATMENT Is early treatment with HCQ + combined treatments beneficial for COVID-19? Retrospective 272 patients in Spain Lower mortality with HCQ + combined treatments (p=0.0011) Bernabeu-Wittel et al., J. Gerontol. A.., Aug 2020 Favors HCQ Favors control

Effectiveness of a On-Site Medicalization Program for Nursing Homes with COVID-19 Outbreaks

Bernabeu-Wittel et al., J. Gerontol. A Biol. Sci. Med. Sci., doi:10.1093/gerona/glaa192
Aug 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Retrospective 272 nursing home residents showing significantly improved survival after establishing a treatment program including HCQ with or without lopinavir/ritonavir and with the addition of adjuvant and antimicrobial treatments depending on circumstances. HCQ (114 patients), HCQ+LPV/RTV (18 patients), and HCQ+AZ (7 patients). Dosage details are in the supplementary appendix.
risk of death, 93.7% lower, RR 0.06, p = 0.001, treatment 24 of 139 (17.3%), control 37 of 83 (44.6%), NNT 3.7, adjusted per study, inverted to make RR<1 favor treatment, odds ratio converted to relative risk, active standard care.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bernabeu-Wittel et al., 1 Aug 2020, retrospective, Spain, peer-reviewed, 13 authors, dosage 400mg bid day 1, 200mg bid days 2-7, this trial uses multiple treatments in the treatment arm (combined with lopinavir/ritonavir, AZ, and/or antimicrobial treatments for some patients) - results of individual treatments may vary.
This PaperHCQAll
Bernabeu-Wittel, MD, PhD Ternero-Vega Je, MD Nieto-Martín, MD, PhD Conde-Guzmán, MD, PhD J Delgado-Cuesta, MD, PhD M Rincón-Gómez, MD, PhD Díaz-Jiménez, MD Lomas-Cabezas Jm, MD, PhD), Muñoz-García Mm, MD S Calzón-Fernández, MD, PhD M Ollero-Baturone, Máximo Bernabeu-Wittel
BACKGROUND: Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to SARS-CoV-2 pandemic. METHODS: A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in four nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of 'clean' and 'contaminated' areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. RESULTS: 272 out of 457 (59.5%) residents and 85 out of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital, occurred in 77%, 72.5%, and 29% of patients diagnosed before MP start, with respect to 97%, 83.7% and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR=15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR=28 ). All outbreaks were controlled in 39 [37-42] days. CONCLUSIONS: A coordinated on-site medicalization program of nursing homes with COVID-19 outbreaks achieved a higher survival or optimal palliative care rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.
A c c e p t e d M a n u s c r i p t 17 deeper integration of health and social care (11, 23, 33) . Second, we learned, that health care resources re-allocation is an effective strategy to manage this pandemic, and that decisive and anticipated actions save lives and prevent unfortunate consequences; one may think, that this mobilization was exaggerated and expensive, but otherwise at least two hundred of these residents would have needed hospital care, so in this scenario the same health care resources would have been used, but in a overcrowded and saturated hospital. And at last we learned, that a true synergistic coordination between Primary and Hospital Care is possible and it works. We all have read a lot about this issue, and know, however, the daily difficulties in its implementation (37) . In these extraordinary circumstances integration worked wonderfully, because it emerged from professionalism values: willingness to serve people, altruism, generosity, and mutual respect. This study has some limitations, that should be remarked. First, the retrospective collection of the cohort's data, which could introduce some biases, as it is already known for this kind of approaches. Second, the confidence intervals for some of the findings are wide, reflecting limits in study power for some analyses. And third, the possible regression to the mean, which is present in most health care initiatives directed towards high-risk populations, could have played a role in the results;..
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