Abstract: Empirical treatment with hydroxychloroquine and azithromycin for suspected cases of COVID-19 followed-up by telemedicine Rodrigo Barbosa Esper M.D., Ph.D., Rafael Souza da Silva M.D., Fernando Teiichi Costa Oikawa M.D., Ph.D., Marcelo Machado Castro M.D., Alvaro Razuk-Filho M.D., Ph.D., Pedro Benedito Batista Junior M.D., Sergio Wilhelm Lotze M.D., Cleber Nunes da Rocha M.D., Roberto de Sá Cunha Filho M.D., Saulo Emanuel Barbosa de Oliveira M.D, Philipe Leitão Ribeiro, M.D., Valéria Cristina Vigar Martins M.D., Fernando Silva Braga Bueno M.D., Priscila Ligeiro Gonçalves Esper M.D., Eduardo Fagundes Parrillo M.D. Affiliation/institution: Prevent Senior Institute, São Paulo, Brazil Corresponding Author: Rodrigo Barbosa Esper M.D., Ph.D. dr.rodrigo.esper@preventsenior.com.br Avenida Lourenço Marques, n 158, São Paulo – Brazil ZIP CODE: 04547-100 Phone: +55 11 999869306 Word Count: 4803 The Ethics Committee approved study number - CONEP/Plataforma Brasil CAAE: 30586520.9.0000.0008 (Número Parecer:3.968.699) ClinicalTrials.gov Identifier: NCT04348474 1 Abstract Background: Telemedicine can facilitate patient’s assessment with initial flu-like symptoms in the COVID-19 pandemic, moreover it promotes social isolation. Hydroxychloroquine and azithromycin are associated with reduction in COVID-19 patients' viral load. This study aims to assess whether empirical prescription of hydroxychloroquine and azithromycin for patients with suspected COVID-19 is associated with less need for hospitalization Methods: A telemedicine team evaluated suspected contraindications COVID-19 were detected, outpatients treatment with with flu-like symptoms, hydroxychloroquine if no and azithromycin was prescribed after consent from subjects. Patients were monitored daily by telemedicine appointments. Results: Of the 636 symptomatic outpatients, 412 started treatment with hydroxychloroquine and azithromycin and 224 refused medications (control group). Need for hospitalization was 1.9% in the treatment group and 5.4% in the control group (2.8 times greater) and number needed to treat was 28 (NNT = 28). In those who started treatment before versus after the seventh day of symptoms, the need for hospitalization was 1.17% and 3.2%, respectively. Conclusion: Empirical treatment with hydroxychloroquine associated with azithromycin for suspected cases of COVID-19 infection reduces the need for hospitalization (p< 0.001). Funding: this study does not have any type of funding Keywords: SARS-CoV-2; COVID-19; hydroxychloroquine; azithromycin; telemedicine, pandemic. 2 1. Background In the past two decades, severe acute respiratory syndromes have been one of the most critical threats to global health. Coronaviruses (Mers-CoV, SARS-Cov) are virus that may affect humans and cause severe infections and deaths worldwide (1). In December 2019, a new Beta-coronavirus, named SARS-CoV-2, was associated with a set of respiratory tract infections in Wuhan, Hubei province in China, and spread rapidly across continents (2). According to the World Health Organization (WHO), the outbreak was declared a public health emergency of international interest on January 30, 2020 and on March 11, WHO announced COVID-19 outbreak a pandemic (3). Patient’s clinical characteristics from China revealed that comorbities such as diabetes, hypertension and others cardiovascular diseases were related to poor outcomes and high death rates, with three to four times more chances..