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0 0.5 1 1.5 2+ Mortality 99% Improvement Relative Risk HCQ for COVID-19  Mitchell et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 2,400,000,000 patients in multiple countries Lower mortality with HCQ (p=0.0001) Mitchell et al., SSRN, May 2020 Favors HCQ Favors control

Markedly Lower Rates of Coronavirus Infection and Fatality in Malaria-Endemic Regions – A Clue As to Treatment?

Mitchell et al., SSRN, doi:10.2139/ssrn.3586954
May 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.
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Analysis of COVID-19 amongst 2.4B people shows a wide counterintuitive disparity between well-developed and less-developed countries, with more affluent countries about one hundred times more likely to be infected and die due to COVID-19. They find the effect is most apparent when comparing to countries with the highest rates of endemic malaria. Since travelers to malaria-endemic countries are likely to be taking antimalarial prophylaxis and there is evidence of efficacy with COVID-19, authors find the data highly probative for the hypothesis that prophylactic antimalarial use by incoming visitors markedly attenuates a country’s COVID-19 fatality rate. While authors do not adjust for age differences, those adjustments can only account for a small fraction of the observed difference.
This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups.
risk of death, 99.0% lower, RR 0.01, p < 0.001.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mitchell et al., 5 May 2020, retrospective, multiple countries, preprint, 2 authors.
This PaperHCQAll
Markedly Lower Rates of Coronavirus Infection and Fatality in Malaria-Endemic Regions -A Clue to Treatment?
This comparative analysis of coronavirus infection and death among 2.4 billion persons around the world demonstrates a wide (two orders of magnitude or one hundred-fold) disparity in coronavirus fatality rates between well-developed and less-developed countries. The difference is backward or counterintuitive. The current data demonstrates the surprising fact that those in more affluent countries are about one hundred times more likely to become infected with coronavirus infection and die. This effect is most apparent when these countries are compared to countries with the highest rates of endemic malaria. It is known that the novel coronavirus, also known as COVID-19, originated in Wuhan China and is transmitted from one country to another by travelers from a coronavirus-infested area. It is also known that travelers to malaria-endemic countries are likely to be taking antimalarial prophylaxis. There is also evidence that antimalarials, notably hydroxychloroquine, may have some efficacy in the treatment of coronavirus. In light of these facts, the mortality data presented here is highly probative for the hypothesis that prophylactic antimalarial use by its incoming visitors markedly attenuates a country's coronavirus fatality rate.
Author details: Geoff
Ahluwalia, Brooks, Weinman, A systematic review of factors affecting adherence to malaria chemoprophylaxis amongst travelers from non-endemic countries, Malar J, doi:10.1186/s12936-020-3104-4
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Gautret, Lagier, Raoult, Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study, Travel Med Infect Dis, doi:10.1016/j.tmaid.2020.101663
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Levenson, Why black Americans are at higher risk for coronavirus, CNN
Lobel, Baker, Gras, Use of malaria prevention measures by North American and European travelers to East Africa, J Travel Med
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Marmot, Friel, Bell, Houweling, Closing the gap in a generation: health equity through action on the social determinants of health Commission on Social Determinants of Health, Lancet, doi:10.1016/S0140-6736(08)61690-6
Mccarthy, New York coronavirus outbreak originated in Europe, new study finds COVID-19 cases in New York City were found as early as February, ABC News
Principia, Esposito, Chloroquine or hydroxychloroquine for prophylaxis of COVID-19, Lancet Infect Dis, doi:10.1016/S1473-3099(20)30296-6
Richardson, Hirsch, Davidson, Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area, JAMA, doi:10.1001/jama.2020.6775
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