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Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo

Nachega et al., The American Journal of Tropical Medicine and Hygiene, doi:10.4269/ajtmh.20-1240
Oct 2020  
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Mortality 28% Improvement Relative Risk Improvement 26% HCQ for COVID-19  Nachega et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 766 patients in DR Congo Lower mortality (p=0.17) and greater improvement (p=0.13), not sig. c19hcq.org Nachega et al., The American J. Tropi.., Oct 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 423 studies, used in 59 countries.
No treatment is 100% effective. Protocols combine treatments.
5,500+ studies for 119 treatments. c19hcq.org
Retrospective 766 hospitalized patients in DRC showing mortality reduced from 29% to 11%, and improvement at 30 days increased from 65% to 84%.
Mortality cox regression adjusted hazard ratio aHR 0.26, p < 0.001
Risk of no improvement adjusted odds ratio aOR 0.28, p < 0.001
Using marginal structural model analysis these risks became:
Mortality MSM adjusted odds ratio aOR 0.65, p = 0.166
Risk of no improvement MSM adjusted odds ratio aOR = 0.65, p = 0.132
Median age 46, 630 treated with CQ+AZ.
Although the 28% lower mortality is not statistically significant, it is consistent with the significant 27% lower mortality [23‑31%] from meta analysis of the 257 mortality results to date.
risk of death, 27.6% lower, RR 0.72, p = 0.17, treatment 69 of 630 (11.0%), control 28 of 96 (29.2%), NNT 5.5, adjusted per study, odds ratio converted to relative risk.
risk of no improvement, 25.8% better, RR 0.74, p = 0.13, adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Nachega et al., 2 Oct 2020, retrospective, database analysis, DR Congo, peer-reviewed, median age 46.0, 25 authors.
This PaperHCQAll
DOI record: { "DOI": "10.4269/ajtmh.20-1240", "ISSN": [ "0002-9637", "1476-1645" ], "URL": "http://dx.doi.org/10.4269/ajtmh.20-1240", "author": [ { "affiliation": [ { "name": "Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania;" }, { "name": "Department of Medicine, Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;" }, { "name": "Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;" } ], "family": "Nachega", "given": "Jean B.", "sequence": "first" }, { "affiliation": [ { "name": "Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo;" } ], "family": "Ishoso", "given": "Daniel Katuashi", "sequence": "additional" }, { "affiliation": [ { "name": "Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo;" } ], "family": "Otokoye", "given": "John Otshudiema", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium;" } ], "family": "Hermans", "given": "Michel P.", "sequence": "additional" }, { "affiliation": [ { "name": "African Center of Biostatistics Excellence (ACBE), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;" } ], "family": "Machekano", "given": "Rhoderick Neri", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Paediatrics, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana;" }, { "name": "International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;" }, { "name": "Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland;" } ], "family": "Sam-Agudu", "given": "Nadia A.", "sequence": "additional" }, { "affiliation": [ { "name": "Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo;" }, { "name": "Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo;" } ], "family": "Bongo-Pasi Nswe", "given": "Christian", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo;" } ], "family": "Mbala-Kingebeni", "given": "Placide", "sequence": "additional" }, { "affiliation": [ { "name": "Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo;" } ], "family": "Madinga", "given": "Joule Ntwan", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo" } ], "family": "Mukendi", "given": "Stéphane", "sequence": "additional" }, { "affiliation": [ { "name": "Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo;" } ], "family": "Kolié", "given": "Marie Claire", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo;" } ], "family": "Nkwembe", "given": "Edith N.", "sequence": "additional" }, { "affiliation": [ { "name": "Direction Surveillance Épidémiologique (DSE), Direction Générale de Lutte contre la Maladie (DGLM), Ministère de la Santé Publique et Riposte COVID-19, Kinshasa, Democratic Republic of the Congo;" } ], "family": "Mbuyi", "given": "Gisele M.", "sequence": "additional" }, { "affiliation": [ { "name": "Direction Surveillance Épidémiologique (DSE), Direction Générale de Lutte contre la Maladie (DGLM), Ministère de la Santé Publique et Riposte COVID-19, Kinshasa, Democratic Republic of the Congo;" } ], "family": "Nsio", "given": "Justus M.", "sequence": "additional" }, { "affiliation": [ { "name": "Faculty of Medicine, University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo;" } ], "family": "Mukeba Tshialala", "given": "Didier", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo;" } ], "family": "Tshiasuma Pipo", "given": "Michel", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo;" } ], "family": "Ahuka-Mundeke", "given": "Steve", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo;" } ], "family": "Muyembe-Tamfum", "given": "Jean-Jacques", "sequence": "additional" }, { "affiliation": [ { "name": "Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia;" } ], "family": "Mofenson", "given": "Lynne", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Real World & Advanced Analytics, Cytel, Vancouver, Canada;" } ], "family": "Smith", "given": "Gerald", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Health Research 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2 ] ] }, "journal-issue": { "issue": "6", "published-print": { "date-parts": [ [ 2020, 12, 2 ] ] } }, "language": "en", "member": "2795", "original-title": [], "page": "2419-2428", "prefix": "10.4269", "published": { "date-parts": [ [ 2020, 12, 2 ] ] }, "published-print": { "date-parts": [ [ 2020, 12, 2 ] ] }, "publisher": "American Society of Tropical Medicine and Hygiene", "reference": [ { "key": "b1", "volume-title": "COVID-19 Dashboard", "year": "2020" }, { "key": "b2", "volume-title": "New WHO Estimates: Up to 190 000 People Could Die of COVID-19 in Africa if Not Controlled", "year": "2020" }, { "DOI": "10.1093/cid/ciaa353", "article-title": "The late arrival of COVID-19 in Africa–mitigating pan-continental spread", "author": "Nachega", "doi-asserted-by": "crossref", "first-page": "875", "journal-title": "Clin Infect Dis", "key": "b3", "volume": "71", "year": "2020" }, { "DOI": "10.1016/S2214-109X(20)30212-6", "article-title": "Limiting the spread of COVID-19 in Africa: one size 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"No Clinical Benefit from Use of Hydroxychloroquine in Hospitalised Patients with COVID-19", "year": "2020" }, { "DOI": "10.1056/NEJMoa2019014", "article-title": "Hydroxychloroquine with or without azithromycin in mild-to-moderate COVID-19", "author": "Cavalcanti", "doi-asserted-by": "crossref", "journal-title": "N Engl J Med", "key": "b38", "year": "2020" }, { "author": "Williamson", "key": "b39", "volume-title": "OpenSAFELY: Factors Associated with COVID-19-related Hospital Death in the Linked Electronic Health Records of 17 Million Adult NHS Patients", "year": "2020" }, { "DOI": "10.1093/cid/ciaa1198", "article-title": "HIV and risk of COVID-19 death: a population cohort study from the western Cape province, South Africa", "author": "Boulle", "doi-asserted-by": "crossref", "journal-title": "Clin Infect Dis", "key": "b40", "year": "2020" }, { "DOI": "10.1001/jamapediatrics.2020.1467", "article-title": "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review", "author": "Castagnoli", "doi-asserted-by": "crossref", "journal-title": "JAMA Pediatr", "key": "b41", "year": "2020" }, { "DOI": "10.1056/NEJMoa2021680", "article-title": "Multisystem inflammatory syndrome in U.S. children and adolescents", "author": "Feldstein", "doi-asserted-by": "crossref", "first-page": "334", "journal-title": "N Engl J Med", "key": "b42", "volume": "383", "year": "2020" }, { "DOI": "10.1093/cid/ciaa556", "article-title": "SARS-CoV-2 (COVID-19): what do we know about children? A systematic review", "author": "Mehta", "doi-asserted-by": "crossref", "first-page": "ciaa556", "journal-title": "Clin Infect Dis", "key": "b43", "year": "2020" }, { "DOI": "10.1016/S2352-4642(20)30272-8", "article-title": "Multisystem inflammatory syndrome in children in South Africa", "author": "Webb", "doi-asserted-by": "crossref", "first-page": "e38", "journal-title": "Lancet Child Adolesc Health", "key": "b44", "volume": "4", "year": "2020" } ], "reference-count": 44, "references-count": 44, "relation": {}, "resource": { "primary": { "URL": "https://ajtmh.org/doi/10.4269/ajtmh.20-1240" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "Virology", "Infectious Diseases", "Parasitology" ], "subtitle": [], "title": "Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo", "type": "journal-article", "volume": "103" }
Late treatment
is less effective
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