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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 419 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 109 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 26% lower mortality [22‑30%] from meta analysis of the 253 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
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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;'}]}, { 'given': 'Daniel Katuashi', 'family': 'Ishoso', 'sequence': 'additional', 'affiliation': [ { 'name': 'Community Health Department, Kinshasa School of Public Health, ' 'University of Kinshasa, Kinshasa, Democratic Republic of the ' 'Congo;'}]}, { 'given': 'John Otshudiema', 'family': 'Otokoye', 'sequence': 'additional', 'affiliation': [ { 'name': 'Epidemiological Surveillance Team, COVID-19 Response, Health ' 'Emergencies Program, World Health Organization, Kinshasa, ' 'Democratic Republic of the Congo;'}]}, { 'given': 'Michel P.', 'family': 'Hermans', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Endocrinology and Nutrition, Cliniques ' 'Universitaires St-Luc, Brussels, Belgium;'}]}, { 'given': 'Rhoderick Neri', 'family': 'Machekano', 'sequence': 'additional', 'affiliation': [ { 'name': 'African Center of Biostatistics Excellence (ACBE), Faculty of ' 'Medicine and Health Sciences, Stellenbosch University, Cape ' 'Town, South Africa;'}]}, { 'given': 'Nadia A.', 'family': 'Sam-Agudu', '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;'}]}, { 'given': 'Christian', 'family': 'Bongo-Pasi Nswe', '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;'}]}, { 'given': 'Placide', 'family': 'Mbala-Kingebeni', '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;'}]}, { 'given': 'Joule Ntwan', 'family': 'Madinga', 'sequence': 'additional', 'affiliation': [ { 'name': 'Epidemiological Surveillance Team, COVID-19 Response, Health ' 'Emergencies Program, World Health Organization, Kinshasa, ' 'Democratic Republic of the Congo;'}]}, { 'given': 'Stéphane', 'family': 'Mukendi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, School of Medicine, University ' 'of Kinshasa, Kinshasa, Democratic Republic of Congo'}]}, { 'given': 'Marie Claire', 'family': 'Kolié', 'sequence': 'additional', 'affiliation': [ { 'name': 'Epidemiological Surveillance Team, COVID-19 Response, Health ' 'Emergencies Program, World Health Organization, Kinshasa, ' 'Democratic Republic of the Congo;'}]}, { 'given': 'Edith N.', 'family': 'Nkwembe', '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;'}]}, { 'given': 'Gisele M.', 'family': 'Mbuyi', '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;'}]}, { 'given': 'Justus M.', 'family': 'Nsio', '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;'}]}, { 'given': 'Didier', 'family': 'Mukeba Tshialala', 'sequence': 'additional', 'affiliation': [ { 'name': 'Faculty of Medicine, University of Mbuji-Mayi, Mbuji-Mayi, ' 'Democratic Republic of the Congo;'}]}, { 'given': 'Michel', 'family': 'Tshiasuma Pipo', '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;'}]}, { 'given': 'Steve', 'family': 'Ahuka-Mundeke', '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;'}]}, { 'given': 'Jean-Jacques', 'family': 'Muyembe-Tamfum', '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;'}]}, { 'given': 'Lynne', 'family': 'Mofenson', 'sequence': 'additional', 'affiliation': [ { 'name': 'Elizabeth Glaser Pediatric AIDS Foundation, Washington, District ' 'of Columbia;'}]}, { 'given': 'Gerald', 'family': 'Smith', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Real World & Advanced Analytics, Cytel, Vancouver, ' 'Canada;'}]}, { 'given': 'Edward J.', 'family': 'Mills', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Health Research Methods, Evidence, and Impact, ' 'McMaster University, Hamilton, Canada;'}]}, { 'given': 'John W.', 'family': 'Mellors', 'sequence': 'additional', 'affiliation': [ { 'name': 'Division of Infectious 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'volume-title': 'No Clinical Benefit from Use of Hydroxychloroquine in Hospitalised ' 'Patients with COVID-19', 'author': 'Horby', 'year': '2020'}, { 'key': 'b38', 'doi-asserted-by': 'crossref', 'DOI': '10.1056/NEJMoa2019014', 'article-title': 'Hydroxychloroquine with or without azithromycin in mild-to-moderate ' 'COVID-19', 'author': 'Cavalcanti', 'year': '2020', 'journal-title': 'N Engl J Med'}, { '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', 'author': 'Williamson', 'year': '2020'}, { 'key': 'b40', 'doi-asserted-by': 'crossref', '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', 'year': '2020', 'journal-title': 'Clin Infect Dis'}, { 'key': 'b41', 'doi-asserted-by': 'crossref', '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', 'year': '2020', 'journal-title': 'JAMA Pediatr'}, { 'key': 'b42', 'doi-asserted-by': 'crossref', 'first-page': '334', 'DOI': '10.1056/NEJMoa2021680', 'article-title': 'Multisystem inflammatory syndrome in U.S. children and adolescents', 'volume': '383', 'author': 'Feldstein', 'year': '2020', 'journal-title': 'N Engl J Med'}, { 'key': 'b43', 'doi-asserted-by': 'crossref', 'first-page': 'ciaa556', 'DOI': '10.1093/cid/ciaa556', 'article-title': 'SARS-CoV-2 (COVID-19): what do we know about children? A systematic ' 'review', 'author': 'Mehta', 'year': '2020', 'journal-title': 'Clin Infect Dis'}, { 'key': 'b44', 'doi-asserted-by': 'crossref', 'first-page': 'e38', 'DOI': '10.1016/S2352-4642(20)30272-8', 'article-title': 'Multisystem inflammatory syndrome in children in South Africa', 'volume': '4', 'author': 'Webb', 'year': '2020', 'journal-title': 'Lancet Child Adolesc Health'}], 'container-title': 'The American Journal of Tropical Medicine and Hygiene', 'original-title': [], 'language': 'en', 'deposited': { 'date-parts': [[2021, 4, 6]], 'date-time': '2021-04-06T00:30:05Z', 'timestamp': 1617669005000}, 'score': 1, 'resource': {'primary': {'URL': 'https://ajtmh.org/doi/10.4269/ajtmh.20-1240'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 12, 2]]}, 'references-count': 44, 'journal-issue': {'issue': '6', 'published-print': {'date-parts': [[2020, 12, 2]]}}, 'URL': 'http://dx.doi.org/10.4269/ajtmh.20-1240', 'relation': {}, 'ISSN': ['0002-9637', '1476-1645'], 'subject': ['Virology', 'Infectious Diseases', 'Parasitology'], 'published': {'date-parts': [[2020, 12, 2]]}}
Late treatment
is less effective
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