Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
Dr Harvey A Risch
doi:10.1093/aje/kwaa093/5847586
More than 1.6 million Americans have been infected with SARS-CoV-2 and >10 times that number carry antibodies to it. High-risk patients presenting with progressing symptomatic disease have only hospitalization treatment with its high mortality. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe.
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:p>More than 1.6 million Americans have been infected with severe acute '
'respiratory syndrome coronavirus 2 (SARS-CoV-2), and\xa0more than 10 times that number carry '
'antibodies to it. High-risk patients with progressing symptomatic disease currently have only '
'hospitalization treatment, with its high mortality, available to them. An outpatient '
'treatment that prevents hospitalization is desperately needed. Two candidate medications have '
'been widely discussed: remdesivir and hydroxychloroquine (HCQ) + azithromycin (AZ). '
'Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials in '
'outpatients have been registered. HCQ + AZ has been widely misrepresented in both clinical '
'reports and public media, and results of outpatient trials are not expected until September. '
'Early outpatient illness is very different from later florid disease requiring '
'hospitalization, and the treatments differ. Evidence about use of HCQ alone, or of HCQ + AZ '
'in inpatients, is irrelevant with regard to the efficacy of HCQ + AZ in early high-risk '
'outpatient disease. Five studies, including 2 controlled clinical trials, have demonstrated '
'significant major outpatient treatment efficacy. HCQ + AZ has been used as the standard of '
'care in more than 300,000 older adults with multiple comorbid conditions; the estimated '
'proportion of such patients diagnosed with cardiac arrhythmia attributable to the medications '
'is 47 per 100,000 users, among whom estimated mortality is less than 20% (9/100,000 users), '
'as compared with the 10,000 Americans now dying each week. These medications need to be made '
'widely available and promoted immediately for physicians to prescribe.</jats:p>',
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