Abstract: Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be SC RI P Harvey A. Risch Correspondence to Dr. Harvey A. Risch, Department of Chronic Disease Epidemiology, Yale AN U School of Public Health, P.O. Box 208034, New Haven, CT 06520-8034 (e-mail: M harvey.risch@yale.edu; phone: (203) 785-2848) ED Author Affiliations: Department of Chronic Disease Epidemiology, Yale School of Public ED IT Health, New Haven, Connecticut (Harvey A. Risch). Funding: None. N Conflict of Interest: Dr. Risch acknowledges past advisory consulting work with two of the more U than 50 manufacturers of hydroxychloroquine, azithromycin and doxycycline. This past work AL was not related to any of these three medications and was completed more than two years ago. He has no ongoing, planned or projected relationships with any of these companies, nor any G IN other potential conflicts-of-interest to disclose. O RI Running Head: Outpatient Treatment of High-Risk Covid-19 © The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e‐mail: journals.permissions@oup.com. 1 T Ramped-Up Immediately as Key to the Pandemic Crisis Abstract More than 1.6 million Americans have been infected with SARS-CoV-2 and >10 times that RI P disease have only hospitalization treatment with its high mortality. An outpatient treatment that SC prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild AN U effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and M public media, and outpatient trials results are not expected until September. Early outpatient ED 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 ED IT 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 U N 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac AL 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 G IN medications need to be widely available and promoted immediately for physicians to prescribe. RI Keywords: Azithromycin; Covid-19; Doxycycline; Hydroxychloroquine; Remdesivir; SARS- O CoV-2; Zinc 2 T number carry antibodies to it. High-risk patients presenting with progressing symptomatic Abbreviations: AZ, azithromycin; CDC, US Centers for Disease Control; FAERS, FDA Adverse Events Reporting System database; FDA, US Food and Drug Administration;..