Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
, Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as..
, , American Journal of Epidemiology, kwaa093, 27 May 2020, doi:10.1093/aje/kwaa093 (meta analysis)
Five studies, including two controlled clinical trials, have demonstrated significant outpatient treatment efficacy.
Currently there are 36 HCQ early treatment studies
and meta analysis shows:
Risch et al., 27 May 2020, peer-reviewed, 1 author.
Abstract: Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be
Harvey A. Risch
Correspondence to Dr. Harvey A. Risch, Department of Chronic Disease Epidemiology, Yale
School of Public Health, P.O. Box 208034, New Haven, CT 06520-8034 (e-mail:
firstname.lastname@example.org; phone: (203) 785-2848)
Author Affiliations: Department of Chronic Disease Epidemiology, Yale School of Public
Health, New Haven, Connecticut (Harvey A. Risch).
Conflict of Interest: Dr. Risch acknowledges past advisory consulting work with two of the more
than 50 manufacturers of hydroxychloroquine, azithromycin and doxycycline. This past work
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
other potential conflicts-of-interest to disclose.
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:
Ramped-Up Immediately as Key to the Pandemic Crisis
More than 1.6 million Americans have been infected with SARS-CoV-2 and >10 times that
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.
Keywords: Azithromycin; Covid-19; Doxycycline; Hydroxychloroquine; Remdesivir; SARS-
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;..
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