What COVID-19 therapy is the real “Game-Changer”?
— Hydroxychloroquine or Zinc?
https://medium.com/@hotvpc/what-therapy-is-the-real-game-changer-cebc8838d447
There has been a tremendous amount of buzz regarding the use of hydroxychloroquine (HC) for the treatment of COVID-19. This has been touted as everything from a “game-changer” and “a gift from God” to begin mostly dismissed for lack of convincing evidence. The skeptics, me being one, have cited the majority of the literature demonstrating negative outcomes. Nonetheless, the pressure to forego formal clinical trials and urgently employ the drug in the face of many impending deaths of an epidemic has been enormous and completely understandable.
A survey reported 2 days ago of doctors around the world who have been managing COVID-19 patients place it as “the most effective coronavirus treatment” to date. The survey, conducted by Sermo, a global health care polling company, asked 6,227 physicians in 30 countries to find out what is the most effective against SARS-CoV-2.
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Despite the lack of compelling clinical evidence, it’s understandable the interest in HC given the presumed mechanism of action to stop viral replication. Chloroquine analogs (quinolines) have been shown to inhibit the acidification of endosomes and to exhibit in vitro a non-specific antiviral activity at high micromolar concentration against a broad range of emerging virus (HIV, dengue, hepatitis C, chikungunya, influenza, Ebola, SARS and MERS viruses) and more recently COVID-19. Furthermore, all the clinical studies are being performed on hospitalized sick patients and the question still remains whether such a therapy would have a more significant effect if started early in the illness or even prophylactically before the onset of the illness.
Hydroxychloroquine and Zinc
Aside from these clinical trials of various quality and weak or negative outcomes, there have been two recent striking clinical observations by clinicians that have played powerfully in the media because of the obviously striking outcomes. These are not clinical trials but rather anecdotal observations of larger populations of patients treated for presumed COVID-19 infections and they did not involve just hydroxychloroquine alone. But just because they are not rigorous clinical trials shouldn’t mean we should discard any clinical benefit that is so obvious that we don’t need a statistical analysis to reveal it particularly if corroborating reports are coming in from multiple observers.
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Reconciling the negative trials versus dramatic clinical observations
So how do we reconcile the negative clinical trials of HC with the dramatic clinical observations made by these two clinicians? One point that Dr. Cardillo made very clear was that those patients he treated with HC alone, did not respond. It was clear to him that zinc supplementation was needed to have the dramatic effect he saw. Indeed, the one commonality between Dr. Zelenko’s regimen of HC/Azithromycin/Zinc and Dr. Cardillo’s HC/Zinc besides HC is Zinc. So maybe the real hero is zinc. Maybe HC is just a doorman assisting the irreplaceable zinc but there are many other doormen out there that can help just as well.
By the way, these doctors are not the first to consider the combination of HC with zinc. There is currently an ongoing clinical trial in Turkey to look at the efficacy and safety of hydroxychloroquine with zinc in the management of COVID-19.