How to End the COVID-19 Epidemic in the US

Hydroxychloroquine + Azithromycin (HCQ + AZ), with optional Zinc, given upon early symptoms, is a cure for COVID-19. This combination is a strong antiviral against the Wuhan coronavirus, quickly reducing the viral load and risk of transmission to other persons. It is a cure both for the treated patient and the epidemic in the country when it adopts this treatment widely, including middle age and young adult population.

Brazilian authorities are inclined to agree that early chloroquine / hydroxychloroquine treatment helps to "bend the curve":

"There is evidence that in some cities and some states early drug treatment was applied and that was exactly what contributed to the decrease in this curve, in this evolution of the epidemic curve in these states," he [Executive Secretary of the Ministry of Health, Élcio Franco] said at a news conference. The use of chloroquine in the treatment of covid-19 patients with mild symptoms has been recommended by the Ministry of Health since May 20.  [translation via Google Translate]

If a large fraction (30%–70%) of COVID-19 patients receive HCQ-based treatment early and isolate themselves for 5–7 days (until the viral loads drops to a reasonably safe level), the virus reproduction rate R drops below 1. The number of cases drops exponentially, and the epidemic ends. This has happened in Italy, Spain, and other countries that adopted this treatment when the infection was already widespread. When the epidemic ends, COVID-19 will likely remain endemic, but easily treated disease, like a common cold or flu. On the other hand, if presumed COVID-19 patients are not treated early, the coronavirus is free to replicate and spread as now, with the risk that it will mutate into something horrible.

We have a real spike in new COVID-19 cases, not an apparent one caused by increased testing. A larger share of tests is coming back positive. On June 15, the FDA revoked its useless Emergency Use Authorization (EUA 039) for HCQ and issued a scientifically illiterate and disingenuous memo that spread unwarranted doubt about the effectiveness and safety of HCQ treatment.

The EUA 039 limited the use of HCQ from the National Strategic Stockpile to hospitals only. Most COVID-19 patients are hospitalized in too advanced a stage of the disease to benefit from HCQ’s antiviral effect. Still, HCQ is beneficial as an immunomodulator.

Many government agencies and even doctors, however, interpreted that crooked EUA as a general guideline for HCQ use in COVID-19 patients. Thus, HCQ was typically given to hospitalized patients in the worst condition. Some possibly politically and financially motivated actors used that to publish incorrect and fraudulent studies that claimed that HCQ was useless or even harmful. Almost all HCQ studies touted by the media were done on hospitalized patients. The Lancet published an obviously fake Mehra et al. paper based on non-existent data. The paper was later retracted, but its conclusions remained in the public mind.

The Henry Ford Hospitals study has shown that HCQ reduces deaths by half even when used in hospitalized patients.

The June 15 EUA revocation letter was as crooked as the original authorization. Almost unnoticed, it restricts its (pseudo-) scientific conclusions to HCQ use under the EUA 039: “It is no longer reasonable to believe that CQ and HCQ may be effective in treating COVID-19 for the authorized uses detailed in EUA 039.” It says nothing about the HCQ outpatient use. This caveat was omitted when the NIH COVID-19 panel added recommendations against HCQ to its guidelines. In this form, the baseless recommendations against HCQ have been propagated by various medical boards and associations.

Combined with a campaign by the media and big tech against what they perceive as a “Trump drug,” these actions intimidated hospitals and many doctors into not prescribing HCQ for COVID-19. From the June 22 declaration by Jeremy Snavely in AAPS v. FDA: “Multiple members of AAPS have communicated to AAPS their inability to prescribe hydroxychloroquine (HCQ) for a full regimen to treat or prevent COVID-19, including but not limited to physicians in Western Michigan, Georgia, New Jersey, Arizona, and Texas.”

HCQ or COVID-19 choose one

COVID-19 is the disease of countries that do not use HCQ and Chloroquine (CQ). All the world uses HCQ or CQ for COVID-19 treatment and, sometimes, prophylaxis. Poor countries in Asia and Africa have mortality from COVID-19 many times lower than that of the US. Countries with endemic malaria have these drugs readily available, and the public used them when they heard that they work against COVID-19. Some cities in India and the Philippines that have low medical standards and a population density 10 times greater than New York City’s, have a small fraction of the COVID-19 deaths that New York experienced.

The Western countries did not have CQ or HCQ ready. Italy and Spain had a nearly exponential growth of cases and deaths through the middle of March, until they learned of the HCQ+AZ regimen developed under Dr. Didier Raoult (France) and “touted” by President Trump. Within a couple of weeks, its application broke and reversed the trend. Now they have 15–50 times fewer new COVID-19 cases and 8–40 times fewer deaths (per million of population) than the US. These countries do not have anything close to “herd immunity.” They do not wear muzzles. They use HCQ + AZ for early treatment and, in some cases, for prophylaxis.

In the US, the attitude to HCQ varied. On March 23, New York state prohibited pharmacies from dispensing HCQ to non-hospitalized COVID-19 patients even with a doctor’s prescription. The infection spread to neighboring and nearby states. The New York Death Corridor, including New Jersey, Massachusetts, Maryland, Pennsylvania, Connecticut, is responsible for more than half of US deaths. California did not interfere with the access to HCQ and had a low COVID-19 deaths rate. California also implemented harsh lockdowns, so HCQ opponents might argue this point.

It is incredible that government agencies are willing and capable of denying citizens access to a lifesaving drug. We do not need their permission to save our lives and health.

Scientific evidence

That said, the testimony of thousands of doctors and dozens of peer-reviewed studies as well as the experiences of other countries provide more than sufficient evidence of effectiveness and safety of early HCQ-based treatment for COVID-19.

See this collection of peer-reviewed studies, and this systemic review of physicians’ surveys about HCQ for COVID-19 treatment.

There is no shortage of HCQ. About 3 million lupus and rheumatoid arthritis patients take it daily. On March 20, the day after Trump “touted” CQ/HCQ, a coordinated media campaign caused a run on HCQ by lupus patients with 90-day prescriptions. It disrupted supplies for only a few days.

Not medical advice

Readers should know that COVID-19 is easily treatable with HCQ + AZ (and zinc, optionally), but the treatment should start early. If your doctor does not use the treatment, look for a doctor who does. Preferably, find such a doctor ahead of time. Do not self-medicate or self-diagnose; contraindications and adverse drug interactions do exist, and moderate side effects (nausea, vomiting, sour stomach etc.) are not rare. If your state demands a positive test result for HCQ-based treatment and you are in a high risk group (over 65 or having certain medical conditions), you may have a problem: the tests frequently return false negative results in the first one-two days of symptoms. This is not medical advice.

Doctors should feel free to prescribe HCQ-based treatment to patients with COVID-19 symptoms whether their state medical boards and medical associations like it or not. Pharmacists should promptly fill such prescriptions.

Support the Association of American Physicians and Surgeons (AAPS).

Hydroxychloroquine + Azithromycin (HCQ + AZ), with optional Zinc, given upon early symptoms, is a cure for COVID-19. This combination is a strong antiviral against the Wuhan coronavirus, quickly reducing the viral load and risk of transmission to other persons. It is a cure both for the treated patient and the epidemic in the country when it adopts this treatment widely, including middle age and young adult population.

Brazilian authorities are inclined to agree that early chloroquine / hydroxychloroquine treatment helps to "bend the curve":

"There is evidence that in some cities and some states early drug treatment was applied and that was exactly what contributed to the decrease in this curve, in this evolution of the epidemic curve in these states," he [Executive Secretary of the Ministry of Health, Élcio Franco] said at a news conference. The use of chloroquine in the treatment of covid-19 patients with mild symptoms has been recommended by the Ministry of Health since May 20.  [translation via Google Translate]

If a large fraction (30%–70%) of COVID-19 patients receive HCQ-based treatment early and isolate themselves for 5–7 days (until the viral loads drops to a reasonably safe level), the virus reproduction rate R drops below 1. The number of cases drops exponentially, and the epidemic ends. This has happened in Italy, Spain, and other countries that adopted this treatment when the infection was already widespread. When the epidemic ends, COVID-19 will likely remain endemic, but easily treated disease, like a common cold or flu. On the other hand, if presumed COVID-19 patients are not treated early, the coronavirus is free to replicate and spread as now, with the risk that it will mutate into something horrible.

We have a real spike in new COVID-19 cases, not an apparent one caused by increased testing. A larger share of tests is coming back positive. On June 15, the FDA revoked its useless Emergency Use Authorization (EUA 039) for HCQ and issued a scientifically illiterate and disingenuous memo that spread unwarranted doubt about the effectiveness and safety of HCQ treatment.

The EUA 039 limited the use of HCQ from the National Strategic Stockpile to hospitals only. Most COVID-19 patients are hospitalized in too advanced a stage of the disease to benefit from HCQ’s antiviral effect. Still, HCQ is beneficial as an immunomodulator.

Many government agencies and even doctors, however, interpreted that crooked EUA as a general guideline for HCQ use in COVID-19 patients. Thus, HCQ was typically given to hospitalized patients in the worst condition. Some possibly politically and financially motivated actors used that to publish incorrect and fraudulent studies that claimed that HCQ was useless or even harmful. Almost all HCQ studies touted by the media were done on hospitalized patients. The Lancet published an obviously fake Mehra et al. paper based on non-existent data. The paper was later retracted, but its conclusions remained in the public mind.

The Henry Ford Hospitals study has shown that HCQ reduces deaths by half even when used in hospitalized patients.

The June 15 EUA revocation letter was as crooked as the original authorization. Almost unnoticed, it restricts its (pseudo-) scientific conclusions to HCQ use under the EUA 039: “It is no longer reasonable to believe that CQ and HCQ may be effective in treating COVID-19 for the authorized uses detailed in EUA 039.” It says nothing about the HCQ outpatient use. This caveat was omitted when the NIH COVID-19 panel added recommendations against HCQ to its guidelines. In this form, the baseless recommendations against HCQ have been propagated by various medical boards and associations.

Combined with a campaign by the media and big tech against what they perceive as a “Trump drug,” these actions intimidated hospitals and many doctors into not prescribing HCQ for COVID-19. From the June 22 declaration by Jeremy Snavely in AAPS v. FDA: “Multiple members of AAPS have communicated to AAPS their inability to prescribe hydroxychloroquine (HCQ) for a full regimen to treat or prevent COVID-19, including but not limited to physicians in Western Michigan, Georgia, New Jersey, Arizona, and Texas.”

HCQ or COVID-19 choose one

COVID-19 is the disease of countries that do not use HCQ and Chloroquine (CQ). All the world uses HCQ or CQ for COVID-19 treatment and, sometimes, prophylaxis. Poor countries in Asia and Africa have mortality from COVID-19 many times lower than that of the US. Countries with endemic malaria have these drugs readily available, and the public used them when they heard that they work against COVID-19. Some cities in India and the Philippines that have low medical standards and a population density 10 times greater than New York City’s, have a small fraction of the COVID-19 deaths that New York experienced.

The Western countries did not have CQ or HCQ ready. Italy and Spain had a nearly exponential growth of cases and deaths through the middle of March, until they learned of the HCQ+AZ regimen developed under Dr. Didier Raoult (France) and “touted” by President Trump. Within a couple of weeks, its application broke and reversed the trend. Now they have 15–50 times fewer new COVID-19 cases and 8–40 times fewer deaths (per million of population) than the US. These countries do not have anything close to “herd immunity.” They do not wear muzzles. They use HCQ + AZ for early treatment and, in some cases, for prophylaxis.

In the US, the attitude to HCQ varied. On March 23, New York state prohibited pharmacies from dispensing HCQ to non-hospitalized COVID-19 patients even with a doctor’s prescription. The infection spread to neighboring and nearby states. The New York Death Corridor, including New Jersey, Massachusetts, Maryland, Pennsylvania, Connecticut, is responsible for more than half of US deaths. California did not interfere with the access to HCQ and had a low COVID-19 deaths rate. California also implemented harsh lockdowns, so HCQ opponents might argue this point.

It is incredible that government agencies are willing and capable of denying citizens access to a lifesaving drug. We do not need their permission to save our lives and health.

Scientific evidence

That said, the testimony of thousands of doctors and dozens of peer-reviewed studies as well as the experiences of other countries provide more than sufficient evidence of effectiveness and safety of early HCQ-based treatment for COVID-19.

See this collection of peer-reviewed studies, and this systemic review of physicians’ surveys about HCQ for COVID-19 treatment.

There is no shortage of HCQ. About 3 million lupus and rheumatoid arthritis patients take it daily. On March 20, the day after Trump “touted” CQ/HCQ, a coordinated media campaign caused a run on HCQ by lupus patients with 90-day prescriptions. It disrupted supplies for only a few days.

Not medical advice

Readers should know that COVID-19 is easily treatable with HCQ + AZ (and zinc, optionally), but the treatment should start early. If your doctor does not use the treatment, look for a doctor who does. Preferably, find such a doctor ahead of time. Do not self-medicate or self-diagnose; contraindications and adverse drug interactions do exist, and moderate side effects (nausea, vomiting, sour stomach etc.) are not rare. If your state demands a positive test result for HCQ-based treatment and you are in a high risk group (over 65 or having certain medical conditions), you may have a problem: the tests frequently return false negative results in the first one-two days of symptoms. This is not medical advice.

Doctors should feel free to prescribe HCQ-based treatment to patients with COVID-19 symptoms whether their state medical boards and medical associations like it or not. Pharmacists should promptly fill such prescriptions.

Support the Association of American Physicians and Surgeons (AAPS).