Prof Raoult has repeatedly said that poor African countries that are used to epidemics and not averse to using cheap and time-tested medication have a much lower death toll than other nations. This is particularly true in Morocco, Nigeria, Benin, Tchad, Cameroon, Burkina Faso and Senegal, which have widely prescribed HCQ. Its efficiency lies in limiting contamination and viral load, which could explain the very low prevalence of COVID in African countries.
Senegal had its first case at the end of February. It chose a light form of confinement because many people need to be able to work from day-to-day for their living; by May 27, the 15 million strong country had only 3,253 cases of contamination and 38 deaths.
South Korea, which was widely recognized for quickly containing the virus with measures such as massive testing and contact tracing, also included hydroxychloroquine as one of several drugs in its recommended treatment protocol. Since the first recorded cases on February 16, total cases reached 11,344 on May 28, with only 269 deaths. With its 51 million inhabitants and level of development, the country is comparable to France (67 million inhabitants) where the death toll is more than 100 times higher.
Other countries using hydroxychloroquine, with or without other medication, are listed here.
“We’ve tried confinement in Marseille, and it didn’t work”
Prof. Raoult was probably also under fire because from the start, he criticized the “mediaeval” method of confinement, insisting that the only possible way to stop an epidemic is to test, isolate those who test positive and do everything possible to treat them and prevent them from dying. “We’ve tried confinement in Marseille, and it didn’t work,” he said, with reference to the cholera plagues that affected that city in the 1800’s.
He noted that in Spain, a study of coronavirus prevalence among people who were confined at home and those who went out to work showed that workers showed a lower contamination rate by the virus than people who “sheltered in place.”
The strength of Raoult’s position lies with the success of his protocol in preventing deaths: a fact that can be verified by looking at the low death-rate at the IHU-Méditerranée which treated the largest sample of COVID-19 patients in the world.
A retrospective analysis of 1,061 cases treated at the IHU published on May 5 by Raoult and his teamin Elsevier showed that over 90 percent of patients treated with HCQ and azithromycin had “good clinical outcome and virological cure” within 10 days; eight patients died, aged between 74 and 95 years, not from cardiac toxicity but respiratory failure. 98.7 percent of all involved patients were cured at the time of publication.
Fewer deaths in Marseille than elsewhere in France
Marseille was the one place in France where most tests were done, but it was also the place where the number of deaths in proportion to the population compared with other regions of France with comparable rates of contamination was lowest. Before the epidemic started off, Marseille was expected to be one of the epicenters of the coronavirus, according to reliable sources from the French Ministry of the Interior.
Marseille is one of the main centers of African immigration. The northern parts of the city are large “ethnic suburbs” where confinement was next to impossible to enforce, as was the case in the northern suburbs of Paris where COVID-19 led to a higher death rate than elsewhere in France under government guidelines – no testing, no treating. However, testing and treating as recommended by Raoult in Marseille appears to have avoided a similar outcome.
In a video published on May 19, Raoult observed that the curve of contaminations, illness and deaths is similar in most places and that, in France, with the arrival of the warm spring days, the epidemic appears to be tapering off as he had suggested was a “substantially possible” outcome if it were to resemble most other similar episodes.
His comments in a previous IHU-Méditerranée video one month earlier were already optimistic. It was published with English sub-titles and can be watched here: https://youtu.be/eTSLFU0wL6A.
In the May 19 video, Raoult observed that the death rate in France per 1 million inhabitants is now officially at 419, “which is a lot,” Raoult stated. He recalled that in the east of France, the death rate was of 600 per 1 million inhabitants, and 500 in the greater Paris region, and even 759 in Paris proper. At the same time, in the region of Marseille (Provence, Alps and Côte d’Azur) the death rate was only 168 per 1 million inhabitants, and 140 in Marseille proper. In other words, five times more coronavirus-infected people died in Paris than in Marseille.
At the IHU itself, where treatment with HCQ and azithromycin was given to a majority of 4,000 treated patients (some refused, others could not receive it for various reasons, mostly because it was too late for it to save them) the mortality rate was of 0.5 percent of infected patients. On May 27, a total of 3,313 patients had been treated at IHU with the HCQ-azithromycin protocol; only 18 of them had died.
Raoult’s IHU-Méditerranée institute has recently published an English abstract of its “real-life cohort of 3,737 patients,” showing “a decreased risk of transfer to the ICU or death,” available here.
Raoult underscored that in places where there was no massive testing of the population nor treatment for seropositive patients at the low symptom stage, such as Wuhan and Italy at the beginning of the epidemic, one half of the victims were less than 70 years old. This changed once systematic testing and treatment were introduced.
Saving the younger patients
In Paris, where absence of testing and treatment remained the official rule, a much larger proportion of people under 70 died than in Marseille, where only two people aged between 60 and 70 died. This was an answer to the criticism according to which the IHU had better statistics because it was treating younger people who would have been cured anyway. Raoult now claims that his protocol was especially efficient in saving the lives of younger patients: patients who would have died if they had been in places such as Paris where many hospitals did not give the treatment.
Interestingly, the proportion of hospital workers at the IHU who have been shown to have been infected during the epidemic through PCR testing or serological tests is more or less the same as in the general population: 3.5 to 4 percent, even though they were in contact with over 17,000 symptomatic patients during the epidemic (of whom less than a third were effectively coronavirus-positive). The reason for this is not clear – were they given HCQ preventively? It does show that this population that was not confined – on the contrary – was not more prone to infection than those who were.
“There are only sporadic new cases left,” Raoult noted. This is also true at the national level in France, where less than 300 declared cases (for a total of 67 million inhabitants with contamination dating several days back) were registered on May 26. Nevertheless, “social distancing” as well as masks in public transport and churches remain the rule, while at the same time HCQ-azithromycin treatment, which appears to have proved its worth, is officially banned for the few who are still falling ill.
Dr Stephen Smith: HCQ is “an absolute game-changer”
Raoult’s experience is matched by that of a US physician, Dr. Stephen Smith, an infectious disease specialist. He also called the HCQ treatment an “absolute game-changer.” At the beginning of April he told Fox News that he had seen “100 percent success” treating 72 seriously ill COVID-19 patients with HCQ and azithromycin: “I think this is the beginning of the end of the pandemic.”
It was he who briefed Donald Trump about the treatment. By May 20, he was telling WND about his “frustration” at seeing the safety of the treatment being questioned. “There’s just a craziness out there, and I don’t know how to correct it,” Smith said according to WND. “The truth doesn’t matter any more.”
He added: “People have doubled down on the toxicity of a drug that is not toxic. They’ve gone around and told everybody it’s killing people. It’s not.” The FDA, he said, has decades of randomized, double-blind studies on hydroxychloroquine for the treatment of lupus and rheumatoid arthritis.
“Every one of them has higher doses than anyone is giving for COVID therapy,” he said, with some giving more than 1,000 milligrams trials a day. “None of them require EKG monitoring. None of them talk about increased death,” he said. “It’s a canard.”
In Texas, Dr Ivette Lozano is having to fight to have her prescriptions honored
There are more similarities between the French and the American situation, with doctors using HCQ being publicly discredited. One Texas physician, Dr Ivette Lozano, told Fox News on May 16 that she is officially no longer allowed to prescribe hydroxychloroquine to COVID-19 patients since she circulated a video in which she explained her success in treating the disease with the drug. She said a pharmacist told her that the “Pharmacy Board had passed a mandate that that drug could not be dispensed unless it was accompanied by a diagnosis.”
Lozano said this “violates medical secrecy.”
In her compelling interview with Laura Ingraham on Fox News, Lozano described the “spectacular” results she obtained with COVID-19 patients at all stages – mild, moderate and severe – and the “ridiculous” situation where many doctors don’t dare prescribe HCQ for fear of getting in trouble with their board, and now pharmacists refusing to sell the drug. In one day, 15 of Lozano’s patients had to “swarm all over Dallas” to obtain their prescribed treatment.
She also stated that many of her patients who are COVID-19 positive, even with high fever, were refused treatment elsewhere before coming to her clinic.
See Ivette Lozano’s Fox News interview
CLICK ARTICLE LINK FOR THE VIDEO
Also see her video titled “the truth about COVID-19”
CLICK ARTICLE LINK FOR THE VIDEO
HCQ prescriptions sky-rocketed in France – and the army has stockpiled the drug
The actual use or stockpiling of hydroxychloroquine in France is also an interesting point. In some parts of the country, prescriptions have skyrocketed, increasing by as much as 7,000 percent since the pandemic began. Many of the prescriptions were in Marseille, where around 10,000 people were reportedly treated with Plaquénil in the last week of March and according to research, 41,000 people were given the drug between March 16 and April 19. No cases have been reported in the press of patients having died because of HCQ-cardiac related problems.
Proportionately, twice as many people received HCQ in and around Marseille than in the east of France, according to the same study by the National Agency for Drug Security (ANSM). A relatively large proportion of patients who were prescribed HCQ by their family doctors in the whole of France, especially in Paris, were members of the most affluent socio-economic groups.
The French army admitted at the end of April that it had imported chloroquine phosphate from China in sufficient quantities to fabricate injectable doses of hydroxychloroquine for the Armed Forces “just in case.”
“Lancet-gate:” how a medical journal published a dubious paper on HCQ
Will these stocks be destroyed or thrown away in the wake of the recent Lancet article?
For that to happen, the Lancet article, which has been used to justify a general prohibition of hydroxychloroquine for COVID-19 patients in many places, would have to be taken seriously. Prof. Didier Raoult, for one, did not do so from the start. He insisted that as a doctor, he prefers to trust what he himself has observed rather than a study based on “Big Data,” a sort of “delirious fantasy” that does not check with what he saw while treating 4,000 patients after performing 130,000 tests.
Raoult insisted that he witnessed no serious conditions linked with the prescription of HCQ, as The Lancet study suggests exist. It is true that at the IHU in Marseille, patients were monitored closely for ventricular tachycardia and dangerous potassium levels; outpatients were called at least every 48 hours by hospital staff to check their general condition.
The study published by The Lancet on May 22 “compared” an array of different treatments, including HCQ with or without azithromycin, without giving any information on dose levels or length of treatment. Raoult called the study “lousy” on his Twitter account, adding in an interview that it was made by people who never saw a patient, “distorted reality” and refused to take real-life observable experience into account. He said he was ready to show cause of death data at the IHU which prove that no one died of ventricular tachycardia there, whereas The Lancet paper speaks of 8 percent of deaths related to that condition.
The recent decision of The Lancet to publish an “Expression of Concern” vindicates Raoult’s criticism.
Unsourced, “implausible” data
In the Lancet study on HCQ, the data are not sourced – it does not state from which hospitals the patient files were collected – and not verifiable. The study says it has patients from five continents, but all the groups have similar compositions, regarding obesity, smoking, etc. Raoult said it was “strange” to find a similar proportion of obese people in Africa and in North America for example. “I do not believe it. As a doctor, I visited many places and it is not my experience,” he said. Raoult now considers the study, signed by four doctors, as a “pure computer” production.
More and more doubts have been raised about the sincerity of the Lancet paper. Dozens of medical professors, ethicists, researchers and statisticians sent an open letter to the editor of that medical journal, voicing “concerns regarding the statistical analysis and data integrity.”
These include: “inadequate adjustment for known and measured confounders (disease severity, temporal effects, site effects, dose used,” no release of code or data as is normally the rule “in the machine learning and statistics community,” and the absence of an “ethics review.”
The signatories, who hail from all parts of the world and many prestigious institutions, also noted that none of the over 600 hospitals who are said to have contributed their data were identified and requests for identification received no response.
Concern number 5 is particularly revealing: “Data from Australia are not compatible with government reports (too many cases for just five hospitals, more in-hospital deaths than had occurred in the entire country during the study period). Surgisphere (the data company) have since stated this was an error of classification of one hospital from Asia. This indicates the need for further error checking throughout the database.”
Further concerns regard “unlikely” data, such as “unusually small reported variances in baseline variables, interventions and outcomes between continents,” 100 mg higher doses of HCQ – when quoted – than are the norm in the US although 66 percent of data are said to come from North American hospitals and other implausible assertions.
In fact, if The Lancet’s study is sincere, it would mean that it included the data of each and every North American COVID-19 patient hospitalized up to April 14, something American doctor James Todaro finds hard to believe. On his Twitter account, he adds:
“Is there a single continent where the Lancet HCQ study numbers make sense? Now for Africa…Surgisphere claims ~25% of COVID-19 cases and 40% of deaths had sophisticated electronic patient data records that included episodes of ventricular tachycardia/fibrillation. Doubt it.”
Big data and machine learning that contradict reality
When questioned in the French media about the Lancet study, Didier Raoult said that he could not believe its conclusions, which are even less accurate than mere “Big Data” models, because of his personal experience and the reality he sees every day, in a unit where every patient reaction to medication is discussed twice daily by the staff.
On his Twitter account, Raoult added on May 29 that he and his team have “questions” regarding “the existence” of the company that did data collecting for the Lancet study, Surgisphere. “To our knowledge, there have been many denials and not a single testimony of either a partner hospital or doctor confirming that they have provided data for the study.”
A Yale study calls for urgent prescription of HCQ to COVID-19 outpatients
On May 27, a Yale professor of epidemiology, Harvey A. Risch, published a study in the American Journal of Epidemiology concluding that a hydroxychloroquine treatment combined with the antibiotic azithromycin and zinc had significant positive outcomes and that “these medications need to be widely available and promoted immediately for physicians to prescribe.”
Risch noted that with deconfinement policies becoming unavoidable because of public pressure, and new contaminations to be expected, it is important to treat COVID-19 patients before their condition worsens, as the title of his paper makes clear: “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.”
Noting that remdesivir shows “mild effectiveness” in hospital patients but that its effects early on in the coronavirus process have not been studied – and that a number of patients have to be taken off the medication because of side-effects – Risch presented statistics showing that HCQ and associated medication has been used for hundreds of thousands of patients. He quotes a very low mortality rate from cardiac arrythmia associated with the treatment: 9 out of 100,000, to be compared with the many lives saved and hospitalizations avoided by the HCQ-azithromycin treatment.
“The key to returning society toward normal functioning and to preventing huge loss of life, especially among older individuals, people with comorbidities, African Americans and Hispanics and Latinos, is a safe, effective and proactive outpatient treatment that prevents hospitalization in the first place,” he wrote. He noted that the treatment allowed up to “50-fold” efficacy when compared with standard care, and has been shown to be “effective in preventing hospitalization for the overwhelming majority” of at-risk patients.
Risch’s paper quotes several large studies involving over 1,000 patients, with not a single case of cardiac arrythmia being reported.
These massive data are being brushed aside and physicians’ liberty to prescribe medicine as they deem fit are being trampled upon by the powers-that-be.
Suppressed evidence in the “British Medical Journal”?
One example of intriguing suppression of evidence favorable to HCQ was quoted by Prof Raoult on May 26. He noted that a recent article by Chinese researcher Tang et al in The British Medical Journalwas edited before definitive publication:
“Tang et al, BMJ: why were some data in favor of hydroxychloroquine, presented in the preprint version, deleted in the published paper? BMJ editorial board requests?”
The removed text noted “more rapid alleviation of clinical symptoms with SOC plus HCQ than with SOC alone.” (“SOC” means “standard of care.”) The paper is presented in the BMJ as showing that HCQ does not have better outcomes and leads to more “adverse events.”
Lung damage in asymptomatic patients
It should also be noted that Raoult’s most recent published research on PCR testing of 65,992 individuals found lung lesions in 581 of the 933 patients with minimal clinical symptoms who were given low-dose computed tomography (CT) scans. “A discrepancy between spontaneous dyspnea, hypoxemia and lung lesions was observed,” he tweeted in a summary of his findings.
In plain language, this means that people who feel quite well, with no apparent respiratory problems, can in fact have damage to their lungs and may have sequelae that should be monitored. This finding also would justify treating asymptomatic patients testing positive to the coronavirus very early on.
The recent prohibition based on The Lancet paper will not change much in France, said Raoult, because individually, doctors still have their liberty to prescribe; plus the cases of COVID-19 are becoming more and more infrequent.
The World Health Organization also based its previous decision to stop clinical testing with the molecule on the study of The Lancet. But many countries, such as Brazil, have decided to use it massively all the same.
COVID-19: a death toll with a political aim?
All in all, COVID-19 – as it has developed, climaxed and already reduced in many countries – will probably cause fewer deaths than other respiratory infections that claim over 4.25 million lives worldwide every year. On May 27, the world total of COVID-19 related deaths reached 351,000, though there are many questions still open regarding co-morbidity and the principal cause of decease.
Will the death toll of the pandemic be considered high enough to justify a future lockdown? The powers that be have made clear that they expect “second waves” (Raoult does not; it is also he who successfully predicted that the end of lockdown in France on May 11 would not lead to a new surge of infections) and that they have already prepared an emergency reconfinement plan. But the general population might reject this new “epidemic of fear.”