RESEARCH BRIEFING

Failure to launch: New York data on hydroxychloroquine use shows no benefit

Medical advice should be given by physicians, not celebrities. In March, Elon Musk initiated an internet rumor that chloroquine and hydroxychloroquine (HCQ) were likely to be effective treatments against SARS-CoV-2, the virus that causes covid-19. Several days later, President Trump tweeted similar sentiments. Approximately one week after Musk's tweet, the first related poisoning in a patient was reported. Many studies have since assessed whether these drugs play a role in improving covid-19 outcomes. To date, the body of evidence suggests that these drugs have either no effect or are harmful on balance. Today, a large new study released today in the New England Journal of Medicine adds to our understanding that these medications appear to have no substantial impact on improving outcomes for patients with this disease. In the observational study in a major New York City hospital, patients who were hospitalized were given HCQ if the patients had oxygen levels of 93% or lower at the time of admission, if the treating doctor deemed it appropriate. Of the 1376 patients who met eligibility, 59 percent received HCQ. The primary goal of the study was to determine whether patients who received HCQ had better odds of avoiding death or mechanical ventilation (intubation). The authors also looked at how long it took for these events to occur in order to determine whether HCQ prolonged life or helped patients stay off of mechanical ventilators for longer than those who did not. Almost half of the patients who received HCQ did so within the first 24 hours of hospitalization and 86 percent by 48 hours. There was no observed difference between patients who did or did not receive HCQ. Of note, the protocol initially advised co-prescribing azithromycin, but that suggestion was removed during the study. The results indicate that 32 percent of patients who received HCQ died versus only 15 percent in those who did not. However, once correcting for the observation that the patients who received HCQ were somewhat more ill at the start of the study than those who did not, the numbers indicate that there was no difference in patients who received HCQ and those that did not. This indicates that HCQ likely confers no benefit. While this study did not assess the cardiac complications that HCQ is known to cause in some patients, the authors note that some other studies have been halted over such safety concerns. These data are compelling, but more definitive answers will come from randomized controlled trials, currently underway. However, HCQ is now in shortage across the United States, making it difficult for patients in whom the drug has been shown to have benefit—including lupus and rheumatoid arthritis—to obtain their usual medications. This highlights the unintended dangers that can emerge when highly influential public figures opine on medical therapies without a proven benefit for covid-19 prematurely.


POLICY BRIEFING

Remdesivir: So now what?

Last week, the Food and Drug Administration (FDA) granted remdesivir emergency use authorization for severely ill hospitalized patients with covid-19 after Anthony Fauci announced that data from a study conducted by the National Institutes of Health preliminarily showed that the medication could shorten the duration of hospitalization for these patients. In an unprecedented move, the United States government will be allocating the drug to authorized distributors and federal agencies, taking allocation decisions out of the hands of the drug's maker, Gilead. While Gilead has not yet announced the price for the medication, it has pledged to donate an initial 1.5 million doses, enough to treat 150,000-300,000 patients, with plans to produce enough medication to treat 1 million people by the end of 2020. Politico.

Allies turn aggressors in war against coronavirus

Concerns are rising throughout the world that the Trump administration's "America First" mentality will hamper efforts to curb the global coronavirus pandemic. The United States has skipped two global gatherings to discuss SARS-CoV-2 vaccine development hosted by the World Health Organization and the European Union, suggesting it has little interest in collaborating with other countries to develop a vaccine and make it widely available. Europeans worry that the announcement that the U.S. government will be responsible for distributing remdesivir means the drug will be limited to the U.S. for now. Fears of a medical arms race have been stoked by reports that the Trump administration pursued exclusive rights to the vaccine development of a German company. Elsewhere, China has also not expressed interest in cooperating with the global effort to develop medication to counter the coronavirus. Politico.

USDA covid-19 food assistance neglects food workers

The USDA Coronavirus Food Assistance Program is providing $16 billion in direct aid to farmers and ranchers while purchasing $3 billion in perishable foods from distributors. The Agriculture Department has also taken steps to purchase food for food bank distribution and to subsidize food bank administrative expenses. Some states have expanded Electronic Benefit Transfer and Supplemental Nutrition Assistance Program benefits (formerly known as the "Food Stamp Program.") (Even so, there has been an alarming rise in American households experiencing food insecurity.) Left out of these relief measures, however, are the workers on whom the supply chain depends. Many have lost jobs—60 percent of jobs lost in March were in food services—while others, like employees of meat packing plants, are considered essential and are working in crowded conditions that have already led to major outbreaks of SARS-CoV-2. At one Tyson Foods plant in Iowa, for example, more than half of the workers have tested positive for the virus. Various.