As a primary care physician, I always want to treat my patients in the most cost effective manner while providing the best treatment outcomes. Like most physicians early in the pandemic, I was excited about a cheap, oral drug for the treatment of mild to severe COVID-19 with hydroxychloroquine/+or- Azithromycin/zinc. However, despite promising in vitro studies and small testimonial success, after 1,800 clinical studies (from treating mild to moderate to severe COVID-19, or prophylaxis in contacts), the outcomes have been either no better than standard care or placebo or even harmful. As an ex-chemist, I can tell you that what looks promising in test tubes or petri dishes, don’t necessarily translate to clinical efficacy in complex biological systems such as human bodies. The early promise of hydroxychloroquine has met this same fate. The cheap, oral dexamethasone showed great mortality benefits in very ill, hospitalized patients but may harm early COVID-19 infection by depressing our immune response and may have harmed hospitalized COVID-19 patients not on oxygen. In the meantime, colchicine, also a cheap oral drug, in a huge double blinded, randomly controlled clinical trial (the best type of clinical trial) in almost 5,000 non-hospitalized COVID-19 participants is a clear winner. Colchicine reduced hospitalizations by 25%, the need for mechanical ventilation by 50%, and deaths by 44% in COVID-19 patients. In fact, when President Trump got COVID-19, the wonderful doctors who treated him followed the data and did not use hydroxychloroquine (most likely the monoclonal antibodies by Regeneron which Emory gives my patients who qualify, turned the corner for him). These monoclonal antibodies reduce hospitalization by 72% and risk of contacting COVID by 54%. So why are some physicians still promoting a debunked therapy for outpatient management of COVID-19 as well as inpatient therapy? That is another editorial altogether.
Christy Blanchford, MD