 What's up everybody? This is Dr. Ali Hader. I am back with another COVID-19 video update And I want to touch again about treatment particularly hydroxychloroquine now I did do a video on hydroxychloroquine and azithromycin when the first study out of France came out and you can Checked out it here if you want a little in-depth look at that and since then there's been some more data That's come out and there's been this ongoing polarization of sides In our country some arguing that this drug should be approved immediately and distributed broadly to all COVID-19 patients and the other side Which is sort of saying look we have some plenumidata, but it's a little too early to make these bold claims We need better data to figure out Where this drug fits in who are the people that actually helps and what are the actual risks in this COVID-19 population, okay? Now first of all Everybody needs to calm down Okay, this is nothing that we should be fighting about because we're all on the same page, right? We all want a treatment for COVID-19 one that works one that can reduce hospitalizations one that can save lives So there's nobody who's not on that page, okay? so regardless of your politics I ask we all put that aside look at things objectively listen to the other people and Figure out where the best way to attack this is Now first let's just answer the question. What's the downside of just saying? Oh, approve the drug for everybody with COVID-19 Even if it may or may not have a benefit. What's the downside even if there's a little glimmer of hope? It could help somebody. Why don't we just give it to everybody first of all is the obvious We don't really know that this drug definitively works. Okay, and I'm going to go over some of the data We have now. Yes. There is some preliminary data sort of low quality data to suggest There is a role for this drug and I believe there's a role for the drug And I would say most of us believe there's a role for the drug and remember we are all using this drug We use this drug doctors who even are saying that they're not convinced that it actually has a role are still using the drug Because we have nothing else Secondly, we don't know exactly the type of patients to use this in is this drug going to be beneficial for COVID-19 patients in the ICU prevent them from dying It doesn't seem to be that case right now. Is it going to be helpful for people who are in the hospital preventing them from going to the ICU? Is it better for people in the community who get the infection and trying to prevent them from getting hospitalized? Or maybe it's best for prophylaxis people who are exposed to the virus like healthcare workers or high risk from the virus like the Elderly and people who are nursing homes. Maybe they should take it before they get the virus, okay? So just because the drug mechanistically works doesn't mean we know exactly how and where it fits in another reason If we give this drug to everybody, we only have a certain supply of the drug right so they're people who actually need this drug for other reasons lupus and rheumatoid arthritis and They will not be able to get the drug already That is happening everywhere that they can't get the drug that they need and they're subsequently going to get hospitalized and issues are going to occur Okay Another reason is the risk of the drug. Okay. Now this drug does have risks In fact, there is a cardiac risk called long QT that can occur from this drug Especially if you use it in conjunction with certain antibiotics like azithromycin and a lot of these patients in the hospital are also on antibiotics That could potentially lead to a lethal cardiac arrhythmia Okay, now in the vast number of rheumatoid arthritis and lupus patients who are taking this drug the incident that is pretty low That does not mean that this drug is going to work the same way and have the same side-effect profile in these patients with COVID-19 because remember they are sicker They have kidney failure issues their livers can have issues They can have cardiac abnormalities and this may increase their risks of having a side-effect from the drug So we don't know that answer yet. So we have to avoid again doing potential harm And finally if we give this drug to everybody then if we don't enroll people in the trials that are going on Not just from hydroxychloroquine, but other promising medications that are being studied like remdesivir and other antiviral agents That could potentially have a role in treating COVID-19 So if no one's gonna be enrolled in that trial and then we're giving this drug to sort of everybody now Down the line we may have realized that you know what we could have saved a lot of people by giving them this drug or Giving hydroxychloroquine focused on a certain population and we missed that opportunity So again, we're not going to have those answers For later on when this surge continues and it's going to continue in many areas and potentially even a second wave of infections Now let's just review the data briefly So that first trial again that I talked about my last video was the French trial where they looked at 36 patients again This is not randomized 20 people got the drug 16 people did not get the drug and what they found was the virus was cleared faster from the nasal cavities All right, so they didn't find if patients got hospitalized less or had less death In fact three patients in the treatment group actually got hospitalized and one of them even died And in the control group none of them So for all we know we could argue that the drug actually made people worse. The point is we don't know, okay? Now since then there was another trial that also looked at viral clearance again It was small 11 patients and they looked at clearance of the virus again from the nasal swab Who got the drug hydroxychloroquine and what they found was actually that getting the drug did not clear the virus Rapidly from the nasal swab so it sort of contradicted some of the data from the French trial now that same group in France also released a Paper that looked at 80 patients again There was no control group they looked at 80 patients and they evaluated their responses when they got hydroxychloroquine plus azithromycin Okay, and they found a low hospitalization rate about three of them ended up being hospitalized and they looked at viral clearance by 7 to 8 days and they found that by day 8 over 90% of them had clearance of the virus But again remember this infection only kills the 1% if not less percent of people who get it Okay, and a small percentage of those people who get the infection will be hospitalized So the majority of the people are going to sort of heal on their own So when we're looking at observational data, it's hard to know what made them better Perfect example is I've gotten a lot of messages about this doctor in New York who's treating hundreds of patients with the combination of hydroxychloroquine, azithromycin and zinc and There's no control group. So he's had 300 plus patients. He's treated with it He's had some good results, but we just don't know is it the drugs that made them better Is it something else or was it their own immune systems, right? So again, it's important to remember that 99% of the people who get this do not die So we can't just base this on anecdotal data Now there's been one randomized trial that has come out out of Wuhan China They looked at 62 patients, all right, 30 half of them got the drug hydroxychloroquine and the other half just got standard care And they actually looked at clinical outcomes. So their clinical outcomes weren't anything hard it was clearance of fever and cough and Symptoms and they did see the people who got the drug had a fever resolution and cough resolution quicker than the people Who did not which sort of supports that the drug is doing something now? Remember these aren't super sick people these aren't people who are in the ICU or on oxygen, etc So what this tells me is again, maybe this drug has a role earlier in the disease So maybe we should be giving it to people who are not so sick yet And are at risk of getting very sick or maybe we should use it in people who are just getting hospitalized and not in the ICU these are the questions we're trying to figure out if you talk to people who've used this drug in ICUs across the US anecdotally, they'll tell you that you know It doesn't seem to really do much and that's because maybe those patients are already too sick so again, this does provide some hope and optimism here, but again, we have to still remain cautious and not Get ahead of ourselves in recommending this completely broadly our multiple studies going on right now The WHO is sponsored a multi-center trial across the world with hydroxychloroquine with hundreds of patients So that's going to definitely give us some more robust answers There's also a trial looking at using hydroxychloroquine as prophylaxis to me that seems to be where the money is because you know Getting to that virus and interrupting it early in the game before it gets overwhelming is probably going to be best bang for a buck So this trial is looking at healthcare professionals who are at high risk for exposure and seeing if there is a Prophylaxis benefit there and if that shows something then we could sort of use this drug and those high-risk patients out there Potentially reducing the risk of hospitalization in them, but again, we don't know So to conclude I will say the following number one. We're all in this together We have to stop fighting. We have to understand that despite what political party you're a part of and what one person's saying That person is saying we have to listen to each other We have to be objective and understand our mission is the same here and that's to help people Okay, secondly the data out there does show there seems to be some role for this medication But we just don't know in which COVID patients it's going to really benefit and we to know the answers We also have to know potential risks, especially in those very sick patients And finally we are using this drug because we have nothing else So we're going to continue to use this drug in the patient populations We feel it's most appropriate for with based on the supplies that we have but you know I really want to see some more definitive answers out there before we get ahead of ourselves So again, that's all for now. Please leave me a comment. Please subscribe to the channel. I'm happy to have a discussion over your thoughts Understand this is trying to be objective here and no one's saying that this drug doesn't work and I'm optimistic It's gonna have a role. I am hopeful that it will and I'm hoping very soon. We're gonna have more concrete data