 So, there's been a lot of buzz on the news and social media about a potential effective treatment against SARS-CoV-2 or COVID-19, and that is the combination of hydroxychloroquine and azithromycin, and this came out of a study out of France, a small study, and since the publication it was tweeted out by President Trump. It was publicized largely by the media and other big accounts, and it was touted as a potential game changer, and there was demands that the FDA immediately approve this therapy. However, the scientific community was sort of like, let's pump the brakes on this and let's take a closer look at this before we make these sweeping recommendations. The hot topic lately seems to be whether this medicine chloroquine or hydroxychloroquine, which are both related, has any action against this virus, and then this study came out touting azithromycin may have a big effect. So let's kind of dive into that. First of all, what exactly is chloroquine and hydroxychloroquine? Chloroquine is an old malaria drug, which we sort of use these days for malaria prophylaxis rather than treatment, and hydroxychloroquine is a very similar agent that is also used in the malaria world, but also for diseases such as slupis and other autoimmune diseases, and it's manufactured in the brand name of Plaquenil. Now there have been some in vitro studies out of China and other labs that showed that chloroquine and hydroxychloroquine do seem to have some activity against the SARS-CoV-2 virus. And in the laboratory setting, now remember, things that happen in the laboratory don't always translate to what's going on in vivo or in the actual human body. So we need more clinical data to support this. There has been some data outside of China that showed that there is clinical benefit using chloroquine and hydroxychloroquine in patients with SARS-CoV-2. Now this data is not published, so I wasn't even able to access that, but it was presented and based on that, several other studies have spun off. Now how exactly would a drug like chloroquine or hydroxychloroquine actually have an antiviral effect? Now there's no direct effect on the virus. The way it works is when a virus takes over a host cell and it travels within the host cell to do its replication, it needs to have a very low pH. It likes to have acidic conditions. This medicine, hydroxychloroquine, actually raises the pH within the cell, which the virus does not like, which stops the replication and essentially allows our immune system to clear the virus, so that's how we think this works. So let's take a look at the study out of France, it's getting all this buzz. So what the study did was it took 36 patients, they divided them into three different groups, some of them got hydroxychloroquine, some of them got hydroxychloroquine and azithromycin, and the third group was a control group. And they compared these groups and they did nasopharyngeal swabs on them almost every day to try to see which group would clear the virus faster. So again, we're relying on clearance of the virus based on nasal swabs, okay? So let's have a look at the results. This is the figure showing the primary outcomes. On the y-axis is the percentage of patients that are PCR positive for the virus, and on the x-axis is the day. The black represents the 16 patients who were controls who did not get the drug. The blue is the 14 patients who got hydroxychloroquine, and the red is the six patients who got the hydroxychloroquine plus azithromycin. Well, you can see there's a clear difference in the number of patients who had positive virus between the control group and the hydroxychloroquine group. And even more dramatic of an effect in the six patients who got hydroxychloroquine and azithromycin. So again, looks pretty and looks encouraging, right? Now, couple of things, number one, super small study, right? Only 36 patients were in the study. Secondly, this is not randomized. So they took a cohort of patients who they gave the drugs to, and they compared it to a separate cohort of patients who did not get the drug, all right? So again, this reduces the sort of scientific robustness of the results. Finally, there were a handful of patients in the treatment group who got the hydroxychloroquine who were not analyzed in the final results. In fact, there were five patients that sort of dropped out. There were three of them who ended up in the ICU. One of them who ended up dying and one of them who ended up withdrawing. So that is a concern to me that we did not actually analyze the really sick patients in that group. Finally, the number of patients who actually got the combination of hydroxychloroquine and azithromycin was only six. So only six patients actually got that combination. So again, to summarize, we're sort of making these claims that there's going to be this big clinical benefit of hydroxychloroquine and azithromycin based on a small non-randomized study that looked at viral clearance and not clinical outcomes and five of the patients who ended up dropping out and only six patients who actually got both hydroxychloroquine and azithromycin. So again, before we make these sweeping claims that this is a game changer, we have to be cautious. Remain optimistic that there is some merit that this is proving proof of concept that the drug may work. But we definitely need more trials to prove this. Now, luckily, there are more trials going on right now across the nation and the world to examine the efficacy of hydroxychloroquine and other promising drugs such as one drug Remdesivir, which is from Gilead. And this was developed to treat the Ebola virus. So there's a lot of hope that this is going to pan out to be efficacious. But until we get a little bit more data, I think we have to really temper our expectations and stay objective and let's not forget about the science. Now what's happening is because of all this buzz based on this small trial, pharmacies have been cleaned out across the nation of hydroxychloroquine, right? And patients who actually need that drug for FDA-approved reasons, such as lupus, are not able to get it. So we gotta be careful here and let's not jump the gun. Now personally, I do think hydroxychloroquine is gonna have a role. It has clear efficacy in vitro. There seems to be data in clinical setting that it's doing something for us, what that is in the end remains to be seen. Whether it simply reduces the duration of the infection. Maybe it's gonna end up being sort of prophylaxis for healthcare professionals and high-risk individuals. Or maybe for a lucky, it can actually reduce the likelihood of someone getting into the ICU or even somebody dying. But again, we just don't know yet. I do remain hopeful, but for now, let's not get too crazy over a trial and make game-changing claims for therapy against this virus based on six patients. But I think we should stop here. Let's go. Let's go. We're in the middle of a pandemic. I'm not sure what's going on.