Abstract
No vaccine against infection by SARS-CoV-2 yet exists. Treatment by hydroxychloroquine (HCQ) medication, among others, has been proposed. However, prophylactic HCQ medication has been little evaluated. We propose to use data from patients with rheumatic diseases (RA, SLR) who have been chronically taking HCQ medication since before the COVID-19 outbreak (hereafter: HCQpa), in order to evaluate the potential of HCQ for preventing infection with SARS-CoV-2. This can be achieved with relative ease by considering whether COVID-19 prevalence is significantly lower in HCQpa than in the general population (i.e., all people that are not HCQpa). Even if COVID-19 prevalence is truly significantly lower in HCQpa, some HCQpa may still present with COVID-19 (lower prevalence does not mean a prevalence of zero). However, given a value for COVID-19 prevalence in the general population and a number of available HCQpa, one may compute the maximum number of HCQpa for that total number of HCQpa considered that can have COVID-19 in order to still be able to conclude a lower COVID-19 prevalence in HCQpa (i.e., if there is one more case of COVID-19 than that maximum number, the COVID-19 prevalence in the HCQpa cannot be said to be lower than in the general population). Because the COVID-19 prevalence in the general population is not known with precision, we will consider different general population prevalence values. Among these contemplated prevalence values, one is derived from the official total number of confirmed cases, others by computing the total number of cases from the number of fatal COVID-19 cases so far and considering different case fatality rates per total cases. Our analyses show that systematic testing for COVID-19 in as few as 5,000 HCQpa is all that is needed for a test of whether HCQ has a prophylactic action against COVID-19, even for a COVID-19 prevalence value as low as 250 per 100,000, provided that test sensitivity is at least equal to its specificity. For higher COVID-19 prevalence values, the number of HCQpa needed is even lower.
Highlights
We all know that “we do not have antivirals, vaccines, antibodybased therapeutics, or specific treatments” [1] with which to avoid infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to treat against coronavirus disease 2019 (COVID-19)
We have established that there is a considerable number of people who are in this situation, as HCQ is used chronically in the treatment of SLE and RA
For a country such as France, supposing a conservative prevalence sum for SLE and RA of 0.6% yields about 400,000 SLE and RA patients, so it is reasonable to suppose that some tens of thousands among them have been chronically taking HCQ medication since before the outbreak of SARS-CoV2
Summary
We all know that “we do not have antivirals, vaccines, antibodybased therapeutics, or specific treatments” [1] with which to avoid infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to treat against coronavirus disease 2019 (COVID-19). Given the global situation and the ongoing debate over whether HCQ medication is effective as a prophylactic means against SARS-CoV-2 and/or as a cure for COVID-19, we deemed worth exploring the feasibility of testing such a hypothesis. Is there a large enough number of identifiable people who have been chronically taking HCQ medication since before the outbreak of SARS-CoV-2 as a treatment for other diseases? Is the number of those people large enough to allow for sound statistical inference? A considerable number of people have been chronically taking HCQ medication as a treatment for other diseases since before the outbreak of SARS-CoV-2. One could derive crucial information on the prophylactic effect of HCQ against infection with SARS-CoV-2 by analyzing data from patients chronically treated with HCQ since before the COVID-19 outbreak (hereafter: HCQpa). The total number of HCQpa in a country with a population of millions constitutes a large, statistically interesting sample
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