Abstract
We evaluated the age-specific mortality of unselected adult outpatients infected with SARS-CoV-2 treated early in a dedicated COVID-19 day hospital and we assessed whether the use of hydroxychloroquine (HCQ) + azithromycin (AZ) was associated with improved survival in this cohort. A retrospective monocentric cohort study was conducted in the day hospital of our center from March to December 2020 in adults with PCR-proven infection who were treated as outpatients with a standardized protocol. The primary endpoint was 6-week mortality, and secondary endpoints were transfer to the intensive care unit and hospitalization rate. Among 10,429 patients (median age, 45 [IQR 32-57] years; 5597 [53.7%] women), 16 died (0.15%). The infection fatality rate was 0.06% among the 8315 patients treated with HCQ+AZ. No deaths occurred among the 8414 patients younger than 60 years. Older age and male sex were associated with a higher risk of death, ICU transfer, and hospitalization. Treatment with HCQ+AZ (0.17 [0.06-0.48]) was associated with a lower risk of death, independently of age, sex and epidemic period. Meta-analysis evidenced consistency with 4 previous outpatient studies (32,124 patients-Odds ratio 0.31 [0.20-0.47], I2 = 0%). Early ambulatory treatment of COVID-19 with HCQ+AZ as a standard of care is associated with very low mortality, and HCQ+AZ improve COVID-19 survival compared to other regimens.
Highlights
The SARS-CoV-2 pandemic infected 200 million people and killed 4.2 million people by August 4, 2021, corresponding to an overall infection fatality rate (IFR) of 2% [1]
Compared to previous retrospective cohort studies of our center [15], this study focused on outpatients with ambulatory treatment, namely, patients who presented with non-severe COVID-19 who returned home and were not immediately hospitalized in a conventional ward
[5, 6, 25,26,27,28,29,30]), treatment with HCQ was not associated with serious cardiac side effects but was associated with a significant IFR decrease of 75%
Summary
The SARS-CoV-2 pandemic infected 200 million people and killed 4.2 million people by August 4, 2021, corresponding to an overall infection fatality rate (IFR) of 2% [1]. Health agencies in Western countries have focused on contagion control measures (lockdown), late-stage hospitalized patients, intensive care units, and vaccination, but for reasons that are yet to be clarified, early treatment has not been emphasized [2,3,4]. In eastern countries such as China, India, Iran, and Saudi Arabia, where early treatment and prevention with repurposed antivirals, hydroxychloroquine (HCQ), has been widely implemented [5,6,7,8], lower IFRs than Western countries, where early treatment with orally available molecules has been overlooked or even discouraged, have been reported [1]. HCQ has several anti-inflammatory and antithrombotic properties [14], which is of particular interest in the context of COVID-19associated inflammation and coagulopathy
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