Month: April 2020

The following article complements my previous one concerning the COVID-19 pandemic and chloroquine. I suggest you read it first, as it will give you an idea of what the scientific literature says about the action of chloroquine on COVID-19 as of April 7^th, 2020. However, this article did neither address the question of ethics, nor fully address whether the situation could justify not to follow the usual methodology.

Indeed, this objection is regularly raised: “even though it has not been established that hydroxychloroquine can actually be used as a treatment for COVID-19, ultimately the dosage is well known and there is probably not a great risk in administering it to patients.” Moreover, there is a view which seems to have some popularity, stating that, considering the circumstances, clinicians should not take too much care to comply with methodology, as the emergency dictates to be less rigorous with procedures. These two issues are related. To address them, one must both look at the collective experience and assess what is not known.

A PDF version of this article is available. An audio version (with quite a robotic voice) is also available.

A worrying suspicion

On March 25^th, 2020, a study presenting the case of 416 patients with COVID-19 was published¹Shaobo Shi, Mu Qin, Bo Shen, Yuli Cain, Tao Liu, Fan Yang, Wei Gong, Xu Liu, Jinjun Liang, Qinyan Zhao, He Huang, Bo Yang, and Congxin Huang, 2020. ‘Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China’, JAMA Cardiology. Doi: 10.1001/jamacardio.2020.0950. Among these patients, 19.7 % had cardiac problems. It is not surprising that patients in respiratory distress, one of the complications of COVID-19, have heart problems. However, the study reports a suspicion that these cardiac problems are not a consequence of this respiratory distress, but directly due to the action of the virus. Another compilation of COVID-19 case analysis also supports this suspicion²Elissa Driggin, Mahesh V. Madhavan, Behnood Bikdeli, Taylor Chuich, Justin Laracy, Giuseppe Bondi-Zoccai, Tyler S. Brown, Caroline Der Nigoghossian, David A. Zidar, Jennifer Haythe, Daniel Brodie, Joshua A. Beckman, Ajay J. Kirtane, Gregg W. Stone, Harlan M. Krumholz and Sahil A. Parikh, 2020. ‘Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic’, Journal of th American College of Cardiology. Doi: 10.1016/j.jacc.2020.03.031.

Continue reading Chloroquine and ethics

This article is written under rather peculiar circumstances, in fact quite dramatic ones to say the least: after a first case declared on November 17^th, 2019¹Josephine Ma, March 13^th, 2020. ‘Coronavirus: China’s first confirmed Covid-19 case traced back to November 17’, South China Morning Post. Available on-line., a COVID-19 pandemic²World Health Organization (WHO), March 11^th, 2020. WHO Director-General’s opening remarks at the media briefing on COVID-19, WHO. Available on-line. has spread throughout the world. Among several consequences, this pandemic caused the confinement of the French population from March 17^th, 2020 at noon. I wrote the following article in France during this confinement. Actually, the seriousness of the pandemic led a group of scientific mediators do launch a coordinate prevention message on March 14^th, 2020 at 6 p.m. I associated myself to this message.

Prior to confinement, on February 25^th, 2020, the IHU Méditerranée-infection released a video stating that a molecule derived from quinine, being chloroquine, is an effective treatment against COVID-19:

This was the starting point for a major media coverage of chloroquine and another derivative from quinine, being hydroxychloroquine. Since this media coverage is extremely problematic, I would like to try to give you some clearer insights. The first goal of this article will be to give you some reliable sources, as quite a lot of uninteresting opinions were given, and too few facts. Yet the facts are there. This article will therefore not contain any opinion.

Continue reading On Chloroquine