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Sunday, 7 June 2020

The Hydroxychloroquine Enigma

By David Macailwain
Hydroxychloroquine 24bf0
For most people, the outbreak of a new severe respiratory disease in China did not ring alarm bells – at least not ones commensurate with the global catastrophe we are now facing. Unlike those specialists who deal with epidemic diseases, or companies and institutes who study them and research drugs and vaccines, we were not familiar with the intricacies of infection and transmission, antibodies and immunity, nor the contingency plans governments had to deal with such outbreaks.
Being a new strain of Coronavirus not previously “tested” on human populations, even those at the Wuhan Institute of Virology who were familiar with these sorts of viruses had much to learn from observing the details of peoples’ symptoms, susceptibility and infectivity, and these early observations were invaluable in guiding other countries’ responses, or should have been.
They were also helpful in enabling us to make judgements on the risk posed by the new disease when it reached our shores – as it inevitably would. Perhaps the simplest and most important feature of this respiratory infection was that it was rarely fatal amongst healthy people under 70, with the majority of deaths – from acute pneumonia – amongst the “old and sick”. It was observed that this age-profile of the virus was very similar to the normal age profile of deaths in the community.
Along with these simple epidemiological observations, there was a focus on treatments that might ameliorate or even cure the infection, and early trials of likely drugs that had been found useful in treating related viral diseases. Several such trials were conducted in China in January and identified a few promising candidates, including Remdesevir and Chloroquine.
When the disease spread to Italy and then to France in February, the world’s most renowned expert on communicable diseases – Professor Didier Raoult – followed up on the Chinese studies with one of his own at his institute in Marseilles. In his career working with various exotic diseases like Ebola in Africa, he already had significant experience with the Malaria drug Hydroxychloroquine, which had been demonstrated effective against Dengue and other dangerous virus diseases.
Raoult’s first study, which trialled Hydroxychloroquine (HCQ) with and without the antibiotic Azithromycin found that:
Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.
Prof Raoult considered the results sufficiently significant to publish immediately, and advocated for the use of HCQ in new cases of COVID-19 infection – an important point, as it is the effect of HCQ on reducing viral load in the early stages of infection which is most vital. As has been demonstrated by the studies of the drug’s use in hospitalised patients, its use once the infection reaches the lungs may even be dangerous.
From the time when I became aware of Didier Raoult’s research, following a revealing article from Pepe Escobar about the inside workings of the French Health Ministry, I have struggled to understand why there appears to be such a determined campaign against both Prof Raoult and against the use of HCQ to treat CV19 patients. It has been repeatedly noted that the drug has been used for sixty years by millions of people and has few and rare side effects which are well known, while evidence continues to mount for its efficacy against the SARS-CoV-2 virus.
“What’s not to like?” – as they say, and as Donald Trump famously declared back in April. Notably he has now put his money (not much as HCQ is very cheap) where his ample mouth is by taking HCQ as a prophylactic following a case of CV19 in the White House. Contrary to the way it has been portrayed in the media, Trump was hardly alone in advocating for HCQ and making it available.
President Macron visited Prof Raoult’s institute in early April at the same time as French pharmaceutical giant Sanofi made a commitment to supply free millions of doses of the drug globally, despite its apparently conflicting interests in vaccine development and production. Macron’s poorly publicised and ambiguous support for Raoult has recently become rather confusing – but more on that later.
Further reinforcing scepticism about the drug is support and advocacy for Hydroxychloroquine from other notable identities – President Bolsonaro of Brazil and Australian mining magnate Clive Palmer, but saner voices have also spoken out. This contribution from a US senator Ron Johnson, which followed after FDA restrictions on HCQ is worth quoting:
Restricting use to hospitalized patients means loss of the critical early window of opportunity to: (1) prevent the virus attaching to host cells, (2) reduce viral replication that prolongs time of infectivity and spread, (3) reduce the number of hospitalizations and need for intubation and mechanical ventilators, and (4) reduce risk of multi-organ damage and death or permanent lung impairment after recovery.
Echoing Trump’s position on the urgent need to act he added that:
We can’t wait months for a completed RCT (randomised controlled trial) or a vaccine. People are dying every day. Staggering numbers of people have lost jobs, incomes, and ability to live life normally, all of which lead to loss of life that could quickly exceed losses from the virus.
Senator Johnson said this on April 10th. What has happened since is hard to ascertain and hard to comprehend, with two different narratives and realities operating in parallel. In the Western media bubble, which envelopes its citizens in an impermeable and invisible shield, scientific and health advisors endlessly repeat the mantra that HCQ is a dangerous drug that can cause heart attacks, citing trials that show it has no benefit in treating COVID-19 patients in hospitals. Their message is that we must wait for a vaccine, maintaining restrictive social habits to reduce any chance of catching the infection. That the novel Coronavirus actually causes only a minor infection – or even an unnoticed one – in the vast majority of people, is never stressed or even noted.
In the parallel world –which with the poor majority world apparently includes many Western countries below the radar, HCQ or Chloroquine is being widely used and with significant effects on controlling the severity of disease and its spread, and reducing the pressure on limited hospital services. This parallel world exists alongside its first-world partner in countries like India and Nigeria, where the poor majority cannot afford to “stay at home”, amusing themselves in Zoom meetings with fellow shack-dwellers and ordering in scavenged take-aways their ex-employers have discarded.
The suggestion, implicit in WHO advice and that of Western government scientists, that they should just “hold on” until a vaccine arrives – in six or twelve months, must be regarded with the utmost disbelief and disdain. They have no choice but to continue their lives regardless, putting the risk of falling sick with CV19 alongside mostly far greater threats from disease and disaster. It has already been noticed that the death toll in poorer countries – in Africa particularly – is far lower than in rich ones, likely due in large part to the low average age of populations.
For them there is the prospect that the new disease will spread through the population and bring “herd immunity” without taking many lives. For those of us who are now trapped in a dystopian nightmare world we never chose, at the beck and call of pharmaceutical and security companies linked to governments, this is an enviable prospect.
Three months ago it seemed like an unlikely conspiracy theory – that we could be manipulated into a prison from which the only escape would be vaccination and electronic surveillance. But it is rapidly becoming clear not just that this has happened but that it was the plan, and that a carefully orchestrated series of actions has achieved the desired goal. Piers Robinson has researched the network of groups and individuals who have provided advice to the UK government’s SAGE committee on how to keep citizens in line. Noteworthy are the recommendations from the “SPI-B” group on behavioural techniques. They identify:
“options for increasing adherence to social distancing measures,” which include persuasion, incentivisation and coercion. In the section on persuasion it states that “the perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging.” The document also mentions “using media to increase sense of personal threat.”
The involvement of key figures from Government intelligence agencies and covert disinformation warfare groups like the IfS and Brigade 77 must ring alarm bells to anyone concerned to know whose interests are being favoured by these unprecedented and draconian restrictions on civil liberties.
Given the oddly similar approaches to the Coronavirus threat followed by so many countries, and despite their vastly different circumstances, it appears that the UK model of media-mediated control is being followed elsewhere. Indeed the evidence for such covert activity is considerable here in Australia, based merely on this similarity, because the actual threat from CV19 – which has never been great – is now almost negligible.
So effective has the “hard-hitting emotional messaging” been that many Australians are now so afraid of catching and dying from COVID-19 that they are content to endure huge restrictions on their freedoms and activities until a vaccine arrives sometime next year. Trying to persuade them there is no danger of catching it now, or that there was no real danger from catching it, is nye impossible.
But this has now become the crux of the matter. And it is hard to avoid the conclusion that those in power are determined to destroy anything that stands in the way of their plans for global vaccination, surveillance and control, and the huge fortunes to be made by their favoured commercial partners and investors.
How else to explain this? – that the WHO just cancelled support for research around the world into Hydroxychloroquine on the basis of a completely fabricated “research study” published in the Lancet on May 22nd. That the Guardian now claims that they exposed the flaws in the research, with the WHO cancelling its ban, only adds further suspicion to the affair – the research was already exposed as scientifically and ethically impossible, while the group “Surgisphere” which supposedly collected data from 96,000 patients at 671 hospitals in 6 countries has NO verifiable credentials.
The cancellation and rescinding of WHO’s support for research into HCQ is, like the trials it sponsored, a complete sham. Not only is HCQ, with or without Azithromycin, already well proven to be useful or even critical in controlling the severity of the disease and its spread, but the trials now being set up in the UK and Australia and around the world are designed to fail. This “poor design” is so obvious in the Australian trial that it is simply astonishing that it was approved, if the intent was to test HCQ’s efficacy as stated:
“COVID SHIELD is gold standard in its design as a multi-centre, randomised, double-blind study,” said Professor Pellegrini (of the Walter and Eliza Hall Institute).
This may be true, as the trial will be on 2000 volunteer health care workers, half of whom will take Hydroxychloroquine and half a placebo – without knowing which, and for four months, the object being to see if the drug has a protective effect against SARS-CoV-2 infection.
But because there are only a few cases of active CV19 infection in hospital, and few more likely, most of the volunteers are unlikely to be exposed to the virus. Not only that – because the trial is double blind, all volunteers will be obliged to behave as if they have no protection and so must wear standard protective equipment for the four month period.
At the end of the “trial”, when half of these volunteers will have taken “the possibly dangerous” HCQ every day for four months for no reason, the Institute will be able to declare that there was no difference between HCQ and a placebo, though the result will not be statistically significant because of the low number of infections. (zero presumably)  Then like the Emperor’s new clothes, the “results” will be paraded around as the last word on this controversial drug.
In the meantime we might consider the recent advice of Harvey Risch in the American Journal of Epidemiology that the drug should be used immediately, in combination with Azithromycin, on Outpatients. Or the last word from Professor Raoult, spoken over two months ago following French restrictions on HCQ use to seriously ill patients in hospital:
“When damage to the lungs is too important, and patients arrive for reanimation, they practically do not harbor viruses in their bodies any more. It’s too late to treat them with chloroquine. Are these the only cases – the very serious cases – that will be treated with chloroquine under the new directive by [French Health Minister] Veran?” If so, he added ironically, “then they will be able to say with scientific certainty that chloroquine does not work.”
Afterword:
Professor Raoult has just approached French TV network BFM to record this long and rather fractious interview with two women challenging his research and opinions. For those with reasonable French understanding it is quite fascinating in the insight into the politics of health and research in France.

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