RECOVERY was a prospective, randomized control trial. Hence, many people consider it to be a proper test and believe its results to be compelling. But maybe, just maybe, most people aren’t reading it correctly.
The RECOVERY trial tested several treatments, among which was hydroxychloroquine (HCQ). In RECOVERY, hospitalized patients were treated with HCQ. No benefit was found against mortality. But this is unsurprising, given the facts.
RECOVERY provided late treatment
The median time that treatment began was nine days after symptom onset, which we see in Table 1. This means that over half of the trial subjects began treatment after day 9. HCQ is an antiviral and antivirals must be given soon after symptom onset begins. Preferably within 72 hours. In most cases, the body will clear the virus by the eighth day after symptom onset:
“It was observed that SARS-CoV-2 was detected up to 20 days after onset of symptoms by PCR in infected patients but that the virus could not be isolated after day 8 in spite of ongoing high viral loads of approximately 105 RNA copies/mL of sample, using the RT-PCR system used in the present study” (The viral isolation was by using cell culture.) The failure to isolate the virus from people showed that the bodies had cleared the virus.
Since the body will clear the virus by the eighth day, then what sense does it makes to give HCQ after the virus has been cleared? Rather, it makes sense to give HCQ much earlier–before the body has overcome the virus, which, in healthy people, occurs about 72 hours after symptom onset. So, HCQ, for best results, must be given within the first 72 hours after symptom onset. And RECOVERY failed to do that, which means that RECOVERY wasn’t a test of early treatment. More on this later.
HCQ antiviral properties
Hydroxychloroquine has antiviral properties. It will at least “lock up” viruses in endosomes. Should those viruses somehow escape endosomes, then zinc will prevent viral replication, because HCQ will transport zinc into endosomes. If viruses can escape endosomes, then so will zinc.
RECOVERY had problems with poisoning and Study Design
The dose given in the RECOVERY trial was 2 grams of HCQ over the first 24 hours, which we see on page 22 in the supplemental appendix. “Severe symptoms can occur with doses as small as 1.5 g with onset one to three hours post-ingestion.” Patient weight factors into toxicity. So, women are likely more susceptible to poisoning than men, because they tend to weigh less. And people who are poisoned tend to discontinue taking the poison. So protocol compliance is in question. So the question of adequate study design becomes an issue. Does it make sense to design a study which will give people toxic levels of a medication which will produce severe symptoms that will cause people to stop taking the medication?
RECOVERY admitted that its results don’t apply to outpatient treatment
“These findings indicate that hydroxychloroquine is not an effective treatment for hospitalized patients with Covid-19 but do not address its use as prophylaxis or in patients with less severe SARS-CoV-2 infection managed in the community.” “Community care” is how outpatient treatment is designated in the UK, where the RECOVERY trial was held. So the NEJM article was pretty clear that its results don’t apply to outpatient treatment? So why did so many medical professionals assume that RECOVERY applied to outpatient treatment?
Medical professionals were misled about the RECOVERY trial results
“Multiple studies have provided data demonstrating that hydroxychloroquine is ineffective in the treatment of SARS-CoV-2, the virus that causes COVID-19 disease.
The RECOVERY Trial from the University of Oxford is a large, randomized, controlled, open-label study evaluating a number of potential treatments for patients hospitalized with COVID-19. The study is being conducted by researchers at the University of Oxford in the UK (the hydroxychloroquine arm is now halted).”
UKRI:
“In June 2020, the RECOVERY trial concluded that hydroxychloroquine had no beneficial effect in patients hospitalised with COVID-19, and stopped enrolling participants to that arm of the trial immediately.
Hydroxychloroquine and chloroquine had received a lot of media attention in early 2020 and was used widely to treat COVID patients, despite the absence of any good evidence.
The RECOVERY trial team issued its preliminary findings due to their important implications for patient care and public health.
The trial team said it was “disappointing” that the treatment was ineffective,”
Martin Landray, one of the RECOVERY investigators:
“This is not a treatment for COVID-19. It doesn’t work.” There is no qualification in this quote, despite the limitation published in the NEJM article. There is no caution and no suggestion that HCQ might be tried in outpatients. Very irresponsible and possibly criminal.
Peter Horby, the chief investigator for the trial:
“The RECOVERY Trial has shown that hydroxychloroquine is not an effective treatment in patients hospitalised with COVID-19. Although it is disappointing that this treatment has been shown to be ineffective, it does allow us to focus care and research on more promising drugs.” There is no question that this is a blanket declaration that HCQ doesn’t work, even in outpatient treatment. This definitely looks criminal. No caution at all that HCQ might help outpatients. A total lack of good faith.
Is it any surprise that the rest of the medical world blindly accepted the statements of people on the RECOVERY team? Is it any surprise that the rest of the medical world didn’t look carefully at RECOVERY’s results and interpret them accurately? After all data about dosing was hidden in the supplemental appendix. Does the medical world perhaps deserve being called “a bunch of sheep?”
Navigating the Covid Confusion 