This May 27 published study on the incredibly effective use of Hydroxychloroquine (HCQ) with zinc and/or azithromycin for treating Wuhan virus infection is the most important development of the coronavirus issue to date. It cannot be overstated how important it is and how many lives WILL BE SAVED if medical societies and governments strongly advocate its proper, doctor-prescribed use.
 
 The many attempts to try to discourage its use, to promote fake or very poorly done studies to give the impression that it is not effective and even dangerous in many cases, and to stop doctors from prescribing this 65-year-old, very safe medication, and to even stop pharmacies from filling doctor’s prescriptions for it has already resulted in hundreds of thousands of unnecessary and mostly preventable deaths. That is, these attempts to falsely discredit this protocol has been killing people and there should be criminal charges made in some cases against those publishing or otherwise widely promoting false information on the efficacy of HCQ for covid infection. It is that serious.
 
Please read this and spread it around.
 

 
May 27 study report by Harvey A Ritsch published in the American Journal of Epidemiology
 
Here is the PDF full version of the study
 
 Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
 
Below, I have selected the most significant items from the study to save readers from having to peruse the entire study. It is a dispassionate, exceptionally common sense, professional review of all the most important real world, as opposed to theoretical, outcomes of the most prominently known usages of Hydroxychloroquine for covid patients and the major criticisms and warnings against using the usual HCQ + Zinc and/or azithromycin protocols to treat covid-infected patients.
 
 Supplements and HCQ to protect against covid infection
 
It does not discuss the use of using HCQ + Zinc as a prophylactic for those who would want to prevent infection if exposed to covid-infected persons. Health care workers, and those living with or frequently visiting one or more infected persons and for persons with pre-existing health conditions are especially in that category. I have been told by both an immunologist and a pulmonary specialist that covid infection is extremely unlikely for anyone on the prophylactic dosage, but also that infection prevention is also highly unlikely for persons who have a healthy diet and/or also take regular supplements of Vitamin C, D and Zinc in order to boost their immune system. I have been assured by the two specialists that the supplements are in fact helpful regardless of articles on the Internet ridiculing that recommendation. There are also studies supporting the use of the supplements. Undoubtedly, it would also be highly appropriate for such persons to be on the HCQ. The prophylactic dosage is a low, once per week and then once per month dose since HCQ has a 22-day half-life. The prophylactic dose is unlikely to cause ANY serious health issues given how low the dosage is and how infrequently it is taken. In all cases, however, the medication should be prescribed by a doctor, especially if the patient has a pre-existing condition that would otherwise make them high-risk for coronavirus infection.
 
 Notable Excerpts from the study
Early outpatient illness is very different than later hospitalized florid disease and the treatments differ.
Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week
These medications need to be widely available and promoted immediately for physicians to prescribe.
The workforce and effort required to carry out contact- tracing on these tens of millions of Americans is not practical. (This is crucial statement – read the full study for the reason for the statement - SJ)
The great majority of infected people are at low risk for progression or will manifest the infection asymptomatically (Isolation, masks, contact tracing and a vaccine are unnecessary for these people - SJ). For the rest, outpatient treatment is required that prevents disease progression and hospitalization
Thus, the key to returning society toward normal functioning and to preventing huge loss of life, especially among older individuals, people with comorbidities, African Americans and Hispanics and Latinos, is a safe, effective and proactive outpatient treatment that prevents hospitalization in the first place. ( We are instead being told that the only way to return to normal is when the public is subjected to a massive, invasive, rights depriving contact tracing program and then EVERYONE being vaccinated. – SJ)
Numerous reviews of HCQ efficacy and adverse events have been and continue to be published. To my knowledge, all of these reviews have omitted the two critical aspects of reasoning about these drugs: use of HCQ combined with AZ or with doxycycline, and use in the outpatient setting. (This admission is astonishing and likely deliberate - SJ)
For example, the Veterans' Administration Medical Centers study (18) examined treated hospitalized patients and was fatally flawed. (This “study” has been referred to in most news media and by health and government leaders as a reason to discourage and even prohibit doctors from prescribing HCQ – SJ)
It appears that the FDA, NIH and cardiology society positions have been based upon theoretical calculations about potential adverse events and from measured physiologic changes rather than from current real-world mortality experience with these medications and that their positions should be revised. In reviewing all available evidence, I will show that HCQ+AZ and HCQ+doxycycline are generally safe for short-term use in the early treatment of most symptomatic high-risk outpatients, where not contraindicated, and that they are effective in preventing hospitalization for the overwhelming majority of such patients. If these combined medications become standard-of-care, they are likely to save an enormous number of lives that would otherwise be lost to this endemic disease.
In this context, we cannot afford the luxury of perfect knowledge and must evaluate, now and on an ongoing basis, the evidence for benefit and risk of these medications (23). Available evidence of efficacy of HCQ+AZ has been repeatedly described in the media as “anecdotal,” but most certainly is not.
This shows that the sooner these medications are used, the better their effectiveness, as would be expected for viral early respiratory disease. The average start date of medication use in this study was day-4 of symptoms. This study has been criticized on various grounds that are not germane to the science, but the most salient criticism is the lack of randomization into the control and treatment groups. This is a valid general scientific criticism, but does not represent epidemiologic experience in this instance.
…the study showed a significant, 7-fold benefit of taking HCQ+AZ over HCQ alone, (Zinc is crucial – SJ)
A second study of the Marseilles group (27) involved 1061 patients tested positive for SARS-CoV-2 and treated with HCQ+AZ for at least 3 days and followed for at least 9 days. The authors state “No cardiac toxicity was observed.” Good clinical outcome and virological cure were seen in 973 patients (92%). Five patients died, and the remainder were in various stages of recovery.
Symptomatic patients presenting to Dr. Zelenko were treated with five days of HCQ+AZ+zinc sulfate if they were considered high-risk, as evidenced by one or more of: age 60 years or older; high-risk comorbidities; body-mass index>30; mild shortness of breath at presentation. Patients were considered to have Covid-19 based on clinical grounds and started treatment as soon as possible following symptom onset, rather than delaying for test results before starting treatment. Of the 1450 patients, 1045 were classified as low-risk and sent home to recuperate without active medications. No deaths or hospitalizations occurred among them. Of the remaining 405 treated with the combined regimen, 6 were ultimately hospitalized and 2 died. No cardiac arrhythmias were noted in these 405 patients.
The fourth relevant study was a controlled non-randomized trial of HCQ+AZ in 636 symptomatic high-risk outpatients in São Paulo, Brazil (29).
Even though the severities of all of the recorded flu-like signs and symptoms and of important comorbidities (diabetes, hypertension, asthma, stroke) were substantially greater in the treated patients than the controls, the need for hospitalization was significantly lower, 1.2% in patients starting treatment before day 7 of symptoms, 3.2% for patients starting treatment after day 7, and 5.4% for controls, P-value<.0001. No cardiac arrhythmias were reported in the 412 treated patients. The most common side effect of treatment was diarrhea (16.5%), but 12.9% of treated patients presented with diarrhea before treatment began.
…it would be ballpark to estimate that some 20% of the 1466 treated high-risk patients in the Zelenko and Marseilles cohorts would have died without outpatient HCQ+AZ treatment, 293 patients, compared to the 7 who did die. (The public perception is that all high-risk patients would die from coronavirus infection whereas this study estimates only one-fifth would die, but that percentage drops very dramatically to .004% when the protocol is implemented. Without the protocol, if these high-risk patients boosted their immune systems with C, D and Zinc that risk would also be far less than 20% - SJ)
For HCQ+AZ use, the argued issue concerns fatal cardiac arrhythmias: the warnings issued by the FDA, the NIH and the cardiology societies. Indeed, both HCQ and AZ produce QT prolongation, rare instances of fatal Torsades de Pointes and long QT-interval syndrome. A number of essays by cardiologists published in JAMA and other journals have anxiously warned about these risks, but have not examined mortality from them. The sole question is whether these fatal events, or even any fatal cardiac arrhythmia events, would occur with enough frequency that general treatment of non-contraindicated high-risk outpatients by HCQ+AZ would outweigh benefit in preventing hospitalization and mortality. A number of studies have examined hospital inpatient use, but these studies have had major flaws discussed at length in the literature, not least of which is that patients hospitalized with multiple medical problems and more-advanced disease do not represent the mortality experience of outpatient use of these medications in patients otherwise well enough not to be hospitalized.
Examination of the database for adverse events reported from the beginning of the database in 1968 through 2019 and into the beginning of 2020, shows for hydroxychloroquine 1064 adverse event reports including 200 deaths for the total of cardiac causes that could be both specifically and broadly classified as rhythm-related. Of these, 57 events including 10 deaths were attributed to Torsades de Pointes and long QT-interval syndrome combined. This concerns the entirety of HCQ use over more than 50 years of data, likely millions of uses and of longer-term use than the 5 days recommended for Covid-19 treatment. For AZ use, the numbers of reported Torsades de Pointes and long QT-interval syndrome events total 37, of which 2 deaths.
This discussion thus shows that the FDA, NIH and cardiology society warnings about cardiac arrhythmia adverse events, while appropriate for theoretical and physiological considerations about use of these medications, are not borne out in mortality in real-world usage of them. Treatment-failure mortality will be much higher, but even that pales in comparison to the lives saved. It would therefore be incuмbent upon all three organizations to reevaluate their positions as soon as possible.
Substantial fractions of physicians treating Covid-19 patients in Europe and elsewhere report use of HCQ+AZ: 72% in Spain, 49% in Italy, 41% in Brazil, 39% in Mexico, 28% in France, 23% in the US, 17% in Germany, 16% in Canada, 13% in the UK (45), much of the non-US use in outpatients. HCQ+AZ has been standard-of-care treatment at the four New York University hospitals, where a recent study showed that adding zinc sulfate to this regimen significantly cut both intubation and mortality risks by almost half
Until we have quantitative evidence for the utility and safety of other medications for preventing hospitalization and mortality in high-risk Covid-19 outpatients, the urgency of current mass mortality requires an immediate application of the best that we have available, even if knowledge is imperfect and even if yet unproven to the standards of double- blinded RCTs. This problem will get even worse as states and cities yield to the acute pressure at this moment to begin lifting stay-at-home restrictions and even more people become infected. Some people will have contraindications and will need other agents for treatment or to remain in isolation. But for the great majority, I conclude that HCQ+AZ and HCQ+doxycycline, preferably with zinc (47) can be this outpatient treatment, at least until we find or add something better, whether that could be remdesivir or something else.
…in this context, we cannot afford the luxury of perfect knowledge and must evaluate, now and on an ongoing basis, the evidence for benefit and risk of these medications (23). Available evidence of efficacy of HCQ+AZ has been repeatedly described in the media as “anecdotal,” but most certainly is not.
 
Until we have quantitative evidence for the utility and safety of other medications for preventing hospitalization and mortality in high-risk Covid-19 outpatients, the urgency of current mass mortality requires an immediate application of the best that we have available, even if knowledge is imperfect and even if yet unproven to the standards of double- blinded RCTs.
It is our obligation not to stand by, just “carefully watching,” as the old and infirm and inner city of us are killed by this disease and our economy is destroyed by it and we have nothing to offer except high-mortality hospital treatment. We have a solution, imperfect, to attempt to deal with the disease. We have to let physicians employing good clinical judgement use it and informed patients choose it. There is a small chance that it may not work. But the urgency demands that we at least start to take that risk and evaluate what happens, and if our situation does not improve we can stop it, but we will know that we did everything that we could instead of sitting by and letting hundreds of thousands die because we did not have the courage to act according to our rational calculations. 

Also, the chief source of zinc is red meat.  Chinese do not get a lot of red meat, and the Italians don't tend to eat red meat.

Is the recent meat shortage an accident or yet another attempt to lower people's levels of zinc?

Good observation and question!

I don't know about the Chinese but the Italians do eat substantial amounts red meat.

A balanced meal with variety will help to make up zinc intake.

According to Healthline.Com:
Meat is an excellent source of zinc ; follwed by
Shellfish; Legumes like chickpeas, lentils and beans;
Seeds, like hemp, pumpkin, squash and sesame;
Nuts, like pine nuts, peanuts, cashews and almonds;
Dairy, Eggs, Whole Grains and most importantly, Dark chocolate

Good observation and question!

I don't know about the Chinese but the Italians do eat substantial amounts red meat.

A balanced meal with variety will help to make up zinc intake.

According to Healthline.Com:
Meat is an excellent source of zinc ; follwed by
Shellfish; Legumes like chickpeas, lentils and beans;
Seeds, like hemp, pumpkin, squash and sesame;
Nuts, like pine nuts, peanuts, cashews and almonds;
Dairy, Eggs, Whole Grains and most importantly, Dark chocolate

I get plenty of zinc then. Besides meat, I also eat lots of cheese, peanuts, beans and 1/2 bar (which is 1/2 a serving according to the package) dark chocolate a day. That's 85% cocoa dark chocolate: very little sugar.

(Ahhh, [expletive! ]  I originally posted this reply on June 02, 2020 at 19:00:32 CDT, but in haste to, um, an inintended subforum.  So now I'm posting this reply where it belongs [×].)

Dang, Ladislaus!  I was skeptical about your claim to priority on C.I.  But I felt obligated to exercise objectivity by due diligence.  So I confined my search to CathInfo, for which it's necessary to submit to Evil Google.  It does seem to confirm your claim to priority on C.I.:

I've been connecting dots and feel that ZINC is the key here.

[....] chloroquin e one helps
Chloroquin e one works by channeling zinc into cells, which then kills viruses.  It's pretty compelling.

"Compelling", Indeed!.  This was early enough in the pandemic that it'd be unfair to complain that the related hydroxychloroquine has been found to be superior, at least because of its less troublesome side-effects, and perhaps other valid reasons.

All that conceded, next time, how's 'bout you making the effort to find the relevant URL for confirming your claim, instead of me?

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Note ×: Being posted by me in haste in an inintended subforum, Matthew should feel free, but not the least bit obligated, to delete this: "Ladislaus told us so!/Re: Truth about Coronavirus - CLUES EMERGE".  <https://www.cathinfo.com/health-and-nutrition/truth-about-coronavirus-clues-emerge/msg702380/#msg702380>.

I agree with much of what is written in the initial posting by Matthew in this topic.  I originally drafted this reply as congratulations, until I discovered that as Ladislaus has claimed, he was already "connecting dots" 2 months ago.

So I'm very disappointed to see so many things wrong with that initial posting.  Especially unidentified insertions in the posting that don't appear in the PDF file (at the link already given above).  Also the continual changes in text style, e.g., in font family (e.g., sans-serif vs. serifed), font size, and even font color [†], that I'm puzzled by exactly who wrote what.  It seems to be an unidentified person's commentary on another unidentified person's commentary (on maybe yet another unidentified person's commentary), where "SJ" is only 1 of them, on the "original unedited manuscript" by "Harvey A Risch" [*].

Right after the full title of the paper (which was bolded or enlarged as is quite reasonable to capture attention for a headline or the title of a published paper), I see this: "Below, I  have selected the most significant items from the study to save readers from having to peruse the entire study."  Huh?  Who's "I"?  It's typically not the author of a paper who's trying to "save readers from having to peruse [his] entire study".  Despite appearing immediately after the title, it's understandably not in the PDF.  Well, Hey-yell!  That title should have been the start of Risch' own words, uninterrupted by any undistinguished insertions of text by some unidentified meddler.  Let's keep in mind that Risch is the only medical professional who's identified in any of the uncertain number of levels of commentary that I've inferred.

In particular, I object to unexplained instances of "--SJ" here and there.  Those 2 letters do not appear as a discrete (character) string anywhere in the full-content PDF by Risch.  That's really no surprise, because they're obviously not the initials of Risch, who is the only author of the cited study.  Yet "SJ" dispenses medical advice plus political opinions.  Most troubling was this: "Isolation, masks, contact tracing and a vaccine are unnecessary for these people" [×].  Those are not the words of Risch, because they do not appear in the PDF file: "The great majority of infected people are at low risk for progression or will manifest the infection asymptomatically ♦.  For the rest, outpatient treatment is required that prevents disease progression and hospitalization" (p. 4) (to provide context, I've inserted a red diamond where the comment was inserted by "SJ").  So in its context, "SJ" is unmistakably claiming that "masks [...] are unnecessary" for "infected people"!  I tried Evil Google's advanced search; altho' it does find text from those puzzling insertions by "SJ", it finds them only in the CathInfo posting by Matthew, and nowhere else on the Web.    I  fear that many readers, off their guards because of the tiring length of an initial posting excerpted from a 29-page docuмent [#], then lengthened by unidentified comments, and the smoothly effective placement of the "SJ" comment, will remember not only the words of Risch, but also the comment by "SJ", as if Risch had written both sets of words.  I realize that "SJ" followed a custom (albeit narrowly interpreted) for using parentheses to enclose embedded commentary, but it's a great example of embedded commentary that's likely to cause confusion for some readers, and so should have been stashed out of the way, in a footnote.    I'm left quite confused: What the [expletive deleted] is really going on in that posting?

To help readers get a start on making sense of it all, especially who's written what, I request that Matthew, as soon as he can reasonably squeze it into his & his household's real life, provide either links, or more-or-less complete citations, for each source of words [‡] in his posting, which seems to have intermixed at least 2 levels of commentary by unidentified writers (if not 3 or 4 levels).  It's unfair to readers to obscure who's written what, thus making it difficult or impossible to figure out which words were written by someone qualified to give medical advice, and which words were not.

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Note *: "Dr. Harvey A. Risch (no ‘t’), Department of Chronic Disease Epidemiology, Yale School of Public Health, [....] New Haven, CT".  As released by Oxford U. Press (OUP) as a PDF file without any pay-wall.

Note †: I recognize the proverb "de gustibus non disputandum", but the excessive use (arguably an understatement) of bright red oversized fonts seems to cause physical pain to my senior eyes, whereas other colors, notably blue and moderate RGB shades of green, simply do not.  And the brightness of my monitor is set so that the white background is not bright white, but instead, what photographic printers might call a clean barely-off white.

Note ×: I strongly disagree with that particular de facto medical advice from "SJ"; the mask is not for the benefit of the wearer, but instead for the benefit of possibly much more vulnerable people around the wearer, as might be recalled from a reply in another topic nearly 3 weeks ago: ‘AlligatorDicax’: "Re: To wear a mask or Not to wear a mask.  Reply #82 on May 15, 2020 at 20:00:02".  <https://www.cathinfo.com/catholic-living-in-the-modern-world/to-wear-a-mask-or-not-to-wear-a-mask/msg699432/#msg699432>.

Note #: Even tho' it's double-spaced (as is common for manuscripts), won't 29 pages of a medical paper, free from comments by unidentified people, be enough homework & PDF eye-strain for even the most studious of CathInfo readers?  Why should we care about reading text inserted by unidentified people, about whose medical qualifications we have been provided not even a clue.

Note ‡: I did my due diligence, using CathInfo-privileged Google, e.g., an insertion by "SJ": ‘this exact word or phrase:’  "Isolation, masks, contact tracing and a vaccine are unnecessary for these people"; ‘site or domain:’  blank (i.e., no restrictions).  <https://www.google.com/search?as_q=&as_epq=Isolation%2C+masks%2C+contact+tracing+and+a+vaccine+are+unnecessary+for+these+people&as_oq=&as_eq=&as_nlo=&as_nhi=&lr=lang_en&cr=&as_qdr=all&as_sitesearch=&as_occt=any&safe=images&as_filetype=&tbs=>.

Well!  It's about time!  I've lately been burning up so much of the otherwise useful time that I've been allowing myself for CathInfo, by trying to rebut the "inverse sheeple" preachers of the alleged NWO mask-conspiracy [*].

Which has left me with too much frustration, and too little time, to compose postings on good news, notably about HCQ+zinc vs. CoVID-19, as posted at last in this topic by Matthew.

The many attempts to try to discourage its use, to promote fake or very poorly done studies to give the impression that it is not effective and even dangerous in many cases, and to stop doctors from prescribing this 65-year-old, very safe medication, and to even stop pharmacies from filling doctor’s prescriptions for it has already resulted in hundreds of thousands of unnecessary and mostly preventable deaths.  That is, these attempts to falsely discredit this protocol has been killing people and there should be criminal charges made in some cases against those publishing or otherwise widely promoting false information on the efficacy of HCQ for covid infection.  It is that serious.

Yesss!  All you "inverse sheeple" out there [*], it's the quoted text immediately above that identifies the real conspiracy!

Despite the proverb "never attribute to malice what can be explained by stupidity", I refuse to believe that the medical professionals who perform the "medical studies" that administer HCQ without zinc, are each innocent via ignorance (i.e., stupidity) of draft-but-credible front-line medical studies [♢] that attest to the importance of administering HCQ with zinc.  And also ignorant of medical studies from the same front-lines that reveal that the treatment is most effective when done long before patients are confronted with the dangers of physical damage by ventilators.  The basic purpose of those machines is to force oxygen into a patient's lungs.  Some front-line medical professionals have questioned how such physically harsh therapy could have been expected to be effective for lungs that the virus has already severely damaged.   That's because protocols of the medical establishment routinely delay treatment by ventilators until then.

Such ignorance is especially implausible when medical professionals who have no day-to-day responsibility to care for patients dismiss as "anecdotal" the practical discoveries of medical professionals on the front lines of treatment [⚕].  The medical successes of each team on the front lines might include hundreds of docuмented patients.  Then following the antiTrump agenda of Red China (i.e., WHO), the Deep State (i.e., CDC) and the mainstream media, the Fake News of (purported) HCQ "ineffectiveness" and "dangers" is spread widely, with impressive promptness and repetition that's stretched long past the stereotypical 24-hour news-cycle.

Let's not forget the exhortation "follow the money! "  Could it be that the medical establishment is determined to discredit and officially disqualify HCQ+zinc as a viable treatment, because it's decades out of patent, there are no significant manufacturing barriers, and the price of its doses is only 5 dollars per month, e.g., the price of my Burger King all-meat Whopper (hamburger) tonight.  Sigh.  Except at the top-gouge pricing in the U.S.A., where it's 5 times that [#].  Altho' for pricing doses of the widely promoted but hypothetical vaccine, the sky's the limit! [†].

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Note ♢ : I.e., draft medical studies that are published semiformally on the Internet, even tho' they are intended eventually for the scientific formalities of refereeing by the same publishers.

Note # : "The wholesale cost in the developing world was about US$4.65 per month as of 2015, when used for rheumatoid arthritis or lupus.[39] In the United States the wholesale cost of a month of treatment is about US$25 as of 2020.[40]  In the United Kingdom this dose costs the National Health Service about £5.15.[41]"   <https://en.wikipedia.org/wiki/Hydroxychloroquine#Cost>: §7.1, which fails to mention where it was invented or where it's manufactured.

Note † : E.g., without a generous health plan and its approval, one of my family members would be paying $4000 (four thousand) for each frequently administered dose that's only 1 milliliter of medication!  That family member is understandably anxious about such recurring costs, because of awareness of national news that some U.S. health plans, lamenting excessive costs they claim to have incurred from treating CoVID-19, are dumping plan members who have survived into their senior-citizen years.  The only viable option, if that happens, is doing without!

Note ⚕ : A draft needing to be tidied up, then posted later.