Professor Harvey Risch, M.D., Ph.D., is a researcher at the Yale School of Public Health with a specialty in cancer etiology, prevention and early diagnosis, and epidemiologic methods.
He recently studied the efficacy of hydroxychloroquine (used in conjunction with two other drugs) to treat people infected with COVID-19 and concluded that the approach should be “widely available” in the fight against the current pandemic.
Describe your findings.
HR: COVID-19 is really two different diseases. In the first few days, it is like a very bad cold. In some people, it then morphs into pneumonia which can be life-threatening. What I found is that treatments for the cold don’t work well for the pneumonia, and vice versa. Most of the published studies have looked at treatments for the cold but used for the pneumonia. I just looked at how well the treatments for the cold worked for the cold. There are five studies done this way, four of hydroxychloroquine plus azithromycin and one with hydroxychloroquine plus doxycycline, and they all show that treating the cold part of COVID-19—the early part—works very well.
Do you think that these drug combinations should be used for all people with COVID-19, or only certain patients?
HR: Most people less than 60 years old who are of healthy weight and who don’t have other conditions like heart disease or diabetes can get by without medications. But if anyone starts to have shortness of breath while doing normal activities like walking around at home, they should get medical care immediately.
But the use of hydroxychloroquine to treat COVID-19 remains highly controversial. Why is there so much disagreement if it is effective?
HR: I think that there has been confusion about treating the cold versus treating the pneumonia. These medications don’t seem to work so well for treating the pneumonia. As early as possible is crucial, within the first five to six days of symptoms.
Are these drugs safe?
HR: The combination of hydroxychloroquine and azithromycin has been used for decades in hundreds of thousands of people with rheumatoid arthritis. There is a concern that these medications do change the heart pacing a little and could cause cardiac arrhythmias. However, these arrhythmias are still very rare in people using these medications. People who already have heart arrhythmias or are predisposed to them or have family histories of them should discuss this with their health care providers and see if using hydroxychloroquine plus doxycycline or some other medications would be a better choice.
Does hydroxychloroquine have the potential to be a “game-changer” in the fight against this pandemic?
HR: Hydroxychloroquine alone is not the whole story. It needs to be combined with azithromycin or doxycycline and probably with zinc to make it most effective. The game changer is to aggressively treat people as soon as possible, before they are hospitalized, to keep them from becoming hospitalized in the first place. Hydroxychloroquine plus the other medications is what we know about now. In a few months we may have data on other medications that also work. We just have to start with something now.
How widely is the drug currently being used to treat people infected with COVID-19? What do you recommend?
HR: Various places around the world have started using these drugs. An international survey of doctors who treat COVID-19 patients recently showed 72 percent of doctors in Spain say that they have been using them. I think that doctors need to be able to use their own clinical judgement about their patients and have objective information about drugs that can work for the early part of the infection, the cold part.
Why did you study this?
HR: This pandemic is undoubtedly the biggest public health crisis of our time. I started seeing reports of treatment benefit in France and New York and couldn’t understand where the controversy was coming from. So, I did an exhaustive search of studies and data on medication use in COVID-19 outpatients and the paper I wrote just describes everything that I found. Every study has details and the details are important.