Changes

There are even more studies that could be cited and, if one is interested, one can go to [https://c19study.com/ C19study.com] which has a fairly comprehensive list of all of the studies involving HCQ and COVID-19.  The overall consensus of these studies is that when HCQ is taken early, it works.  If instead it is taken late in the disease progression, the data is more inconclusive.<ref name=c19study/>

There are even more studies that could be cited and, if one is interested, one can go to [https://c19study.com/ C19study.com] which has a fairly comprehensive list of all of the studies involving HCQ and COVID-19.  The overall consensus of these studies is that when HCQ is taken early, it works.  If instead it is taken late in the disease progression, the data is more inconclusive.<ref name=c19study/>

==HCQ, QT elongation, and torsade de pointes==

==HCQ, QT elongation, and torsades de pointes==

One of the recurring arguments opponents of HCQ make is that is it is dangerous because it could lead to sudden death visa vi QT elongation.  This is a valid concern ''if'' there is evidence that HCQ actually causes death through QT elongation.  So why don't we evaluate the evidence?

One of the recurring arguments opponents of HCQ make is that is it is dangerous because it could lead to sudden death visa vi QT elongation.  This is a valid concern ''if'' there is evidence that HCQ actually causes death through QT elongation.  So why don't we evaluate the evidence?

The clinical name for sudden death caused by excessive lengthening of the QT interval is {{wpl|Torsades de pointes}} and it is monitored through EKGs.  Some people have long QT intervals due to genetic factors, but QT elongation can also be acquired through medications.<ref>[https://www.mayoclinic.org/diseases-conditions/long-qt-syndrome/symptoms-causes/syc-20352518 Long QT syndrome] by Mayo Clinic Staff (accessed 7-31-2020) ''Mayo Clinic''</ref> There are several medications that have this effect, including Abarelix, Aclarubicin, Alfuzosin, Alimemazine, Amiodarone, Anagrelide, Apalutamide, Apomorphine, Aripiprazole, Arsenic trioxide, Artemether, Artenimol, Asenapine, Astemizole, Atomoxetine, and Azithromycin (and those are just the A's).<ref>[https://crediblemeds.org/index.php/new-drug-list  Risk Categories for Drugs that Prolong QT & induce Torsades de Pointes (TdP)] (May 12, 2020) ''CredibleMeds.org''</ref>.  Because of the concern of torsades de pointe, people taking these medications in a hospital setting will be monitored and the course of their medication may be altered due to perceived risk.  The following is how the Henry Ford study described their procedure.   

The clinical name for sudden death caused by excessive lengthening of the QT interval is torsades de pointes and it is monitored through EKGs.  Some people have long QT intervals due to genetic factors, but QT elongation can also be acquired through medications.<ref>[https://www.mayoclinic.org/diseases-conditions/long-qt-syndrome/symptoms-causes/syc-20352518 Long QT syndrome] by Mayo Clinic Staff (accessed 7-31-2020) ''Mayo Clinic''</ref> There are several medications that have this effect, including Abarelix, Aclarubicin, Alfuzosin, Alimemazine, Amiodarone, Anagrelide, Apalutamide, Apomorphine, Aripiprazole, Arsenic trioxide, Artemether, Artenimol, Asenapine, Astemizole, Atomoxetine, and Azithromycin (and those are just the A's).<ref>[https://crediblemeds.org/index.php/new-drug-list  Risk Categories for Drugs that Prolong QT & induce Torsades de Pointes (TdP)] (May 12, 2020) ''CredibleMeds.org''</ref>.  Because of the concern of torsades de pointes, people taking these medications in a hospital setting will be monitored and the course of their medication may be altered due to perceived risk.  The following is how the Henry Ford study described their procedure.   

{{An electrocardiogram (ECK) based algorithm was utilized for hydroxychloroquine use. QTc>500 ms was considered an elevated cardiac risk and consequently hydroxychloroquine was reserved for patients with severe disease with telemetry monitoring and serial QTc checks.<ref name =Fordstud/>}} People with naturally long QT intervals or other cardiac risk factors may also be excluded from the use of drugs that prolong QT due to the risk of torsades de pointes.   

{{quotebox|"Apart from halofantrine, the oral antimalarial drugs, particularly chloroquine and piperaquine, have been used extensively with very few reports of cardiotoxicity...Despite hundreds of millions of doses administered in the treatment of malaria, ''there have been no reports of sudden unexplained death'' associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation."<ref name=WHOHCQ/><ref name=CMside/>}} People with naturally long QT intervals or other cardiac risk factors may also be excluded from the use of drugs that prolong QT due to the risk of torsades de pointes.   

The largest study to monitor cardiac risk in regards to COVID-19 and HCQ use was the one conducted by Didier Raoult's team where 3,119 patients were treated with HCQ and AZ.  Of those patients, QT prolongation was only observed in 25 of them (0.67%) and this led to cessation of treatment in 12 of the cases.  There were ''zero'' cases of torsades de pointes.<ref name =Francestud/>  The Henry Ford Health System study was somewhat smaller (1985 patients treated with HCQ) and they reserved the HCQ + AZ treatment to people with minimal cardiac risk factors.  They also had zero cases of torsades de pointes.<ref name =Fordstud/>  Thus, the likelihood of HCQ-induced torsades de pointes in two large studies was zero, with the caveat that the researchers screened out patients with HCQ risk factors and used EKGs to monitor their patients for risk.  

The largest study to monitor cardiac risk in regards to COVID-19 and HCQ use was the one conducted by Didier Raoult's team where 3,119 patients were treated with HCQ and AZ.  Of those patients, QT prolongation was only observed in 25 of them (0.67%) and this led to cessation of treatment in 12 of the cases.  There were ''zero'' cases of torsades de pointes.<ref name =Francestud/>  The Henry Ford Health System study was somewhat smaller (1985 patients treated with HCQ) and they reserved the HCQ + AZ treatment to people with minimal cardiac risk factors.  They also had zero cases of torsades de pointes.<ref name =Fordstud/>  Thus, the likelihood of HCQ-induced torsades de pointes in two large studies was zero, with the caveat that the researchers screened out patients with HCQ risk factors and used EKGs to monitor their patients for risk.  

Alright, one may argue, but that was in hospitalized patients.  What about people who aren't monitored at a hospital?  According to Dr. Zelenko, the question "Has there been any cardiac arrhythmias using the combination of HCQ and AZ?" has been addressed by electrophysiologists in the USA who used their equivalent of "WhatsApp" to discuss the problem amongst themselves. The answer was no in the outpatient setting.  In the ICU setting, the answer becomes more muddled as COVID-19 can cause cardiomyopathy which, in turn, can cause QT elongation. Thus it is uncertain whether it is HCQ or COVID-19 that is the cause.<ref name=Zalenko2/>   

Alright, one may argue, but that was in hospitalized patients.  What about people who aren't monitored at a hospital?  According to Dr. Zelenko, the question "Has there been any cardiac arrhythmias using the combination of HCQ and AZ?" has been addressed by electrophysiologists in the USA who used their equivalent of "WhatsApp" to discuss the problem amongst themselves. The answer was no in the outpatient setting.  In the ICU setting, the answer becomes more muddled as COVID-19 can cause cardiomyopathy which, in turn, can cause QT elongation. Thus it is uncertain whether it is HCQ or COVID-19 that is the cause.<ref name=Zalenko2/>   

As HCQ is commonly used in outpatient settings for diseases such as malaria, the likelihood of sudden death from its use has already been addressed. A massive study entitled [https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf The cardiotoxicity of antimalarials] was conducted by the WHO in 2016 and found the following:

As HCQ is commonly used in outpatient settings for diseases such as malaria, the likelihood of sudden death from its use has already been addressed. A massive study entitled [https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf The cardiotoxicity of anti-malarials] was conducted by the WHO in 2016 and found the following:{{cquote|"Apart from halofantrine, the oral antimalarial drugs, particularly chloroquine and piperaquine, have been used extensively with very few reports of cardiotoxicity...Despite hundreds of millions of doses administered in the treatment of malaria, ''there have been no reports of sudden unexplained death'' associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation."<ref name=WHOHCQ/><ref name=CMside/>}} So out of hundreds of millions of doses being administered, the likelihood of sudden death is zero?  Well not quite zero as shown by [https://pubmed.ncbi.nlm.nih.gov/16615675/ this case report, although that person didn't die due to medical intervention]. But the risk is still ''really'' low, particularly when compared to the risk associated with being harmed by SARS-CoV-2 (or malaria, for that matter). If one has risk factors such as a naturally long QT interval, HCQ may still pose some risk, which is probably why it is not an over-the-counter medication.  But if one is healthy, it is difficult to beat HCQ's safety profile.  Just don't expect to hear that from the mainstream media as they are in the business of promoting a false narrative.

 

{{cquote|"Apart from halofantrine, the oral antimalarial drugs, particularly chloroquine and piperaquine, have been used extensively with very few reports of cardiotoxicity...Despite hundreds of millions of doses administered in the treatment of malaria, ''there have been no reports of sudden unexplained death'' associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation."<ref name=WHOHCQ/><ref name=CMside/>}} So out of hundreds of millions of doses being administered, the likelihood of sudden death is zero?  Well not quite zero as shown by [https://pubmed.ncbi.nlm.nih.gov/16615675/ this case report, although that person didn't die due to medical intervention]. But the risk is still ''really'' low, particularly when compared to the risk associated with being harmed by SARS-CoV-2 (or malaria, for that matter). If one has risk factors such as a naturally long QT interval, HCQ may still pose some risk, which is probably why it is not an over-the-counter medication.  But if one is healthy, it is difficult to beat HCQ's safety profile.  Just don't expect to hear that from the mainstream media as they are in the business of promoting a false narrative.

==Motivated reasoning among the mainstream media?==

==Motivated reasoning among the mainstream media?==