Many countries either adopted or declined early treatment with HCQ, forming a large country-randomized controlled trial. 2.0 billion people were assigned to the treatment group, and 663 million to the control group. As of August 6, 2020, an average of 38.5/million in the treatment group have died, and 440.2/million in the control group, relative risk 0.087. After adjustments, treatment and control deaths become 79.6/million and 630.0/million, relative risk 0.13. Confounding factors affect this estimate, including varying degrees of spread between countries. Accounting for predicted changes in spread, we estimate a relative risk of 0.21. The treatment group has 79.1% lower chance of death. We examined diabetes, obesity, hypertension, life expectancy, population density, urbanization, testing level, and intervention level, which do not account for the effect observed.
Trial Setup
Treatment.
We investigate early or prophylactic treatment for COVID-19 with hydroxychloroquine (HCQ), which has been adopted or declined in different countries. Since the severity of COVID-19 varies widely based on age and comorbidities, treatment was generally only initiated in higher risk individuals. The primary endpoint was death.
Results
2.0 billion people were assigned to the treatment group, and 663 million to the control group. As of August 6, 2020, an average of 38.5/million in the treatment group have died, and 440.2/million in the control group, relative risk 0.087. After adjustments, treatment and control deaths become 79.6/million and 630.0/million, relative risk 0.13. Confounding factors affect this estimate, including varying degrees of spread between countries. Accounting for predicted changes in spread, we estimate a relative risk of 0.21. The treatment group has 79.1% lower chance of death. We examined diabetes, obesity, hypertension, life expectancy, population density, urbanization, testing level, and intervention level, which do not account for the effect observed. Figure 1 shows cumulative demographic adjusted death rates by country and trial group. Adjustments are detailed in the next section. Some analyses adjust graphs for the date since a specific milestone was reached, such as 0.1 deaths per million. We do not do this because an effective treatment will alter the time that such a milestone is reached.
