Anyone can publish on Medium per our Policies, but we don’t fact-check every story. For more info about the coronavirus, see cdc.gov.

Statement from Yale Faculty on Hydroxychloroquine and its Use in COVID-19

Gregg Gonsalves
Aug 4 · 7 min read
Image for post
Image for post

We write with grave concern that too many are being distracted by the ardent advocacy of our Yale colleague, Dr. Harvey Risch, to promote the assertion that hydroxychloroquine (HCQ) when given with antibiotics is effective in treating COVID-19, in particular as an early therapeutic intervention for the disease. As his colleagues, we defend the right of Dr. Risch, a respected cancer epidemiologist, to voice his opinions. But he is not an expert in infectious disease epidemiology and he has not been swayed by the body of scientific evidence from rigorously conducted clinical trials, which refute the plausibility of his belief and arguments. Over the last few weeks, all of us have spent considerable time explaining the evidence behind HCQ research, as it applies to early and late stage COVID-19 patients to the scientific community and general public, and now are compelled to detail the evidence in this open letter.

We are seriously alarmed for the safety of patients and the coherence and effectiveness of our national COVID-19 emergency response when misinformation about HCQ is spread and when rigorous scientific evidence and consensus produced by the community of expert researchers in infectious diseases, federal agencies and national and global health organizations are not heeded. Let us be clear: we are unanimous in our desire to see the development of therapies to treat COVID-19 and to prevent the transmission or acquisition of SARS-CoV-2. If HCQ was shown to be effective, even among subgroups of patients with COVID-19 in ongoing high quality trials, we would join our colleagues in promoting access to it for all who need it. However, the evidence thus far has been unambiguous in refuting the premise that HCQ is a potentially effective early therapy for COVID-19.

HCQ is used for the treatment of rheumatological diseases, such as lupus and rheumatoid arthritis. However, this does not ensure that the drug will be safe in patients with COVID-19 or in widespread use to treat early illness. In fact, rigorously-conducted clinical trials have found that HCQ is not effective as an early prophylactic therapy in preventing illness due to COVID-19 in people exposed to the virus. Furthermore, HCQ, alone or together with the antibiotic, azithromycin, has not been shown to be effective in improving the clinical status of patients with COVID-19. Moreover, clinical trials have found that treatment with HCQ may be associated with increased risk of adverse reactions. Taken together, the scientific evidence does not support the widespread use of this drug, alone or in combination with an antibiotic, as advocated by Dr. Risch and others, unless rigorous evidence from clinical trials demonstrates otherwise.

Finally, we point to the recent memorandum from the US Food and Drug Administration revoking the Emergency Use Authorization for HCQ that has assembled the data on the drug as of June 2020 (Food and Drug Administration Memorandum Explaining Basis for Revocation of Emergency Use Authorization for Emergency Use of Chloroquine Phosphate and Hydroxychloroquine Sulfate). The Infectious Diseases Society of America now advises against the drug alone or in combination with azithromycin in the setting of COVID-19 except in the context of ongoing clinical studies. If these trials do show a clinical benefit for HCQ, we would revise our views on its use in the management of COVID-19.

The disproportionate focus on treatment with HCQ, in addition to the lack of a strong scientific rationale for its use and the risk of its potentially harmful effects, has major opportunity costs. In a recent analysis of COVID-19 clinical trials, one in every six studies of treatments against SARSCoV-2 was designed to study HCQ or chloroquine. We understand the desperation of many to see an effective treatment for COVID-19 emerge that will stop the pandemic in its tracks or slow its relentless spread in the US. But investing our resources in HCQ after multiple studies have not shown it to be effective for COVID-19 has serious implications for more than just individual patients. The continuing advocacy on behalf of HCQ distracts us from advancing the science on COVID-19 and seeking more effective interventions in a time when more than 1000 people are dying per day of this disease. There are multiple approaches to expedite the evaluation and approval of drugs for serious and life-threatening diseases in the US that have existed for decades now, but they all still rely on data from rigorous, well-conducted clinical trials to guide us. In addition, this ongoing promotion of HCQ has global implications as well, as many countries in the global South only have access to HCQ and use of HCQ is still common in this setting despite the lack of evidence and potential risks.

It is critical that we follow the science and where the evidence leads us on a quest to treat and prevent COVID-19. In this climate, it’s important to rely on the data above all else when making clinical or regulatory decisions. Making these kinds of choices guided by personal endorsements outside of the context of the existing scientific evidence is medicine by testimonial and risks people’s lives. Randomized controlled trials are how we keep from fooling ourselves, test our assumptions about new drugs and new uses for old ones. For instance, flecainide was initially proposed as a drug to treat those at risk of severe arrhythmias after sudden myocardial infarction. However, the Cardiac Arrhythmia Suppression Trial showed for the first time that mortality was actually three times higher among persons receiving the drug for this purpose. Even though the drug was known to be effective in those experiencing severe arrhythmia, it ended up increasing mortality in those simply at risk. And no one noticed because sudden death after myocardial infarction was not a rare event and this tripling of the risk was not detected until a randomized, controlled trial was done. The FDA has rescinded the EUA for HCQ for a reason: the vast preponderance of the evidence suggests that the drug is without merit in clinical care for COVID-19 and presents real dangers to patients by its continued use.

In 1987, University of California at Berkeley Professor Peter Duesberg gained notoriety by expounding on his belief that AIDS was not caused by the human immunodeficiency virus, but by antiretroviral agents like azidothymidine (AZT) and recreational drugs. However, the data on antiretroviral therapy was clear: these drugs extended life and health and turned around the course of the AIDS epidemic worldwide. But Professor Duesberg persisted in his quest. Professor Duesberg’s thesis dissuaded many from taking antiretroviral therapy, and after the President of South Africa Thabo Mbeki endorsed these views, it led to delays in the roll-out of these life-saving drugs costing hundreds of thousands of lives in that country. While minority opinions, anecdotal evidence, novel interpretations and challenges to orthodoxies in a field can be important, at some point, the application of the scientific method generating evidence from multiple, well-designed clinical trials and observational studies does matter and should be heard over the noise of conspiracy theories, purported hoaxes, and the views of zealots.

Signed,

Jason Abaluck, PhD

Associate Professor of Economics

Yale School of Management

Amy Bei, PhD

Assistant Professor of Epidemiology (Microbial Diseases)

Yale School of Public Health

Theodore Cohen, MD, DPH

Professor of Epidemiology (Microbial Diseases)

Co-director, Public Health Modeling Concentration

Yale School of Public Health

Gary V. Desir, MD

Paul B. Beeson Professor of Medicine

Vice Provost, Faculty Development and Diversity

Chair, Internal Medicine, Yale School of Medicine

Chief, Internal Medicine, Yale New Haven Hospital

Gail D’Onofrio MD

Professor & Chair, Emergency Medicine

Yale School of Medicine

Yale School of Public Health

Howard P. Forman, MD, MBA

Professor of Radiology & Public Health (Health Policy)

Yale School of Public Health

Yale School of Medicine

Professor in the Practice of Management

Yale School of Management

Alison Galvani, PhD

Burnett and Stender Families Professor of Epidemiology (Microbial Diseases)

Director of the Center for Infectious Disease Modeling and Analysis (CIDMA)

Yale School of Public Health

Gregg Gonsalves, PhD

Assistant Professor of Epidemiology (Microbial Diseases)

Yale School of Public Health

Associate Professor (Adjunct) and Research Scholar

Yale Law School

Nathan D. Grubaugh, PhD

Assistant Professor of Epidemiology (Microbial Diseases)

Yale School of Public Health

Roberta Hines, MD

Nicholas M. Greene Professor & Chair of Anesthesiology

Yale School of Medicine

Valerie Horsley, PhD

Associate Professor of Molecular, Cellular & Developmental Biology

Yale University

Akiko Iwasaki, PhD

Waldemar Von Zedtwitz Professor of Immunobiology and Molecular, Cellular and Developmental Biology

Yale School of Medicine

Professor of Molecular Cellular and Developmental Biology

Yale University

Amy Kapczynski, JD

Professor of Law

Yale Law School

Trace Kershaw, PhD

Department Chair and Susan Dwight Bliss Professor of Public Health (Social and Behavioral Sciences)
Yale School of Public Health

Albert I. Ko, MD

Professor of Epidemiology and Medicine and Chair of Epidemiology of Microbial Diseases

Yale School of Public Health

Stephen R. Latham, JD, PhD

Director, Interdisciplinary Center for Bioethics

Yale University

Brett Lindenbach, PhD

Associate Professor, Microbial Pathogenesis

Yale School of Medicine

Fiona Scott Morton, PhD

Theodore Nierenberg Professor of Economics

Yale School of Management

Ruslan Medzhitov, PhD

Sterling Professor of Immunobiology

Yale School of Medicine

Saad B. Omer, MBBS MPH PhD FIDSA

Professor of Medicine (Infectious Diseases),Yale School of Medicine

Adjunct Professor, Yale School of Nursing

Susan Dwight Bliss Professor of Epidemiology of Microbial Diseases, Yale School of Public Health

A. David Paltiel, PhD

Professor of Health Policy & Management

Yale School of Public Health

Yale School of Management

Sunil Parikh, MD, MPH

Associate Professor of Epidemiology and Medicine

Yale School of Public Health

Yale School of Medicine

Karen Santucci, MD

Professor & Chief, Pediatric Emergency Medicine

Yale School of Medicine

Marcella Nunez Smith, MD, MHS

Associate Professor, General Internal Medicine, Public Health, and Management

Yale School of Medicine

Yale School of Public Health

Yale School of Management

Director, Equity Research and Innovation Center

Daniel Weinberger, PhD

Associate Professor of Epidemiology (Microbial Diseases)

Yale School of Public Health

Gregg Gonsalves

Written by

Gregg Gonsalves is an Assistant Professor in the Department of the Epidemiology of Microbial Diseases at Yale School of Public Health.

Gregg Gonsalves

Written by

Gregg Gonsalves is an Assistant Professor in the Department of the Epidemiology of Microbial Diseases at Yale School of Public Health.

Welcome to a place where words matter. On Medium, smart voices and original ideas take center stage - with no ads in sight. Watch

Follow all the topics you care about, and we’ll deliver the best stories for you to your homepage and inbox. Explore

Get unlimited access to the best stories on Medium — and support writers while you’re at it. Just $5/month. Upgrade

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store