Convinced of having the miracle cure, the Marseille doctor announced Monday that he would treat all of his Covid-19 patients with hydroxychloroquine. An eagerness that contrasts with the caution of the French health authorities.
On Sunday evening, the Director General of Health, Jerôme Salomon, confirmed that a large clinical trial would study several treatments of Covid-19 in the coming weeks, including hydroxychloroquine. During the day, Didier Raoult, director of the IHU-Mediterranean and fervent defender of the treatment for weeks, announced that he would not wait for the results to administer it massively to his patients with Covid-19. “I do not care”, he said to Parisian. Drawing on the results of a study conducted by his services with a small number of patients, he said: “Like any doctor, once a treatment has been shown to be effective, I find it immoral not to administer it. It’s that simple.”
While France reached the 674 dead of the Covid-19 on Monday evening, the IHU-Mediterranean thus announced by communicated what would be proposed “a treatment with the combination of hydroxychloroquine + azithromycin for all infected patients at the earliest of the disease, upon diagnosis” By the way, Raoult also takes the opposite of the national doctrine in matters of tests, by assuring in his press release his will to test each “Febrile patient” knocking on the door of his establishment. Since the start of the crisis, the professor from Marseille has sharply criticized the French screening strategy: “OWe took a strategy which is not the strategy of the rest of the technological world. Which is very low. Which is very little to test“, he lamented on March 16. He prides himself, with the unrivaled testing capacity in France of the Mediterranean IHU (which performs 1,500 screenings per day, where the national total reaches around 4,000 tests), to screen more people, and not just cases. serious. His model? Seoul more than Paris, he explained : “Lhe Koreans have managed to control the epidemic by doing this: screening, treatment. ” What it promises from today. As of this morning, a crowd gathered in front of the Marseille hospital.
– Provence (@laprovence) March 23, 2020
Raoult: “I am convinced that in the end everyone will use this treatment”
There is nothing to prevent Raoult, or any other doctor, from administering treatment before it is validated by health authorities. “Each doctor has his medical, scientific and personal convictions”, says a doctor at a Paris hospital. “Today all doctors are empowered to prescribe plaquenil [nom sous lequel est commercialisée l’hydroxychloroquine, ndlr], confirms the Directorate General for Health. They must specify that it is not a marketing authorization. But the doctor therefore takes full responsibility if there is a concern. ”
But it is an understatement to say that Raoult’s eagerness contrasts with the reservations expressed in recent days by the health authorities. Pressed with questions about the effectiveness of hydroxychloroquine, Jerôme Salomon and Olivier Veran kept repeating that it was too early to go into therapy. “I would be the happiest of ministers if I could tell you tomorrow that we have a treatment that has proven to be effective, said Olivier Veran on Saturday, warning against false hopes. But again, the history of infectious diseases, viral diseases, is filled with fake good news, disappointment, and sometimes reckless risk-taking. “ AT CheckNews, Olivier Veran’s cabinet repeated Monday evening: “You have to wait until the end of the protocol to find out if hydroxychloroquine works. We don’t want to allow it on a large scale and then realize that there are harmful side effects. ” Didier Raoult is already convinced that he has found the remedy: “With my team, we believe we have found a cure. I am sure that in the end everyone will use this treatment. “
The controversy surrounding hydroxychloroquine begins in February, when France still knows only a few isolated cases of Covid-19. In a “letter” published by the newspaper BioScience Trends, Two researchers from Qingdao University in China recommend using the molecule against the new coronavirus. They rely on another article, claiming that in vitro tests have shown the effectiveness of hydroxychloroquine against infection. The news was relayed in France by Professor Didier Raoult, who then toured the media. At the AFP, the director of the Mediterranean Infection Institute in Marseille explains: “Ultimately, this infection is perhaps the simplest and cheapest to treat of all viral infections.”
“A doctor must be a Saint Thomas”
But on February 26, the Ministry of Health comes to temper these hopes for the first time, and indicates “There are no rigorous studies, published in an international peer-reviewed journal, that demonstrate the effectiveness of chloroquine in combating coronavirus infection in humans.” After an enthusiastic first media sequence, the temperature dropped several notches. As a miracle cure, treatment with hydroxychloroquine (often named after another nearby antimalarial, chloroquine) has turned into fake news in the media. In an article on looking for a cure for Covid-19, Release quotes Professor Xavier Lescure, specialist in infectious and tropical diseases at Bichat Hospital in Paris: “A doctor must be a Saint Thomas. It must be based on facts and there, I do not see the color. From experience, I observe that when researchers demonstrate the effectiveness of a treatment, they publish their raw results, not just treatment recommendations, as is the case. I’m waiting for evidence. “
Near CheckNews, Doctor Alexandre Bleibtreu, infectious disease specialist at Pitie-Salpetriere, also explains his reservations at the end of February: “What we can say at the moment is that the molecule is active on the virus in vitro. But there is no scientifically proven data supporting the use of chloroquine in patients. “ On the fact that the studies did not provide precise data supporting their discoveries, a spokesperson for the IHU Mediterranean explained to CheckNews : “We are in a certain urgency today. We are starting to have cases in France, so we must find solutions to treat them. We don’t have the long time needed for scientific publications and clinical studies. “ On March 5, Raoult’s research project was accepted by the National Medicines Safety Agency (ANSM): 24 patients will be treated with hydroxychloroquine at the Timone Hospital in Marseille.
Ten days later, on March 16, a triumphant Didier Raoult took the floor to present his first results. Two groups of patients were tested, he explains : Patients who did not receive treatment in Avignon and Nice, and 24 patients, therefore, who were treated with plaquenil. After six days, 90% of patients in Nice and Avignon were still carriers of SARS-CoV-2, compared to 25% of patients treated with plaquenil. This means, says the Raoult team, that 75% of the patients were cured after six days. Theclinical test led by the Marseille team is very strongly criticized by part of the scientific world, for the way they were published, or (and above all) because the trial involved only a small number of patients.
“Widely debated” molecule
Still, as the epidemic spreads, positions are shifting. Alexandre Bleibtreu, from Pitie Salpetriere, makes a spectacular about-face in a series of tweets : “Dear all, to be transparent, I said two weeks ago that the data available on chloroquine was” bullshit “. At the time it was true. New data from Marseille contradict what I said and what I thought. “ And to announce the start of treatment with plaquenil at Pitie-Salpetriere. “I love humor and criticizing dogma. So I apply it to myself. I think I was wrong enough to become a Raoultian ascendant chloroquinist. ” AT CheckNews, he then explains that the molecule is now used on almost all the patients hospitalized in his department (around fifty), except those who refuse or have contraindications.
According to another infectiologist from a French hospital, other doctors also use the treatment, without publicizing it, and without necessarily having waited for the work of the professor from Marseille: “The antiviral activity of hydroxychloroquine has been known for decades. Dhis clinical colleagues in France and around the world are using it in the management of Covid-19, pending the results of clinical trials, given the seriousness of the situation. But this case-by-case approach is different from communicating to the general public information that seems final, when it is not.“
In fact, clinical trials on chloroquine, a molecule “Widely debated” were already mentioned as of March 9, therefore before the results of Professor Marseille’s studies, in the expert recommendations on the management of patients with Covid-19. It reads: “More than 10 clinical trials have been or are underway for this antimalarial drug. The side effects are already well known. To date, there is no consensus for widespread use in Sars-CoV 2 infection. ”
“Existence of side effects of chloroquine”
On the authorities side, Raoult’s first results are met with measure. On March 17, government spokeswoman Sibeth Ndiaye tempered: “The ministry wanted to extend these clinical trials, which will be duplicated on a larger number of patients. However, we don’t have scientific evidence that this treatment works. ” Basically, the Marseille results have not changed anything: treatment is still not considered a priority. As Checknews writes then, hydroxychloroquine is not among the treatments intended to be studied within the framework of the vast European clinical trial Discovery which has just been set up in emergency, including 3,200 patients, including 800 in France. Professor Yazdan Yazdanpanah, director of the REACTing consortium, who chose the projects, justifies himself to the World invoking “The problem of drug interactions with other treatments in intensive care patients, and the existence of side effects of chloroquine, which make us cautious about its use”.
But in a few days, the media pressure and the craze for the promise (“Even Donald Trump tweeted about the results of our tests”, Raoult breastplate) have obviously changed the game. Saturday, Echoes announced that hydroxychloroquine will eventually slip into the giant Discovery clinical trial, at the cost of an emergency protocol amendment.
“This large trial is necessary to produce results that are strong enough to determine whether patients can be treated with hydroxychloroquine”, says infectious disease hospital practitioner Jade Ghosn at Bichat Hospital in Paris, who will take part in this upcoming study. “Normally, a protocol like this can take weeks to months, do we breathe in the general direction of health. But in this case everyone is on the bridge to do it as quickly as possible. “ Clarification from doctor Jade Ghosn: “There will be an intermediate analysis of the results, which will make it possible to exclude within the framework of the protocol drugs which do not work, or conversely to favor those which work best.”
If the trial were to validate the antiviral efficacy of hydroxychloroquine, the interest of the results would then also be to specify the indications for such treatment, notes an infectiologist from a French hospital: “In prevention, to treat all cases and their contacts at the end of containment and prevent the resumption of transmission? In prevention of a serious infection in people at risk of developing it, subject to defining this population? In treatment of serious illness? ” An essential issue, “Because these drugs are currently in limited quantities”, explains the same source, who on this point sharply criticizes the communication from the Marseille professor: “Telling everyone through YouTube and Twitter and in the mainstream press that this miracle treatment is absolutely necessary seems dangerous because it risks creating a shortage that could have an impact on the patients who need it most.” And in fact, as we explained to you in a previous article, plaquenil stocks melted like snow in the sun, both in some hospitals and in pharmacies, since the announcement of Didier Raoult’s results.
Following this new wave of excitement, many internet users believed they saw in hydroxychloroquine a miracle cure. Going so far as to imagine a plot in the fact that it is classified on list II of poisonous substances, or wishing to self-medicate, a practice that warns all doctors because of the side effects and the lack of perspective on the molecule. Alexandre Bleibtreu tempers the ambient panic: “It’s hard to hear right now: people want to be told” yes, we’re all going to heal you “or” no it doesn’t work. ” But the results will probably be in between, that’s how medicine is. ”