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What you need to know about COVID-19: October 23, 2020
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Last week I wrote in this space about corticosteroids and COVID-19 , but the real point was to mark the arrival of a new epoch of the pandemic. For the first time doctors performing high-grade traditional medical studies found out that something seemed to work, rather than that something didn’t. The side of the path behind us is already littered with terrific theories of what ought to help patients recover from COVID-19. On Monday a paper published in the Lancet warned that the antibiotic azithromycin may be destined for the ditch.
When doctors were essentially trying to spitball an approach to COVID-19 that could be used immediately — involving safe, existing, well-understood, preferably venerable drugs in mass production — many of them settled on a twin attack involving two mutually compatible drugs that fit the bill. These were hydroxychloroquine and azithromycin.
It already seems strange that the first weapons immediately to hand in fighting a new viral disease would be an antimalarial and an antibiotic (i.e., a killer of bacteria rather than viruses), but there were decent reasons to think either or both might be effective. In “in vitro” lab studies, azithromycin does seem to squash some kinds of viruses, and it was quickly confirmed that our friend SARS-CoV-2 is one of these. In general it also has desirable effects on the immune system and seems to be good for the lungs.
It was hydroxychloroquine that attracted the attention of researchers first, partly for weird political reasons that the future will have trouble understanding, and it hasn’t had a good run. After plenty of study, no evidence has emerged that it helps anybody in a scientifically observable or reproducible way. A large Brazilian group did one of the initial hydroxychloroquine studies that came up with a negative result, and they realized that the other half of the drug tandem had been under-researched, so they arranged a proper randomized trial with a control group and careful operator blinding, focusing this time on azithromycin instead of its yokemate.
There’s a problem with the study, in that everybody in it was still receiving hydrochloroquine for lack of a superior standard of care. As an accompanying editorial in the Lancet notes, it now seems “unlikely that hydroxychloroquine has any effect on disease progression,” but its use might still, in principle, be interfering with the effect of azithromycin. The antibiotic probably won’t be abandoned outright for COVID-19 patients, since it is pretty safe and inexpensive, but the researchers couldn’t find any benefit. And doctors are discouraged, even now, from building up population resistance to useful antibiotics by handing them out like Tic Tacs. So azithromycin as a weapon against COVID-19 may be about to zoom from A to Z.
Copyright Postmedia Network Inc., 2020