Monday, April 13, 2020

Trump 'IGNORED' National Security Council's coronavirus warning and calls for social distancing in January, called health secretary Alex Azar 'alarmist' and 'WAS told about Navarro's memo' 

The National Security Council office responsible for tracking pandemics received intelligence reports in early January about coronavirus 


The report predicted the devastation the virus would cause to the US once it hit 

Within weeks of receiving the report, NSC officials raised options Trump that would prevent the spread of the virus, including shutting down cities 


Donald Trump ignored the warnings, and instead waited until March to implement such measures, the report reveals 


This comes as the death rate from coronavirus in the Untied States rises to 20,087 fatalities - overtaking Italy's death toll after 2,000 Americans died in one day


By KAYLA BRANTLEY FOR DAILYMAIL.COM 11 April 2020

President Trump ignored advice by the National Security Council back in January to consider shutting down cities and keep Americans home from work, memos reveals.

The NSC office responsible for tracking pandemics received intelligence reports in early January predicting the devastation coronavirus could cause to the US once it hit, according to The New York Times.

Within weeks of receiving the report, NSC officials raised options Trump that would prevent the spread of the virus, including shutting down entire cities the size of Chicago. But Donald Trump ignored the warnings, and instead waited until March to implement such measures, the report reveals.

This comes as the death rate from coronavirus in the Untied States rises to 20,087 fatalities - overtaking Italy's death toll after 2,000 Americans died in one day - as the president celebrates Easter while social distancing in Washington, DC.

Donald Trump ignored the warnings from the NSC, and instead waited until March to implement such measures, the report reveal






President Trump tweeted his outrage at the New York Times' findings Saturday afternoon

This is just one of a dozen reports that reveal the US had ample warning ahead of the devastation the coronavirus could cause, but ignored intelligence reports.


President Trump tweeted his outrage at the New York Times' findings Saturday afternoon, 'When the Failing @nytimes or Amazon @washingtonpost writes a story saying “unnamed sources said”, or any such phrase where a person’s name is not used, don’t believe them. Most of these unnamed sources don’t exist. They are made up to defame & disparage. They have no “source”, the president wrote.

'Does anyone ever notice how few quotes from an actual person are given nowadays by the Lamestream Media. Very seldom. The unnamed or anonymous sources are almost always FAKE NEWS,' he continued.

Just this week it was revealed Donald Trump's trade adviser Peter Navarro issued his first grim warning in a memo dated January 29 - just days after the first COVID-19 cases were reported in the US.

At the time, Trump was publicly downplaying the risk that the novel coronavirus posed to Americans - though weeks later he would assert that no one could have predicted the devastation seen today.

Navarro penned a second memo about a month later on February 23, in which he warned that as many as two million Americans could die from the virus as it tightened its grip on the nation.

The January memo marks the earliest known high-alert to circulate within the West Wing as officials planned their first substantive steps to confront the disease that had already spiraled out of control in China.

It serves as evidence that top officials in the administration had considered the possibility of the outbreak turning into something far more serious than Trump was acknowledging publicly at the time.

'The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,' Navarro wrote.

'This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.'

Another report shows that Trump dismissed Health Secretary Alex Azar's initial warnings about the deadly coronavirus as 'alarmist' back in January.

Trump's administration continues to be heavily criticized for its delayed reaction to COVID-19 by failing to mobilize upon early warnings, form a chain of command, and organize efficient nation-wide testing - as the US suffers heavy casualties from the virus with over 9,600 deaths.

But the president had time to respond as he was first notified about the coronavirus outbreak in China on January 3.

Azar called Trump on January 18 while the president was at his Mar-a-Lago resort in Florida to brief him about the severity of the novel coronavirus.

During that call the president reportedly cut him off before Azar could explain and instead criticized the health secretary over his handling of the axed federal vaping ban.

At that time the president was reportedly more concerned about his then-ongoing impeachment trial.







Trade adviser Peter Navarro warned top Trump officials in late January and again in February that failing to contain coronavirus could cost the US trillions of dollars and millions of American lives. Trump is seen with Navarro (center) at a March 9 press briefing on coronavirus

Trump voters 'are less likely to practice social distancing' in pandemic, claims analysis of phone data 'scoreboard' that grades states by how effectively they are locked down

A new analysis of nationwide cell phone location data suggests that counties which voted for President Donald Trump in higher proportions are less likely to practice social distancing measures to limit the spread of the coronavirus pandemic.

The analysis, by Princeton sociologist Patrick Sharkey for Vox, also found that attitudes toward climate change are 'one of the strongest and most robust predictors of social distancing behavior.'

In parts of the country, a recalcitrant minority of people continue to openly blow off stay-at-home orders, defiantly congregating for recreational events in the midst of the pandemic that has infected more than 500,000 Americans and killed at least 18,798.

In New Mexico, at least 31 off-road enthusiasts gathered last weekend by the 'Welcome to Las Cruces' sign for a photo, which was posted online with the dismissive remark 'If you got it, you got it,' according to the Las Cruces Sun News.

A 'scorecard' from Unacast shows state and county-level data on how much people have reduced their outdoor movement during the coronavirus pandemic

In New Mexico, at least 31 off-road enthusiasts gathered last weekend by the 'Welcome to Las Cruces' sign for this photo, which drew fury after it was posted to Facebook



Unacast data shows county-level ratings for social distancing in Florida (TOP) and the results of the 2016 presidential elections (BOTTOM)

The Facebook post presenting the photographs read: 'Social Distancing Mtherfkers! And if you don't like (it) ur staying hm ok bye!' with emojis simulating hands raising their middle fingers.

New Mexico has been under a statewide stay-at-home order since March 23, currently scheduled to last until the end of April.

According to Sharkey's analysis of location data, 'politics and civic engagement bear a strong relationship to social distancing behavior.'

Sharkey's analysis relies on aggregate location data complied by Unacast, an advertising company that has recently emerged as one of the top sources of information about how much people continue to move about in the pandemic.

Unacast gives each county in the U.S. a letter score of A through F based on how much people have reduced their movement and non-essential travel during the pandemic, with 'F' representing the least change in outdoor movement.

Sharkey used a statistical analysis of the letter grades from Unacast to compare them with other

'Counties with larger populations, with more educated residents, and with higher percentages of white and Hispanic residents tend to receive higher grades on social distancing, while the age structure, the median income, and the unemployment rate are no longer associated with social distancing behavior,' Sharkey writes.

He continues: 'grades fall with the percentage of the county voters who cast a ballot for Trump in 2016.'




The average score of the counties is broken into three cohorts in a variety of categories


A Unacast chart shows the changed in non-essential visits since the pandemic began, with daily new cases in the US shown in grey bars



Unacast data shows county-level ratings for social distancing in California



Unacast data shows county-level ratings for social distancing in New York



Unacast data shows county-level ratings for social distancing in Texas


'Lastly, even after adjusting for all of these other characteristics, counties within the same state where a greater share of residents do not agree that global warming is happening are substantially less likely to change their behavior in response to Covid-19,' Sharkey writes.


Sharkey says his analysis shows that attitudes toward climate change are 'one of the strongest and most robust predictors of social distancing behavior.'


'In the places where residents don't think global warming is real, where they don't believe humans are responsible, where they don't think citizens have a responsibility to act, residents are also failing to change their behavior during the coronavirus crisis,' he writes.


As the crisis continues, cell phone location data is coming to the forefront as a key tool in the battle -- raising privacy concerns and exposing just how much data is being collected on Americans by private advertising and technology companies.


On Friday, Apple and Google announced a joint effort to help public health agencies worldwide use smartphone data to contain the COVID-19 pandemic.


New software the companies plan to add to phones would make it easier to use Bluetooth wireless technology to track down people who may have been infected by coronavirus carriers.



Signs displaying directions for maintaining social distancing due to COVID-19 concerns are posted on a New York supermarket as customers wait outside on Friday

he idea is to help national, state and local governments roll out apps for so-called 'contact tracing' that will run on iPhones and Android phones alike.

The technology works by harnessing short-range Bluetooth signals. Using the Apple-Google technology, contact-tracing apps would gather a record of other phones with which they came into close proximity.

Such data can be used to alert others who might have been infected by known carriers of the novel coronavirus, typically when the phones' owners have installed the apps and agreed to share data with public-health authorities.

Developers have already created such apps in countries including Singapore and China to try to contain the pandemic.

In Europe, the Czech Republic says it will release an app after Easter. Britain, Germany and Italy are also developing their own tracing tools.

No such apps have yet been announced in the United States, but Governor Gavin Newsom of California said Friday that state officials have been in touch with the companies as they look ahead at how to reopen and lift stay-at-home orders.


Surgeon general under fire for telling African Americans not to smoke, drink or take drugs and 'highly offensive' use of 'big momma' as coronavirus pandemic hits black community hardest

Surgeon General Jerome Adams has been met with outrage by the black community for using phrases like 'abuela', 'big momma' and 'poppop', while pleading for minorities to not drink or smoke and follow the government's guidelines to slow the spread of the coronavirus .
'We need you to do this if not for yourself than for your abuela. Do it for your granddaddy, do it for your big momma, do it for your poppop,' the nation's top doctor said Friday at the daily coronavirus taskforce briefing - while also advising those groups to 'avoid alcohol, tobacco and drugs.'

Adams told Americans of color that they need to 'step up' to stop the spread of coronavirus, and said 'social ills' are likely a contributing factor when looking at the dire statistics that the outbreak has killed twice as many black and Latino people than white Americans.

Now members of the black community are calling out the Surgeon General for 'pandering' to them with his use of slang and also for his 'offensive' instruction that those specific communities to stop drinking and smoking during this pandemic.



Surgeon General Jerome Adams asked members of communities of color in the United States to follow the White House guidelines, imploring them to 'do it for your granddaddy, do it for your big momma, do it for your poppop'


The surgeon general talked about some of the dire statistics that show black and Latino Americans are dying twice as much of coronavirus complications than their white peers

TV host and actress Claudia Jordan took to Twitter to express her outrage at Adams' comments.

'The surgeon general telling black folks not to drink and smoke and do it for ya "paa paa and big momma". Where they get this guy from? How dumb do they think we are with this? How bout suggesting that EVERYONE cut back? Let's not do that ok?' Jordan said.

One man on Twitter, David DeLoatch, said: 'Let me tell a lot of you something, we don't talk the way movies, songs, and the media portrays us. The Surgeon General is trying to relate to a life he never lived, listen to his voice and they way he speaks. He has never called anyone "big momma," and neither have I.'

Other questioned why Adams' word choice, writing: 'As if people wouldn't understand him if he said, "Do it for your grandparents"?'

Some bashed him for using 'stereotypical ethnic names for our relative'.

And activist Blaine Hardaway wrote: 'I really would like to say I'm surprised but of course I'm not. Trump sent the only black guy on his team out to chastise black and Latino people for smoking and drinking, as if that's the reason our communities are predisposed to this virus. Just disgusting.'

Adams was met with immediate push back for his comments later in the briefing when PBS NewsHour's Yamiche Alcindor asked him to respond to those who might have been offended by his colloquialisms.

'We need targeted outreach to the African-American community and I used the language that is used in my family,' Adams said. 'I have a Puerto Rican brother-in-law, I call my granddaddy "granddaddy" I have relatives who call their grandparents big momma.'

'That was not meant to be offensive,' he added. 'That's the language that we use and I use and we need to continue to target our outreach to those communities.'

Alcindor also pressed Adams on why he mentioned drugs and alcohol, when talking specifically about communities of color.

'All Americans need to avoid these substances at all times,' he said.



TV host and actress Claudia Jordan took to Twitter to express her outrage at Adams' comments


Adams was met with immediate push back for his comment later in the briefing by PBS News Hour's Yamiche Alcindor



Activist Blaine Hardaway wrote: 'I really would like to say I'm surprised but of course I'm not




Other questioned why Adams didn't choose the word 'grandparents' instead, writing: 'As if people wouldn't understand him if he said, "Do it for your grandparents"?'



Members of the black community are calling out the Surgeon General for 'pandering' to them and his 'offensive' instruction to stop drinking and smoking during this pandemic



Some bashed him for using 'stereotypical ethnic names for our relative'



One man David Deloatch said the Surgeon General is 'trying to relate to a life he never lived'

On Wednesday, New York released data that showed black and Latino people were twice as likely to die from coronavirus than white residents.

Similar figures are popping up around the country including in Chicago where 70 per cent of the deaths have been black people, who only make up 30 per cent of the population.

In Louisiana, with New Orleans being another hot spot, 70 per cent of the dead have been black. Black people only make up 32 per cent of residents in the state.

'Everywhere we look, the coronavirus is devastating our communities,' said Derrick Johnson, president and CEO of the NAACP.

Johnson and other black leaders, including Rev. Jesse Jackson, were on a call Friday with Vice President Mike Pence, who is leading the White House's coronavirus taskforce, and Adams, who took over the briefing room podium to discuss the call and the numbers.

'So what's going on?' he said. 'Well it's alarming, but it's not surprising that people of color have a greater burden of chronic health conditions.'

Among those are high blood pressure, which Adams said African-Americans and Native Americans see at a much younger age than their white counterparts.

'Puerto Ricans have higher rates of asthma and black boys are three times as likely to die of asthma than their white counterparts,' Adams said.

PBS NewsHour's Yamiche Alcindor asked Adams to respond to those who might have been offended by his colloquialisms during the briefing


Crosses are seen outside of a church, as each cross represents one life lost to coronavirus disease (COVID-19) in the state of Louisiana, in Baton Rouge, Louisiana U.S, April 10

Adams then pulled out his own red inhaler, used to open the airwaves during an asthma attack.

'As a matter of fact, I've been carrying an inhaler in my pocket for 40 years out of fear of having a fatal asthma attack,' said Adams, who is black. 'And I hope that showing you this inhaler shows little kids with asthma all across the country that they can grow up to be Surgeon General one day.'

'But I more immediately share it so that everyone knows it doesn't matter if you look fit, if you look young, you are still at risk for getting and spreading and dying from coronavirus,' he warned.

Adams said the 'chronic burden of medical ills' among Americans of color is making those communities less resilient to the 'ravages' of COVID-19.

'And it's possible, in fact likely that the burden of social ills is also contributing,' he remarked.

He mentioned trends like fewer people of color having jobs where they can work from home. He also pointed to housing trends - where many Americans of color live in urban, and thus more densely-packed, places and have multi-generational living arrangements.

'We tell people to wash their hands, but a study shows that 30 per cent of homes on Navaho nation don't have running water, so how are they going to do that?' he asked.

The takeaway, Adams said, was that 'people of color experience both more likely exposure to COVID-19 and increased complications from it.'

Adams was asked later in the briefing if he should have used language like 'big momma' and brought up alcohol and drug use when speaking about communities of color

'But let me be crystal clear, we do not think people of color are biologically or genetically predisposed to get COVID-19, there is nothing inherently wrong with you,' he said. 'But they are socially pre-disposed to coronavirus exposure and have a higher incidence of the very diseases that put you at risk for severe complications of coronavirus.'

Adams then encouraged members of those communities to follow the guidelines of social distancing, mask-wearing and hand-washing strictly.

'Wash your hands more often than you ever dreamed possible,' he said. 'Avoid alcohol, tobacco and drugs,' he advised.

'And call your friends and family, check in on your mother, she wants to hear from you right now,' Adams said.

And with the mention of mothers, Adams listed nicknames for Spanish grandmothers and black moms.

Read more:
He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus - The New York Times

Trump IGNORED National Security Council's coronavirus warning and its push for social

Here's why top officials are concerned about the coronavirus' growing racial gap
Anjalee KhemlaniSenior Reporter,Yahoo Finance•April 11, 2020


The coronavirus pandemic hammering the global economy is taking a hefty toll on people of color in the United States — a disturbing trend that’s being addressed more frequently by officials at the highest levels of government.

The world’s largest economy is grappling with over 500,000 diagnosed COVID-19 infections and a death toll over 18,000 — close to Italy’s, the world’s largest cluster of coronavirus-related deaths.

To be certain, the virus has cut an indiscriminate swath across the globe, affecting the working and white-collar classes, politicians and celebrities alike. Yet in recent days, President Donald Trump, U.S. Surgeon General Jerome Adams and National Institute of Allergy and Infectious Disease director Anthony Fauci have all addressed the pandemic’s growing racial disparity.

As Trump vowed this week that the U.S. was “doing everything in our power to address this challenge,” New York Governor Andrew Cuomo also pledged to boost testing for African Americans in the hard-hit Empire State, the nation’s epicenter of COVID-19 diagnoses. Still, it was unclear how officials plan to stem the pandemic’s rising tide of non-white casualties.

In a press conference on Friday, Adams said known health predispositions that have dogged black, Latino and Native American populations historically. Among other ailments, asthma, high blood pressure and obesity all exacerbate COVID-19’s effects.

Adams explained that people of color were not biologically or genetically inclined to be infected by the coronavirus. However, he pointed to Milwaukee County, where blacks are 25% of the population but almost 50% of the cases and 75% of the deaths.

“It’s alarming, but it’s not surprising that people of color have a greater burden of chronic conditions,” the nation’s top medical officer said — holding up his own asthma inhaler as proof.

“People of color are more likely to live in densely packed areas and in multi-generational housing...which create higher risk for spread of a highly contagious disease like COVID-19,” Adams added.

Separately, NIAID’s Fauci also addressed the issue this week, noting that when people of color get infected “their underlying medical conditions — the diabetes, the hypertension, the obesity, the asthma — those are the kind of things that wind them up in the ICU and ultimately give them a higher death rate,” he said

Experts point out that longstanding social disparities are at heart of the virus’ rising casualty count. For example, officials have been pushing citizens to wash their hands frequently — but Adams pointed out that some Native American reservations lack running water.

According to a recent report from the Centers for Disease Control, blacks are being “disproportionately affected by COVID-19.” The data showed that 33% of those hospitalized are black, a rate that outstrips their relative population size.

Those socioeconomic barriers are also exacerbating health care disparities. “Social distancing and tele-work are critical...yet only one in five African-Americans and one in six Hispanic Americans has a job that lets them work from home,” the Surgeon General said on Friday.

It’s what Michellene Davis, executive vice president of RWJBarnabas Health — one of the largest health systems in New Jersey — described to Yahoo Finance as “folks who don’t have the ability to stay home are stocking your shelves and delivering your packages.”

Other health experts like Dr. Michael Williams, a surgeon at University of Virginia Health in Charlottesville, didn’t find the current COVID-19 trends surprising.

Among those dying, the definition of underlying health conditions “describes the vast majority of African Americans, particularly those who live anywhere below wealthy.
The demographics of a troubling trend

 
Photo by: John Nacion/STAR MAX/IPx 2020 4/10/20
 Life amidst the cornonavirus in New York City. Empty subway cars


As the crisis gathers momentum, data show that non-whites are contracting — and dying — from the coronavirus at higher rates than their counterparts, with many of the hardest hit living in poverty.

Recently, Yahoo Finance analyzed several neighborhoods with some of the highest rates of coronavirus in the country, underscoring how race, class and ethnicity are playing a combustible mix in the current outbreak.

In New York City, there are currently over 5,100 coronavirus fatalities, with Queens County being the hardest hit. More than 1,600 residents of the borough have died; in the ironically-named Corona neighborhood, nearly 78% of those tested had the virus. More than 60% of Corona residents are not white, and a fifth live below the poverty line, Census data shows.

Meanwhile, Michigan and Illinois have also taken a battering from the virus. In the Great Lakes State, Wayne (which includes the city of Detroit) and Oakland Counties have the highest COVID-19 cases. numbers have been the hardest hit counties in the state.

And with the highest number of residents testing positive for the coronavirus, Detroit is also 79% black, and more than a third of its residents live in poverty, according to 2018 Census Bureau data.

In neighboring Oakland county, communities of color are suffering from the highest infection rates. Southfield, Michigan has the highest number of positive cases in the county, where more than 70% of the residents are black. Over 10% of the population in Southfield lives in poverty, compared to just 2% for Southfield township.

In Illinois, Cook County — including the city of Chicago — has contributed the most to the state’s growing COVID-19 case count. African Americans there have a rate of 332 positive cases of the virus for every 100,000 people, far greater than just 92 for whites and 108 among Asians. And in Chicago, black residents comprise more than half of all the positive cases — more than double the percentage of positive cases among whites in the city.

Disparities abound


Along with underlying conditions, communities of color have long struggled with disparate levels of access and utilization of care, compared to their white counterparts.

“Disparities in teen birth rates, infant mortality rates, and HIV or AIDS diagnosis and death rates were particularly striking for Blacks, Hispanics, and AIANs [Native Americans],” a study from the Kaiser Family Foundation (KFF) found.

And like African Americans, Hispanics have also been overrepresented in the death toll numbers. In New York City, the Hispanic death rate is 34%, despite making up only 29% of the city’s population. That’s higher than the 27% fatality of whites living in the city.

Only a few states break down coronavirus deaths by race, but in areas where such information is available, black death rates are sometimes well over 100% that of whites.

In both Illinois and Michigan, death rates for blacks were at least 40%, well below that of whites. The trend was most striking in Louisiana, where fatalities among blacks stood at a whopping 70.5% compared to 28.6% of whites, and in Washington, D.C. There, the African-American COVID-19 death rate checked in at 59%, compared to 18% for whites.

In addition, communities of color are more likely to be uninsured than that of their white counterparts, data shows, and suffer from disparities in care. The KFF found that 11% of blacks are uninsured, while just under 20% also lack health insurance. That compared to 8% of whites.




Access problems

Underpinning the racial disparity of the current crisis is the hot-button study of social determinants of health— the idea that a job and income, access to food and zip code all play a role in a person’s health.

In recent years, hospitals and health insurers have rolled out a number of programs to try and address shortfalls in food and housing. Yet as Newark Mayor Ras Baraka recently told Yahoo Finance, the system is frequently overwhelmed by people using emergency rooms “as their primary care physician.”

Minorities without access to a car have to rely on public transportation —where service is now drastically reduced — and are unlikely to be able to afford a ride-sharing service, which is also harder to find amid the outbreak, according to Daniel Dawes, a professor of health law and policy at the Morehouse School of Medicine.

He told Yahoo Finance that over the years, living in industrial or urban zones has resulted in increased exposure to pollution while curbing access to fresh food. In addition, minorities disproportionately have lower-income jobs.

“COVID19 doesn’t discriminate. But our economic and social policies do,” Dawes said. “Folks need to get that into their heads. We know that history has already shown us who is going to go without.”

Those factors also serve as barriers to accessing drive-through testing sites opening up around the country. Mobile testing sites and increased testing for younger African-Americans could have helped in slowing the death rate in the community, RWJ Barnabas’ Davis said.

Additionally, “these individuals have asthma (or other co-morbidities) because they live in higher population density where environmental injustices played a role. We’ve seen it in Flint [Michigan]. The evidence is sound and we’ve seen this play out historically,” Davis added.
           ---30---
Is France’s president fueling the hype over an unproven coronavirus treatment? 

Didier Raoult has complained about the “dictatorship of the methodologists” 
who insist on randomization and control groups in clinical trials.
MOURA/ANDBZ/ABACA/SIPA VIA AP IMAGES


OMG HE LOOKS LIKE TRUMPS DOCTOR WHO GIVE HIM 
A CLEAR BILL OF HEALTH FOR THE 2016 ELECTION



By Yves Sciama Apr. 9, 2020
Science’s COVID-19 reporting is supported by the Pulitzer Center.

The highly politicized debate about the use of chloroquine and hydroxychloroquine, two antimalarial drugs, to treat COVID-19 has reached an extreme in France, where two small trials purporting to show potential benefit were done. French physicians have come under enormous pressure from desperate patients to prescribe hydroxychloroquine, despite scant evidence that it works, and 460,000 people have already signed a petition to make it more widely available. Leading the advocacy is a controversial and politically well-connected figure, microbiologist Didier Raoult.

Today his profile rose even higher, as French President Emmanuel Macron traveled to Marseille to meet Raoult, a hospital director and researcher who led the two trials. Macron did not comment after the meeting, but the rendezvous, initiated by Macron, was a clear sign of Raoult’s newfound political clout. Jean-Paul Hamon, president of the Federation of Doctors of France, one of many scientists and doctors critical of the meeting, called it “showbiz politics.”

A survey released by French polling institute IFOP on 6 April revealed that 59% of the French population believes chloroquine is effective against the new coronavirus. Confidence in the drugs is higher on the far right and far left, and reached 80% among sympathizers of the “yellow vest” movement that staged massive protests against Macron’s economic policy in 2018 and 2019. Support is also very high, at 74%, in the Marseille region.

Karine Lacombe, head of infectious diseases at the Saint Antoine Hospital in Paris, has said on French TV that she and her team have received repeated “physical threats” for refusing to prescribe chloroquine; she said she has also seen many falsified prescriptions for the drug. Other doctors have reported similar experiences. The pressure comes on top of the stress caused by shortages of protective equipment, diagnostic tests, and medical staff.

The popular faith in hydroxychloroquine stands in stark contrast to the weakness of the
data. Several studies of its efficacy against COVID-19 have delivered an equivocal or negative verdict, and it can have significant side effects, including heart arrhythmias. Raoult’s positive studies have been widely criticized for their limitations and methodological issues. The first included only 42 patients, and Raoult chose who received the drug or a placebo, a no-no in clinical research; the International Society of Antimicrobial Chemotherapy has distanced itself from the paper, published in the society’s International Journal of Antimicrobial Agents. The second study, published as a preprint without peer review, didn’t have a control group at all.

Raoult has dismissed the criticism and complained about the “dictatorship of the methodologists” who insist on randomization and control groups in clinical trials. In his hospital, every patient diagnosed with COVID-19 receives hydroxychloroquine combined with azithromycin, an antibiotic. Raoult claims this has resulted in a very low death rate, which he says he will document soon in a publication.

His advocacy has made him a kind of medical prophet whose work is discussed incessantly in news outlets and on social media. His political connections have amplified his influence. Former conservative industry minister and Nice Mayor Christian Estrosi, a personal friend of Raoult’s, recently appeared on TV after recovering from COVID-19 and told viewers he was “convinced” the combination of hydroxychloroquine and azithromycin cured him.

Raoult has also found some high-level support in the medical world. The online petition in support of hydroxychloroquine was started by cardiologist and former Minister of Health Philippe Douste-Blazy—France’s candidate to lead the World Health Organization in 2017—and Christian Perronne, head of infectious diseases at the renowned Raymond Poincaré University Hospital in Garches, near Paris. Ten other prominent figures from the medical community, including two members of the Academy of Medicine, co-signed the petition, which demands hydroxychloroquine be authorized for mild cases in hospital settings. (Current regulations, which Raoult ignores, allow the drug to be used only for severe cases of COVID-19.)

In the conservative newspaper Le Figaro, three prominent retired oncologists argued that “all patients tested positive for COVID-19 and not included in a clinical trial” should receive the hydroxychloroquine-azithromycin combo.

The French Ministry of Health has been “incredibly rigid” and has “diabolized” hydroxychloroquine, Perronne tells ScienceInsider. He says there is considerable—though “imperfect and often unpublished”—evidence that the drug has benefits, and he believes its side effects are rare and easy to avoid. Perronne says he has refused to enroll patients in a randomized trial of hydroxychloroquine because a placebo group would be “unethical” for a fatal disease. Instead, he recently decided to give the drug to all patients except the mildest cases.

But many scientists in France are outraged that a potentially harmful drug can be widely used with so little evidence for its efficacy. The fervor also makes it harder to test the drug in a rigorous fashion.

Discovery, a randomized trial launched in at least seven European countries to study the efficacy of hydroxychloroquine and several other treatments, is struggling to recruit participants in France, says Jean-François Bergmann, a former head of infectious disease at the Saint Louis Hospital in Paris. (Macron has met with Discovery’s leaders as well.) “In some hospitals, four out of five patients are declining to take part and refuse any treatment but hydroxychloroquine,” Bergmann says, adding that France is witnessing a form of “medical populism” that is “slowing the emergence of the truth.”

Correction, 10 April, 8:10 a.m.: A previous version of this story said the Discovery trial is double-blinded; it is not.
doi:10.1126/science.abc1786
Some Patients Really Need the Drug That Trump Keeps
Pushing

When he touts hydroxychloroquine as a COVID-19 treatment, shortages endanger those of us who already take it.


Maya L. Harris Civil-rights advocate and lawyer in San Francisco
THE ATLANTIC APRIL 12, 2020

One morning during my last semester in college, I woke up with a strange rash on my face. When it didn’t go away after exhausting a tube of over-the-counter cortisone, my mother persuaded me to see a doctor. The diagnosis was lupus: a life-changing autoimmune disease in which the body literally attacks itself. The physical effects of the disease are cruel, including excruciating joint pain, organ damage, dramatic hair loss, and debilitating fatigue—most of which I have experienced again and again, often for long stretches, throughout my life. And while lupus can be managed, it has no cure.

For three decades, I kept this private and spoke of my condition only with my family and a handful of close friends. I had no intention of changing that until the coronavirus changed everything.

Millions of Americans find themselves vulnerable to COVID-19 because of underlying health challenges, but this pandemic has unearthed particularly deep fractures along our nation’s racial and gender fault lines. This is especially true of lupus. Roughly 1.5 million Americans live with lupus, and we are overwhelmingly female and disproportionately black or brown. For black women like me, lupus tends to take hold at a younger age with more serious, life-threatening consequences. For us, the coronavirus could very well be a death sentence.

Worse still, the pandemic is amplifying the inequities of the health system in tragic ways. For instance: when the president of the United States decided to hype—as a coronavirus treatment—the primary medication used for controlling lupus, he put an already disadvantaged group of patients in even greater jeopardy.

Not long ago, Donald Trump started talking and tweeting about hydroxychloroquine, which I have taken for most of my adult life, as if it were a miracle drug—a “game changer” for treating COVID-19, the president insists. Immediately, thousands of people began hoarding it, causing shortages that have resulted in lupus patients—and their doctors—struggling to get the supply they need. The more Trump pushed the unproven remedy from the White House podium, the more I wondered: Did he not care that the Food and Drug Administration hadn’t approved the drug for COVID-19? Was he that desperate to contain a crisis of his own making?

Trump has even said that people should consider taking hydroxychloroquine preventively. Talking about the drug during a recent briefing, he asked again and again: “What do you have to lose?” But for a president to casually invite Americans to self-medicate is harmful and potentially deadly. And if the supply shortages continue, those of us whose well-being depends on the drug have plenty to lose.

Even on a good day, lupus extracts a physical and emotional toll. There is always the looming possibility that a flare-up could leave you bedridden and racked with pain, and often the only relief comes from this essential medication. Unnecessary shortages caused by false medical narratives peddled from the nation’s highest office not only create fear and anxiety in those who desperately need hydroxychloroquine, but also engender false hopes in those who hoard the drug but might derive no benefit at all from it.


Experts such as Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, have urged caution, pointing out that hydroxychloroquine is unproven against coronavirus and that there’s “only anecdotal evidence” it can be effective. The experience in other countries has been negative to neutral at best. Yet the U.S. government is stockpiling 29 million doses of the drug anyway—and not out of concern for patients with lupus. 

Having spent my career as a civil-rights advocate, I’m acutely aware that the people most affected by the hydroxychloroquine drug shortages live in communities or belong to demographic groups that are among the most vulnerable, even in the absence of a pandemic. Black Americans suffer higher rates of not only lupus but a host of other chronic conditions such as diabetes, asthma, and hypertension, making them more susceptible to the coronavirus. This is compounded by structural inequalities that have denied too many black people access to adequate health insurance, employment, housing, and transportation—all keys to high-quality health care in this country.

In addition, for years, racial bias has infected the way medical care is delivered to black patients, whether children or adults, from diagnosis to treatment. Research has supported the growing recognition that medical professionals have too often dismissed black patients’ reported symptoms, such as pregnancy complications and pain. The coronavirus is raising questions anew about such bias, amid stories about black women who have been turned away from hospitals despite displaying severe COVID-19 symptoms.

Because of these and other factors, medical professionals have been warning—for weeks—that the coronavirus would hit the black community especially hard. And now the experts’ worst fears are coming true.

One day, generations will recall with shame and outrage how the federal government foresaw but failed to prevent this unfolding human tragedy. While President Trump continues to make unfounded claims about hydroxychloroquine, others in positions of responsibility—doctors, hospital administrators, and state and local officials—can take steps to ensure access to vital medications for those who need them. For example, the Ohio and Nevada Boards of Pharmacy have limited how much hydroxychloroquine can be prescribed for certain cases—and banned pharmacists from selling it for preventive use.

Even if people with lupus can get hydroxychloroquine, the broader injustices revealed—and reinforced—by the pandemic will remain. For that reason, authorities need to collect more and better data about how the coronavirus is affecting communities of color. A range of other steps—from vastly expanding our mobile-clinic capacity, to targeted outreach, education, and testing—would also help overcome years of disinvestment and bias in the medical-delivery systems on which people of color depend.

These measures are not aspirational. They will save lives now—which is more than can be said for Trump’s false narratives about a miracle drug.


MAY 1 GENERAL STRIKE NO RETURN TO WORK!




Former FDA leaders decry emergency authorization of malaria drugs for coronavirus 


After U.S. President Donald Trump advocated widespread use of two malaria drugs for COVID-19 patients, the Food and Drug Administration, led by Commissioner Stephen Hahn (left) produced an emergency use authorization for the medications.YURI GRIPAS/ABACA/SIPA VIA AP IMAGES

By Charles Piller Apr. 7, 2020 , 6:20 PM


Science’s COVID-19 reporting is supported by the Pulitzer Center.

The recent Food and Drug Administration (FDA) emergency use authorization (EUA) for two malaria drugs to treat COVID-19, based on thin evidence of efficacy, has jeopardized research to learn the drugs’ real value against the pandemic coronavirus, say former agency executives under President Donald Trump and former President Barack Obama. They also charge that the 28 March EUA for chloroquine phosphate and hydroxychloroquine sulfate undermines FDA’s scientific authority because it appeared to be a response not to scientific evidence, but to fervent advocacy of the drugs by Trump and other political figures.
FDA has multiple mechanisms to allow the use of unapproved, experimental drugs for small numbers of desperately ill patients outside of clinical trials. Because chloroquine and hydroxychloroquine are approved for malaria, doctors could prescribe them “off label” for COVID-19 patients even without the EUA. Since Trump first endorsed the drugs on 19 March, however, shortages have been reported, depriving some people with autoimmune disorders such as lupus who also depend on hydroxychloroquine. The EUA will immediately add tens of millions of doses of the drugs for distribution to hospitalized COVID-19 patients through health care centers.


Related

Unprecedented nationwide blood studies seek to track U.S. coronavirus spread


Trump has suggested the EUA was needed because effective clinical trials of the drugs would take too long during the global crisis. At a 5 April news conference, he said: “We don’t have time to go and say, ‘Gee, let’s take a couple of years and test it out, and let’s go and test with the test tubes and the laboratories.’”


“I’d love to do that, but we have people dying today,” he added.


Scott Gottlieb, FDA commissioner under Trump until last year, has consistently called for more research on the efficacy of hydroxychloroquine, with or without the antibiotic azithromycin. “If the drug combo is working its effect is probably subtle enough that only rigorous and large-scale trials will tease it out,” he tweeted on 5 April.

Margaret Hamburg, FDA commissioner during most of Obama’s tenure, including the H1N1, Zika, and Ebola crises, says she was “surprised and perturbed” by the EUA. “I understand the desire to find hope, but we need more evidence than is currently available before we encourage widespread use,” says Hamburg, who is a past president of AAAS, which publishes ScienceInsider. Valuable clinical trial evidence on the two malaria drugs could be gathered in a few weeks, Hamburg adds—but the EUA could make that more difficult. “Making the drugs available in a more widespread way might actually interfere with the ability to get the data that we need.”


Since 2005, FDA has issued EUAs more than 100 times, mostly for diagnostic tests to detect emerging pathogens, including 34 such authorizations for tests for the novel coronavirus that causes COVID-19. (Here’s a table of all EUAs.) The recent authorizations for the use of chloroquine and hydroxychloroquine, based on what FDA cited as “limited in-vitro and anecdotal clinical data in case series,” and Chinese and South Korean COVID-19 treatment guidelines, fell below earlier standards for therapeutic EUAs, Hamburg and others say. In contrast, the European Medicines Agency called for use of the drugs only in clinical trials or for emergency use as defined by each nation’s policies.

The only comparable EUAs—an antibiotic to treat anthrax in 2011 and antiviral drugs to treat the pandemic H1N1 influenza virus in 2009—enjoyed far stronger evidence of safety and efficacy, former FDA officials say. Even then, one of the drugs authorized for use on H1N1 turned out to be ineffective.

EUAs might prove crucial in the new pandemic, but only if credible, says Luciana Borio, a former FDA acting chief scientist who directed medical and biodefense preparedness for Trump’s National Security Council. “You want the EUA to be seen by the public as a step the government is taking to facilitate access to a product that they truly believe has benefits that outweigh the risks. Not, ‘We’re not sure,’” says Borio, who was part of a team set up under Obama to coordinate actions to fight pandemics that was eliminated by the Trump administration during a 2018 reorganization.

Making the drugs available in a more widespread way might actually interfere with the ability to get the data that we need.
Margaret Hamburg, former FDA commissioner

Although the World Health Organization last month deemed the two malaria drugs worthy of

being tested in rapidly organized global COVID-19 treatment trials, the push to use hydroxychloroquine—it’s considered a relatively safe form of chloroquine—on a mass scale in the United States came after a tweet from Trump. On 21 March, he said that when taken with azithromycin, the drug has “a real chance to be one of the biggest game changers in the history of medicine.” Trump cited a small French trial of 42 COVID-19 patients that has been criticized for lapses widely viewed as rendering its findings unreliable. Even the International Society of Antimicrobial Chemotherapy, publisher of the peer-reviewed journal that released the study, recently said it “does not meet the Society’s expected standard.”

FDA Commissioner Stephen Hahn initially tried to temper the president’s enthusiasm, calling for clinical trials as a first step at a 19 March news conference. Nine days later, with those trials ramping up, the EUA authorized health care centers to draw on the Strategic National Stockpile’s massive supply of the drugs for “treatment of COVID-19 when clinical trials are not available, or participation is not feasible.” FDA said that in the absence of approved or available alternatives for treating COVID-19, the drugs’ “known and potential benefits … outweigh the known and potential risks.”

FDA Chief Scientist Denise Hinton, who signed the EAU, did not respond to a request for comment. An FDA spokesperson wrote in an email that the EUA was not a response to Trump’s prodding. Instead, the spokesperson said, it was prepared by career staff who consulted with the relevant federal agencies, and was based on “studies in countries including China, Korea, and France.” Two small Chinese trials, which many infectious disease researchers and clinicians regard as more scientifically sound than the French study Trump tweeted about, reached opposite conclusions. In one, COVID-19 patients taking hydroxychloroquine had better outcomes, and in the other, those who received a placebo improved more. A second small French trial found hydroxychloroquine plus azithromycin ineffective for severely ill COVID-19 patients.

Borio, now a vice president at In-Q-Tel, a national security–oriented venture capital firm, adds that FDA, in issuing the EUA, also overlooked the drugs’ record against other viruses. She cites a “long history of having tried hydroxychloroquine as a treatment for emerging viral infections, and seeing it fail to help patients despite some activity in vitro and even in animal models.”

Impeding clinical trials

David Boulware, an infectious disease researcher at the University of Minnesota, Twin Cities, working on COVID-19 trials, suggests the EUA may impede testing of another potential COVID-19 treatment. He says colleagues working on a randomized, placebo-controlled, multisite trial of remdesivir, Gilead Sciences’s experimental antiviral drug, have encountered hospitalized COVID-19 patients who ask, “Do I want to get a placebo? I’m really sick and I can get hydroxychloroquine.” Some are opting out of the remdesivir study, Boulware says.

People say that the time to do these studies is not during a public health emergency—it’s too hard. Actually, that’s the best time, because with a crisis unfolding you have the greatest opportunity to learn about these products the quickest way, because of rapid enrollment.
Luciana Borio, former FDA acting chief scientist

Purposely or not, and despite skepticism from many doctors, FDA might have made hydroxychloroquine the de facto standard of care for COVID-19, he and others suggest. That could also undermine the COVID-19 trials of it and chloroquine. It’s too soon to know what the impact might be, researchers organizing those trials told ScienceInsider. But Peter Lurie, a physician and FDA executive under Obama and Trump who now heads the Center for Science in the Public Interest, a Washington, D.C., advocacy group, says the EUA weakens the incentive to sign up for a trial. “Why take a 50% chance of getting a placebo when you can be guaranteed to get a drug you’re hoping to get? Then you’re left in a situation where a drug is widely used and evidence of its effectiveness for this indication is never generated.”

With so many people dying from COVID-19, calling for more data before widespread use of the malaria drugs can be “a hard message,” Hamburg concedes. “People want to have a treatment available to them and their loved ones. But until [it’s] examined with some rigor, we won’t know whether this will work now, and it’s also making it hard to get answers for patients tomorrow and the future.”

Borio adds that proper trials need not take long. “People say that the time to do these studies is not during a public health emergency—it’s too hard. Actually, that’s the best time, because with a crisis unfolding you have the greatest opportunity to learn about these products the quickest way, because of rapid enrollment,” she says. “If it’s a blockbuster, we would know so quickly.”

FDA declined to comment specifically about trial enrollment concerns but said it is working with other federal agencies to plan clinical trials of the two drugs.
Risks rise when millions use a drug

Some FDA observers defend the agency by pointing out it has occasionally given full commercial approval to drugs based on relatively scant evidence, including a controversial treatment for Duchenne muscular dystrophy last year. Erika Lietzan of the University of Missouri School of Law, who studies food and drug regulation, cited Ceprotin—a biologic to treat patients with a genetically linked, life-threatening blood clotting problem—approved by FDA in 2007 based on a nonrandomized trial of only 18 subjects.

But the rare diseases addressed by those FDA actions affect few people compared with COVID-19. When FDA endorses a drug with known, life-threatening side effects for use by millions of hospitalized people to treat a poorly understood condition, the potential for harm rises exponentially, Lurie and others warn.

“What is quite certain: When you get large numbers of people exposed to [hydroxychloroquine], there will be important adverse effects,” including sometimes-lethal cardiac toxicity, Lurie says. “That can be acceptable in the setting of known benefits, but it’s more difficult to accept when there isn’t now and might never be evidence of benefit.”

“The idea that we have nothing to lose by trying anything with the smallest glimmer of hope is terribly misguided,” adds Patricia Zettler, a law professor at Ohio State University, Columbus, and former FDA associate chief counsel under Obama. “As a society, we risk losing the opportunity to understand what actually works, and what doesn’t.”

Another safety concern emerged on 20 March, when FDA lifted its import restrictions on Ipca Laboratories, a leading Indian maker of the drugs. FDA has repeatedly cited the company for manufacturing lapses, most recently in a scathing inspection report in August 2019. The agency told ScienceInsider the reprieve was only for the malaria drugs, to meet surging U.S. demand. It said the firm “agreed to perform additional quality mitigation steps” for the drugs.

“Ipca had data integrity issues and cascading failures in quality control,” says Hamburg, who led FDA when the firm was cited for such problems in 2014. “That signals to me that it’s probably not a drug we want from that supplier.”
Dangerous precedent?

FDA watchers also wonder how the agency will respond to the next remedy supported by anecdotal reports when facing public fears about a growing death toll and presidential pressure. There is no shortage of candidates—including zinc, remdesivir, the Japanese flu drug favipiravir (branded as Avigan), and a stem cell product touted by Trump attorney Rudy Giuliani. FDA said that by law, it “generally cannot confirm, deny, or comment” about such prospects, and “will not speculate” on future EUAs; it has, however, already approved the testing of the stem cell product in a clinical trial of COVID-19 patients.

“When the evidence base for granting the EUA is as flimsy as this, the question becomes, ‘Whose EUA will not be granted, especially in the context of an epidemic?’” Lurie says. “What happens when the epidemic is not [historically] bad, when it’s just a bad season of the flu?”

And Hamburg says she fears that with its EUA, FDA has taken “a step away from scientific rigor, to a system that is much more subject to all kinds of interference, from wishful thinking to frank political and economic motivations.”

doi:10.1126/science.abc1337

Charles Piller is a contributing correspondent based in Oakland, California.
‘This is insane!’ Many scientists lament Trump’s embrace of risky malaria drugs for coronavirus 


A Chinese pharmaceutical company employee checks the creation of chloroquine phosphate, an old malaria treatment being touted for COVID-19; the company resumed its production last month after a 15-year break. FEATURE CHINA VIA AP IMAGES

By Charles Piller Mar. 26, 2020 


When President Donald Trump recently touted the common malaria treatments hydroxychloroquine and chloroquine as potential remedies for coronavirus disease 2019 (COVID-19), he ignited unprecedented demand for the drugs—and set scientists’ teeth on edge. Although the World Health Organization (WHO) agrees the compounds are worth testing more fully on the pandemic coronavirus, few drug or infectious disease experts—not even the president’s own advisers—share his optimism that the drugs could become “one of the biggest game changers in the history of medicine,” as he tweeted. And many are critical of the small French clinical study of just 42 patients that seems to have touched off most of the excitement.

“The president was talking about hope,” Anthony Fauci, director of National Institute of Allergy and Infectious Diseases, said diplomatically at one of the White House briefings where Trump praised the drugs’ potential.

thers are less diplomatic. Darren Dahly, a co-author of one of several critiques of the initial study and a principal statistician at the University College Cork School of Public Health, said it would be “egregious” to recommend treatments for millions of people based on such a small trial, regardless of its quality. “This is insane!” tweeted Gaetan Burgio, an Australian National University expert on drug resistance, noting what he sees as lapses in the 6-day trial, including inconsistent testing of virus levels in the patients.


Related


The new coronavirus is finally slamming Russia. Is the country ready?

How diseases rise and fall with the seasons—and what it could mean for coronavirus

To Dahly and others, only much larger, better studies such as one WHO has just started can show whether any optimism about the compounds is warranted. “The best way to know whether a medication for COVID-19 is effective is through a high-quality clinical trial,” says Joshua Sharfstein, a vice dean at Johns Hopkins University’s Bloomberg School of Public Health and a former principal deputy Food and Drug Administration commissioner. “Efforts to widely distribute unproven treatments are misguided at best and dangerous at worst.”

Such cautions were buried under an avalanche of demand for hydroxychloroquine, also sold under the brand name Plaquenil, and chloroquine, as doctors rushed to prescribe one or the other for confirmed or possible COVID-19 infections. Among the immediate consequences:
Shortages of the drug are endangering patients who need it for lupus or rheumatoid arthritis.
India, a major producer, has banned exports, and some doctors are hoarding both drugs by writing prescriptions for themselves or family members.
Deaths in Nigeria among people self-treating for apparent COVID-19 were attributed to chloroquine overdoses, and an Arizona man trying to avoid COVID-19 infection died after reportedly self-medicating with a toxic form of chloroquine used to clean fish tanks.
Brazilian President Jair Bolsonaro, a staunch Trump ally, ordered that nation’s military labs to ramp up production of chloroquine. Panic buying has ensued.

“Here in Brazil even good scientists are backing this, saying we should waive rigor in difficult times,” says Natalia Pasternak Taschner, a microbiologist at the University of São Paulo, São Paulo. “We should be even more rigorous lest we give people false hope and invest [limited] time and money on unwarranted claims.”

Although doctors regard hydroxychloroquine as relatively safe at prescribed doses for short periods, it has been associated with life-threatening cardiac side effects and suicidal behavior. “Given the toxicity of the drug, I’m afraid my government is going to kill people,” Taschner said.


Trump’s initial public remarks on the drug candidates at a 19 March briefing appeared to be based on anecdotal reports from China and the tiny French study, which Vanity Fair reports he learned of after Elon Musk tweeted about it and Fox News amplified the information. In that trial, the Mediterranean Infection University Hospital Institute (IHU) treated 26 COVID-19 patients with hydroxychloroquine alone, or combined with the antibiotic azithromycin. The authors reported “clearance”—no virus present in samples taken by nasopharyngeal swabs—in most of them, but continued infection in most of a 16-person control group of COVID-19 patients. The patients who received both drugs cleared the fastest, the researchers reported in a peer-reviewed paper in the International Journal of Antimicrobial Agents.

HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to

be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).....
— Donald J. Trump (@realDonaldTrump) March 21, 2020


Many scientists have criticized the French trial as riddled with enough methodological flaws to render its findings unreliable or misleading. Biostatisticians from the United Kingdom and Ireland cited a basic failure: Investigators didn’t randomize the groups—essential to ensuring dependable comparisons. They also noted that six of the treated patients were lost to the study, five of whom fared badly—one died, three entered intensive care, and one stopped treatment because of nausea. Yet they were dropped from the analysis, potentially skewing the outcome.

Elisabeth Bik, a scientific integrity consultant, wrote on her blog that for some patients supposedly helped by the treatments, daily tests for the presence of the coronavirus fluctuated between positive and negative, suggesting the virus might have persisted, just below the test’s detection threshold. Investigators should have confirmed viral clearance over two or three consecutive days, she said, particularly because the trial did not keep track of clinical indicators such as fever or shortness of breath. But the viral tests also ended after no more than 6 days total for all patients.

Bik and other researchers have raised questions about other aspects of the paper, including its peer review, noting the submission and acceptance dates suggest it was reviewed in less than 24 hours. One of the paper’s authors is also the journal’s editor-in-chief, which Bik says might be “perceived as a huge conflict of interest.”

“Let’s put our work into running some proper trials, and see if this effect holds up in well-conducted studies,” Dahly says.

One of the French study authors, Didier Raoult, a prominent researcher who heads IHU, released a statement on Monday in response to the criticisms. He said he would treat any COVID-19 patient with a combination of hydroxychloroquine and azithromycin immediately after diagnosis. (“Like any doctor, once a treatment has been shown to be effective, I find it immoral not to administer it. It’s as simple as that,” he told the French newspaper Libération.)

A clearer verdict may come from the WHO megatrial and two other major trials of hydroxychloroquine in different doses that have started at Columbia University and the University of Minnesota. New York Governor Andrew Cuomo announced that the state also will fast-track a trial of hydroxychloroquine plus azithromycin.

Yet evidence from pending studies will certainly lag massive off-label use of chloroquine and hydroxychloroquine given the presidential endorsement. Several major pharma companies announced production of nearly 200 million doses of the two drugs in coming weeks to fight the pandemic.

Vinay Prasad, a hematologist and oncologist at Oregon Health & Science University who studies evidence-based medicine, calls the rush to use the drugs unwise. “In times of epidemic, you want to prioritize manufacturing things that have been proven to work,” many of which are in short supply, he says. “Masks, gowns, ventilators. Have at it. Before ramping up the supply of pills, it’s best to know if the pills work.”


doi:10.1126/science.abb9021

LETTERS
Disinfection threatens aquatic ecosystems

Disinfectants used to combat the spread of COVID-19 will end up in the environment.

Hong Zhang1,4,*,
Wenzhong Tang1,4,
Yushun Chen2,4,
Wei Yin3
See all authors and affiliations

Science 10 Apr 2020:
Vol. 368, Issue 6487, pp. 146-147
DOI: 10.1126/science.abb8905
Article
PDF

PHOTO: NARAYAN MAHARJAN/NURPHOTO/GETTY IMAGES

In an effort to contain the spread of coronavirus disease 2019 (COVID-19), China has been applying chlorine disinfectants to both indoor and outdoor spaces. To minimize opportunities for the severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2)—the virus that causes COVID-19—to thrive, China has dispensed more than 5000 tons of disinfectants in Wuhan City alone (1). These chemicals can get into sewage systems and pollute drinking water resources (1). Both the direct runoff and indirect sewage effluents will eventually end up in lakes and rivers, putting aquatic ecosystems at risk (2).

Chlorine disinfectants threaten aquatic plants and wildlife in two ways. 
First, chlorine can directly harm organisms by destroying their cell walls or damaging their proteins by oxidation (2). Second, the chemicals in the disinfectants can bond with other materials to form harmful compounds. In surface water, dissolved organic matter is extremely high (3), which could allow the synthesis of disinfection by-products, such as trihalomethanes or haloacetic acids (2). These by-products have been shown to be very toxic to aquatic organisms (4). In addition, disinfectants could combine with nitrogen, forming chloramine or N-nitrosodimethylamine (5), both of which have been identified as carcinogens (6).

As COVID-19 spreads across the globe, the increased use of disinfectants could lead to worldwide secondary disasters in aquatic ecosystems. We appeal to the governments of China and other affected countries to conduct aquatic ecological integrity assessments (7) during and after the pandemic. This could save biodiversity and protect humans from future health threats stemming from polluted water.

http://www.sciencemag.org/about/science-licenses-journal-article-reuse
This is an article distributed under the terms of the Science Journals Default License.

References and Notes

China Ministry of Ecology and Environment, “Will viruses and disinfection affect water quality? 
The Ministry of Ecology and Environment responded” (2020);www.mee.gov.cn/ywgz/ssthjbh/dbssthjgl/202003/t20200311_768408.shtml [in Chinese].

D. L. Sedlak, U. von Gunten , Science 331, 42 (2011).

J. A. Leenheer , in Environmental Chemistry of Lakes and Reservoirs, L. A. Baker, Ed. (American Chemical Society, 1994), pp. 195–221.

J. Liu, X. Zhang , Water Res. 65, 64 (2014).

E. Bei et al ., Water Res. 98, 168 (2016).

S. Krytopoulos , Br. J. Cancer 40, 666 (1979).
J. R. Karr , Environ. Toxicol. Chem. 12, 1521 (1993).