1 00:00:02,759 --> 00:00:07,600 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day eighty nine 2 00:00:07,800 --> 00:00:12,360 Speaker 1: since coronavirus was declared a global pandemic. Our main story 3 00:00:13,039 --> 00:00:18,160 Speaker 1: the ongoing drama over hydroxy chloroquine. Studies have shown conflicting 4 00:00:18,239 --> 00:00:21,840 Speaker 1: information about the value of using hydroxy chloroquine to fight 5 00:00:21,920 --> 00:00:27,000 Speaker 1: the coronavirus. The flip flopping raises questions about not just 6 00:00:27,120 --> 00:00:31,120 Speaker 1: the drugs efficacy and safety, but also on the reliability 7 00:00:31,240 --> 00:00:36,680 Speaker 1: and accuracy of the scientific review process itself. But first, 8 00:00:37,640 --> 00:00:47,960 Speaker 1: here's what happened today. Transmission of the coronavirus by people 9 00:00:48,080 --> 00:00:53,040 Speaker 1: who aren't showing symptoms is quote very rare. The World 10 00:00:53,120 --> 00:00:57,960 Speaker 1: Health Organization said Monday that contradicts earlier speculation by public 11 00:00:57,960 --> 00:01:01,440 Speaker 1: health officials and researchers that disease was being spread by 12 00:01:01,480 --> 00:01:06,360 Speaker 1: people who weren't shown signs of illness. New York City 13 00:01:06,400 --> 00:01:09,800 Speaker 1: on Monday opened up non essential retail stores for the 14 00:01:09,880 --> 00:01:14,080 Speaker 1: first time in months. Governor Andrew Cuomo says a little 15 00:01:14,080 --> 00:01:17,160 Speaker 1: more than one percent of New Yorkers tested Sunday were 16 00:01:17,200 --> 00:01:21,120 Speaker 1: infected with the new coronavirus, the lowest rate since the 17 00:01:21,160 --> 00:01:25,880 Speaker 1: pandemic began. The UK death toll rose by fewer than 18 00:01:25,959 --> 00:01:30,000 Speaker 1: one hundred for the second straight day, and London reported 19 00:01:30,200 --> 00:01:34,319 Speaker 1: no new fatalities for the first time since its lockdown began. 20 00:01:36,760 --> 00:01:42,319 Speaker 1: But worldwide infections from the coronavirus surpassed seven million. That's 21 00:01:42,400 --> 00:01:45,200 Speaker 1: up by one million cases in just a little more 22 00:01:45,240 --> 00:01:49,240 Speaker 1: than a week. The surge is driven by hotspots including 23 00:01:49,280 --> 00:01:54,600 Speaker 1: Brazil and India. That worrisome trend adds weight to the 24 00:01:54,680 --> 00:01:59,280 Speaker 1: value of social distancing. A report showed that lockdowns and 25 00:01:59,400 --> 00:02:02,760 Speaker 1: other public health measures may have prevented about half a 26 00:02:02,880 --> 00:02:08,040 Speaker 1: billion infections in six countries, including China and the US, 27 00:02:15,240 --> 00:02:21,560 Speaker 1: And now our main story. Hydroxychloroquine is back in the news. 28 00:02:22,480 --> 00:02:25,880 Speaker 1: In the early days of the pandemic, the antimalarial drug 29 00:02:26,000 --> 00:02:29,440 Speaker 1: was touted by President Trump and some doctors as an 30 00:02:29,440 --> 00:02:34,440 Speaker 1: effective treatment for COVID nineteen, but the drug has largely 31 00:02:34,480 --> 00:02:39,280 Speaker 1: been discredited for use against the virus. Now the studies 32 00:02:39,480 --> 00:02:43,639 Speaker 1: dismissing the drug have also been thrown into doubt. So 33 00:02:43,760 --> 00:02:47,520 Speaker 1: what's the truth about this controversial drug? I spoke to 34 00:02:47,560 --> 00:02:51,440 Speaker 1: Bloomberg Health and Science reporters Michelle Cortes and Robert Langrath 35 00:02:51,760 --> 00:03:01,800 Speaker 1: for some answers. Thank you both for joining us UM 36 00:03:01,840 --> 00:03:03,840 Speaker 1: you know in the news. We have heard a lot 37 00:03:04,120 --> 00:03:07,880 Speaker 1: about this drug, hydroxy chloroquin in terms of whether or 38 00:03:07,919 --> 00:03:12,880 Speaker 1: not it can treat COVID nineteen, but we've also heard 39 00:03:12,880 --> 00:03:16,560 Speaker 1: that it's an actually antimalarial drug. Can you maybe walk 40 00:03:16,680 --> 00:03:20,640 Speaker 1: us through the narrative here about how this drug began 41 00:03:20,800 --> 00:03:25,680 Speaker 1: being touted as a potential treatment for COVID nineteen. When 42 00:03:25,840 --> 00:03:29,000 Speaker 1: coronavirus first started circulating around the world, we had nothing 43 00:03:29,360 --> 00:03:32,079 Speaker 1: for it at all. It was a brand new virus 44 00:03:32,120 --> 00:03:35,520 Speaker 1: and the entire world was a vulnerable So drug companies 45 00:03:35,600 --> 00:03:39,160 Speaker 1: and academic researchers started combing through all the evidence that 46 00:03:39,200 --> 00:03:41,760 Speaker 1: they had, looking at every type of drug. They looked 47 00:03:41,760 --> 00:03:45,080 Speaker 1: at antibiotics, they looked at other anti virals, they looked 48 00:03:45,080 --> 00:03:48,360 Speaker 1: at anti fungals, they looked at at immune system drugs, 49 00:03:48,400 --> 00:03:51,680 Speaker 1: they looked at everything. And in laboratory tests, it looks 50 00:03:51,760 --> 00:03:54,880 Speaker 1: like this drug actually makes it more difficult for the 51 00:03:54,960 --> 00:03:57,880 Speaker 1: virus to penetrate a healthy cell. And that's where it 52 00:03:57,880 --> 00:04:02,080 Speaker 1: all started. When we saw something that effectiveness, it was approved. 53 00:04:02,400 --> 00:04:06,240 Speaker 1: They believed that there was an acceptable amount of side 54 00:04:06,240 --> 00:04:10,400 Speaker 1: effect risk. They moved forward with it, and as hydroxy 55 00:04:10,440 --> 00:04:14,480 Speaker 1: chloroquine has been this new potential in terms of a 56 00:04:14,520 --> 00:04:18,760 Speaker 1: treatment for COVID nineteen. Obviously, we've seen many new reports 57 00:04:18,800 --> 00:04:22,760 Speaker 1: being issued, a lot of discussion about its efficacy, and 58 00:04:22,880 --> 00:04:25,239 Speaker 1: I was wondering if you might be able to explain 59 00:04:25,240 --> 00:04:28,680 Speaker 1: a little bit about some of these reports and some 60 00:04:28,800 --> 00:04:31,599 Speaker 1: of the conflicting evidence that we seem to be getting 61 00:04:31,600 --> 00:04:35,520 Speaker 1: from the reports about whether it is indeed defective. Very 62 00:04:35,560 --> 00:04:39,960 Speaker 1: early on, some researchers in France tested them the medicine 63 00:04:39,960 --> 00:04:42,479 Speaker 1: and patients, and they found that it dramatically lowered the 64 00:04:42,480 --> 00:04:46,080 Speaker 1: amount of virus in patients who are affected with coronavirus, 65 00:04:46,160 --> 00:04:49,359 Speaker 1: and so they believed that that would translate to a benefit. 66 00:04:49,400 --> 00:04:51,680 Speaker 1: If you have less virus in your body, you're likely 67 00:04:51,720 --> 00:04:54,719 Speaker 1: to have fewer symptoms and less likely to get deadly ill. 68 00:04:55,400 --> 00:04:58,080 Speaker 1: Then there were other smaller studies that were coming out. 69 00:04:58,440 --> 00:05:01,840 Speaker 1: There were anecdotal reports. A doctor said that they gave 70 00:05:01,839 --> 00:05:04,840 Speaker 1: the medicine to patients and within hours and days they 71 00:05:04,839 --> 00:05:08,880 Speaker 1: were getting miraculously better. The thing is, in these cases 72 00:05:09,320 --> 00:05:13,720 Speaker 1: they didn't have comparison patients, and most patients with coronavirus 73 00:05:13,760 --> 00:05:16,360 Speaker 1: do get better, so it wasn't clear whether or not 74 00:05:16,440 --> 00:05:19,160 Speaker 1: they were getting better because of this medicine or just 75 00:05:19,240 --> 00:05:21,640 Speaker 1: because of time and their bodies taking care of the virus. 76 00:05:22,520 --> 00:05:25,000 Speaker 1: And then what happened there was there's this giant study 77 00:05:25,000 --> 00:05:28,360 Speaker 1: he suddenly published a couple of weeks ago in the LANDSTUH, 78 00:05:28,680 --> 00:05:31,839 Speaker 1: a well known medical journal, and it was led lead 79 00:05:31,880 --> 00:05:36,560 Speaker 1: author was a you know, big name Harvard professor UH. 80 00:05:36,600 --> 00:05:38,599 Speaker 1: And it purported to do kind of the mother of 81 00:05:38,640 --> 00:05:42,400 Speaker 1: all data gatherings from around the world and UH. And 82 00:05:42,440 --> 00:05:47,359 Speaker 1: they purported to gather data from nine patients from around 83 00:05:47,400 --> 00:05:50,599 Speaker 1: the world on all continents, hundreds and hundreds of hospitals, 84 00:05:51,040 --> 00:05:55,400 Speaker 1: from all sorts of different electrotronic medical records UH providers 85 00:05:55,920 --> 00:05:58,760 Speaker 1: UH and combine them to one joint report of how 86 00:05:58,880 --> 00:06:01,520 Speaker 1: patients who got I draw c clorkin did. And it 87 00:06:01,640 --> 00:06:04,240 Speaker 1: said that not only was it not working, UH, it 88 00:06:04,360 --> 00:06:07,240 Speaker 1: was causing all sorts of harms, including increasing the risk 89 00:06:07,360 --> 00:06:09,599 Speaker 1: of heart disease and death. So what beyond that it 90 00:06:09,640 --> 00:06:12,800 Speaker 1: didn't work and said it was dangerous? And what was 91 00:06:12,839 --> 00:06:16,400 Speaker 1: the upshot of this study? This caused a great concern 92 00:06:16,520 --> 00:06:19,120 Speaker 1: and caused the Double World Health Organization to pause a 93 00:06:19,200 --> 00:06:24,040 Speaker 1: trial clinical trial hydroxychloricin UH that was going on. So 94 00:06:24,080 --> 00:06:27,359 Speaker 1: there's a very very big impact to this study. But 95 00:06:27,400 --> 00:06:31,320 Speaker 1: A problem with this study is that as data researchers 96 00:06:31,360 --> 00:06:36,360 Speaker 1: and kind of online sluice doctors and places around the 97 00:06:36,400 --> 00:06:39,560 Speaker 1: world and the internet started, Internet started looking more carefully 98 00:06:39,600 --> 00:06:42,080 Speaker 1: at the data behind this study. They found a large 99 00:06:42,120 --> 00:06:45,520 Speaker 1: number of inconsistenccies and red flags and things that just 100 00:06:45,760 --> 00:06:48,440 Speaker 1: didn't add up. And one of the most basic ones was, 101 00:06:48,480 --> 00:06:53,000 Speaker 1: how could uh this Uh, this small group of researchers 102 00:06:53,800 --> 00:06:56,320 Speaker 1: gather all this data on from so many hospitals and 103 00:06:56,360 --> 00:06:59,120 Speaker 1: around the world, with so many different privacy research privacy 104 00:06:59,240 --> 00:07:01,400 Speaker 1: laws and rules, and put it all together in such 105 00:07:01,400 --> 00:07:03,919 Speaker 1: a short period of time. Uh. And then it turned 106 00:07:03,920 --> 00:07:06,640 Speaker 1: out that the data all came from one tiny company 107 00:07:06,640 --> 00:07:08,719 Speaker 1: that nobody had ever heard of, called service Fare, that 108 00:07:08,800 --> 00:07:12,920 Speaker 1: was led by a vascular surgeon in Illinois with a 109 00:07:13,000 --> 00:07:16,280 Speaker 1: very few employees and very little up presence. Uh. It 110 00:07:16,440 --> 00:07:20,360 Speaker 1: just seemed highly implausible to outside researchers that this tiny 111 00:07:20,360 --> 00:07:22,440 Speaker 1: little company could have gathered all this that nobody had 112 00:07:22,480 --> 00:07:24,320 Speaker 1: ever heard of, could have just gathered all this data 113 00:07:24,360 --> 00:07:26,640 Speaker 1: in the midst of the pandemic and done such a 114 00:07:26,680 --> 00:07:29,440 Speaker 1: giant study so fast. But what else do we know 115 00:07:29,640 --> 00:07:33,040 Speaker 1: about this small company that otherwise we would never have 116 00:07:33,120 --> 00:07:37,080 Speaker 1: heard about? Yeah, we know very little about it. It's 117 00:07:37,160 --> 00:07:40,800 Speaker 1: very mysterious. It's very few employees are the main person associated, 118 00:07:40,800 --> 00:07:47,840 Speaker 1: which appears to be this vascular surgeon, Zapandasi, who Illinois 119 00:07:47,840 --> 00:07:51,480 Speaker 1: based vascular surgeon. Uh, but you know, we know very 120 00:07:51,480 --> 00:07:54,080 Speaker 1: little about the company. It's very mysterious. And so as 121 00:07:54,160 --> 00:07:57,800 Speaker 1: people started asking questions about this data, uh, the Harvard 122 00:07:57,800 --> 00:08:00,880 Speaker 1: researchers on the top researchers on the paper that his 123 00:08:00,960 --> 00:08:03,760 Speaker 1: collaborators went back and said, we need an independent audit 124 00:08:03,840 --> 00:08:05,960 Speaker 1: to verify that this data is real and where it 125 00:08:06,000 --> 00:08:08,480 Speaker 1: came from, there's not problems with it and what and 126 00:08:09,400 --> 00:08:12,680 Speaker 1: uh he uh. Dr Desi said at first that he 127 00:08:12,880 --> 00:08:16,640 Speaker 1: would cooperate with the audit, but then apparently he wouldn't 128 00:08:16,640 --> 00:08:19,280 Speaker 1: provide the raw data, names of the hospitals, and that's 129 00:08:19,280 --> 00:08:23,440 Speaker 1: when the paper was retracted. How did then this get published? Um? 130 00:08:23,480 --> 00:08:25,880 Speaker 1: I mean, what were the circumstances that the Lancet was 131 00:08:25,920 --> 00:08:30,760 Speaker 1: willing to accept clearly something that was very problematic in 132 00:08:30,840 --> 00:08:34,040 Speaker 1: terms of its data sources. Well, yeah, I mean that 133 00:08:34,240 --> 00:08:37,080 Speaker 1: is exactly the question. It is, you know, pretty unbelievable 134 00:08:37,080 --> 00:08:40,160 Speaker 1: in retrospect that these studies got got published and there's 135 00:08:40,160 --> 00:08:42,520 Speaker 1: not just one study by this group. There's a second 136 00:08:42,520 --> 00:08:44,760 Speaker 1: study that had to end up being retracted in the 137 00:08:44,800 --> 00:08:47,840 Speaker 1: New England Journal Medicine. So this group got multiple studies 138 00:08:48,320 --> 00:08:51,679 Speaker 1: into multiple major journals. And one of the things that 139 00:08:51,679 --> 00:08:55,440 Speaker 1: it may be happening is that in this rush to 140 00:08:55,600 --> 00:08:59,600 Speaker 1: come out with new data and you know, healthful information 141 00:09:00,040 --> 00:09:02,600 Speaker 1: COVID nineteen because it's new virus, and because we know 142 00:09:02,679 --> 00:09:05,360 Speaker 1: so little and have so few treatments, you know, the 143 00:09:05,440 --> 00:09:08,680 Speaker 1: journal also appearing the major medical journals also appeared to 144 00:09:08,720 --> 00:09:12,240 Speaker 1: be pushing out you know, stuff quicker than ever before, 145 00:09:12,280 --> 00:09:15,040 Speaker 1: and that appears to be leading to some mistakes, including 146 00:09:15,120 --> 00:09:18,520 Speaker 1: some major mistakes here such as this. This leads me 147 00:09:18,600 --> 00:09:23,080 Speaker 1: to kind of too related questions in terms of what 148 00:09:23,240 --> 00:09:26,440 Speaker 1: is the fallout from this um Both from the sense of, 149 00:09:27,160 --> 00:09:30,800 Speaker 1: you know, this report had seems to have had significant 150 00:09:30,800 --> 00:09:35,920 Speaker 1: impact in halting other clinical trial programs, other um studies 151 00:09:35,960 --> 00:09:39,320 Speaker 1: involving hydroxy chloroquine. What is going to be the impact 152 00:09:39,360 --> 00:09:43,719 Speaker 1: of this one report being retracted and also, i mean 153 00:09:43,760 --> 00:09:47,680 Speaker 1: one of the longer, perhaps more broader impacts in terms 154 00:09:47,720 --> 00:09:51,720 Speaker 1: of well, certainly the reputation of the lancet. But again, 155 00:09:51,880 --> 00:09:55,280 Speaker 1: this this rush to research and rush to publication as 156 00:09:55,360 --> 00:09:58,560 Speaker 1: far as what we can find out about how to 157 00:09:58,679 --> 00:10:02,520 Speaker 1: treat COVID nineteen. When it comes to hydroxy chloroquine, we 158 00:10:02,640 --> 00:10:06,680 Speaker 1: can see that this imperfect and very fast science has 159 00:10:06,720 --> 00:10:09,400 Speaker 1: really had an impact across the board. In the early 160 00:10:09,480 --> 00:10:13,040 Speaker 1: days when we were grasping for anything and President Trump 161 00:10:13,080 --> 00:10:15,720 Speaker 1: got on board with this, we saw use of hydrox 162 00:10:15,800 --> 00:10:19,160 Speaker 1: chloroquine go through the roof. Then we started seeing some 163 00:10:19,280 --> 00:10:23,160 Speaker 1: pulling back, and after the lance At trial, we actually 164 00:10:23,200 --> 00:10:26,079 Speaker 1: saw the w h O and others halt their trials because, 165 00:10:26,120 --> 00:10:29,760 Speaker 1: of course, the idea that patients were actually being harmed 166 00:10:29,800 --> 00:10:33,280 Speaker 1: by this medicine is terrifying. You don't want to make 167 00:10:33,320 --> 00:10:37,520 Speaker 1: people who are already critically ill even worse. The questions 168 00:10:37,520 --> 00:10:40,959 Speaker 1: that are surrounding all of these drugs, though, are leaving 169 00:10:41,080 --> 00:10:44,720 Speaker 1: us just with unanswered issues of what do we do 170 00:10:44,800 --> 00:10:47,920 Speaker 1: going forward. The University of Minnesota did do a trial. 171 00:10:48,120 --> 00:10:52,000 Speaker 1: It was double blind, randomized. It was a trial to 172 00:10:52,000 --> 00:10:54,280 Speaker 1: see if people who had been exposed to the virus 173 00:10:54,559 --> 00:10:59,200 Speaker 1: could get protection from coming down with it from actually 174 00:10:59,760 --> 00:11:03,320 Speaker 1: be coming infected if they take hydroxychloroquin and it did 175 00:11:03,360 --> 00:11:05,560 Speaker 1: not find that. It found that it didn't help those 176 00:11:05,600 --> 00:11:10,439 Speaker 1: patients avoid getting infected, but it also didn't cause significant 177 00:11:10,480 --> 00:11:13,800 Speaker 1: side effects. So where that leaves us now is just 178 00:11:13,960 --> 00:11:16,000 Speaker 1: in the same unknown space that we were in the 179 00:11:16,080 --> 00:11:19,000 Speaker 1: very beginning. There are some people who really believe this 180 00:11:19,040 --> 00:11:21,320 Speaker 1: is going to work, and there are other people who 181 00:11:21,360 --> 00:11:24,240 Speaker 1: really believe that it doesn't work. If it does anything, 182 00:11:24,280 --> 00:11:26,920 Speaker 1: it's not significant, it's not worth the time and effort, 183 00:11:27,240 --> 00:11:29,960 Speaker 1: and patients should be moving on to other treatments that 184 00:11:30,080 --> 00:11:33,320 Speaker 1: might give them more benefit. Yeah, so I think this 185 00:11:33,480 --> 00:11:36,200 Speaker 1: is a major warning sign for some of the medical journals, 186 00:11:36,440 --> 00:11:38,960 Speaker 1: including the lance of the England Journal of Medicine, which 187 00:11:39,000 --> 00:11:42,680 Speaker 1: also had a retraction on a different uh subject matter 188 00:11:42,720 --> 00:11:45,600 Speaker 1: but from the same tiny company. Um this is a 189 00:11:45,640 --> 00:11:48,040 Speaker 1: warning sign that they need to perhaps move a little 190 00:11:48,040 --> 00:11:50,400 Speaker 1: bit slower to make as to make sure that the 191 00:11:50,520 --> 00:11:54,800 Speaker 1: data coming out about this virus is really true and 192 00:11:54,840 --> 00:11:57,640 Speaker 1: correct data. It has really just been kind of a 193 00:11:57,679 --> 00:12:01,040 Speaker 1: perfect storm when it comes to this early suggestions of 194 00:12:01,120 --> 00:12:05,720 Speaker 1: possible benefit, this environment where we didn't have anything except 195 00:12:05,720 --> 00:12:10,120 Speaker 1: for some fear data set that appeared at least initially 196 00:12:10,120 --> 00:12:13,440 Speaker 1: to be good doctors who wanted to be helpful and 197 00:12:13,920 --> 00:12:17,640 Speaker 1: get out information right away. But Bob's point is exactly 198 00:12:18,240 --> 00:12:21,640 Speaker 1: exactly right. We actually need to make sure that our 199 00:12:21,760 --> 00:12:24,560 Speaker 1: data is accurate and safe and that doctors are making 200 00:12:24,559 --> 00:12:27,920 Speaker 1: decisions based on things that are scientifically true. And the 201 00:12:27,960 --> 00:12:30,200 Speaker 1: other thing to keep in mind is this virus is 202 00:12:30,240 --> 00:12:32,600 Speaker 1: not going away. This is going to be with us 203 00:12:32,640 --> 00:12:35,600 Speaker 1: for months, perhaps years, and we need to know the 204 00:12:35,679 --> 00:12:43,319 Speaker 1: right answers, not just the fast ones. That was Michelle 205 00:12:43,320 --> 00:12:47,240 Speaker 1: Cortez and Robert Langrath, and that's our show today. For 206 00:12:47,360 --> 00:12:51,800 Speaker 1: coverage of the outbreak from around the world, visit Bloomberg 207 00:12:51,880 --> 00:12:56,160 Speaker 1: dot com slash coronavirus and if you like the show, 208 00:12:56,640 --> 00:12:59,520 Speaker 1: please leave us a review and a rating on Apple 209 00:12:59,559 --> 00:13:02,960 Speaker 1: podcast Us or Spotify. It's the best way to help 210 00:13:03,000 --> 00:13:07,880 Speaker 1: more listeners find our global reporting. The Prognosis Daily edition 211 00:13:07,960 --> 00:13:13,080 Speaker 1: is produced by Topher Foreheads, Jordan Gaspoure, Magnus Hendrikson, and 212 00:13:13,200 --> 00:13:17,920 Speaker 1: me Laura Carlson. Today's main story was reported by Michelle 213 00:13:17,920 --> 00:13:23,400 Speaker 1: Cortes and Robert Langrith. Original music by Leo Sedrin. Our 214 00:13:23,600 --> 00:13:28,280 Speaker 1: editors are Francesco Levi and Rick Shine. Francesco Levi is 215 00:13:28,320 --> 00:13:31,840 Speaker 1: Bloomberg's head of Podcasts. Thanks for listening.