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How can we manage the virus AFTER we flatten the curve? PROPHYLAXIS

Effective prophylaxis for COVID-19 simply put would be a game-changer.

Prophylaxis is the use of medication to prevent or reduce the chance of the infection ever occurring. It has been used in infections ranging from malaria to HIV.

There are two types of strategies: pre-exposure and post-exposure. Pre-exposure treatment is usually done on an ongoing basis. Post-exposure prophylaxis is usually done after a specific event (e.g., health care workers exposed to a large amount of virus in the ICU).

There are 12 active clinical trial studies currently on clinicaltrials.gov looking at hydroxychloroquine (HOCQ) prophylaxis.  It’s parent Chloroquine, has a long track record of 50 years of being effective for prophylaxis for malaria. There are no other drugs being actively studied for prophylaxis at this point for COVID.

An example of the 12 studies is a randomized study looking at 3000 healthcare workers and first responders in the Henry Ford Health System and in a separate study for healthcare workers run by the University of Minnesota. The dose of HOCQ prophylaxis in these 2 studies ranges from:

  • Once a week intervention 400mg a week Twice a week intervention 400 mg
  • Twice a week
  • Daily intervention 400 mg a day

Another research approach that might get us insights quicker on HOCQ prophylaxis is the use of big data. There is a natural prophylaxis strategy already occurring in the population – the patients who are already taking HOCQ because of lupus.  Researchers are actively using pharmaceutical databases and insurance claims to follow outcomes in these patients and compare them to controls to see if COVID-19 infections are less in patients on HOCQ compared to controls. These studies can be done quickly, and we will keep close track in the next 30 to 60 days to see the preliminary results.

We naturally focus on the medical issues of COVID-19 rather than the economic and policy issues. However, we did want to point the reader to a good bipartisan economic and policy working paper authored by Avik Roy, Bob Kocher and others that is being continually updated with new evidence and policy ideas. Importantly it discusses both optimistic scenarios and pessimistic scenarios, which is critical in this time of uncertainty.

Please stay tuned,

Dr. Craig Tanio

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