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Lockdowns and Mask Mandates Do Not Lead to Reduced COVID Transmission Rates or Deaths, New Study Suggests

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Lockdowns and Mask Mandates Do Not Lead to Reduced COVID Transmission Rates or Deaths, New Study Suggests

– August 26, 2020


Anew National Bureau of Economic Research (NBER) working paper by Andrew Atkeson, Karen Kopecky, and Tao Zha focused on countries and U.S. states with more than 1,000 COVID deaths as of late July. In all, the study included 25 U.S. states and 23 countries. 

Based on their analysis, the authors present four “Stylized Facts” about COVID-19, which are:

  1. Once a region reaches 25 total COVID deaths, within a month the growth rate in deaths per day falls to approximately zero. In other words, no matter the country or state and its policies, deaths per day stop increasing within 20-30 days of passing a threshold of 25 deaths
  2. Once that happens, deaths per day either begin to fall or the trend remains flat.
  3. The variability in death trends across regions has fallen sharply since the beginning of the epidemic and remains low. All states studied, all countries studied, have become more similar in their trends and have remained so.
  4. Observations 1-3 suggest that the effective reproduction number, R, has hovered around one worldwide after the first 30 days of the epidemic

The paper’s conclusion is that the data trends observed above likely indicate that nonpharmaceutical interventions (NPIs) – such as lockdowns, closures, travel restrictions, stay-home orders, event bans, quarantines, curfews, and mask mandates – do not seem to affect virus transmission rates overall

Why? Because those policies have varied in their timing and implementation across countries and states, but the trends in outcomes do not.


From the study’s authors:

Location and sampling uncertainty. The black solid line in both charts represents the median posterior estimate. The solid magenta line in the top chart represents the median growth rate of 7-day smoothed daily deaths for all 50 locations and corresponds only to the left scale. The two dash-dotted bands in both charts contain two thirds of the posterior probability at each point in time and the two dashed bands, 0.90 of the posterior probability. The growth rates of death is estimated according to the fitted Weibull function. Effective reproduction numbers and normalized transmission rates are based on the SIR model. Day 0 is the earliest date when the cumulative death toll reached 25 in each location.

This study runs counter to previous studies claiming that NPIs were effective in reducing transmission rates during the early stages of the epidemic. The authors explain:

Given the observation that transmission rates for COVID-19 fell virtually everywhere in the world during this early pandemic period, we are concerned that these studies may substantially overstate the role of government-mandated NPIs in reducing disease transmission due to an omitted variable bias. 

One of the key candidates for the key “omitted variable,” i.e. the true cause of the decline in transmission rates after the first month of an epidemic, is that human interaction does not conform to simple epidemiological models. In the real world human social networks overlap in such a way that a virus can spread rapidly for a short period of time, as some people contact more networks than others, but reaches natural dead-ends and roundabouts where potential new hosts in a “new” social network have already been exposed through other networks. The effect can resemble what some think of as “herd immunity,” but at relatively low infection rates.

The authors reason that even if NPIs were effective early on, they do not appear to be anymore:

Moreover, given the observation that disease transmission rates have remained low with relatively low dispersion across locations worldwide for the past several months as NPIs have been lifted, we are concerned that estimates of the effectiveness of NPIs in reducing disease transmission from the earlier period may not be relevant for forecasting the impact of the relaxation of those NPIs in the current period, due to some unobserved switch in regime.

This study provides strong statistical support for what so many have been observing for six months. The epidemic has a natural tendency to spread quickly at first and slow down, seemingly on its own, a point made not only here but as early as April 14 by Isaac Ben-Israel. Meanwhile governors imagine that very specific rules for opening bars and restaurants are the key to containment.

Governments have conducted an unprecedented social, economic, and political experiment in controlling whole populations’ behavior, with high economic and human cost. The authors ask the right question: has this experiment in government-managed virus control and suppression made a difference? The startling answer they found, after examining data from around the country and the world, is that the evidence simply is not there. 

If we are concerned about the evidence on this global experiment, we must concede that most government authorities have likely acted in error. Read the entire report at American Institute of Economic Research

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[1] point out serious limitations that they say should be corrected on the record: patients receiving HC 5/10 Positive Late Alberici et al., Kidney Int., 98:1, 20-26, July 1, 2020, doi:10.1016/j.kint.2020.04.030 (preprint 5/10) (Peer Reviewed) A report from the Brescia Renal COVID Task Force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection Analysis of 94 hemodialysis COVID-19 positive patients. Reduction in death seen with HCQ but p=0.12, OR 0.44 (0.16–1.24). 5/8 Positive Late Carlucci et al., doi:10.1101/2020.05.02.20080036 (Preprint) Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients Observational retrospective. Addition of Zinc to HCQ+AZ reduces mortality. 5/7 Theory Theory Derendorf, H., Int. J. Antimicrobial Agents, 7 May 2020, doi:10.1016/j.ijantimicag.2020.106007 (Peer Reviewed) (Theory) (not included in the study count) Excessive lysosomal ion-trapping of hydroxychloroquine and azithromycin Discusses pharmacokinetic properties of HCQ+AZ as a potential underlying mechanism of the observed antiviral effects. 5/7 Inconc. Late Geleris et al., NEJM, May 7, 2020, doi:10.1056/NEJMoa2012410 (Peer Reviewed) Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19 There appears to be a major error in this paper. Before propensity matching, 38 control patients had hypertension. After propensity matching, 146 patients had hypertension (Table 1). This is not possible. Even if all propensity matched co.. 5/7 Positive
      (news) N/A Sermo (News) (not included in the study count) Sermo reports: COVID-19 treatment trends over 6 weeks and 33,700 interviews: Usage, efficacy and safety perceptions of most-used therapies HCQ used by 55% of physicians worldwide for COVID. Survey of 6,150 physicians. 5/6 Animal Animal Maisonnasse et al., Nature, 2020, doi:10.1038/s41586-020-2558-4 (preprint 5/6) (Peer Reviewed) (not included in the study count) Hydroxychloroquine use against SARS-CoV-2 infection in non-human primates Monkey study which reports no effect of HCQ or HCQ+AZ. However, there are actually several signs of effectiveness despite the very small sample sizes and 100% recovery of all treated and contr.. 5/5 Positive Late Membrillo de Novales et al., Preprints 2020, 2020050057, doi:10.20944/preprints202005.0057.v1 (Preprint) Early Hydroxychloroquine Is Associated with an Increase of Survival in COVID-19 Patients: An Observational Study 166 patients hospitalised with COVID-19, HCQ increased survival 1.4 - 1.8 times when patients admitted in early stages. Early is relative to hospital admission here - all patients relatively serious condition. 5/5 Positive Early, Late Million et al., Travel Med Infect Dis., 2020 May 5, doi:10.1016/j.tmaid.2020.101738 (Peer Reviewed) Early Treatment of COVID-19 Patients With Hydroxychloroquine and Azithromycin: A Retrospective Analysis of 1061 Cases in Marseille, France Retrospective 1061 patients. HCQ+AZ safe and results in a low fatality rate. 5/5 Inconc. PrEP Gendelman et al., Autoimmunity Reviews, 19:7, July 2020, doi:10.1016/j.autrev.2020.102566 (Peer Reviewed) Continuous Hydroxychloroquine or Colchicine Therapy Does Not Prevent Infection With SARS-CoV-2: Insights From a Large Healthcare Database Analysis Very small study of rheumatic disease/autoimmune disorder patients showing no significant difference but with only 3 chronic HCQ patient cases. Only considers people tested at a time when primarily symptomatic cases.. 5/1 Safety N/A Mercuro et al., JAMA Cardiol., May 1, 2020, doi:10.1001/jamacardio.2020.1834 (Peer Reviewed) (not included in the study count) Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19) Study of 90 hospitalized patients given HCQ, 53 also receiving AZ, 53% hypertension, 29% diabetes mellitus, baseline median QTc 473ms for HCQ, and 442ms for HCQ+AZ. Medi.. 5/1 Safety N/A Bessière et al., JAMA Cardiol., May 1, 2020, doi:10.1001/jamacardio.2020.1787 (Peer Reviewed) (not included in the study count) Assessment of QT Intervals in a Case Series of Patients With Coronavirus Disease 2019 (COVID-19) Infection Treated With Hydroxychloroquine Alone or in Combination With Azithromycin in an Intensive Care Unit Study of 40 very serious condition ICU patients, 75% required invasive mechanical ventilation, 63% received vasoactive drugs, 50% received other treatments favoring QT prolongation. HCQ with or w/o AZ was given to 4.. 5/2 Positive
      (news) Late Seydi (News) (not included in the study count) Coronavirus: a study in Senegal confirms the effectiveness of hydroxychloroquine Preliminary results of Senegal trial with 181 patients showing faster recovery with HCQ, and even faster recovery with HCQ+AZ. 4/30 Positive Early Meo et al., Eur. Rev. Med. Pharmacol. Sci. 2020, 24 (8), 4539-4547, doi:10.26355/eurrev_202004_21038 (Peer Reviewed) Efficacy of chloroquine and hydroxychloroquine in the treatment of COVID-19 Analysis of COVID-19 and malaria, finding that COVID-19 is highly pandemic in countries where malaria is least pandemic, and vice versa, suggesting that CQ/HCQ (widely used for malaria) are pr.. 4/29 Safety N/A Saleh et al., Circulation: Arrhythmia and Electrophysiology, doi:10.1161/CIRCEP.120.008662 (Peer Reviewed) The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection 201 hospitalized patients. No serious side effects of HCQ. No instances of Torsade de pointes, or arrhythmogenic death were reported. They report that although use of these medications resulted in QT prolongation, c.. 4/25 In Vitro In Vitro Andreani et al., Microbial Pathogenesis, doi:/10.1016/j.micpath.2020.104228 (Peer Reviewed) (In Vitro) (not included in the study count) In vitro testing of combined hydroxychloroquine and azithromycin on SARS-CoV-2 shows synergistic effect HCQ and AZ has a synergistic effect in vitro on SARS-CoV-2 at concentrations compatible with that obtained in human lung. 4/24 Positive Early Ashraf et al., medRxiv doi:10.1101/2020.04.20.20072421.t (Preprint) COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes 100 patients. HCQ improved clinical outcome. 4/21 Positive Early Izoulet M., SSRN, doi:10.2139/ssrn.3575899 (Preprint) Countries which Primarily Use Antimalarial Drugs As COVID-19 Treatment See Slower Dynamic of Daily Deaths Compares the dynamics of daily deaths in the 10 days following the 3rd death in countries using and not using [H]CQ, showing dramatically lower death in [H]CQ countries. This paper does not at.. 4/21 Negative Late Magagnoli et al., Med (2020), doi:10.1016/j.medj.2020.06.001 (preprint 4/21) (Peer Reviewed) Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19 Retrospective 368 hospitalized patients, no significant reduction in mortality or the need for mechanical ventilation with HCQ or HCQ+AZ. Study notes HCQ was more likely.. 4/17 Positive PEP Lee at al., Int. J. Antimicrob. Agents, 2020, Apr 17, doi:10.1016/j.ijantimicag.2020.105988 (Peer Reviewed) Can Post-Exposure Prophylaxis for COVID-19 Be Considered as an Outbreak Response Strategy in Long-Term Care Hospitals? Post exposure prophylaxis of 211 high-risk people after major exposure event in a long term care hospital, showing no positive cases after 14 days. 4/16 Negative Late Borba et al., JAMA Network Open, doi:10.1001/jamanetworkopen.2020.8857 (Peer Reviewed) Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study) Increased incidence of prolonged QT and death in high dose treatment arm. Patients >75 only enrolled in high dose arm, age of high dose arm significantly higher than low dose arm (p=0.02). Very sick at baseline, 43% in ICU, 88.9% on respi.. 4/15 Positive Early Esper et al., Prevent Senior Institute, São Paulo, Brazil (Preprint) Empirical treatment with hydroxychloroquine and azithromycin for suspected cases of COVID-19 followed-up by telemedicine 636 patients. HCQ+AZ reduced hospitalization 79% when used within 7 days (65% overall). Non-randomized. 4/14 Negative Late Tang et al., BMJ 2020, 369, doi:10.1136/bmj.m1849 (Peer Reviewed) Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial 150 patients very late stage RCT. No significant difference. More symptomatic relief with HCQ. No safety concerns of HCQ. Treatment very late, average 16.6 days after symptom onset. Data favor.. 4/13 Positive Late Gao et al., Biosci Trends, May 21, 2020, 14:2, 156-158, doi:10.5582/bst.2020.03072, Epub Apr 13, 2020 (Peer Reviewed) Update on Use of Chloroquine/Hydroxychloroquine to Treat Coronavirus Disease 2019 (COVID-19) Increasing evidence from completed clinical studies shows CQ and HCQ effective (HCQ more effective). 4/12 Negative Late Barbosa et al., Preprint (Preprint) Clinical outcomes of hydroxychloroquine in hospitalized patients with COVID-19 : a quasi-randomized comparative study Small retrospective study with 63 patients (32 treated with HCQ), showing no effectiveness, however the baseline state of each arm significantly differs. This preprint was submitted to NEJM but has not been publishe.. 4/11 Positive Early Gautret et al., Travel Medicine and Infectious Disease, doi:10.1016/j.tmaid.2020.101663 (Peer Reviewed) Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study Pilot study suggesting improvement with HCQ+AZ and recommending further study. 4/10 Meta
      (negative) Late Lover, medRxiv, doi:10.1101/2020.03.22.20040949 (Preprint) (meta analysis - not included in the study count) Quantifying treatment effects of hydroxychloroquine and azithromycin for COVID-19: a secondary analysis of an open label non-randomized clinical trial (Gautret et al, 2020) Secondary analysis of Gautret et al. showing "modest to no impact of HCQ treatment, with more significant effects from [HCQ+AZ]". 4/1 Positive Late Huang et al., Journal of Molecular Cell Biology, Volume 12, Issue 4, April 2020, 322–325, doi:10.1093/jmcb/mjaa014 (Peer Reviewed) Treating COVID-19 with Chloroquine 22 patients. All CQ patients discharged by day 14 versus 50% of Lopinavir/Rotinavir patients. Symptom onset to treatment 2.5 days for CQ vs. 6.5 days for Lopinavir/Rotinavir. 3/31 Positive Late Chen et al., medRxiv doi:10.1101/2020.03.22.20040758 (Preprint) Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial 62 patients. RCT showing significantly faster recovery with HCQ. 13% progressed to severe cases in the control group, versus 0% for the treatment group. Significant improvement seen in pneumonia on chest CT for 61% .. 3/31 In Vitro In Vitro Clementi et al., Front. Microbiol., 10 July 2020, doi:10.3389/fmicb.2020.01704 (preprint 3/31) (Peer Reviewed) (In Vitro) (not included in the study count) Combined Prophylactic and Therapeutic Use Maximizes Hydroxychloroquine Anti-SARS-CoV-2 Effects in vitro In vitro study, not included in the study count or percentages, showing greater inhibition for combined pre and post-exposure treatment for Vero E6 and Caco-2 cells. 3/28 Negative Late Molina et al., Médecine et Maladies Infectieuses, 50:4, June 2020, 10.1016/j.medmal.2020.03.006 (preprint 3/28) (Letter) No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection 11 patients with severe cases. No evidence of benefit for HCQ. 3/26 Positive
      (news) Late Zhong Nanshan (钟南山) (News) (not included in the study count) Efficacy and safety of chloroquine for treatment of COVID-19. An open-label, multi-center, non-randomized trial 197 patients. HCQ effective. Viral RNA negative in 95.9% versus 79.6% control. Median time to negative tests 3 days versus 9 days for control. 3/24 Theory Theory Pagliano et al., Clin. Infect. Dis., 2020 Mar 24, doi:10.1093/cid/ciaa320 (Peer Reviewed) (Theory) Is Hydroxychloroquine a Possible Post-Exposure Prophylaxis Drug to Limit the Transmission to Health Care Workers Exposed to COVID19? CQ and HCQ inhibit replication at early stages of infection, no similar effect reported for other drugs which are only able to interfere after cell infection. Large volume of existing data on .. 3/23 Theory Theory Hu et al., Nature Nanotechnology, 15, 247–249, 2020, doi:10.1038/s41565-020-0674-9 (Peer Reviewed) (Theory) (not included in the study count) Insights from nanomedicine into chloroquine efficacy against COVID-19 CQ is known in nanomedicine research for the investigation of nanoparticle uptake in cells, and may have potential for the treatment of COVID-19. 3/21 Positive
      (advisory) PrEP ICMR, Indian Council of Medical Research (Advisory) (not included in the study count) Advisory on the use of hydroxy-chloroquine as prophylaxis for SARS-CoV-2 infection Recommends HCQ for prophylaxis in asymptomatic healthcare workers as found effective in-vitro and in-vivo. 3/20 Positive
      (news) Late Hu et al., Shanghai Combined Task Force on COVID-19 (News) (not included in the study count) Shanghai Experience of COVID-19 Management Clinical studies of HCQ with 184 cases and 21 hospitals show HCQ is effective. 3/18 In Vitro In Vitro Liu et al., Cell Discovery 6, 16 (2020), doi:10.1038/s41421-020-0156-0 (Peer Reviewed) (In Vitro) (not included in the study count) Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro HCQ effective in vitro and less toxic than CQ. In addition to direct antiviral activity, HCQ is a safe and successful anti-inflammatory agent that has been used extensiv.. 3/17 Positive Early Gautret et al., Int. J. of Antimicrobial Agents, 17 March 2020, doi:10.1016/j.ijantimicag.2020.105949 (Peer Reviewed) Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial HCQ significantly associated with viral load reduction / elimination, enhanced with AZ. 3/17 Review N/A Sahraei et al., Int. J. Antimicrobial Agents, April 2020, 55:4, doi:10.1016/j.ijantimicag.2020.105945 (Peer Reviewed) (not included in the study count) Aminoquinolines against coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine Discussion of mechanisms of action, CQ vs. HCQ, early studies, safety. 3/13 Review N/A Todaro and Rigano (Preprint) (not included in the study count) An Effective Treatment for Coronavirus (COVID-19) Discussion of existing research, treatment guidelines, and mechanisms of action for CQ and HCQ, recommending use. 3/12 Theory Theory Devaux et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.105938 (Peer Reviewed) (Theory) (not included in the study count) New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? Discusses mechanisms of CQ interference with the SARS-CoV-2 replication cycle. 3/10 Meta
      (positive) N/A Cortegiani et al., J. Crit. Care, June 2020, 57:279-283, doi:10.1016/j.jcrc.2020.03.005, Epub Mar 10, 2020 (Peer Reviewed) (meta analysis - not included in the study count) A Systematic Review on the Efficacy and Safety of Chloroquine for the Treatment of COVID-19 Review of six articles and 23 ongoing clinical trials in China recommending research and clinical use adhering to MEURI. 3/9 In Vitro N/A Yao et al., Clin. Infect. Dis., 2020 Mar 9, doi:10.1093/cid/ciaa237 (Peer Reviewed) (not included in the study count) In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) HCQ is more potent than CQ in vitro for inhibiting SARS-CoV-2. Simulates HCQ concentration in lung fluid and provides dosing recommendations. 3/6 Negative Late Chen et al., J. Zhejiang University (Med Sci), doi:10.3785/j.issn.1008-9292.2020.03.03 (Peer Reviewed) A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19) 30 moderate hospitalized cases, all recovered. Time to RNA negative comparable. Less frequent radiological progression with HCQ but not statistically significant. One HCQ patient developed to .. 3/4 Positive Late Colson et al., Int J. Antimicrob Agents, doi: 10.1016/j.ijantimicag.2020.105932. Epub 2020 Mar 4. (Peer Reviewed) Chloroquine and Hydroxychloroquine as Available Weapons to Fight COVID-19 Recommending CQ and HCQ for COVID-19 based on 20 clinical studies in China and a strong rationale for use. 2/20 Positive Late Jiang et al., Chin. J. Tuberc. Respir. Dis., 2020, 43, doi:10.3760/cma.j.issn.1001-0939.2020.0019 (Peer Reviewed) Expert Consensus on Chloroquine Phosphate for the Treatment of Novel Coronavirus Pneumonia Early trials in China show CQ results in shorter hospital stays and improved patient outcomes. 2/19 Positive Late Gao et al., BioScience Trends, 2020, doi:10.5582/bst.2020.01047 (Peer Reviewed) Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies Results from 15 clinical trials in China showing CQ is effective. 2/17 Positive
      (news) Late Sun Yanrong, deputy head of the China National Center for Biotechnology Development (News) (not included in the study count) Antimalarial drug confirmed effective on COVID-19 HCQ under clinical trials in >10 hospitals in China and has shown fairly good efficacy. 2/4 In Vitro In Vitro Wang et al., Cell Res. 30, 269–271, doi:L10.1038/s41422-020-0282-0 (Peer Reviewed) (In Vitro) (not included in the study count) Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro In vitro study, not included in the study count or percentages. Remdesivir and CQ potently blocked virus infection in vitro. 2014 In Vitro In Vitro de Wilde et al., Antimicrobial Agents and Chemotherapy, Jul 2014, 58:8, 4875-4884, doi:10.1128/AAC.03011-14 (Peer Reviewed) (In Vitro) (not included in the study count) Screening of an FDA-Approved Compound Library Identifies Four Small-Molecule Inhibitors of Middle East Respiratory Syndrome Coronavirus Replication in Cell Culture CQ inhibits SARS-CoV, MERS-CoV, and HCoV-229E-GFP replication in the low-micromolar range. 2012 Animal Animal Yan et al., Cell Research, 23, 300–302, doi:10.1038/cr.2012.165 (Peer Reviewed) (not included in the study count) Anti-malaria drug chloroquine is highly effective in treating avian influenza A H5N1 virus infection in an animal model CQ, a known autophagy inhibitor that is in clinical use, can efficiently ameliorate acute lung injury and dramatically improve the survival rate in mice infected with live avian influenza A H5N1 virus. 2009 Animal Animal Keyaerts et al., Antimicrob. Agents Chemother, August 2009, 53(8), doi:0.1128/AAC.01509-08 (Peer Reviewed) (not included in the study count) Antiviral Activity of Chloroquine against Human Coronavirus OC43 Infection in Newborn Mice CQ inhibits HCoV-OC43 replication in HRT-18 cells. A lethal HCoV-OC43 infection in newborn C57BL/6 mice can be treated with CQ acquired transplacentally or via maternal milk. The highest survi.. 2008 In Vitro In Vitro Kono et al., Antiviral Research, 77:2, February 2008, 150-152, 10.1016/j.antiviral.2007.10.011 (Peer Reviewed) (In Vitro) (not included in the study count) Inhibition of human coronavirus 229E infection in human epithelial lung cells (L132) by chloroquine: Involvement of p38 MAPK and ERK CQ significantly decreased viral replication of HCoV-229E at concentrations lower than in clinical usage. CQ affects the activation of p38 mitogen-activated protein kinase (MAPK) and extracell.. 2006 In Vitro In Vitro Savarino et al., Lancet Infect. Dis., doi:10.1016/S1473-3099(06)70361-9 (Peer Reviewed) (In Vitro) (not included in the study count) New insights into the antiviral effects of chloroquine Update to 2003 paper, not included in the study count or percentages. Hypothesis of CQ inhibiting SARS replication has been confirmed in two in-vitro studies. CQ affected an early stage of SAR.. 2005 In Vitro In Vitro Vincent et al., Virol. J. 2:69, 2005, doi:10.1186/1743-422X-2-69 (Peer Reviewed) (In Vitro) (not included in the study count) Chloroquine is a potent inhibitor of SARS coronavirus infection and spread In vitro study, SARS-CoV-1, not included in the study count or percentages. CQ has strong antiviral effects on SARS CoV infection when cells treated either before or after exposure, suggesting prophylactic and treat.. 2004 In Vitro In Vitro Keyaerts et al., Biochem. Biophys. Res. Comm., 323:1, 8 October 2004, doi:10.1016/j.bbrc.2004.08.085 (Peer Reviewed) (In Vitro) (not included in the study count) In vitro inhibition of severe acute respiratory syndrome coronavirus by chloroquine In vitro study, SARS-CoV-1, not included in the study count or percentages. IC50 of CQ for antiviral activity (8.8) is significantly lower than cytostatic activity CC50 (261.3), selectivity index of 30. IC50 for inh.. 2003 Theory Theory Savarino et al., Lancet Infect. Dis., doi:10.1016/S1473-3099(03)00806-5 (Peer Reviewed) (Theory) (not included in the study count) Effects of chloroquine on viral infections: an old drug against today's diseases Not included in the study count or percentages. Discussion/review noting that CQ exerts antiviral effects, inhibiting the replication of several viruses including members of the flaviviruses, retroviruses, and coron.. 1889 Inconc.
      (news) N/A Edwin Wiley Grove (News) (not included in the study count) Laxative Bromo Quinine Quinine has been used for respiratory infections since 1889. Not included in the study count or percentages, just as an interesting observation.  
      Note: In Vitro, Meta, Theory, Safety, Review, News, and Retracted items are not included in the percentages and study count. There is a total of 112 items. Positive/negative effects vary in degree and certainty, please read the papers or descriptions thereof for more details. Every study has some limitations when considered in isolation (for example confounding factors; sub-optimal treatment regimens; dosing regimens that may be too low, too high, or insufficiently account for the long half-life of HCQ; large treatment delays; small sample sizes; lack of focus on severity; reliance on Internet surveys; and patient characteristics very different from the most at-risk population).
        Please send us corrections, updates, comments. Please send us any missing papers but check first - almost all submissions to date were already posted.     NOTE: If the excuse of mandating masks that "it will not eliminate but greatly reduce the chance to get COVID" is used, why is not the smae reasoning applied to the use of a concoction of HCQ+Zinq+Zithromax? Yet HCQ is banned and masks are not. Science just like law, is never settled. If you question this just ask Einstein.
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