Talk Evidence covid-19 update - hydroxy/chloroquinine, prognostic models and facemaskss

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Talk Evidence 37 min 6 speakers 8 chapters transcribed
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What is the main topic discussed in this episode?

Duncan Jarvis 0:06
Welcome back to Talk Evidence, your now weekly look at the world of evidence and especially around coronavirus, COVID-19. Last week we talked about pneumonia and testing and this week we've got even more for you.

What is the potential therapeutic role of hydroxychloroquine for COVID-19?

Duncan Jarvis 0:25
As always we've got our starts and stops and we've got some information on treatment on chloroquine or hydroxychloroquine and maybe something on diagnostic and prognostic modelling and then lastly we are going to be talking about PPE again. As always, we're joined by our two favourite EBM nerds. I've got Helen MacDonald and Carl Hennigan here. Helen, can I get you to introduce yourself?
Helen MacDonald 0:52
Hi, I'm Helen MacDonald, UK Research Editor at the BMJ.
Carl Hennigan 0:55
and Carl. Hi, I'm Carl Hennigan. I'm Professor of Evidence-Based Medicine at the University of Oxford and Editor-in-Chief of BMJ Evidence-Based Medicine.
Duncan Jarvis 1:04
And I realise I keep forgetting to introduce myself. I'm Duncan Jarvis.

What are the limitations of current prognostic models for COVID-19?

Duncan Jarvis 1:08
I'm Multimedia Editor here at the BMJ.
Helen MacDonald 1:11
With a very relaxing voice. Thank you.
Duncan Jarvis 1:14
It's, yeah, from being horizontal so much at home.
Duncan Jarvis 1:26
So, as I said, last week we talked about pneumonia a little bit. And Carl, it seems like NICE have paid attention to what you were saying.
Carl Hennigan 1:35
Yeah, no, it's really interesting. I think what we've seen now is a lot more organisations coming to the table, if you like. and ramping up the evidence and production of evidence. And so we've seen very helpful guidance come out from NICE on managing and keeping patients in the community, and particularly the helpful advice about viral and bacterial pneumonia and what to do. And I think what we'll do is it'll be helpful to put the link to that at the end on the page for the podcast today.
Duncan Jarvis 2:08
And we'll do that so everyone can access that. Great. So as always, every week we try and do a start and a stop and continuing that in this new coronavirus world.

How reliable are the studies on hydroxychloroquine and COVID-19?

Duncan Jarvis 2:23
So the question I've been wondering about is, chloroquine or hydroxychloroquine. We've seen Trump really pushing this and that's led to some problems. India, which is one of the large producers, first stopped export and now they've allowed that to happen again. But just seems like there is a lot happening around this drug and lots of uncertain evidence. Helen, you've been having a look at this.
Helen MacDonald 2:53
I have, and I think my headline message is don't get your hopes up about these drugs. As you said, there's been lots of enthusiasm, and I think that's probably all we need to say on that. So we really wanted to try and get behind the hype, would it be fair to call it hype? I called a long-term friend of the BMJ, clinical pharmacologist Robin Ferner in Birmingham, who is in isolation like us all, but together with Jeff Aronson. at the University of Oxford, they have been looking into the evidence for hydroxychloroquine and chloroquine in COVID-19.
Robin Ferner 3:34
I'm Robin Turner. I'm an honorary consultant physician and clinical pharmacologist in Birmingham and honorary professor of clinical pharmacology at the University of Birmingham. Well, they're closely related.

What evidence supports the use of face masks during the pandemic?

Robin Ferner 3:46
Hydroxychloroquine is a derivative of chloroquine, a chemically similar structure, and as far as we know, has very similar actions. Chloroquine has been used since the Second World War to prevent and to treat malaria, and it's still used to treat some forms of malaria. Many malaria parasites are now resistant to it. Hydroxychloroquine is... used by rheumatologists to damp down inflammation in rheumatoid arthritis. And I think actually the anti-inflammatory action is secondary in importance. And the most important logic, insofar as there is logic, is that chloroquine upsets the way in which viruses get into cells and it upsets the way in which they reproduce inside cells. In COVID-19, the evidence base is really very, very fragile.
Robin Ferner 4:46
There are, in the public domain, the results of four poorly conducted trials, two of which produced positive results and a great deal of excitement, and two of which were negative. These are very slim pickings. Well, my colleague Jeff Aronson has looked at up-to-date trial registers and found over 80 trials which mentioned chloroquine or hydroxychloroquine in the treatment of COVID-19.

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