WHO resumes hydroxychloroquine and chloroquine trials                                                                 


World Health Organisation (WHO) has decided to resume hydroxychloroquine and chloroquine (HCQ/CQ) trails after Indian scientists have questioned its earlier decision to halt it temporarily. WHO had stopped the trails based on a study published in the journal Lancet.

This news has received overwhelming response from all spheres. “We're happy that the WHO resumed trials of hydroxychloroquine. I firmly believe that the WHO's decision was taken in haste. It was a kind of knee-jerk reaction. They should have analysed the data on their own before temporarily suspending trials” said Shekhar C Mande, Director General, Council of Scientific and Industrial Research (CSIR).

“I think that HCQ/CQ trails are of global importance and I am glad to see them resumed,” said Dr Anurag Agarwal, Director, Institute of Genomics and Integrative Biology (IGIB), while speaking with India Science Wire.

For the development of antibodies or antidots, virus cultures are important. Inactivated viruses can trigger antibody response in other mammalian hosts in addition to humans. Various such hosts are currently under test for their efficiency of antibody response. Such antibodies generated in these non-human hosts can be purified, processed and collected. The antibodies can be used as therapeutic intervention for patients suffering from the infection. Such antibodies can trigger antiviral response upon injection into humans and have the potential of limiting the infection. Administering antibodies does not provide immunity like a vaccine does, but can be considered as anti-dotes against the virus.

These cultures may also be helpful in the process of drug screening. Potential drugs can be tested against the virus in a test-tube for their efficacy.

“We're happy that the WHO resumed trials of hydroxychloroquine. I firmly believe that the WHO's decision was taken in haste. It was a kind of knee-jerk reaction. ”

Dr Mande, Dr Agrawal (IGIB), and Dr Rajeeva Karandikar from the Chennai Mathematical Institute (CMI) have written a joint letter to the WHO’s chief scientist Soumya Swaminathan, where they have pointed out several limitations in the study as the authors have themselves acknowledged it in the article. “This study is highly flawed and should not be used to judge CQ/HCQ effectiveness or toxicity. A high quality RCT is needed,” tweeted Dr Agarwal.

The scientists have stated in the letter that the Lancet article represents an observational study. Unlike randomized blinded trails where subjects are chosen randomly to receive a treatment to minimize differences between treatment groups, this study does not any such prior design.

They have also pointed out that the methodology of the paper mentions that all patients who were hospitalized between 20 December 2019 and 14 April 2020 with PCR-confirmed COVID-19 infections were analysed. “Whereas, the first reported symptoms of the diseases as cluster of cases of pneumonia were recorded on 31 December 2019 in Wuhan, China. It was only on 5 January 2020 that WHO published the first disease outbreak news on the new virus. It was only on 20 January 2020 that the first case was recorded in the United States of America. Thus, scanning the records of hospitalisation from 20 December 2019 appears to be unjustified,” said the letter.

It is mentioned in the letter that while it is not expected to make any difference since PCR confirmation would not be there for non-COVID-19 cases. It is worth noting that the number of patients and the number of deaths in this study are inconsistent with public health records of the same, often exceeding them despite surveying only a subset of healthcare organisations. This raises the concern for errors in data extraction from electronic records. Even if the data were correctly extracted, severe flaws remain. India Science Wire