JAMA Rejected my Comment on Masks and HCQ

JAMA Current  has rejected my comment to a recent peer-reviewed paper, used by the CDC to justify recommendations of universal masking and to downplay the role of hydroxychloroquine in preventing COVID-19 spread. It is well known that health care workers have been taking hydroxychloroquine for COVID-19 prevention, and rightfully so. Such use increased after President Trump mentioned chloroquine derivatives in a March 19 briefing. For example, NPR wrote on March 23:

Dentists and doctors writing prescriptions for themselves

“Our members are definitely seeing more demand for this medication and possibly some people trying to hoard the medication,” says Todd Brown, executive director of the Massachusetts Independent Pharmacists Association.  According to Brown, it appears the hoarders include doctors and dentists who are writing prescriptions for themselves or family members.

(O, horror! Doctors protect themselves and their family members from infection by the novel coronavirus, without permission.)

On July 14, JAMA published an article Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers, Xiaowen Wang, MD et al. (doi:10.1001/jama.2020.12897). On the same day, it published an Editorial Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now  by John T. Brooks, MD; Jay C. Butler, MD; Robert R. Redfield, MD (doi:10.1001/jama.2020.13107). All the authors are employees of CDC in Atlanta, Georgia. Dr. Redfield is the Director of the CDC. The Editorial was based largely on Wang et al.

I noticed that the data in Wang et al. better matches the hypothesis that the reduction in new COVID-19 cases in health care workers is associated with hydroxychloroquine self-prophylaxis, rather than the universal masking. Yesterday, July 19, I submitted a comment to Wang et al. JAMA editors politely declined to publish it, referring to their commenting policy. The following is the comment as submitted and rejected

(1) shows 80% effectiveness of hydroxychloroquine (HCQ) prophylaxis against COVID-19 in HCW.

Many HCW started HCQ prophylaxis on March 20 and achieved some degree of protection by March 22. The average time from infection to symptoms and PCR test positiveness is 5 (4-7) days.

The data shows near exponential growth of the numbers and ratios of positive tests through March 26 (22% positives), an almost 3-fold drop in the ratio from March 26 to March 27 (8%), and a stabilization at slightly higher level after that. Symptoms & PCR results on March 27 roughly correspond to March 22 infections.

Thus, the decrease in the HCW test positivity is consistent with a wide spread usage of HCQ for self-prophylaxis, in combination with other measures, including masks.

Note that the tests show results of containment measures with 4-7 days lag. Masks and other measure implemented since March 25 could have effect on the number and ratio of positive tests on March 29-30 and later.

  1. Pranab Chaterjee et al. Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. IJMR. 2020; 151(5):459-467.

DOI: 10.4103/ijmr.IJMR_2234_20

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