Re Hydroxychloroquine Shortages

A new article in JAMA Network (Vaduganathan et al.) describes a peak in hydroxycholoroquine dispensing by pharmacies in the week of March 15-21, although misinterprets its cause. But its statistics confirms conclusions of my article Distributed Denial of HCQ to COVID-19 Victims, published in WUWT on May 11. That was panic buying by chronic lupus and/or rheumatoid arthritis patients, triggered by the news media and amplified by Google and so-called social media. On March 20, multiple outlets announced  that HCQ buying by COVID-19 patients was causing shortages for its “legitimate users”. There were no shortages at that time. But multiple repetitions of that lie caused lupus and RA patients to buy as much HCQ as they could – and many had unfulfilled prescriptions for 90 days.That led to actual shortages in a few days.

Vaduganathan et al. breaks down HCQ fills by size, and unintentionally shows just that.

A) As shown in Table 1, the amount of HCQ pills dispensed in the week of March 15-21 (a shrp peak in HCQ buying), 2020 tripled compared with the same week in 2019, from an 8.5 Millions to 25 Millions (estimated). Most of 60% of the extra came from re-fills of more than 60 tablets, indicating long term patients with available prescriptions for more than 30 days. Only 5% of the extra was in small  amounts (<28 pills), sufficient for COVID-19 treatment or prophylaxis.

B) Even more remarkable, starting with the next week, the weekly number of large (>60 pills) re-fills dropped below 2019 level. It stabilized in April 2020 at 36% (i.e., almost one third) of the April 2019. Some regular HCQ users with 90-day prescriptions acquired enough of it on the week of March 15-21 (more precisely, on March 20-21), and did not need to buy it in April. Apparently, many pharmacies limited refills to 30-day supply, which caused decrease in the large (>60) refills, and increase in medium (28-60) refills. That matches the expectation that more lupus patients would maintain their prescribed HCQ regimen (See Christine A. Peschken in The Journal of Rheumatology)

C) Vaduganathan et al. insinuates that President Trump, speaking at the press conference on March 19, directly caused shortages. This is far from the truth. HCQ is a prescription drug. Only very lucky COVID-19 sufferers could find a doctor prescribing HCQ, make an appointment, get the HCQ prescription, and to fill it by March 21.

Table 1. Calculation of extra HCQ pills dispensed on the week of March 15-21, using Vaduganathan et al.

  pills / fill est. average (*) March 15-21 (**)
fills pills extra
Baseline, 2019 <28 20 2,208 44,160
28-60 45 70,472 3,171,240
>60 120 44,245 5,309,400
Total Baseline 116,925 8,524,800
2020 <28 20 45,858 917,160 873,000
28-60 45 196,606 8,847,270 5,676,030
>60 120 124,833 14,979,960 9,670,560
Total and extra, 2020 367,297 24,744,390 16,219,590

(*) Estimated average of pills in a fill

(**) Vaduganathan et al. combine numbers for HCQ and CQ, but almost all of it is HCQ, so all of it is counted as HCQ here.

Correction: The number of HCQ pills that was dispensed weekly before COVID-19 is estimated as 8.5 Millions here, more accurate than the 20-30 Millions estimate in my May 11 article. This error does not affect the conclusions.

Remarks

One of the study authors is Mandeep R. Mehra, the first author of the anti-hydroxychloroquine paper, based of the fake data from Surgisphere. I hope the data in Vaduganathan et al. is not fake.

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