We Don’t Know if Hydroxychloroquine Effectively Treats COVID-19 Yet

Most people, myself included, had never heard of the drug hydroxychloroquine until President Trump started claiming it might be a ‘game changer’ in the treatment of COVID-19. Hydroxychloroquine is used to treat malaria, lupus, and rheumatoid arthritis, although its mechanism of action isn’t fully understood. While doctors and scientists across the world are scrambling to try to find better ways to treat COVID-19 and decrease the number of deaths, it is important to make sure we only use treatments that work and don’t cause inadvertent harm.

What is the Evidence that Hydroxychloroquine is Effective in Treating COVID-19?

In cells in a test tube, hydroxychloroquine has anti-viral activity and inhibits the replication of the SARS-CoV-2 virus that causes COVID-19. While that is encouraging, many drugs are effective in killing viruses in isolated cells and then fail to provide clinically relevant results in people. A small trial in France claimed to find a huge improvement in COVID-19 patients treated with both hydroxychloroquine and the antibiotic drug Azithromycin. However, that trial did not measure patient clinical outcomes, included a very small number of patients, and for some reason did not include the results from 6 of the 26 hydroxychloroquine-treated patients, 3 of whom entered the ICU and 1 who died. Including those 4 patients with negative outcomes would have almost certainly eliminated any significant improvement with treatment (more comprehensive critique of this paper by Elisabeth Bik). Another small trial in China found some improvement in clinical outcome with hydroxychloroquine treatment, but appears to be too underpowered to be sure that the effect is real and the study has yet to undergo peer review.

What Type of Evidence Would be Convincing that Hydroxychloroquine is Effective in Treating COVID-19?

The gold standard in medical science is a double blind, placebo controlled study. In these studies, both the doctors and patients don’t know whether the patient is receiving the drug being tested or a placebo (inactive drug like a sugar pill). Participants are randomly assigned into one of the two groups and there shouldn’t be any difference between the two groups, like one group including more older patients that are at higher risk. You would then want to see whether patients in the hydroxychloroquine group had better clinical outcomes like less severe disease and fewer deaths. NYU’s Medical School and others are currently conducting these type of trials to test the efficacy of hydroxychloroquine in a more rigorous way.

Isn’t it Worth Treating COVID-19 with Hydroxychloroquine if There is a Chance it Can Work?

The short answer is no. Every treatment will have potential side effects and could actually cause harm. Hydroxychloroquine’s side effects include lengthening the QT interval of the heart which can lead to heart arrhythmias which are dangerous and can lead the heart to stop pumping blood. Azithromycin also elongates the QT interval and the combination of the two drugs is even more dangerous. If these drugs work in treating COVID-19, those side effects may be worth the benefit of treating COVID-19. There have also been reports of people being poisoned or dying from self medicating with the hydroxychloroquine found in aquarium cleaners.

The other issue in this particular case is the unproven promise of hydroxychloroquine to treat COVID-19 is leading to hoarding and shortages. This means people that need hydroxychloroquine to treat lupus or other diseases are having trouble finding the drugs they need to stay healthy.

Bottom Line: Hydroxychloroquine may be beneficial in the treatment of COVID-19, but we need to see the results of ongoing larger, properly designed clinical trials before using it to treat COVID-19 patients.

Good News: Coronavirus Can’t Actually Survive on Surfaces for 17 Days

A news story has been making the rounds on social media inaccurately saying that the CDC found coronavirus on the Diamond Princess cruise ship 17 days after people left the ship. The coronavirus is made of genetic material (RNA) wrapped by lipids and proteins. You need all of that to infect people. The cited CDC study just looked at whether viral RNA was present, not whether there was still infectious virus. There have been some studies looking at how long intact virus can survive on surfaces, and it does look like the virus can survive on some surfaces up to 3 days. However, the number of surviving virus on the surface drops rapidly. Additionally, you can’t get infected just by touching a surface–you have to get that virus into your respiratory system, for instance by touching your face, especially your eyes or nose. Similarly, coronavirus can’t infect you by coming through a cut or if you eat it. So, bringing in packages, takeout, and groceries is totally fine as long as you wash your hands before touching your face. I’ve answered some common questions about coronavirus transmission below.

How Is Coronavirus Transmitted?

To get infected, the coronavirus must get into your respiratory system. The major route of transmission is from being in close contact (less than 6 ft away) with an infected person. Respiratory droplets formed when the person coughs or sneezes then can enter your mouth or nose. It is possible that touching a contaminated surface and then touching your face can cause infection, but this is not thought to be the main way that the virus is spread.

Can You Get Coronavirus Just From Breathing the Air in a Room an Infected Person Just Left?

This is very unlikely, except potentially in medical settings. Coronavirus isn’t ‘airborne’ as an aerosol under normal conditions. When people sneeze or cough, larger respiratory droplets stay in the air for about 3 seconds before dropping. Some medical procedures can produce an aerosol, which is like fog–much smaller particles that can remain in the air for a longer time. This is why it is so important for medical professionals to have access to N95 masks and other personal protective equipment (PPE). For the rest of us, as long as we stay 6 feet away from an infected person we shouldn’t be worried about getting infected by breathing the same air as them.

Do I Need to Leave My Groceries Out in the Garage for 3 Days?

Contrary to what a widely circulating video suggests, you really don’t need to leave groceries outside for 3 days or to sterilize every item you bring in. While you are unpacking and handling the groceries or packages, make sure you don’t touch your face. Wash your hands afterwards and wipe down the counters and you should be fine. While it is theoretically possible to get infected by touching a surface, this does not seem to be a major route of disease transmission.

Can I Get COVID-19 From Eating Food Prepared By An Infected Person?

There is no evidence for transmission of coronavirus via food. Again, the virus needs to get into your respiratory system. If the coronavirus managed to survive the heat during cooking, it would be destroyed by the acid in your stomach. Of course, it is still important to wash your hands before eating.

The Bottom Line: To reduce your chances of getting COVID-19, wash your hands with soap and water often, clean often used surfaces in your home, and practice social distancing by staying at least 6 ft away from everyone not in your household.

Why Funding to the Environmental Protection Agency Should Matter to You

Many news sources are reporting that funding for new grants and contracts at the Environmental Protection Agency (EPA) are frozen and scientists are barred from communicating with the public. This may be a normal part of the transition between administrations as new political appointees enter the agency. However, the new administration has made it clear they want to slash the EPA’s budget and this is something that should concern us all.

The mission of the EPA is to protect human health and the environment. If you enjoy clean water and air, you can thank the hard working people at the EPA. Budget cuts could mean that clean up and monitoring of Superfund sites may be neglected. There is a Superfund site very close to the municipal ground water wells that supply my family and 300,000 other people with drinking water (want to know if you live near a Superfund site: https://www.epa.gov/s…/search-superfund-sites-where-you-live). An EPA grant is being used to test the lead levels in Flint, Michigan. I could go on and on about the valuable work done by federal funding to the EPA.

The scientists at the EPA are funded by us, the taxpayers, and we deserve to know what they are finding. Hiding evidence of climate change or pollution by industry doesn’t change the fact that it is happening. Reasonable people can disagree on what action we should take and how to prioritize jobs, the environment, and other factors, but we should all be working off the best available evidence.

Happy Voter Registration Day!

In honor of National Voter Registration Day I plan to send the following announcement to my Introductory Biology class:

Today is National Voter Registration Day. The deadline to register to vote in California is October 24th if you want to vote in the November Presidential Election. College students can register to vote at either their college address or permanent home address. You can register to vote online or by mail: http://www.sos.ca.gov/elections/voter-registration/. You can check your voter registration status here.

I hope that you use some of the critical thinking skills you are learning in your college classes to carefully consider the many issues on this year’s ballot. For some of you, it is your first chance to vote for president. At ScienceDebate.org you can see the presidential candidates’ stances on some important science issues, including biodiversity, vaccination, mental health, and public health. There are many other races on the ballot, including a California Senate seat, every House seat, and many local offices. California also has 17 ballot initiatives this year, including propositions regarding marijuana legalization and two opposing measures on the death penalty. This year’s book in the SJSU Reading Program is Bryan Stevenson’s Just Mercy. Stevenson co-founded the Equal Justice Initiative and has spent his career representing poor clients on death row. This book is a very eye-opening look into the application of the death penalty in this country that you may find useful as you consider Propositions 62 and 66. KQED’s Forum also had a very good discussion of the two initiatives. I hope you will all join me at the polls on November 8th.

Happy National Immunization Awareness Month: Spotlight on the Chickenpox Vaccine

August is National Immunization Awareness Month and a time to celebrate all the pain, suffering, and deaths avoided thanks to vaccines. I’m currently on maternity leave and very thankful for all of the people who have been vaccinated and help to protect my daughter until she is old enough to be fully vaccinated. Unfortunately, the Bay Area has dangerously low immunization rates in many places (you can find out the immunization rate at the kindergartens in CA here), which compromises herd immunity. This month is a great time to discuss how vaccinations can protect your children from painful and often deadly diseases. In a previous post I discussed how serious a case of the measles can be, especially for babies where there is a 1-2 in 1000 chance they will die. Today I’d like to talk about the importance of the Varicella or Chickenpox Vaccine.


Babies like my daughter rely on herd immunity to stay safe from vaccine preventable diseases

Some people think that children are given too many vaccines and often point to the chickenpox vaccine as one that is unnecessary. There is extensive evidence that the vaccine schedule suggested by the CDC and endorsed by every reputable medical organization is safe and effective so I won’t spend time on that here (see the Children’s Hospital of Philadelphia’s Vaccine Education Center or the CDC for more information). What I would like to discuss is why it is important for your child to get the chickenpox (varicella) vaccine.

Chickenpox is an unpleasant and sometimes fatal disease

If you are my age you have likely had chickenpox and probably remember the itchy bumps. Chickenpox is extremely contagious and most of us had it along with our siblings. For most children chickenpox is a mild disease, though definitely unpleasant and disruptive to school attendance and parent work schedules.  About 1 in 1000 children will get severe pneumonia, though, and before the widespread use of the chickenpox vaccine about 70 children died every year. Chickenpox is especially dangerous for babies under 1 yr old and anyone over 15. There are heartbreaking stories of babies too young to be vaccinated and adults that never got chickenpox dying from a ‘simple’ case of chickenpox. If there is a chance my baby can die from a disease I definitely want her to be vaccinated.

The virus that causes chickenpox can lead to a painful case of shingles later in life

Following a case of the chickenpox, the virus remains dormant in your body and can reappear later in life as a painful disorder, shingles. Shingles causes a painful, blistering skin rash that persists for 2-4 weeks. A common side effect of shingles is post-herpetic neuralgia (PHN) where the pain from shingles lingers for months or years. Some people also experience vision loss from shingles.  About 1 in 3 Americans will get shingles in their life and there are ~1 million shingles cases in America per year. The incidence of shingles increases with age and about half of shingles cases occur in people over 60. The chickenpox vaccine uses a live but weakened strain of the virus that can still cause shingles, but at a much lower rate than the live virus. In about 40 years once the first generation vaccinated for chickenpox ages we will know the level of shingles reduction that can be gained by widespread chickenpox vaccination. For now, there is a shingles vaccine that is recommended for people over 60.

The chickenpox vaccine is very safe and side effects are usually mild

The most common side effects from the chickenpox vaccine are pain at the injection site, a low grade fever, and a rash near the injection site (rash occurs in ~4 in 100 people). The chickenpox vaccine is very safe and helps prevent your children from getting an uncomfortable and potentially deadly disease. Seeing a child get shots is often hard on parents, but you can find some evidence based tips for how to keep your child as happy as possible during routine vaccinations at the Science of Mom blog.

Want to learn more about vaccines? 

The internet contains a lot of misinformation about vaccines and it is important to get your information from trusted sources. The Children’s Hospital of Philadelphia has a great Vaccine Education website with easy to understand information about every vaccine recommended for your child, including the dangers of your child contracting that disease and the known side effects of each vaccine. This site has been recognized for its accurate information by the World Health Organization (WHO) and is a member of WHO ‘s Vaccine Safety Net, which aims to provide accurate public health information to the public online. The Centers for Disease Control (CDC) also has a very good Vaccine Safety site.