It’s right out of Machiavelli’s The Prince.

#covid_19 #coronavirus

Even for the Trump administration, it is odd they are pushing #Hydroxychloroquine and #Azithromycin so hard, against medical advice and evidence.

I’ve thought about this and, given the growing animosity between Trump and Navarro and the physicians, I think I know what’s going on. By vigorously advancing #Hydroxychloroquine and #Azithromycin, Trump, Giuliani, and Navarro are setting up the medical community and the HHS/CDC/FDA to be fall guys in case the #covid_19 virus produces far more fatalities than the administration’s projections. Note, by the way, that no reputable forecaster backs those projections up and the administration is refusing to reveal how they came up with them. For if they push these drugs whose efficacy is found to be zero or worse, they know the medical community will oppose their wholesale administration, and if the pandemic causes many more American deaths, they can claim that, well, if only the medical community didn’t oppose them so much maybe it wouldn’t have been so bad. In other words, it’s setting up so they don’t take the blame for the deaths, or at least can sow doubt among their core supporters.

Typical Trump administration. Typical Machiavelli.

Update, 2020-04-07

Government officials have reportedly been told not to contradict Trump in public regarding his support for hydroxychloroquine and azithromycin. The original report apparently came from Politico. In addition, Trump is directing some of his government medical staff to work using these drugs into the population, thereby diminishing the number of them actually contending with the pandemic.

Without surprise, the American medical community, as demonstrated by an advisory editorial in the Annals of Internal Medicine, continues to argue that using these drugs as prophylactic or treatment against COVID-19 is inadvisable and harmful.

There are also now concerns about method and data analysis regarding the paper which is most cited in support of using these drugs, including some questions about how p-values were calculated (they did not use Yate’s correction for the contingency tables). A critical scholar did a reanalysis using better methods and discovered, among other things, that a mixed-effects logistic regression¹ fit poorly but suggested that improvement in outcomes results primarily because of the passage of time.

¹ Using R‘s glmer function, “with chloroquine and time as fixed effects, and a random intercept per patient”.

Afterthought, 2020-04-07

Since hydroxychloroquine is used to treat Lupus, you would think that those afflicted with Lupus would have a statistically lower chance of getting COVID-19 were hydroxychloroquine a prophylactic for it. That threshold would need to be adjusted because Lupus itself is an autoimmune disease which weakens immune systems and makes its victims more susceptible to infection. However, there is no evidence that these patients are protected and, in fact, Lupus patients need to be even more careful about handwashing and distancing.