The study claims that HCQ did not prevent severe cases, but the study is among hospitalized patients, i.e., they already have cases severe enough for hospitalization - this study can not identify a protective effect of HCQ that reduces the probability of disease severe enough for hospitalization. Despite the very large differences between the groups, no adjustments are made. Adherence for chronic HCQ patients was not examined.

61% of control patients also received HCQ. Bias against HCQ is clear in the abstract which mentions differences favoring HCQ but ignores those favoring control (large differences in ethnicity, rheumatic conditions, hypertension, coronary artery disease, solid organ transplant recipients, immunosuppresive drugs). Tiny retrospective database analysis of hospitalized COVID-19 patients with rheumatologic disease containing 14 chronic HCQ and 28 control patients. Pham et al., Rheumatology Advances in Practice, 10.1093/rap/rkab014 (Peer Reviewed)ДЇailure of chronic hydroxychloroquine in preventing severe complications of COVID-19 in patients with rheumatic diseases Time based confounding is likely because HCQ became increasingly controversial and less used over the time covered (March 1 to May 31, 2020), while overall treatment protocols during this period improved dramatically, i.e., more control patients likely come later in the period when treatment protocols were greatly improved. Oxygen therapy and ICU admission (possibly, the paper includes ICU admission for model 2 in some places but not others) were the only variables indicating severity used in adjustments. In the supplementary appendix, authors note that the treatments were usually given for patients that required oxygen therapy. Retrospective 283 patients in the USA showing higher mortality with all treatments (not statistically significant). Gadhiya et al., BMJ Open, doi:10.1136/bmjopen-2020-042549 (Peer Reviewed)Д¬linical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state

1/42 0/42 Sawanpanyalert 42% 0.58 varies progression n/a n/a Early treatment 64% 0.36 148/20,390 996/34,231 64% improvement All 32 hydroxychloroquine COVID-19 early treatment studies TauвЂ‹ 2 вЂ‹ = 0.20 IвЂ‹ 2 вЂ‹ = 52.9% Z = 8.20 Effect extraction pre-specified, see appendix Favors HCQ Favors control

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