Covid-19 and hydroxychloroquine: 5 minutes to understand the political and health scandal shaking Brazil

    “Laboratory of horror”, “one of the greatest barbarities in the history of Brazilian medicine” … In Brazil, the media echo a political and health scandal, which has been working for several days the Senate Parliamentary Commission of Inquiry (CPI), which has been analyzing government management of the Covid-19 epidemic since the end of April. At the heart of the matter: a clinical study, carried out by the private hospital group Prevent Senior, to test the efficacy in patients of hydroxychloroquine and azithromycin as an anti-Covid treatment. A cocktail of drugs considered by the scientific community to be ineffective against the disease, but popularized by Professor Didier Raoult in France and promoted, in Brazil, by the far-right president Jair Bolsonaro.

    What is the origin of the scandal?

    The alert came from a group of twelve doctors and former doctors from Prevent Senior, who submitted a 10,000-page dossier to the ICC in August, and whose GloboNews media broadcast extracts in mid-September. We learn that the company administered an experimental treatment to nearly 600 of their patients, in the spring of 2020, without their consent. As proof, the Brazilian channel reveals private messages exchanged between the management of Prevent Senior and its employees. “We are going to start the hydroxychloroquine + azithromycin protocol,” warns the director Fernando Oikawa, who intends, in capital letters, to his subordinates: “Please DO NOT INFORM THE PATIENT or THE FAMILY about the drug or the program. “

    The group launched its study in March 2020, without even waiting for authorization from the Brazilian National Research Ethics Commission, which will only grant it in April. Only three days after this green light, the company published the conclusions of its test, specifies the commissioner of the commission to Associated Press (AP). Results which, according to whistleblowers, would have been manipulated to appear favorable to the use of hydroxychloroquine against the disease.

    Doctors also said they had to prescribe, in addition to hydroxychloroquine and azithromycin, ivermectin, an antiparasitic whose effectiveness in the fight against Covid has also not been demonstrated. The whistleblowers claim to have been pressured to give these “Covid kits” to their infected elderly patients, used as real “human guinea pigs”. Lawyer Bruna Morato, who represents the 12 medical professionals, told senators on September 28 that her clients have been repeatedly asked to choose between prescribing questionable drugs or losing their jobs.

    What does Prevent Senior hold against?

    Founded in 1997, the Prevent Senior group, with 11,500 employees, is both one of the largest private hospital chains and a mutual insurance company. It targets an elderly population that does not have the means to treat themselves via conventional private insurance, in this country where the public health system is used only by the poorest fringe of the population. The company has more than 500,000 customers, the average age of which is 68 years.

    The company is accused of having “disguised its statistics”, according to GloboNews, by underreporting deaths linked to Covid-19 in its study. Nine “guinea pig” patients died during the research, but the trial authors only mentioned two. “It was intentional. I’ve never seen anything of this magnitude, ”protested to AP Dr. Gonzalo Vecina, one of the founders of the health regulatory body in Brazil. On Wednesday, Brazil’s National Supplementary Health Agency (ANS) announced the creation of a technical committee to investigate these practices.

    Summoned to senators at the end of September, the director of the hospital group, Pedro Benedito Batista JĂşnior, denied all the accusations. At Associated Press, Prevent Senior refutes “any wrongdoing, any irregularity in its facilities or the fact of having carried out unapproved tests”. The company also claims that “all patients or their family members had given their consent before receiving treatment.”

    Why is Bolsonaro implicated?

    Since the very beginning of the pandemic, Brazilian President Jair Bolsonaro has continued to oppose containment measures for his country and to praise hydroxychloroquine. “More and more, the use of chloroquine is presented as something effective,” he was excited on April 8, 2020 on Twitter.

    According to the Brazilian media, he would have been fully informed of what was going on at Prevent Senior. According to whistleblowers, the study in question “is the result of an agreement between the Bolsonaro government and Prevent”. Opposition senators question a kind of “parallel cabinet”, bringing together relatives of Jair Bolsonaro, entrepreneurs and doctors in favor of “early treatment” against Covid-19, reports El Pais Brasil. Its objective was to do everything to avoid containment measures wanted by governors and local elected officials.

    “The Ministry of Health was beheaded at the start of the pandemic, all the doctors were replaced by soldiers,” said Gaspard Estrada, executive director of the Political Observatory of Latin America and the Caribbean. “This commission (Senate parliamentary inquiry) has already had the merit of making the facts much more transparent, ”he analyzes with the Parisian.

    Why is this study so criticized?

    Beyond accusations of falsifying its results, the study conducted by Prevent Senior has several biases. Already, it was not published in a scientific journal, but pre-published on Dropbox, and not on a classic server such as bioRxiv or medRxiv. “It has not been peer reviewed,” recalls Dutch microbiologist Elisabeth Bik.

    Above all, the patients treated have “flu-like symptoms”, but have not performed Covid screening tests. In addition, they were recruited by “telemedicine”, so they were not screened.

    The two-armed study – a treated group, an untreated control group – has “an unusual configuration”, notes Elisabeth Bik, on a blog post. “Patients could choose which group they wanted to be in. This could create all kinds of problems, not least because patients knew if they were being treated, and because the decision to choose treatment might have been influenced by their condition or length of illness. “

    Why does the name of Didier Raoult appear in this dossier?

    “A manuscript whose publication should make people talk. It is in these terms that Didier Raoult relayed, on April 18, the study published on Dropbox. Not surprisingly, the protocol tested (hydroxychloroquine and azithromycin) being the one advocated by the director of the IHU Méditerranée Infection since the very beginning of the crisis.

    But would he be more involved? This is what an audio message from the study coordinator of Prevent Senior suggests, recorded on April 19, 2020, revealed by O Globo in mid-September and which was broadcast during the commission of inquiry several days later. Speaking to the authors of the work, he says they will “change the course of medicine”. “Didier Raoult, I got in touch with him yesterday, he quoted our work on Twitter, I answered him, and in this case we must be perfect, the data is OK,” he also affirms.

    He would therefore have exchanged with the microbiologist the day he spoke. But before or after during the day? Didier Raoult’s tweet having been posted at one minute past twelve, i.e. 7 a.m. in Brazil, we can assume that it dates from before the exchange with the manager of Prevent Senior (if the date indicated by this is correct).

    “People in Brazil have taken a stand to say that they were in contact with Didier Raoult. This may have had an influence, he must explain it and deflate it if this is not the case, “said general practitioner JĂ©rĂ´me Marty to Le Parisien. When contacted, the entourage of the director of the IHU MĂ©diterranĂ©e Infection was unable to react, being too busy in scientific advice this week. Auditioned in June 2020 at the National Assembly, Didier Raoult assured “not to know” Jair Bolsonaro and therefore not to have “told him to use chloroquine”.

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