While it was heralded with much promise, the anti-malarial drug hydroxychloroquine commanded much attention in the early dates of the COVID-19 pandemic. From the primary repurposed drug in a number of high profile studies to the then President of the United States touting the benefits, the spotlight was pretty bright. But that certainly didn’t last with a number of unfolding affairs, from shady journal entries to side effects to some lackluster study results, a backlash to the policization in America and perhaps other economical agendas—not as friendly to generic drugs for COVID-19—combined to kill the promise of the drug fast in the rich economies of America, Europe, etc. However, the drug continued to be used as a treatment against COVID-19 in many parts of the world. In Africa, for example, TrialSite reported that the World Health Organization-affiliated ANTICOV study actually based the core study treatment as hydroxychloroquine. Recently, the head of the infectious disease department at Fann Hospital as well as a full professor and chair of infectious diseases at Cheikh Anta Diop University in Dakar, Dr. Moussa Seydi, discussed the use of the controversial drug here in this West African nation of Senegal. Interviewed by a French publication recently, the researcher emphasized that his study team used hydroxychloroquine as they faced emergency conditions with no other real choices at the time. Even through several studies, the World Health Organization (WHO) rejected the drug, declaring that it lacks efficacy and poses risk of side effects, while the independent-minded physician suggested that the studies here in Senegal show positive results for COVID-19 treatment, evidencing only minor side effects, such as diarrhea.What has been his observations and what is next for Senegal?
While today Senegal gets discovered by a growing number of travelers, it’s a culture that goes way back, occupied from prehistoric times continuously till the present moment. Over time, a few different empires manifest here such as the Jolof Empire that occupied these lands for a couple hundred years. But starting in the 16th century, Europeans showed up, first the Portuguese traders, and things would never be the same. The French ultimately maintained a lock on the colony; and that culture’s influence can still be seen till this day. The capital city of Dakar literally sticks out into the Atlantic, representing what is literally the western most part of the African Continent. Densely populated, nearly 4 million people live in the area along the peninsula; the city actually serves as the French colonial capital for Africa. The country secured national independence after a soldiers’ mutiny right around the end of World War 2, and the first president even tried to establish a vision for the city as a “Sub-Saharan African Athens.” That didn’t quite work out, but the French influence was strong even after independence. Perhaps that’s why the controversial physician Didier Raoult, a big hydroxychloroquine advocate for targeting COVID-19 but largely discredited, possibly held sway on the research community here. Dr. Seydi suggested recently that the French physician was a key reference point for research and care here.
Recently, the Senegalese researcher was interviewed by Célia Cuordifede writing for France’s Marianne. Kicking off the discussion, the French interviewer quickly opened up with the controversial usage of hydroxychloroquine here to face COVID-19. Commenting that WHO doesn’t recommend the drug, Dr. Seydi quickly retorted, “We do not blindly follow the WHO.” Apparently, Senegal is finding its own path to treating coronavirus and has, in addition to the anti-malaria drug, included azithromycin. He mentioned in this interview that while Senegal and many other African nations are using the combination of hydroxychloroquine and azithromycin to treat COVID-19 patients, other nations are using ivermectin while in America they are using remdesivir (of course remdesivir in America is only used in the hospital and other certain conditions). He emphasized that WHO has rejected all of these drugs and that “each country must make its own decisions while waiting for a more fluid and verified process to be found in a more comprehensive way.”
COVID-19 in Senegal
The pandemic wasn’t too bad here till the end of 2020. Then things started heating up here and other parts of Africa for the worse. With about 16 million people in this relatively geographically condensed land situated on the westerly most edge of Africa, Senegal currently reports about 39,664 cases and 1,096 deaths. The country experienced a major crisis by January 2021 which spiked by mid-February. While the total average number of COVID cases waned, the New Years’ spike worried many here. The number of cases, severe cases and deaths all are on their way down now while the local hospitals have more capacity.
Why is the Incidence of COVID declining?
Dr. Seydi suggests that a few different factors may be at play, including 1) various confinements and semi-lockdowns, while not too strict were strong enough to reduce more transmission; 2) ongoing vaccination program, starting first with high risk populations such as the elderly those with comorbidities, and a target focus—for example, 60% of those falling to COVID-19 are in the city of Dakar and they emphasized inoculations there. Also, 3) climatic factors may be at play in contributing to the decrease as the changing weather patterns had some impact. However, Seydi, a good scientist, acknowledges they cannot be certain if these and /or other factors have played a role, such as his treatment regimen.
The Study Drug: Not Beneficial Alone
Dr. Seydi, as it turns out, did agree with the majority of researchers in Europe and America that hydroxychloroquine by itself wasn’t that effective. In fact, he was able to prove this in a 1,000 patient case series study finding that the anti-malaria drug had no real material impact helping COVID patients. However, the researcher’s confidence intervals are high when it comes to a combination therapy involving hydroxychloroquine and azithromycin, a regimen he sees as quite successful here in the treatment targeting early onset mild COVID-19.
The Institut Pasteur Study
Dr. Seydi was on the record a year ago that he and team conducted a study involving the treatment of COVID-19 patients with hydroxychloroquine and azithromycin, apparently inspired by well-known Dr. Raoult in France.
This particular study was conducted in collaboration with Institut Pasteur in Dakar and its director Dr. Amadou Alpha Sall. Seydi reports that the collaborators have submitted their write up for peer review in a scientific journal.
But how are cases today in association with this drug combination? Dr. Seydi emphasized that “we continue to use it. Since then we have made several interim analyses which allow us to say that this treatment is beneficial. The last one we did involve almost 1,000 patients, 926 to be exact.” The doctor emphasized that “in the international context where opinions and results of this association are diverse, it is very important for us to carry out these intermediate analyses in relation to our methods.”
Seydi commented that the study team evaluated endpoints on the 15th day or two weeks post hospitalization. The team compared their results of the patients on the investigational combination as compared to those that took no regimen. They discovered that the treatment program significantly favored those on the hydroxychloroquine and azithromycin arm of the study.
The team was operating in “an emergency” situation where “We couldn’t sit back and do nothing,” reported Dr. Seydi. Performing multivariate analysis, the study team learned important lessons such as timing—the combined hydroxychloroquine and azithromycin dosage must be administered at the right time, for example, not too late in the illness. To avoid bias, the team here opted to employ the multivariate analysis, meaning that in their cohort the study participants must be mixed together; and they found that throughout the analysis, they came to the same conclusion: the combination of hydroxychloroquine and azithromycin has been beneficial for their COVID-19 study participants and patients.
On the Contribution of Didier Raoult
Although again not necessarily considered a beacon of investigational inspiration among many COVID-19 research circles, Dr. Didier Raoult has nonetheless made his impact here. Dr. Seydi told the French journalist that he personally didn’t know Dr. Raoult, “But I know he’s a great scientist, a great infectious disease specialist. He has made a huge contribution to infectious diseases to Senegal.” Apparently, Raoult was bestowed with a “head of state” and Dr. Raoult declared, “I am happy with it.”
Dr. Moussa Seydi, MD, Fann Hospital in Dakar, professor and chair of infectious diseases at Cheikh Anta Diop University