20200517u Day 138: Some US States have 6x Higher CFR – Hydroxychloroquine?

20200517u Santa Cruz, CA: I’m curious about the almost 5-9x difference in case fatality rate (CFR) between the US states with the lowest CFR and the US states with the highest CFR. As of today, the CFR for the United States is 5.96% (275 deathsPerM divided by 4615 casesPerM).

The four best states have a CFR near 1%:

1. Wyoming: 1.07% (14 deathsPerM / 1303 casesPerM)
2. Utah: 1.11% (25 deathsPerM / 2258 casesPerM)
3. South Dakota: 1.11% (50 deathsPerM / 4507 casesPerM)
4. Nebraska: 1.20% (64 deathsPerM / 5349 casesPerM)

The seven worst states have a CFR over 6%:

1. Michigan: 9.57% (490 deathsPerM / 5121 casesPerM)
2. Connecticut: 9.11% (956 deathsPerM / 10495 casesPerM)
3. New York: 7.85% (1456 deathsPerM / 18498 casesPerM)
4. Louisiana: 7.24% (536 deathsPerM / 7407 casesPerM)
5. New Jersey: 6.99% (1167 deathsPerM / 16685 casesPerM)
6. Pennsylvania: 6.85% (352 deathsPerM / 5141 casesPerM)
7. Massachusetts: 6.74% (841 deathsPerM / 12479 casesPerM)

Timeline of Hydroxychloroquine related actions in the US States above. In reviewing these, I thought I might notice that some states were treating with hydroxychloroquine and others were not. If this is going on, I think doctors and pharmacists are keeping this information to themselves due to the politics surrounding hydroxychloroquine.

1. March 4, 2020: From Nebraska UNMC, Clinical trial begins for COVID-19 medication, a video of Andre Kalil, MD, leading a COVID-19 Clinical Trial
2. March 7, 2020: New York Executive Order restricts dispensing hydroxychloroquined
3. March 17, 2020: Nebraska Medicine post recommendations for Hydroxychloroquine treatment: COVID-19 Antiviral and Pharmacotherapy Recommendations
4. March 21, 2020: President Trump Tweet that ““HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.”
5. March 23, 2020: No. 202.10: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency, an executive order from Andrew Cuomo, Governor of the State of New York, which included the following: “No pharmacist shall dispense hydroxychloroquine or chloroquine except when written as prescribed for an FDA-approved indication; or as part of a state approved clinical trial related to COVID-19 for a patient who has tested positive for COVID-19, with such test result documented as part of the prescription. No other experimental or prophylactic use shall be permitted, and any permitted prescription is limited to one fourteen day prescription with no refills.”
6. March 25, 2020: Notice of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures Under Executive Order 13910 and Section 102 of the Defense Production Act of 1950, which specifically identifies “Drug product with active ingredient chloroquine phosphate or hydroxychloroquine HCl”
7. March 27, 2020: Utah Medical Association Email, which included the statement ”

   recommending that providers use a long-standing medication to treat COVID-19. This medication, Hydroxychloroquine, Hydroxychloroquine/zinc compound or Chloroquine/zinc is showing some promising data for affecting the course of COVID-19.” This was followed by an email the next day that said “The UDOH has withdrawn its guidance on hydroxychloroquine from March 27. They are instead endorsing the launching of the clinical studies and urging patients to participate in the trial to get access to the investigative drugs in a controlled environment with gathering of data.”

8. March 28, 2020: FDA Emergency Authorization for use of Hydroxychloroquine
9. March 29, 2020: Limitations on Prescribing and Dispensing of Medications for Treatment of COVID-19, New Jersey order for limiting hydroxychloroquine prescriptions
10. April 6, 2020: Penn researchers assess hydroxychloroquine for Covid-19
11. April 13, 2020: South Dakota launched the nation’s first statewide clinical research study to investigate hydroxychloroquine: Sanford Health to lead clinical trial for COVID-19 treatment
12. April 13, 2020 (last updated):  COVID-19: Hydroxychloroquine, Chloroquine, and Azithromycin has different state policies on hydroxychloroquine
13. April 16, 2020: Federal, state authorities step up efforts to prevent hoarding of chloroquine, hydroxychloroquine
14. April 24, 2020: FDA Safety Warning on use of Hydroxychloroquine
15. April 27, 2020: Boards of pharmacy and other actions relating to COVID-19 prescribing:

    “The A.M.A. is calling for a stop to any inappropriate prescribing and ordering of medications, including

    chloroquine or hydroxychloroquine, and appealing to physicians and all health care professionals to follow the highest standards of professionalism and ethics,” said AMA President Patrice A. Harris, MD.

16. May 12, 2020 (last updated): NIH Treatment Guidelines “There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19″

Author: J. Sands Loch

Student and teacher of reality in all its forms. I self-published my personal experience of discovering and trying to understand and use a model of reality based on the Many Worlds Interpretation of Quantum Mechanics: Surfing the Multiverse: Finding Happiness One Universe at a Time Available on Kindle and from Amazon, and found in blog post form at: SurfingTheUniverse.com View all posts by J. Sands Loch