COVID-19 Case Series at UnityPoint Health St. Luke’s Hospital in Cedar Rapids, IA

McGrail et al., medRxiv, doi:10.1101/2020.07.17.20156521, Jul 2020
Mortality -70% improvement lower risk ← → higher risk HCQ for COVID-19  McGrail et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 75 patients in the USA Study underpowered to detect differences c19early.org McGrail et al., medRxiv, July 2020 0 0.5 1 1.5 2+ RR
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 424 studies, used in 59 countries.
Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
6,200+ studies for 200+ treatments. c19early.org
Download Meta Analysis
HCQ+AZ early in the epidemic had a fairly good success rate with few complications, 86% of HCQ patients survived and 92% of HCQ+AZ patients. Patients not receiving either had 93% survival but were not considered comparable because the treated groups were significantly more ill (100% hypoxic at admission vs. 59%) and this study does not adjust for the differences.
Transition from an early intubation strategy to aggressive utilization of high flow nasal cannula and noninvasive ventilation (i.e, BiPAP) was successful in freeing up ICU resources.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups.
Important missing comments or errors? Let us know.
risk of death, 70.0% higher, RR 1.70, p = 0.69, treatment 4 of 33 (12.1%), control 3 of 42 (7.1%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
McGrail et al., 19 Jul 2020, retrospective, USA, preprint, 2 authors.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
COVID-19 Case Series at UnityPoint Health St. Luke’s Hospital in Cedar Rapids, IA
Dianna Edwards, Daniel Mcgrail
doi:10.1101/2020.07.17.20156521
A retrospective, descriptive study of all patients tested for SARS-CoV2 on admission for illness to a community hospital in Iowa from 3/21/20 thru 6/14/20 consisted of evaluation as to demographics, presentation and hospital course. Ninety-one patients were SARS-CoV2 PCR+ with 63% being male and a median age of 60. Cardiovascular disease was a significant comorbidity in the PCR+ group. Fever, cough, dyspnea, nausea, emesis, diarrhea, headache and myalgias were significantly more common in that group, as was an elevated CRP, LDH, serum ferritin and transaminases. Overall survival of the COVID-19 patients was 88%, 77% in the critically ill, 59% of those mechanically ventilated and 33% of those requiring new dialysis. Survival was 93% in those not receiving any antivirals. Survival of those treated with hydroxychloroquine-azithromycin was 92%, compared to 86% of those treated with hydroxychloroquine alone. The latter two groups were significantly more ill than the untreated group. A transition from an early intubation strategy to aggressive utilization of high flow nasal cannula and noninvasive ventilation(i.e BiPAP) was successful in freeing up ICU resources.
References
Arnetz, Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State, JAMA, doi:10.1001/jama.2020.4326
Bhatraju, Ghassemieh, COVID-19 in Critically Ill Patients in the Seattle Region-Cse Series, NEJM, doi:10.1056/NEJMoa2004500
Fantini, Synergistic antiviral effect of hydroxychloroquine and azithromycin in combination against SARS-CoV-2: what molecular dynamics studies of virus-host interactions reveal, International Journal of Antimicrobial Agents
Gautreta, Hydroxychloroquine and azithromycin as a treatment of COVID-19 -results of an open label non-randomized clinical trial, International Journal of Antimicrobial Agents
Glantz, Primer of Biostatictics -The Program
Grasselli, Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy, JAMA, doi:10.1001/jama.2020.5394
Guotao, SARS-CoV-2 infection presenting with hematochezia, Med Mal Infect
Gustafson, Epistat, Gustafson, None
Huang, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Okour, Hydroxychloroquine and azithromycin as potential treatments for COVID-19 -clinical status impacts the outcome, Journal of Pharmacokinetics and Pharmacodynamics, doi:10.1007/s10928-020-09689-x
Richardson, Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area, JAMA, doi:10.1001/jama.2020.6775
Rodriguez, Dozens of Iowans traveled on cruise ships linked to coronavirus cases, Gov. Reynolds says, Des Moines Register Star
Saleh, The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection, Circulation -Arrhythmia and Electrophysiology
Whittle, Pavlov, Respiratory Support for Adult Patients with COVID -19, Journal of American College of Emergency Physicians, doi:10.1002/emp2.12071
Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019(COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention, JAMA, doi:10.1001/jama.2020.2648
Young, Ong, Kalimuddin, Novel Coronavirus Outbreak Research Team. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore, JAMA, doi:10.1001/jama.2020.3204
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Late treatment
is less effective
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