An Orange County doctor who set up testing for COVID-19 patients a month ago says he has seen a dropoff in those testing positive and success in treating them with an anti-malaria medication.
Dr. Gregg DeNicola of the Caduceus Medical Group said he started testing around March 10 in Laguna Beach and then spread out to Yorba Linda and Orange.
“We were a little unique,” he said, adding, “We required telemedicine to evaluate patients first. One they passed that evaluation, they were directed to one of our three curbside locations.”
DeNicola has been treating his patients with hydroxychloroquine and Z-Pak, a five-day course of the antibiotic azithromycin.
“We’ve gotten very good results,” DeNicola said.
Only one of his patients has had to be hospitalized so far, he said.
The patients are placed into four categories — some are asymptomatic, some have mild to moderate symptoms and others are considered severe.
“If they’re mild or less, we put them on the Z pack or Zinc, but we haven’t seen it do much,” he said.
But Plaquenil, the brand name for hydroxychloroquine, has produced “pretty good results,” DeNicola said. “At least 75 to 80% notice definite improvements in a day or two.”
DeNicola estimated his practice has tested 700 to 800 patients and 56 patients have tested positive for coronavirus so far.
“We were doing 50 to 75 (tests) a day,” he said. “(On Tuesday) we did 25” and Wednesday, “we probably did 20. So the demand is dropping off. That’s the social distancing. People aren’t getting coughs and cold because there’s nobody to spread it around.”
DeNicola said he used to average about 10 strep throat cases a week, but “nobody is passing that around either.”
Some people are calling his practice to get hydroxychloriquine “for the heck of it, but the health department is asking us not to (accommodate) those people,” he said.
Dr. Shruti Gohil, a professor of infectious diseases at UC Irvine, said hydroxychloroquine is worth studying, but there’s not enough data to show it is effective yet.
“I don’t think it’s a bad idea at all,” she said. “I think we should look at it. But it does really have to be studied properly before it’s handed out like candy to patients. We have to be more careful.”
Gohil said she might use it “in my patients who are not doing well,” reserving it for elderly and high-risk patients.
The risk is the medication can cause cardiac arrhythmia, Gohil said.
Jerika Lam, a Chapman University associate professor of pharmacy and expert on viral infections, said that as of now, “there is no strong, reliable scientific evidence to support hydroxychloriquine for the treatment against SARS-CoV-2. The use of hydroxychloroquine against COVID-19 stemmed from a small, open-labeled, non-randomized French study.”
The study sample size was 26 patients, who were given hydroxychloriquine and azithromycin, Lam said.
“Of the 26 patients, six dropped out from the study, three transferred to the (intensive care unit), one patient died, one patient stopped the treatment because of severe nausea and one left the hospital,” Lam said.
Researchers concluded the study was too small and larger randomized clinical trials were needed to evaluate its effect on COVID-19, Lam said.
DeNicola does PCR nasal swab testing, considered the most reliable way to diagnose COVID-19.
Some of “the quickie ones they’re doing have too high a false negative,” he said. “A false positive I can live with, but a false negative is devastating.”
The serology tests that measure whether a person has developed an immunity after overcoming the virus are not reliable enough, DeNicola said.
“They want to know if they’re still contagious,” DeNicola said of his patients. “The only test that’s going to tell you that is the PCR, so you have to keep swabbing.”