Craig Kelly has been the subject of derision here before. His opinion that ancient photos are a reliable measure of sea level rise1, and that Pacific atolls float on the ocean2, and that climate change is not happening3, were astonishing. However, the stupidity continues.
For some time the idiotic Kelly has used social media and the federal parliament to advocate for the use of hydroxychloroquine to combat Covid-19 despite numerous warnings from health officials and scientists across the globe that the drug is ineffective and potentially harmful when used to treat Covid-19 patients4.
In parliament, on Tuesday, Kelly said, in the first half of his speech: “About half an hour ago we heard the most extraordinary attack on the reputation of Professor Harvey Risch by the shadow health minister of this country—statements that were a disgrace. What is Professor Risch under attack for? He has said, ‘The evidence in favour of hydroxychloroquine benefit in high-risk patients treated as outpatients is stronger than anything else I’ve studied in my career.’ He has 38 years as a professor of epidemiology, and you Labor people are criticising this gentleman without any idea what you’re talking about. I have never seen a greater example of groupthink and inability to think”5.
Risch is a cancer epidemiologist, not an infectious diseases epidemiologist, from Yale University, who published a review article in the American Journal of Epidemiology that cites evidence that he believes supports hydroxychloroquine use for out-patient infection with SARS-CoV-2. Dr. Risch believes that other studies which showed no effect or harmful effects should be dismissed by based on his assertion that these studies enrolled patients too sick to benefit from hydroxychloroquine. This caused Sten Vermund, the Dean of the Yale School of Public Health to note that: “Yale-affiliated physicians used [hydroxychloroquine] early in the response to COVID-19, but it is only used rarely at present due to evidence that it is ineffective and potentially risky. The Food and Drug Administration of the U.S. Public Health Service issued the following statement (in part): ‘June 15, 2020 Update: Based on ongoing analysis and emerging scientific data, FDA has revoked the emergency use authorization (EUA) to use hydroxychloroquine and chloroquine to treat COVID-19 in certain hospitalized patients when a clinical trial is unavailable or participation is not feasible. We made this determination based on recent results from a large, randomized clinical trial in hospitalized patients that found these medicines showed no benefit for decreasing the likelihood of death or speeding recovery. This outcome was consistent with other new data, including those showing the suggested dosing for these medicines are unlikely to kill or inhibit the virus that causes COVID-19. As a result, we determined that the legal criteria for the EUA are no longer met’”6
Kelly continued: “I was asked what medical journals I read. I will quote from the European Journal of Internal Medicine. You two might like to read it after and go and do some homework. This was a recent study, only out yesterday, by Dr Augusto Di Castelnuovo. What did Dr Di Castelnuovo say of his study? This was a study of 3,451 hospitalised patients in 33 clinical settings in Italy. His conclusion was—you might like to take this to your shadow health minister, who has no idea what he’s talking about—’We observed that the patients treated with hydroxychloroquine had a 30 per cent lower in-hospital mortality rate than those not receiving it.’ That’s 30 per cent fewer deaths. And you people are engaged in groupthink and not reading the evidence. The statements that we heard today from the shadow health minister of this country were a disgrace.”5
The paper mentioned by Kelly was an observational study of 3,451 patients hospitalised in 33 clinical centres in Italy, from February 19, 2020 to May 23, 2020, with laboratory-confirmed SARS-CoV-2 infection7. The results showed that out of 3,451 COVID-19 patients, 76.3% received hydroxychloroquine. Death rates (per 1,000 person-days) for patients receiving or not receiving hydroxychloroquine were 8.9 and 15.7, respectively. After adjustment for propensity scores, we found 30% lower risk of death in patients receiving hydroxychloroquine. However, their conclusions are less than indicated by Kelly. They stated “[Hydroxychloroquine] use was associated with a 30% lower risk of death in COVID-19 hospitalised patients. Within the limits of an observational study and awaiting results from randomised controlled trials, these data do not discourage the use of hydroxychloroquine in inpatients with COVID-19.”7 This is effectively saying that this was an observation, and that trials with a control group are required before we can consider hydroxychloroquine efficacious in the treatment of Covid-19.
There are other trials of hydroxychloroquine which have been undertaken. One was an open-label randomised controlled trial. An open label trial is one in which information is not withheld from the patients, and the patients and researchers know which drug is being administered8. It is the opposite of a double-blind trial where neither patient nor researcher know which drug is being administered. This trial, by Tang et al. was carried out in China from 11-29 February 2020 and studied 150 patients with laboratory confirmed Covid-19. The administration of hydroxychloroquine did not result in a significantly higher negative conversion (becoming virus-free) probability than care alone in patients mainly hospitalised with persistent mild to moderate COVID-19. Adverse events were higher in hydroxychloroquine recipients than in hydroxychloroquine non-recipients9. While this did not test mortality, it did show that hydroxychloroquine had no measurable effect on recovery.
A meta-analysis (a study of the results of previous studies) of the efficacy of hydroxychloroquine (or chloroquine) with or without the antibiotic azithromycin has been carried out and was published on August 26th, 2020. Both drugs have been widely promoted to treat COVID-19 because early in vitro tests showed antiviral effects against SARS-CoV-2. The aim of this meta-analysis was to assess whether chloroquine or hydroxychloroquine with or without azithromycin decreased COVID-19 mortality compared to normal care10.
The initial search for studies yielded 839 articles, of which 29 articles met the inclusion criteria. All studies except one were conducted on hospitalized patients and evaluated the effects of hydroxychloroquine with or without azithromycin. Among the 29 articles, 3 were randomized controlled trials, one was a non-randomized trial and 25 were observational studies, including 10 with a critical risk of bias and 15 with a serious or moderate risk of bias (Note that the observational trials are susceptible to bias, from critical to moderate). After excluding studies with critical risk of bias, the meta-analysis included 11,932 participants for the hydroxychloroquine group, 8,081 for the hydroxychloroquine with azithromycin group and 12,930 for the control group. This study found that hydroxychloroquine was not associated with mortality (neither decreased or increased), whereas hydroxychloroquine with azithromycin was associated with an increased mortality10.
The irony of Craig Kelly quoting articles from medical journals as to the efficacy of hydroxychloroquine makes one laugh, especially when he ignores the thousands of published peer-reviewed papers on climate change, the results of which may make the current pandemic look like a minor inconvenience by comparison. Craig Kelly is certainly the stupidest parliamentarian, although Gerard Rennick11, Pauline Hanson12 and Malcolm Roberts13 do give him a run for his money.
Kelly thinks science is simply choosing what you want to believe and finding some data or a publication to support it, while ignoring anything that doesn’t fit his prejudice. Not only that, but Kelly does not understand that observational studies are at risk of bias, because there is little in the way of randomisation, nor are controls used. The fact that Kelly doesn’t understand the difference between an observational study and a randomised control trial simply demonstrates his profound ignorance. Using his position as a parliamentarian to promote something that is likely useless when people’s lives are at stake is criminal. I am being generous to Kelly because of his demonstrable stupidity. If he wasn’t so stupid one could be forgiven for thinking he is pushing hydroxychloroquine as a favour to the appalling Clive Palmer, who bought a shedload of it and is now stuck with it14.