Driving forces for COVID-19 clinical trials using chloroquine: the need to choose the right research questions and outcomes

Abstract

The first cases of the new coronavirus (COVID-19) were reported in December, 2019, when a group of patients was admitted to hospitals with an initial diagnosis of pneumonia of unknown etiology1 . Initially, the outbreak of the new SARSCoV-2 coronavirus (coronavirus disease 2019; formerly 2019-nCoV) was centralized in the province of Hubei, Republic of China, and later spread to many other countries2 . SARS-CoV-2 infection appears to cause a wide range of symptoms, encompassing asymptomatic infection, mild infections of the upper respiratory tract, severe viral pneumonia, respiratory failure, multiple organ failure and death3 . Some studies have shown detailed clinical features of some patients with SARSCoV-24 . Of the 44,672 laboratory confirmed patients in China, almost 5% had critical illnesses and almost 50% of the critical patients died, with the overall rate of fatal cases (2.3%) being higher than that observed for seasonal influenza5 . Most deaths involved older adults, many of whom had underlying chronic diseases4,6, while children are less likely to develop severe infections7 . Despite there being no available data so far, anecdotal data from Italy showed a huge number of deaths in the elderly, paving the way for drastic control measures worldwide and compassionate use of drugs in severe cases.