Ioannidis / Raoult: Dialogue of the Deaf?

This February 20, the IHU Marseille had as distinguished guest for a video conference: the prestigious Stanford Professor, John P.A. Ioannidis, MD, PhD

The theme was: “Epidemiology of COVID-19: proofs, risks and misunderstandings”

Professor Ioannis made a presentation with powerpoint slides. He then took a few questions and also did dialogue with Professor Raoult.

When it comes to medical science, Professor John P.A. Ioannidis is extremely recognized. He holds the position of C.F. Rehnborg Chair in Disease Prevention, Professor of Medicine, of Epidemiology and Population Health, and (by courtesy) of Biomedical Data Science, and of Statistics; co-Director, Meta-Research Innovation Center at Stanford University. See a more detailed bio here.

The invitation may have been triggered by extremely controversial comments made recently by Professor John P.A. Ioannidis in a podcast two weeks ago about “Building a Meta-Research Career and Constructing COVID-19 Health Policy”

“We have a paper coming out in Nature Communications, which is a meta-analysis of hydroxychloroquine trials. We show a significant increase in mortality,” asserted Professor Ioannidis, adding:

“Probably we killed about 100,000 people with hydroxychloroquine as a treatment globally.”

The full podcast can be found at:

The relevant excerpt can be found here in audio:

Ioannidis is very respected globally, including by Professor Raoult, who presents him as the world’s number one when it comes to epidemiological analysis.

The conference by Professor Ioannidis can be viewed at the link below. It touches about key aspects of the response to the pandemic. He stresses how the disease is mostly lethal to older people, and emphasizes that risk stratification can easily be implemented.

He emphasizes that we may have sought to protect those at low risk and failed to protect those at risk, i.e. older people.

He deplores that not enough emphasis has been put in protecting the vulnerable groups of society, especially in nursing homes, using terms such as massacres to refer to what happened, and continues to happen, in these aged care facilities.

In his recommendations, he stresses much heightened protection measures in nursing homes to avoid infections, among various other measures (see screenshot of slide).

During his powerpoint presentation, he does not refer to early outpatient treatment, and does not refer to either hydroxychloroquine (despite his claim that it killed 100,000 people) or ivermectin (despite the considerable attention currently given to this therapeutic agent).

During the Q&A session, it was not Professor Raoult, but someone in the audience who asked about the elephant in the room, i.e. early outpatient treatment.

Question: “What do you think about the early outpatient treatment?”

Response: “Oh goodness uh I think it’s unclear to me how much we can achieve with early outpatient treatment.”

“What I do believe is that we should avoid overcrowding hospitals. I think that somehow the response to the pandemic has been centered on hospitals a lot of attention has fallen on how many ICU beds do we have, at kind the end of the chain.

This is very unfortunate because this is a community infection. It needs to be managed in the community we need to do our best to keep pretty much most of the management in the community and avoid hospitals being overwhelmed.

“I’m not sure that, of all the people who get admitted, we do really much for them. We have some options for treatment. It’s very difficult to document how effective they are and or how ineffective they are as you realize especially for early treatment the outcomes are going to be pretty good in the vast majority of patients anyhow. So it’s very difficult to substantiate this.”

“There’s huge polarization, there’s huge debate, there’s a lot of people have nothing to do with science who have been talking about it.”

“I know that Didier (Raoult) has suffered in that mix of journalism and politics and then upheaval that has ensued”

“I just think that we should try to keep the infection away from hospitals as much as possible and much of the time there’s nothing to do other than being calm and wait.”

Yet Ioannis further notes: “the earlier the treatment, the least likely you will have bad outcomes,” yet warns about a risk of over reaction and of over-treatment: “the earlier the treatment, the higher the risk of over reaction” he declared.

He mentions there are “zillions of trials” but a small fraction of them has been completed. “There is still a lot to learn.”

“We need very solid data before I can say we know what to do in that case”

Professor Didier Raoult then explained what was done at IHU-Marseille regarding early treatment.

“We have treated something like 14,000 people, among those 11,000 as outpatients. Our fatality for outpatients in 1 out of 1000, so it’s quite low.”

“For patients that come, more late they come, more high is the fatality rate.”

“We are also getting better, because we have these apparatus to provide high oxygen to people over 80 …”

Further in the discussion, Ioannis talks about people in a later stage of the disease.

“For most people who die from COVID-19, There is very little that can be done. You know, once you get to that advanced stage of the disease, you know that dexamethasone probably works so we have even randomized controlled trial for that.”

“It’s very difficult to think of other interventions that have a very clear ability to save lives once you are at that late stage.”

“For early treatment, it’s a different thing, but as I said, almost all those people do very well anyhow, so it’s very difficult to identify specific interventions with clear benefits in that population.”

Professor Raoult did not challenge Professor Ioannis assertion that “it’s very difficult to identify specific interventions with clear benefits” for outpatient treatment, while he has treated such 11,000 outpatients since the beginning of the pandemic.

The outpatient treatment protocol at IHU-Marseille has evolved considerably, with the addition of zinc, anti-coagulants, corticosteroids, etc. as outlined in this recent video.

In sum, Professor Ioannis kept his position that there is no outpatient treatment for C19 showing clear benefits, yet he did not reiterate or explained how he found that 100,000 people would have died because of hydroxychloroquine.

Professor Raoult probably chose to avoid challenging his guest speaker about his bold claim, and only stressed as defence that the fatality rate among outpatients treated at IHU Marseille was only 1 out of 1,000.

Somewhat bizarrely, Professor Ioannis emphasizes the need to treat the disease early, in the community, to avoid hospitals, but does not provide any form of solution about it.

And Professor Raoult, who has treated thousands of outpatients at IHU-Marseille, did not even try to convince Professor Ioannis that he and his team are actually saving lives through early therapies.

Many relevant elements were not brought into the discussion, including the study showing a reduction in mortality in nursing homes in the Marseille area, at the initiative of Prof. Raoult and IHU Marseille, the study by Derwand et al of Dr Zelenko’s patients, and that by McCullough et al, of Dr Procter’s patients, showing a considerable reduction in the need for hospitalization with early treatment, to name just those.

So here is a question: was this videoconference a real academic discussion, going into the depth of the issue and attempting to find concrete responses and solutions, or was this kind of a (diplomatic) dialogue of the deaf?

Maybe it’s time now for Professor Harvey Risch, Dr Peter McCullough and others to invite Professor Ioannis to debate this critical question of early outpatient treatment.

It’s doubtful that they will let Professor Ioannis get away with his 100,000 hydroxychloroquine deaths claim, and his assertion that “it’s very difficult to identify specific interventions with clear benefits” for outpatient treatment. will be very happy to facilitate such encounter / debate!