Covid-19 - USA, two diverging fights : Democrats target Trump, Republicans target citizen's health ?

In France, the themes of the moment polarize the crowds: masks and their mandatory use, the precision and widespread uses of PCR tests, as well as treatments for Covid 19. And this is without talking about the personal attacks on professors Raoult and Perronne. On the one hand, the french government attempts to impose measures with authority, some of which are considered liberticidal; for example, the mandatory usage of masks outdoors or the increase in the number of tests (capacity of more than 1 million tests per week in France). On the other hand, the medical association  SPILF (infectiology professionals) attacks Professor Raoult in front the local Doctor’s governing body, on several grounds, including that he allegedly, misused hydroxychloroquine. The situation becomes complex to analyze as the two sides oppose each other by instrumentalizing science at micro levels.

Taking the helicopter view helps understand what is happening in other countries (who heals the best France or Italy?). Today we cross the Atlantic to study the case of the United States. The debate on hydroxychloroquine has taken political turns with the FDA's recommendations not to use this treatment for Covid-19. Simone Gold, a doctor in the United States, fought, alongside many others, against this decision. With America's Front Line Doctor, these doctors have been censored on social media.

What is really going on in the United States?

The diagram below summarizes the U.S. situation by looking at mortality rates per million inhabitants according to the respective state’s health policy on the use of hydroxychloroquine as a treatment for Covid-19.

The states are divided into three groups according to their health policy on hydroxychloroquine for the treatment of Covid-19. The health policy of each state is derived from the information provided by the AFLDS website.

• In green:  states where hydroxychloroquine is freely prescribed (standard prescription)
• In yellow: states where hydroxychloroquine is more difficult to obtain
• In red: states where hydroxychloroquine cannot be obtained

In the states where hydroxychloroquine is prescribed as a "standard prescription" have an average mortality rate of 390 fatalities per million inhabitants (range between 53 and 530 deaths per million). States, where it is more complicated to obtain, have an average of  515 fatalities per million inhabitants (range 52 to 1315) and those where it is impossible to obtain it have an average of 1011 fatalities per million inhabitants (range 128 to 1807).

More interestingly, fatality rates  are  18.2% for states with a standard hydroxychloroquine prescription and  40% or more for states where it is assessed difficult or impossible to obtain it. States prescribing hydroxychloroquine therefore have a fatality rate reduced by 56%.

These figures, statistically different, can be interpreted in greater depth.

Among the states prescribing hydroxychloroquine, Florida has an older population (20.6% of its population is over 65 vs 14.3% on average in the USA) and its fatality rate (530 fatalities per million inhabitants) is lower than that of the national average (563 fatalities per million inhabitants). In contrast, among the states where hydroxychloroquine is impossible to obtain, there is Utah, where the population is the youngest in the USA (only 11% are over 65 years of age) and where 62% of the inhabitants are Mormons. Mormons do not drink alcohol, tea or coffee and should refrain from taking prescription or over-the-counter medications.

These few elements provide a better understanding of a country as large as Europe. In a continent country, where the use of hydroxychloroquine divides, more than in France where it was banned, the fatality rate per million inhabitants is 563 versus 458 in France. The fatality rate in France is still  significantly higher than that of the States that prescribed hydroxychloroquine as standard (390 per million inhabitants), these states represent 26% of the American population with approximately 80 million inhabitants, thus slightly more than the French population.

André Savarino, a researcher in the Department of Infectious Diseases, Instituto Superiore di Sanità in Rome, Italy, with more than 3,000 citations to his credit, told FranceSoir how hydroxychloroquine was politicized in the United States, polarizing  debates between Republicans and Democrats with just two months to go before the U.S. presidential election.

The following graph illustrates the fatality rates of states according to their political color.

The states in blue (37% of the population) are historically Democrats and the states in red (32% of the population) historically republicans, these states have not changed political color during the last four presidential elections. The states, which we called "uncertain" have changed political color over this same period are in purple in the middle.

There is a trend. Democratic states (37.2% of the population) have a Covid-19 fatality rate of 779 fatalities per million inhabitants (range 52-1807) versus 427 fatalities per million inhabitants (range 53 - 1072) for Republican states (31.9% of the population). So there is a clear trend: the fatality rate in Republican governed states is 45% lower than that of Democratic governed states.

Let’s focus on standards of prescription

The next step is to overlay the prescribing practices of hydroxychloroquine in various states and the political color of these states.

Yet again, a clear trend appears. The states prescribing hydroxychloroquine as standard care are overwhelmingly Republican or “uncertain”, and the states that have made its prescription impossible are overwhelmingly Democrats. This make sense since the President in office Trump, is a Republican, and he has been a staunch supporter of hydroxychloroquine while the Federal Drug Administration (FDA) and the NAID led by  Dr. Fauci (close to Gilead and opponent of hydroxychloroquine, until now), who are rather social-democratic, opposed it.

Focusing on the exceptions among the states that prescribed hydroxychloroquine, and are not clearly Republican, Florida stands out, with the population most at risk since relatively old. In contrast, in some states that have made the use of hydroxychloroquine almost impossible, the republican led Utah and Arkansas are among the good students in terms of fatality rates.

On reflection, this situation in the USA is very surprising since the Democrats are historically favoring care for Americans. Let's remember that President Obama set up the  ObamaCare health program and warned  President Trump in 2017:

"We should always assume that any changes to our health care system must make it better, not worse for American workers."

By opposing the standard prescription of hydroxychloroquine, a generic and inexpensive drug, and promoting the costly remdesivir with serious side effects, approved by the FDA and promoted by Dr. Fauci, would the Democrats have forgotten the words of their former president?

Andréa Savarino is clearly right in his analysis of the politicization of the debates around hydroxychloroquine in the United States. This has led to a reversal of roles where Democrats, historically favoring  health plans for all, have been against hydroxychloroquine. This political position is effectively reflected in much higher fatality rates in the states they control.  In the opposite camp, the Republicans have been pragmatics.

Let us bet that this is not the end of the story and the vaccine war is not far behind. But this political struggle, through hydroxychloroquine, could weigh heavily in the balance in the US elections. After all it's about people's lives. The United States have so far reported more than 188,000 deaths related to Covid-19.