Many times, during the Covid-19 pandemic, the topic of possible virus treatments came up and sparked controversy. On the initiative of Mauro Rango, an Italian passionate about medicine who lives in Rodrigues (Republic of Mauritius), a study group was formed which has been recently formalized in the Hippograte.Org association. Let’s talk about it with some of them. Mauro, Maria, Adriana, Nicola, Massimo.
Mauro can you summarize what happened?
MAURO: I live in the Republic of Mauritius. The island where I live is Rodrigues, 600 km east of Mauritius, the last point of Africa in the Indian Ocean. I have always loved medicine, although I am not a doctor. At the outbreak of the Covid-19 Pandemic, I started researching possible therapies with medical friends; these researches always led to the combined utilization of azithromycin and hydroxychloroquine.
When the Coronavirus hit Italy and caused the first people to die, I contacted a friend, Dr. Alberto Palamidese, a pulmonologist now retired, who in early March confirmed that the target organ of the virus were the lungs and that the related consequence was interstitial pneumonia similar to the one caused by the Mycoplasma Pneumoniae which, if not promptly addressed, would lead to the patient’s death. He told me that, in his experience, the treatment consisted of azithromycin, high dosages of cortisone, low molecular weight heparin, and ultimately the use of hyper immune plasma.
At the beginning of March, I called a very dear friend, MD at the USL-2 Umbria Prevention Department who told me that they were treating all patients in the area at the first symptoms with hydroxychloroquine 400 mg / day for 7 days and azithromycin 500 mg / day for 6 days, and keeping them at home. Except for a few hospitalizations, all cases had been resolved within a week. Zero deaths (including the hospitalized patients). Zero side effects.
At the same time, I learnt that the local health authorities in Mauritius were stocking up on hydroxychloroquine and azithromycin. I inquired with the authorities and, upon the arrival of the Covid-19, the plan (which would later be announced by the Prime Minister) was to treat the patients with hydroxychloroquine and azithromycin, in the same dosage as in Umbria and, in the most serious cases, with hyper immune plasma.
The same therapy had previously been used in South Korea where the epidemic was fairly quickly resolved.
So I found that all my research efforts consistently led to the same answer.
I started writing long email messages to various newspapers asserting that the therapy existed, while in my very region, Veneto, countrymen and friends of friends were getting sick and they were being left to die in hospitals, without any therapy, other than oxygen. Then began the massacre in Lombardy. I kept on writing without anyone listening to me.
On March 17, the AIFA memorandum authorized the off-label use of hydroxychloroquine, but it also warned against the combined use with azithromycin, due to the lengthening of the QT curve and possible cardiac arrest for serious arrhythmias.
The memorandum of the federation of the family doctors recommended the use of hydroxychloroquine at home but only few clinicians, especially in Northern Italy, followed it combined with azithromycin.
While in central and southern Italy the situation was different.
In many large hospitals, I’m thinking of the Tor Vergata Rome’s Second University Hospital or the Cutugno in Naples, azithromycin and hydroxychloroquine were being used in association since the middle of March.
Finally, in mid-April, the therapy with azithromycin and hydroxychloroquine was also taken into consideration by hospitals in Lombardy and Veneto, though not applied with a consistent approach. Based on the advice of many virologists, immunologists and epidemiologists, treatments with antivirals, which lead to unsatisfactory results, were still used in the hospitals of those regions.
At the same time, Professor Cavanna, Piacenza Hospital Primary, was prescribing treatment of patients at their homes with hydroxychloroquine and azithromycin, without any deaths and without any side effects being reported.
In Germany they were able to keep the mortality within the 3% rate thanks to a wide use of hydroxychloroquine, azithromycin and hyper immune plasma. This was done discretely following German tradition.
I suffered a lot witnessing my compatriots die. My anger increased in observing that the media were crowded with laboratory doctors, experts of various kinds and statisticians but no clinical doctor and no pulmonologist, who are able to understand and treat the pathology. There was a lot of confusion and no one at top level was committed, or able, to establish therapeutic rules for regional or local hospital level. Each Region, each hospital, each hospital ward and, more generally, any practitioner, they all followed their own policy regarding therapy.
I believe that, another reason for these contradictions and for the confusion that led to catastrophic consequences, relates to the fact that part of the medical community, kept on following the known path, waiting for some validation from scientific research. Such validation could not be achieved in such a short time, consequently they maintained a “wait-and-see” attitude, in the hope that a drug be identified and validated at all levels. On the contrary, another part of the medical community, more used to filtering the results of research through their own personal clinical experience or through the one of other doctors, endeavored to reproduce experiences that had had the validation of results successful in other specific fields of utilization, in other words, therapies that had been recognized for having healed patients.
The clinical intuition of doctors validated by striking results still does not seem to find the right place and consideration in the current medical-scientific community. The clinical experience confirmed by successful medical records showing many healed patients correctly treated without any side effects, appears to be less significant than a randomized study. I would like to recall the recent retrospective work of the Marseille group which demonstrated the validity of the protocol (therapy) with hydroxychloroquine and azithromycin on more than 3700 Covid 19 patients:
On May 5, I received a WhatsApp message from a friend in Milan. He is telling me about the appearance on the National Television show conducted by F. Fazio of the virologist Roberto Burioni who in the course of this important broadcast applied himself to slow down the initiative by some doctors to use hyper immune plasma.
A rush of anger led me to write my first WhatsApp message on the subject. I sent it to about forty friends, asking them to forward it to their acquaintances.
From that day, my life changed.
I received thousands of WhatsApp messages and thousands of emails. Among the people who contacted me there were also many doctors. Many of them had made the same attempts as I to inform that the cure already existed. A group was created immediately consisting of on-duty and retired hospital doctors, local doctors and even nursing staff with the aim of informing about the therapeutic possibilities. But also by thousands of citizens with different professions.
Who is in the group right now and what are you doing?
The group was born as a convergence of people with different professional skills and ideas who found themselves wondering what could be done to find a cure for this coronavirus. The first thing we wanted to do was to reconstruct how things actually went.
Basically, as early as March, in large Roman, Neapolitan, Sardinian and Sicilian hospitals, and certainly in others also, therapy with hydroxychloroquine, azithromycin as basic drugs always available, was used. Protocols differed between hospitals and between different departments of a same hospital (testifying to the complete absence of a main direction). Those who added vitamin C, cortisone, heparin, those who added various antivirals and heparin and vitamin A, but the basic core remained azithromycin and hydroxychloroquine. In these hospitals, where the protocols contained the aforementioned drugs, mortality was substantially limited to those patients over 80 with multiple pathologies. At the same time, however, in the Lombard and Veneto hospitals, the number of deaths was enormously higher, reaching in the Lombardy Region the record figure of 17% of mortality.
My YouTube video talking about the 30,000 lives that could have been saved was removed after 9,000 views. YouTube responded to our objection instantly with an apparently automatic, prepackaged message, telling us that the content was inappropriate.
With this group of doctors and in dialogue with the coordinator of another group of territorial doctors who have used hydroxychloroquine widely with their patients, we have carried out various initiatives, without giving them too much publicity, these include:
- A letter signed by about eighty Italian doctors that I personally sent to The Lancet cc the WHO dismantling, with the help of Dr. Adriana Privitera, a cardiologist, the study published by The Lancet following which WHO withdrew hydroxychloroquine from trials and AIFA suspended off-label use of it for Covid patients. Unlike The Guardian and the 120 scientists (https://zenodo.org/record/3862789#.XvikvV9xfIX) who attacked the study from the point of view of the method, we have shown that the deaths referred to in the study have occurred for two reasons: 1. Inclusion of patients with too far advanced state of the disease, 2. Use of hydroxychloroquine in heart patients (ischemic, decompensated and arrhythmic) who should not have been given it. The study computed these deaths as a direct cause of the effects of the drug in question and concluded for the ineffectiveness of hydroxychloroquine and its danger due to increased mortality and arrhythmias. Conclusions that we have shown to be unreliable from a medical and scientific point of view.
- We have written a letter to President Mattarella of Italy evidencing the absurd position of AIFA and asking him to intervene.
Now we are committed to assisting some South American countries in the protocols and we are engaged in researching plasma machines for Somalia.
In addition to doctors, we have involved thousands of civil citizens around a project called IppocrateOrg. The Facebook page (https://www.facebook.com/IppocrateOrg/) is already active, while the website www.ippocrateorg.org will be very soon.
This project has NO political ambitions. We have rejected intrusions of representatives of various political formations, aid, requests for collaboration with affiliated or party-related associations that we have kindly refused because we are born as an aggregation of citizens and health professionals whose only goal is the defense of Human Health. We intend to develop a movement that knows how to give voice to that part of the medical-scientific community that, in this Coronavirus affair, has not felt represented by the Health Institutions. At the same time, we will be committed to opposing all that research or information that had as its purpose the weakening of access to medical therapies suitable for the treatment and damaging the Human Right to Health and Wellness.
Hydroxychlorichin therapy ended up in the spotlight of the mainstream and aroused conflicting positions from the WHO, research institutes and the Italian Medicines Agency: can you briefly summarize the history of this diatribe?
ADRIANA: It is appropriate to clarify a little. The use of chloroquine goes back in time.  And during the Covid-19 epidemic, China and South Korea used hydroxychloroquine with and without association with macrolide, (WangMet al. Remsedivir and chloroquine effectively inhibit the recently emerged novel coronavirus. CellRes 2020 Feb 4 ). About 20 in vitro studies with excellent results in China have made it recommended that it be used for the prevention and treatment of pneumonia from Covid-19 (https://pubmed.ncbi.nlm.nih.gov/32075365/ ). In March 2020 a study in France conducted on 20 patients showed less persistence of the virus especially in the association with azithromycin (https://pubmed.ncbi.nlm.nih.gov/32205204/). After these studies, the combination hydroxychloroquine azithromycin was prescribed worldwide even outside authorized clinical trials. In Italy in April, the Italian Federation of General Practitioners (FIMMG) advised its use in both proven cases of Covid-19 and in suspects, so many family doctors have used the treatment early avoiding hospitalizations. On February 26, 2020, the United Kingdom government added chloroquine to the list of medicines that could not be exported, given the growing number of tests on the effectiveness of the drug. In March, with a circular, AIFA authorized the use of off-label hydroxychloroquine, warning against the simultaneous use of azithromycin for several studies that demonstrated the danger of severe arrhythmias . But after so much positivity the problems begin . In May, Mandeep Mehra and collaborators publish in The Lancet an observational study on 96032 patients hospitalized in 6 continents who took hydroxychloroquine and chloroquine alone or with macrolides concluding for evidence of serious arrhythmias in the treated patients compared to the control group, high mortality and absence of therapeutic advantage of hydroxychloroquine and chloroquine either alone or in association with macrolide.
On this basis, the WHO stops investigations and studies on hydroxyclorokine, AIFA on May 29, no longer grants off-label prescription and allows only official trials to be continued. This creates a very serious situation because this therapy had been very useful in dealing with the first phase of the disease.
Fortunately, the Lancet study is challenged by 120 researchers from around the world who challenge both the data collection and the methodology. The Lancet thus withdraws the study and the WHO resumes experimentation on hydroxychloroquine on 3 June.
And, with the signature of 80 doctors, we write to the journal, challenging the merits of its scientific value. Unfortunately, AIFA does not take a step back, keeping the indication for the use of hydroxychloroquine for covid-19 only for clinical studies both in hospital use and home use, the prescription is therefore excluded from reimbursement and even more serious who prescribes responds personally of any side effects for treatment. A group of doctors makes a legal request to AIFA asking to be able to use it again for the early treatment of the disease. Finally, in June the British RECOVERY trial (www.recoverytrial.net/files/recovery-protocol-v6-0-202005-14.pdf) which used very high doses of the drug, did not find any difference in mortality between the treated groups and the controls after a month of treatment. This study is also to be criticized, in fact over 10,000 patients have been recruited from hospitals throughout the United Kingdom, the dose of hydroxychloroquine is VERY HIGH, and patients are treated on monotherapy, when the effect of hydroxychloroquine is in association with the macrolide, also including serious patients, some under ventilator. As everyone now knows, hydroxychloroquine is the ideal treatment in the early or intermediate middle stage of the disease, which avoids aggravation with the known fatal complications. Bologna’s Prof. Viale offers a very useful explanation of the natural history of the disease and therapeutic interventions in the various phases (https://youtu.be/mVBfCzDWxPQ).
After RECOVERY, WHO has once again blocked everything. Remember that Recovery receives funding from Oxford but also from the Bill and Melinda Gates foundation.
From the analysis of all the studies, to date there is NOT ONE STUDY that demonstrates the dangerousness of the drug, when given with the CORRECT indications. So it is legitimate to ask where is scientific research going?
What do you ask the government and Italian medical institutions?
NICOLA. Italy entered phase 2 of the epidemic with the reduction of infections in almost all regions and the emptying of intensive care units and the constant decline in deaths. This happened, in our opinion, for three concomitant factors:
- the lock down has been observed by citizens in a commendable way, together with sanitation (masks, social distancing, hand hygiene, surfaces, etc.).
- The good therapy used even if empirically and in random spots, with wide use in particular of the hydroxychloroquine in the initial phase of infection and of heparin as soon as the fatal mechanism of multi-organ thrombosis was discovered, which caused the clinical condition of the patients to precipitate.
- the climatic conditions of the hot season which seem favorable to the limitation of the infections by this class of respiratory viruses.
In light of the foregoing, in order not to run the risk of nullifying what has been obtained so far, we ask the Italian Government but also the regions, to make the population aware of the therapy to be implemented after the ban on the use of hydroxychloroquine, until yesterday the winning weapon of the initial therapy. The loss of its use, in fact, to date, suggests that it has been decided to leave patients in inflammatory state completely unprotected, leaving the difficult task only to the anti-viral to prevent the subsequent cytokine storm. We also ask which one type of antiviral molecule will be used, and the cost of an entire Covid patient treatment, to assess whether there is a correct and acceptable cost / benefit ratio. In the case of a recovery of the epidemic in Italy, what will be the intervention on the territory?
In the absence of the use of hydroxychloroquine as a drug of first immediate use in the territory, there will inevitably be a greater influx of patients in serious conditions to the health facilities: a script already seen and terrifying, especially in the RSA! (nursing homes)
MARIA: I would like a serious and independent experimentation of Hydroxychloroquine to resume, which clearly, like all drugs, must be used wisely and with the precautions that Adriana has already exposed in full, giving everyone a correct and true information on statistical data and possible therapies.
Furthermore, it seems important to us that we all start to assess the responsibilities of those who managed the epidemic at government level, ISS, AIFA and the Regions, in particular Lombardy, reviewing the whole process of information flows, investigating the following of events with the start from a broad profile that includes the environment, prevention, awareness and freedom of citizens. In short, a broad vision that reinterprets the process as a whole.
I would like to highlight, data and timing at hand, that if the correct therapies had been put in place from the very first phase and throughout the territory, the prophylaxis measures, with particular attention to the protection of health workers, would have avoided the hecatomb and the national lock-down economic crisis. Not to mention the massacre of our elderly in nursing homes!
Now, with the epidemic almost off, the need for mass vaccination against influenza is declared, to the advantage of pharmaceutical companies, when the connection between influenza vaccination and severity of Covid 19 is increasingly evident.
In addition, we would like to know what scientific evidence justifies the flu vaccination of children aged six months to six years. Explain it to us!
We have been projected into a surreal dimension in which, alongside the actual danger of the virus, nobody knew anything, famous virologists and politicians, but everyone pretended to know making the country fall into anguish and panic, with serious harm to children, the elderly, the disabled and people with psychic suffering.
Healthcare should be of good quality and free of charge worldwide: Covid 19 has shown how far we are from this goal. What do you think Big Pharma’s role is in this matter and what should we citizens do?
MASSIMO. The influence of Big Pharma distorts reality on the actual relevance of diseases and their respective treatments, sometimes substantially modifying public information.
To remedy this important problem, it would be necessary that whoever is invited to speak in public be required to declare any links with the companies in the sector.
The COVID2019 pandemic has shown that field doctors know how to find effective (and sustainable!) Answers long before researchers can verify their validity. The real strength lies in the ability to freely and quickly exchange experiences and results. We believe that the clinic should be returned to the value and dignity that the very expensive research has stolen from them.
Big Pharma’s research is taking advantage of the COVID case by investing billions of dollars to offer expensive or even non-existing drugs, when we already have drugs available that have shown great efficacy for the early stages of the disease (hydroxychloroquine, azithromycin, heparin), and for the more advanced stages (hyper immune plasma).
The huge philanthropic funds in the medical field should be able to be addressed exclusively and transparently by independent governmental bodies in order to avoid a deleterious mingling between economic interests, management of advertising information and health needs.
MARIA: Thanks Olivier for the question “what should we citizens do?” as it shifts attention to all of us, to our ability to understand and act, without totally delegating the reading of reality to the experts, or presumed such. I believe this is a responsibility that we must take to start thinking about what has happened, critically and creatively. We can as citizens and doctors, rediscover together the wisdom that is deeply innate in the human feeling and coordinate knowledge in a functional way to the emergence of truth, not meant in a dogmatic and static way, but as a continuous becoming that is revealed to those who observe reality without prejudices, complaints or interests to be preserved.
Without the recovery of critical thinking and the freedom of expression of doctors, I fear that we will find ourselves again in a dramatic situation due to another virus or to the climatic and environmental emergency that is already putting us in check at all levels.
MAURO After the publication of the Marseille study, cited above, we ask ourselves how many doctors have experimented with the hydroxychloroquine-azithromycin protocol in their clinical practice in Italy and invite them to join our research to conduct together a retrospective epidemiological study on the cases treated.
WRITE US TO THIS PROVISIONAL MAIL: firstname.lastname@example.org (as soon as the Ippocrateorg.org site is active we will open another one)
www.ippocrateorg.org (opening soon);
Medical request to AIFA for the reintroduction of Hydroxychloroquine in Covid 19: https://www.nursetimes.org/coronavirus-caos-hydroxychloroquine-140-medici-contro-laifa/90879
Letter to Lancet
All videos by Mauro Rango:
 Today in addition to the treatment of malaria, hydroxychloroquine is indicated both in adults and in children in case of rheumatoid arthritis, systemic lupus erythematosus juvenile idiopathic arthritis, with recommended precautions for: problems with the retina, cardiovascular pathologies, cardiomyopathies, insufficiency cardiac, QT interval prolongation, liver and kidney failure, deficiency of glucose 6 phosphate dehydrogenase
 The antiviral effect of hydroxychloroquine may be due to the increase of PH inside the cell precisely because it binds to acid radicals causing an increase in PH which becomes more alkaline with consequent inability of the virus to develop in the cell. Another action of hydroxychloroquine is that prevents the virus from binding to Porphyrin by inhibiting the EME which is the non-protein part of the hemoglobin (consisting of the Iron + Porphyrin + oxygen complex) Coronavirus prevents the link between iron and porphyrin and therefore it becomes no longer possible for oxygen to be transported, hydroxychloroquine forms a stable bond with the EME by subtracting it from the coronavirus. On the other hand, azithromycin, in addition to its anti-inflammatory action, has antiviral and immunomodulation activity.
 In 2015, 33 Chinese studies found this hazard (https://pubmed.ncbi.nlm.nih.gov/26564594/
 A retrospective study by New York University showed lengthening of the QT tract up to 500msec (val nor QTc in men 0.44sec, in women 0.45 sec) with risk of severe arrhythmias, it is therefore incredible that patients with kidney deficiency were included in the study and simultaneous intake of Amiodarone contraindicated in the treatment with hydroxychloroquine and azithromycin !!!, it is spontaneous to wonder if such a study is ETHICAL In fact, an extension of the QT tract can determine a severe arrhythmia called torsade de pointes-type ventricular arrhythmia which easily degenerates into a ventricular fibrillation, deadly arrhythmia that can be resolved only with electrical defibrillation