Does Widespread Use of Hydroxychloroquine Reduce the Transmissibility of SARS-CoV-2 / COVID-19? An Ecological Correlational Study

BACKGROUND: At the beginning of the coronavirus disease (COVID-19) pandemic, hydroxychloroquine (HCQ) was widely used as a possible antiviral agent. Current knowledge indicates that HCQ has little or no effect on individual clinical outcomes of COVID-19, but populational effects on disease transmissibility are still unknown. OBJECTIVE: This study investigates the hypothesis that massive HCQ consumption by a population may contribute to reducing the transmissibility of SARS-CoV-2 and COVID-19 spread by reducing the viral load of infected individuals. METHODS: Public database of seven states from Brazil in 2020 were assessed, before the start of COVID-19 vaccination. The daily values of the COVID-19 effective reproduction number (Rt) were obtained. Associations between Rt values and the proposed predictor variables (prevalence of COVID-19 as a marker of collective immunity; social isolation indices; consumption of HCQ) were tested using multiple linear regression analysis. RESULTS: In all seven states, consumption of HCQ was a significant negative predictor of Rt (β ranged from -0.295 to -0.502, p = 0.001). Furthermore, the mean derivative of Rt during the declining period of the COVID-19 incidence (the mean rate of variation) was also significantly negatively related to the mean HCQ consumption in that period (R(2) = 0.895; β = -0.783; p = 0.011), meaning that the higher the HCQ consumption, the faster the decline of COVID-19 Rt. It suggests a dose-response phenomenon and a causal relationship in this association. CONCLUSION: The results of this study are compatible with the hypothesis that HCQ has small but significant in vivo antiviral effects that are able to reduce SARS-CoV-2 transmissibility at the populational level.