Clinical Outcomes of Outpatients With Suspected Covid-19 Treated With Chloroquine Compounds in Brazil: A Nationwide Telemedicine Study

Introduction: Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment. Method(s): Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p<0.10) were included in 4 multivariate models: 1: unadjusted;2: adjusted for age and sex;3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact). Result(s): In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260;G2: 871;G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p<0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p<0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p<0.001;phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p<0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28). Conclusion(s): Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.

TeleCOVID-19: A Multifaceted Strategy from a Public Brazilian Telehealth Service during the COVID-19 Pandemic

The COVID-19 pandemic has quickly and radically transformed health systems worldwide. The challenges are imposed by the need for social distance, remote management of less severe cases, and the constant need for updating health care professionals and the population with reliable information. We aim to describe the experiences and developments of a Brazilian telehealth public service during the pandemic. Numerous tools have been developed and made available, to be used in an integrated manner, by both health professionals and the general public. Those included a chatbot for guidance, a teleconsultation platform combined with a telemonitoring system, a teleconsulting service, and a tele-education program. The TNMG services appear to be efficient and robust during the health crisis of COVID-19, through different tools and methodologies focused on both professionals and users of the health systems. © 2021 The authors and IOS Press.