Surgisphere has been making noises about rapid policy shifts as the world seeks treatments for Covid-19. But as researchers began to examine it more closely glitches can be observed.
But what is Surgisphere?
Surgisphere data is used for retrospective observational studies, a type of study which can be problematic because of the presence of variables that were not controlled for, and selection bias. The discoveries should made public and Scientists worldwide and the World Health Organization have repeatedly executed control trials are needed to show which drugs, if any, are effective for Covid-19 .
The man behind this is Chaccour who is known for his work with the research institute ISGlobal in Spain examining parasites and microbes, exploring how these vectors spread disease and what works to treat the infections they transmit. He is particularly interested in mosquito-killing drugs, especially ivermectin. With too much curiosity and wave of intrigues about the study which was published on 14 April in a version known as “preprint”. This means it was made available online before reviewed or accepted by a medical journal.
“I saw the researchers had looked at this huge database … they included 169 hospitals in Asia, Europe, Africa, North America and South America and 1,900 Covid-19 patients seen by hospitals in those countries by 1 March,” Chaccour says.
With the amount of data gathered of other studies and related to finding of potential cure, the study methodology said its data had been obtained from Surgisphere. The Surgisphere website says it owns a data analytics system called QuartzClinical which monitors global healthcare in real time through data collection from 1,200 international hospitals “has led to advances in care for kidney failure, aneurysms, lymphedema, peripheral artery disease, colon cancer, and cardiovascular disease”.
As Chaccour and other researcher work with the database, they quickly found some alarming glitches and those doubts would only increase.
Surgisphere itself came under greater scrutiny, culminating in two of the world’s most prestigious medical journals reconsidering studies based on its data, an about-turn from the World Health Organization on research into a potential Covid-19 treatment, and a Guardian investigation that uncovered worrying inconsistencies in the Surgisphere story.
‘It was so weird’
With the promising results, Chaccour’s was surprise that the study had found 52 Covid-19 patients who had received ivermectin even though it is not being widely discussed as a potential Covid-19 treatment. The study also included data from three patients in Africa who, as of 1 March, were on mechanical ventilation and receiving ivermectin.
“But there were two patients in the entire continent alone at that time, let alone people on ventilators,” Chaccour says.
“And they’re supposed to be connected to a fancy automatic thing that gives all this data to a corporation in the US? It was so weird.” He added.
Chaccour, was medically exposed from Africa and knows African healthcare systems runs and he believes many hospitals there are not equipped with the electronic health systems required to be one of the recipients of the said database.
US data in the study also raised questions. The paper found mortality of the Covid-19 patients on mechanical ventilation and in the control group was 2%. By contrast, a paper published in the journal JAMA about New York state’s largest health system found almost 25% of those on ventilators died. Only the most critically ill patients require ventilation, so this high death rate wasn’t a surprise. The low death rate from the preprint study was.
“So these guys have a control group with 10-fold less deaths?” Chaccour says. “But it was a preprint, and prepublication, and I said to myself, ‘well this is just another non-reviewed thing, whatever, it doesn’t make much sense’.” Busy with his own work, he tried to forget the study.
“They talk about propensity scores, this huge database from 169 hospitals, five continents, it sounds fancy, and people started latching to this study out of hope,” Chaccour says. “Doctors were desperate for something to treat Covid-19.”
. Peru reported its first Covid-19 case on 6 March, but by the beginning of May it was in a state of emergency, having recorded 42,000 cases and about 1,200 deaths. A doctor in Peru wrote a white paper for the government about the use of ivermectin to treat Covid-19, heavily citing the preprint Surgisphere on 2 May, two weeks after the study appeared online. Less than a week after the white paper was published, the Peruvian government included ivermectin in its national Covid-19 therapeutic guidelines.
Ivermectin had continued to be used as potentital cure for coronavirus in Latin America. The ivermectin preprint paper had been downloaded more than 15,000 times, its abstract viewed 90,000 times. Bolivia went a step further than Peru, announcing on 19 May that 350,000 doses of the drug would be distributed. “Demand goes up hugely, so much so that a blackmarket of ivermectin emerges,” Chaccour says. “So ivermectin threatens to become the new hydroxychloroquine in Latin America.” Researchers in Latin America who found hydroxychloroquine was not effective for Covid-19 began receiving death threats after their findings were published in a US medical journal.
Chaccour was concerned. He knew ivermectin well and was shocked at how quickly it was being adopted as part of treatment protocols without rigorous research to back up its use. He believes more studies should be done first, as he wrote in an editorial in which he was lead author, published on 16 April. He sent the lead researcher on the preprint paper an email with some questions and concerns about the data, which were forwarded to a co-author of the paper, the Surgisphere founder and chief
“Let’s just say my concerns about the study did not reduce whatsoever,” Chaccour says.
‘It was a royal mess’
“I thought, [maybe the ivermectin study] was just a side project while they were busy working on this big New England Journal of Medicine study. I didn’t look closely at the study, because cardiovascular disease is not my area.” Chaccour thought this might explain his concerns about the ivermectin study.
Meanwhile, a malaria drug called Hydroxychloroquine, a derivative of chloroquine, was being observed and examined as a potential Covid-19 treatment in the US after Donald Trump described it as possibly “one of the biggest game changers in the history of medicine,” adding, “it’s not going to kill anybody”. Soon after, a US man died after he drank chloroquine found in fish tank cleaner because he was scared of getting sick. Nigeria also reported chloroquine poisonings.
“It was a royal mess,” Chaccour says. “There was huge political polarisation about hydroxychlorioquine, politics became mixed in with policy. So there are people defending hydroxychloroquine because they like Donald Trump, and people opposing it because they don’t like Donald Trump. This should be about data, not opinions, and absolutely not about politics. The world had gone crazy.”
“The Lancet study was published on a Friday. In less than 24 hours, the World Health Organization [WHO] had stopped the hydroxychloroquine arm of the trial they’re sponsoring,” Chaccour says. “This had massive consequences. There are 131 hydroxychloroquine Covid-19 trials registered. Many national funding agencies stopped or paused these trials. Many patients read the news about the study. Thousands of patients enrolled in these trials feel fear and anguish. How can you continue these trials now? When patients just read this drug is not good?”
On Thursday, following growing concern from the medical community about the Lancet study and the database, the WHO reversed the decision to halt hydroxychloroquine trials. It too had reviewed the study, and found there was no reason to discontinue trials based on the data. However, WHO officials also reiterated there was as yet no evidence that hydroxychloroquine, or any drug, reduces the mortality in patients who have Covid-19.