COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin: A Retrospective Case Series Study

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  • Martin Scholz
  • Roland Derwand
  • Vladimir Zelenko
Date June 30, 2020

Retrospective case series of 141 patients with COVID-19 who received outpatient treatment with low-dose hydroxychloroquine, azithromycin, and zinc resulted in a significantly lower hospitalization rate than untreated controls from the same community (2.8% vs 15.4%, p<0.001).

The study reported a single death resulting in a mortality rate of 0.7% compared to 3.5% in the untreated control group. The mortality difference did not reach significance (p=0.16).

This is one of the first large analyses evaluating outpatient treatment with hydroxychloroquine, azithromycin and zinc with a median time between symptom onset and treatment of only 4 days.

Major Issues

All patients included in this study were white and from a relatively homogenous community in New York State. Data on the untreated control group was limited to only outcome data and did not include patient characteristics or symptoms. Comparing hospitalization rates between these two groups should be cautioned considering that most retrospective studies on treatment of COVID-19 require risk adjustment, which was not possible in this study (e.g. race has been shown to be a prognostic indicator of COVID-19 outcomes).

The generalizability of these results is also called into question given the homogenous population in the treatment group.

Minor Issues

Many of the patients were evaluated via telehealth consultations that depended on self-reported symptoms in the absence of objective parameters such as vital signs and viral loads.


This serves as one of the largest US retrospective analyses on the potential efficacy of hydroxychloroquine, azithromycin and zinc in early outpatient treatment of COVID-19.

Article Revisions

None at this time.