key: cord-1000169-iucz1ips authors: Lapostolle, Frederic; Vianu, Isabelle; Stefano, Carla De; Goix, Laurent; Petrovic, Tomislav; Adnet, Frederic title: COVID-19 Epidemic: Chloroquine, a French Obsession? date: 2021-03-19 journal: nan DOI: 10.1016/j.lpmope.2021.100007 sha: ee77e9844a6e5ee9a459fb0b555999da2e6e3785 doc_id: 1000169 cord_uid: iucz1ips Introduction: One potential COVID-19 treatment, hydroxychloroquine has been the focus of much debate since its first publication by a French research team. To an unusual degree, this debate has extended outside of the medical community into the public sphere. Objective: To know if this interest, which conceals the reality of scientific debate, occurred worldwide. Methods: Methodological use of the Google-Trends was standardized. We researched the web queries for “hydroxychloroquine” and “chloroquine” and “amoxicillin” and “acetaminophen” as reference. Analysis was detailed by country. The relationship between these queries and the COVID-19 epidemic was supported by analysis of the main “related queries”. Google-Trends provided results on a relative value basis, on a scale from 0 to 100, with a value of 100 indicating the most researched criterion over the study period. Results: Web queries for “amoxicillin” never exceeded the value of 1. Searches for “acetaminophen” peaked on March 13 with a value of 13. “Hydroxychloroquine” was the most frequently researched term. It reached its peak value of 99 on April 7. Queries for “chloroquine” peaked (value 100) on March 24. Searches for “hydroxychloroquine” came essentially from Asia and the United States, with France in 22nd position (value of 21). Searches for “chloroquine” came essentially from Africa, with France in 8th position (value of 55). The five main related searches were in both cases associated with the COVID-19 epidemic. Conclusion: Interest in chloroquine is not specific to France. Results of ongoing studies have been and will be scrutinized attentively in all corners of the globe. One potential COVID-19 treatment, hydroxychloroquine has been the focus of much debate since its first publication by a French research team. To an unusual degree, this debate has extended outside of the medical community into the public sphere. To know if this interest, which conceals the reality of scientific debate, occurred worldwide. Methodological use of the Google-Trends was standardized. We researched the web queries for "hydroxychloroquine" and "chloroquine" and "amoxicillin" and "acetaminophen" as reference. Analysis was detailed by country. The relationship between these queries and the COVID-19 epidemic was supported by analysis of the main "related queries". Google-Trends provided results on a relative value basis, on a scale from 0 to 100, with a value of 100 indicating the most researched criterion over the study period. Web queries for "amoxicillin" never exceeded the value of 1. Searches for "acetaminophen" peaked on March 13 with a value of 13. "Hydroxychloroquine" was the most frequently researched term. It reached its peak value of 99 on April 7. Queries for "chloroquine" peaked (value 100) on March 24. Searches for "hydroxychloroquine" came essentially from Asia and the United States, with France in 22 nd position (value of 21). Searches for "chloroquine" came essentially from Africa, with France in 8 th position (value of 55). The five main related searches were in both cases associated with the COVID-19 epidemic. Interest in chloroquine is not specific to France. Results of ongoing studies have been and will be scrutinized attentively in all corners of the globe. As we observe COVID-19 associated mortality, our attention is focused on potential treatments.(2) A recent review identified over ten medications currently being evaluated.(3) One potential treatment, the association of hydroxychloroquine and azithromycin has been the focus of much debate since its publication by a French research team.(1) To an unusual degree, this debate has extended outside of the medical and scientific community into the public sphere.(4,5) Such lively debate strongly contributed to trouble the discussion on COVID-19 treatments. First, because it contributed to increase the number of (not always indispensable) researches and publications dedicated to hydroxychloroquine and/or chloroquine. Second, because some relevant discussions on COVID-19 epidemic have been omitted due to the preeminent place accorded to this debate in the media. Third, because it contributed not only to disturb the medical community, but also the physicians-to-patients relation, as some of the latter were demanding this controversial treatment. And finally, because the risk of side-effects related to chloroquine and/or hydroxychloroquine, particularly in association with other drugs, cannot be excluded. We wanted to know if this interest expressed by the public, which conceals the reality of scientific debate, occurred exclusively in France. To answer this question objectively, we used the tool Google Trends®, which analyses trends in web queries. Methodological use of the Google Trends was standardized.(6) We used "hydroxychloroquine" and "chloroquine" as query keywords. We added the terms "amoxicillin" and "acetaminophen", both among the most prescribed drugs worldwide. They served as reference. Analysis was detailed by country. In order to have a timeframe that included a baseline as well as the COVID-19 epidemic, the analysis period of three months was done from January 1, 2020, to April 20, 2020. The relationship between this research and the COVID-19 epidemic was supported by the analysis of the main related queries. Google Trends provided results on a relative value basis, on a scale from 0 to 100, with a value of 100 indicating the most researched criterion over the study period. The analysis was conducted on April 20, 2020. Page 4 of 8 J o u r n a l P r e -p r o o f 4 Web queries for "amoxicillin" never exceeded the value of 1. Those for "acetaminophen" peaked on March 13 with a value of 13 ( Figure 1 ). "Hydroxychloroquine" was the most frequent query (Figure 1 ). It reached its peak value of 99 on April 7 (second peak, Figure 1 ), while that of "chloroquine" peaked (value 100) on March 24 (first peak Figure 1 ). The main related queries associated with the first peak were queries on "hydroxychloroquine" and/or "chloroquine" and/or "azithromycin" (6/10). The main related queries associated to the second peak were queries on Acharya Prafulla Chandra Ray (a chemist from India who was believed to have discovered hydroxychloroquine) and the companies producing hydroxychloroquine (7/10), most of them coming from India. (7) Queries for "hydroxychloroquine" occurred essentially from Asia and the United States of America (Table 1 - Annexes), with France in 22 nd position (value of 21). Queries for "chloroquine" came essentially from Africa (Table 1 -Annexes), with France in 8 th position (value of 55). The five queries most frequently related to "hydroxychloroquine" and "chloroquine" queries, were also related to the COVID-19 epidemic (in fact, this was true for the 20 first related queries -results not presented) ( Table 1 -Annexes). Interest for chloroquine is not specific to France. Notwithstanding the particular attention drawn to chloroquine in France due to the highly mediatized work of a team in Marseille, interest is global. Results of ongoing studies will be scrutinized attentively in all corners of the globe. Funding: none Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial Brief Review on COVID-19: The 2020 Pandemic Caused by SARS-CoV-2 Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review Trump's claims on chloroquine, disinfectant draw rebukes Shining a light on the evidence for hydroxychloroquine in SARS-CoV-2 The use of google trends in health care research: a systematic review Letter to the Editor: Acharya Prafulla Chandra Ray, Hydroxychloroquine and COVID-19 Hydroxychloroquine prophylaxis for COVID-19 contacts in India Chloroquine and Hydroxychloroquine for the Prevention or Treatment of Novel Coronavirus Disease (COVID-19) in Africa: Caution for Inappropriate Off-Label Use in Healthcare Settings Drug Evaluation during the Covid-19 Pandemic The online competition between pro-and anti-vaccination views Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID-19 in Italy