Early multidrug treatment of SARS-CoV-2 (COVID-19) and decreased case fatality rates in Honduras

Abstract INTRODUCTION Within 2 months of first detection of SARS-CoV-2 in Honduras, its government promoted nationwide implementation of multi-drug COVID-19 inpatient and outpatient treatment protocols. This was associated with a case fatality rate decrease from 9.33% to 2.97%. No decrease was seen in Mexico, a similar Latin American country that did not introduce multi-drug treatment protocols at that time. OBJECTIVE The primary objective of the study was to use statistical process control to assess the likelihood that the decrease in case fatality rate in Honduras was due to chance, using Mexico as a control country. METHODS Fourteen day running average COVID-19 case fatality rates in Honduras and Mexico were used to create Shewhart control charts during the first 6 months of the epidemic. The date of implementation in Honduras of the inpatient and outpatient multi-drug COVID-19 protocols were plotted on control charts, with a Mexican COVID-19 case fatality control chart for comparison. RESULTS The case fatality rate for COVID-19 in Honduras dropped below the lower control limit 9 days after implementation of an inpatient and outpatient multi-drug therapeutic protocol, from an average 9.33% case fatality rate to 5.01%. The Honduran COVID-19 case fatality rate again dropped below the lower control limit to 2.97%, 17 days after launching a substantial government program to make the protocol medications accessible to underserved areas. Shewhart control chart plots of case fatality rates in Honduras suggest a plausible temporal association between the implementation dates of both the initial protocol implementation on May 3, 2020, and the outreach effort on June 10, 2020, and statistically significant control chart anomalies. No control chart anomalies were seen during that time in Mexico. CONCLUSION Decreases in COVID-19 case fatality rates in Honduras were associated with both the initial publication a multi-drug COVID-19 therapeutic protocol and a subsequent outreach program.