adjusted for severity of illness, the lack of advantage from HCQ remains
That would be true if their "adjustment for severity of illness" was for a linear illness progression. But it looks like serious Covid-19 progression is almost two different illnesses. During the earlier virus replication phase, antivirals might have an effect. During the later predominately inflammation phase, antivirals have little effect. The amount of virus may actually be going down anyway, because of the immune system response. This phase is essentially an acute autoimmune disease. The important pathology is the attack on the endothelium and the resulting VWF clotting and thrombosis. That's why EVMS only uses HCN in the early phases, and then treats the inflammation phase with prednisolone and heparin and no more HCN or remdesivir.
So we have no new data. All we know is that it looks like HCN is useless in the latter phases.
The EVMS puts HCQ+AZ as OPTIONAL because there isn't enough data. It's an unproven hope at this point, and the hope has been fading more and more.
Studies so far haven't shown a benefit for HCQ in mild cases either. I strongly suspect that when all studies are in, including the Columbia University prophylaxis one is in (the quintessential one that hits the virus before replication), the conclusion will be that HCQ is not active against the SARS-CoV-2 at all, in any stage of the disease.
It's certainly active in-vitro... which accounts for very little, other than helping with hypothesis generation.
But it is looking more and more doubtful that HCQ helps in-vivo, for mild, moderate, or severe infections.
