The questionable data were used in studies published in The Lancet and The New England Journal of Medicine in May 2020, suggesting that COVID-19 patients on hydroxychloroquine had a "significantly higher risk of death".

[7] In its promotional material and press releases, Surgisphere claimed to have a cloud-based healthcare data analytics platform and to be "leveraging... its global research network and advanced machine learning" using decision tree analysis.

[11][12] The African Federation for Emergency Medicine (AFEM) had promoted the COVID-19 Severity Scoring Tool for use in 26 countries and some institutions had started validation studies.

[13] In April 2020, Desai et al. published a paper based on purported Surgisphere data which suggested ivermectin reduced COVID-19 mortality.

[4][14][22] The NEJM study claimed that hospital data records showed that COVID-19 patients were not harmed by treatment with ACE inhibitors and angiotensin-receptor blockers.

[25][26][27][4] As a result, on 28 May over 200 researchers and doctors from various countries published "An open letter to Richard Horton, editor-in-chief of The Lancet, regarding Mehra et al", stating "Both the numbers of cases and deaths, and the detailed data collection, seem unlikely.

"[28] Science Magazine said critics had "pointed out many red flags in the Lancet paper, including the astonishing number of patients involved and details about their demographics and prescribed dosing that seem implausible.

"[14][20] One of the signatories, Adrian Hernandez of the Duke Clinical Research Institute, said "the biggest thing that raised a red flag was that there was such a large database across more than 600 hospitals, and no one had really known about its existence".

[20] Elisabeth Bik et al. analyzed one of Desai's early first author papers and found apparent evidence of image manipulation.