From the oval office to India’s largest medical profession, an old malaria drug is increasingly being billed as the world’s most immediate hope for accessible treatment for Covid-19.
President Donald Trump led the way as a champion of hydroxychloroquine, calling the drug “revolutionary” and inspiring boosterism on Fox News. India recommends that all healthcare workers take the drug – which contains a synthetic form of the quinine that has made gin and the tonic a popular antimalarial – and is currently being tested on a limited number of Covid-19 patients in Europe.
But some experts say it is a dangerous bet given the lack of evidence on the effectiveness of the drug and the danger of side effects.
Rather than a calculated risk, Trump’s sense of sale has fueled the idea that the hydroxychloroquine rush is the result of desperation to find a way out of the pandemic. In announcing the drug’s potential on the White House podium, the President himself said, “What do you have to lose? “
Eric Topol, director of the Scripps Research Translational Institute, said the promotion was “reckless, rash and deplorable.”
“It is singular in history that you have a president who goes against all science,” he said (although Mr. Trump has faced the same accusation of downplaying the threat of change. climate).
Peter Navarro, Trump’s chief commercial advisor, reportedly submitted studies on the drug at a recent meeting of the coronavirus task force, saying he understands them because he is a social scientist. But Trump’s allies rely on small studies that do not meet scientific standards, as well as the allegations of an eclectic mix of doctors, including a sharpshooter virologist Didier Raoult and Mehmet Oz, host of American television. The Dr Oz Show.
The federal government’s top infectious disease specialist Anthony Fauci has taken a different view, warning that the information about the drug’s effectiveness is “anecdotal.”
“I think we have to be careful not to take this majestic leap to assume it’s a knockout drug,” he said earlier this month.
If hydroxychloroquine works for Covid-19, no one knows how. A 2006 study on Sars suggested that it did not act as an antiviral that prevents viruses from replicating, but some believe it can help treat patients by acting as an anti-inflammatory or helping the system immune to fight the virus.
Magnus Gisslén, a professor at the University of Gothenburg in Sweden, who treats patients with Covid-19, said that the hospital had stopped using the drugs a few weeks ago, after hearing reports of side effects important, which may include effects on patients’ vision and hearts.
“Doctors are wrong to rush to treat people,” he said. “Evidence-based medicine is important.”
There have been reports worldwide of overdoses of chloroquine, a related but more toxic drug, and although hydroxychloroquine is somewhat safer, the number of poisonings involving the drug has doubled in the United States in recent weeks, according to the American Association of Poison Control Centers.
In China, the central government recommended chloroquine in early February, but then had to adjust the dose due to side effects. There are no official government directives on hydroxychloroquine.
India has been less cautious, a Covid-19 task force set up by the Indian Council for Medical Research recommending that it be taken by frontline health workers who may be exposed to the coronavirus.
A world leader in the manufacture of generics, India has also banned exports of hydroxychloroquine and its active ingredient. The United States federal government has stored 30 million doses. These measures have contributed to shortages in the United States and Europe for people who need them for its proven purposes – not only to prevent malaria, but also to treat autoimmune diseases, lupus, and rheumatoid arthritis
In the United States, the Food and Drug Administration has granted it emergency approval, which means it can be used to treat Covid-19 when no approved alternative is available.
But Jeremy Faust, an emergency doctor at Brigham Women Hospital in Boston, said that a problem was that some doctors treating Covid-19 “threw everything in the kitchen sink and saw what was going on” – and didn’t not isolate the drug that worked.
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President Trump’s enthusiasm seems to be linked to a French study that claimed success in treating patients with hydroxychloroquine and the antibiotic azithromycin. But last week, the medical journal that published it said it did not meet its standards.
Other studies have been small, rushed, and have not gone through the peer review process which aims to ensure robustness before publication. They showed mixed results: one article from China showed that hydroxychloroquine worked, another found it not.
Michael Ackerman, cardiologist at the Mayo Clinic, said that while hydroxychloroquine was likely to be safe for 90% of people, it was only “potentially fatal” because it can disrupt the electrical system of the heart. “We could end up with sudden cardiac death from medication,” he said.
There may also be psychological side effects. Jessica Gold, assistant professor of psychiatry at the University of Washington in St Louis, noted that the drug was associated with increased anxiety, depression and sometimes psychosis.
Most scientists do not intend to reject the drug as snake oil. They just want to wait for the results of large trials examining its safety and effectiveness – including those conducted by the World Health Organization and the National Institute of Health in the United States.
At the same time, said Vish Viswanath, professor of health communication at the Harvard School of Public Health, it had become more difficult for specific messages to reach people through mainstream media – and easier to people to access scientific journals and make their own interpretations. This creates unnecessary suspicions, he said, that “scientists never decide”.
Additional reporting by Stephanie Findlay in New Delhi and Wang Xueqiao in Shanghai