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May 28, 2020 (LifeSiteNews) – As the world continues to navigate the COVID-19 outbreak and doctors continue the search for the most effective means of treatment and prevention, the medication hydroxychloroquine (HCQ) continues to be an unusual focal point for partisan contention.
HCQ is an FDA-approved drug developed in the 1950s to treat malaria, and has been commonly used since as a treatment for autoimmune conditions and arthritis (with applications to heart disease, as well). The FDA has not officially approved its use for the coronavirus, but has allowed it “to be distributed and prescribed by doctors to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible.” (At the same time, the FDA warns not to use it outside of trials or hospitals.)
“Hydroxychloroquine calms inflammation, a reason why it is widely used for autoimmune diseases,” explains infectious disease expert Dr. Kristin Moffitt of Boston Children’s Hospital. “Research has shown that some of the devastating effects of COVID-19 are related to an over-exuberant immune response. The result is a so-called ‘cytokine storm’ — overproduction of inflammatory molecules called cytokines. It is hypothesized that hydroxychloroquine may be useful in tempering this cytokine inflammation, but further studies are needed to validate the actual benefit.”
In the early days of the COVID-19 outbreak, scientists began researching its potential applications in treating the new virus – a development that was quickly promoted by President Donald Trump.
The mere fact of Trump touting the drug’s potential turned HCQ into a political lightning rod, with partisans going so far as to blame Trump for the death of a man who drank an aquarium cleaning chemical containing a similar-sounding ingredient, (chloroquine phosphate), and to falsely suggest the drug killed patients at Veterans Administration hospitals.
Meanwhile, actual studies appear to find conflicting results as to HCQ’s effectiveness in treating COVID-19, and many in the medical establishment are pushing back against it.
Early on, several promising results were reported from studies and trials, including in Seattle, France, and China. More recently, however, another French analysis in The Lancet found “no benefit” to using HCQ but instead found “decreased in-hospital survival and an increased frequency of ventricular arrhythmias,” leading the French High Council for Public Health (HCSP) to recommend against prescribing it outside of clinical trials.
Uncertainty and confusion persist as to what all of this means. Preliminary research seems to suggest that HCQ’s effectiveness depends on being administered in the earliest stages of COVID-19, and that, given the drug’s long-established uses for other purposes, fears of its health dangers may be overblown, provided that researchers and prescribing physicians take into account a patient’s medical history and don’t use it in conjunction with other medications.
“When used alone, we’re not seeing major issues,” said Dr. Sarah Lofgren of the University of Minnesota Medical School, who is currently involved in researching HCQ. “Out of our thousands of patients, we’re not seeing things people are quite concerned about, particularly the heart arrhythmias.”
“If you bring on a star player consistently [only] in the last minute of a game and you’re still losing, you might say, ‘This star player is no good,’” adds Washington University School of Medicine anesthesiologist Michael Avidan. “But that’s not a good use of your star player, because most of the outcome is already established at that very late stage.”
On Wednesday, the American Journal of Epidemiology published a paper by Yale’s Dr. Harvey Risch attempting to sift through the dueling narratives, coming to the conclusion that the timing of HCQ’s use makes all the difference.
“Early outpatient illness is very different than later hospitalized florid disease and the treatments differ,” he writes. “Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease.”
From HCQ’s use for “more than 300,000 older adults with multicomorbidities,” the paper observes cardiac arrhythmias caused by the drug in just 47 out of 100,000 patients, leading to death in just 9 out of 100,000.
Contrasting those numbers with the “10,000 Americans now dying each week,” Risch concludes that “these medications need to be widely available and promoted immediately for physicians to prescribe.”
The National Institutes of Health (NIH) began a clinical trial for HCQ along with the antibiotic azithromycin on May 14, and University of Oxford researchers are currently in the process of enrolling people for a global trial. The World Health Organization (WHO) is also overseeing trials, though they are currently on a two-week pause as researchers evaluate the data collected so far.
Even so, hydroxychloroquine faces resistance – not just from the media and political activists, but from medical associations and some governments. Belgium, France, and Italy banned the use of HCQ as a COVID-19 treatment this week, citing safety concerns.
Disagreeing with the FDA, the American College of Physicians opposes doctors choosing to write off-label HCQ prescriptions for COVID-19 patients, and that the drug should only be administered in clinical trials. Last month, the left-wing American Medical Association joined with the American Pharmacists Association and American Society of Health-System Pharmacists to issue a joint statement to “strongly oppose” the prescribing of HCQ for anything other than its current FDA-approved uses.
Last month, former U.S. Biomedical Advanced Research and Development Authority director Rick Bright claimed that the Trump administration fired him for attempting to further limit the use of HCQ. U.S. Health and Human Services Secretary Alex Azar responded that Bright was exaggerating his contributions to the administration’s COVID-19 efforts, faulting him for “not showing up for work to be part of” the initiative to develop a vaccine. Azar also noted that Bright in fact signed the FDA application to use HCQ for COVID-19.
On May 19, Trump said he’d been taking HCQ and a zinc supplement for “a few weeks” as a prophylactic. He has repeatedly tested negative for the coronavirus.
As of May 27, the United States is estimated to have seen more than 1.7 million COVID-19 cases, with more than 101,000 deaths and 482,000 recoveries. An estimated 43% of those deaths have come from nursing homes.