What is the latest on hydroxychloroquine and the coronavirus? We first wrote about drugs being considered to treat SARS-CoV-2 on March 16 (“Are There Compounds That Might Help Control Coronavirus?”). We described chloroquine, hydroxychloroquine, remdesivir and a natural substance called quercetin. On March 19 we went deep with “The Inside Story of Chloroquine and Hydroxychloroquine for COVID-19.” In this article you learned about the history as well as the pros and cons of these drugs for malaria, lupus and rheumatoid arthritis.
Physicians and Hydroxychloroquine (HCQ):
Now we revisit the hydroxychloroquine story and reveal what doctors are doing. Are there any clinical trials underway that will tell us how effective this old drug for malaria, lupus and rheumatoid arthritis really is against COVID-19?
In addition, we answer a crucial question: are people who recover from the coronavirus protected from reinfection? When can they move about without fear of spreading the virus to others?
There is growing controversy around HCQ for treating the coronavirus. On the one hand, many health professionals are absolutely opposed to trying this drug on patients until there are large double-blind, placebo-controlled trials. Such RCTs (randomized controlled trials) are the gold standard for drug approval.
Balancing Potential Benefits vs. Known Risks:
Without RCTs, many clinicians and FDA officials believe that the risks are just too great. These drugs do have a number of serious side effects. (See this link for more details about adverse reactions).
It will take several months to conduct the kinds of large RCTs that physicians can trust and the FDA requires for a new drug indication. In the meantime, hospitals are in crisis mode. Some clinicians are considering a different way to dealing with this infection.
The Other Side of the Hydroxychloroquine Equation:
Some physicians believe that there is enough preliminary data to warrant administering HCQ to patients who are sick and test positive for COVID-19. They point to a Chinese study published in the journal Clinical Infectious Diseases (March 9, 2020). This in vitro (test tube) research revealed that hydroxychloroquine inhibits the coronavirus.
A small French study was published in the International Journal of Antimicrobial Agents (online, March 17, 2020). It was carried out in patients who tested positive for SARS-CoV-2 and were sick. Patients who got HCQ and the antibiotic azithromycin cleared the virus from the nose and throat in three to six days instead of the usual time of three weeks or longer.
A number of non-randomized “open label” clinical trials have been conducted in China and several are ongoing. Preliminary reports are positive, but data have not been published, so it is hard to assess the true effectiveness of hydroxychloroquine against COVID-19.
We are hearing through the grapevine that doctors in South Korea, China and France are administering HCQ to some sick patients who have tested positive for the virus. The anecdotal reports are also positive, but unscientific.
Clinical trials are starting in France. The World Health Organization will be testing HCQ along with other drugs in a large multi-national study called SOLIDARITY.
The University of Minnesota Trial:
Meanwhile, a team at the University of Minnesota is seeking to recruit 1,500 people who have been exposed to the virus. They could be family members or health care workers who have had contact with someone who was diagnosed with the virus.
The Duluth News Tribune (March 18, 2020) described the evolution of this randomized controlled trial:
“More than a week ago, David Boulware had a eureka moment. The professor of medicine at the University of Minnesota thought to himself — what if a common, inexpensive, “old school” anti-malaria pill could help prevent the spread of the novel coronavirus?
“Virtually overnight, Boulware has assembled a team of 10 U of M medical scientists, statisticians and pharmacologists to test out his theory, which involves feeding a preventative medication that’s been around since 1955 to volunteers for five days. His team will monitor which ones contract the COVID-19 virus and which ones don’t.”
Doctors in the Trenches:
Dr. Jeff Colyer is chairman of the National Advisory Commission on Rural Health. He was governor of Kansas between 2018 and 2019. Dr. Daniel Hinthorn is Diretor of Infectious Disease at the University of Kansas Medical Center. These are not wild-eyed physicians ready to try any crazy treatment.
They wrote this opinion piece in The Wall Street Journal (March 22, 2020):
“A couple of careful studies of hydroxychloroquine are in progress, but the results may take weeks or longer. Infectious-disease experts are already using hydroxychloroquine clinically with some success. With our colleague Dr. Joe Brewer in Kansas City, Mo., we are using hydroxychloroquine in two ways: to treat patients and as prophylaxis to protect health-care workers from infection.
“We had been using the protocol outlined in the research from China, but we’ve switched to the combination prescribed in the French study. Our patients appear to be showing fewer symptoms.
“Our experience suggests that hydroxychloroquine, with or without a Z-Pak, should be a first-line treatment. Unfortunately, there is already a shortage of hydroxychloroquine. The federal government should immediately contract with generic manufacturers to ramp up production. Any stockpiles should be released.”
When HCQ Is Contraindicated!
“Contraindicated” is doctorspeak for NEVER prescribed! That’s because it would be too harmful to the patient. Some people should not take HCQ. Those with a special heart condition called a long QT interval must not take any chloroquine-type drug. That’s because the drug can also affect this cardiac rhythm. It could lead to a fatal outcome!
Another group of people MUST NOT take chloroquine (CQ) or HCQ. They have a genetic condition called G6PD (glucose-6-phosphate dehydrogenase) deficiency. This genetic anomaly occurs primarily in men of African or Mediterranean origin. Because the G6PD enzyme does not work properly, the body does not handle carbohydrates in the usual way. In addition, the body has difficulty processing free radicals. When this happens, red blood cells are severely impacted. This can lead to serious anemia.
People don’t always experience symptoms if they have G6PD deficiency, unless they develop a condition called hemolytic anemia. Infections can trigger this. So can drugs like CQ or HCQ. Anyone who has this genetic condition must avoid these drugs!
Some people with psoriasis may also get into trouble with such medications. There are reports that their skin condition gets markedly worse while taking CQ or HCQ.
The bottom line on such drugs is this: they require very careful medical management. People should only take them under medical supervision!
Shortages of HCQ are Disturbing:
We are disheartened to learn that both chloroquine and hydroxychloroquine are in short supply. There are people with lupus and rheumatoid arthritis (RA) who rely upon HCQ for their health. Once the president mentioned these drugs on television, they disappeared almost overnight. Generic manufacturers are racing to make more, but that will take time. People with lupus and RA need their refills now!
One of the big questions that has many people worried is, can you become re-infected with the coronavirus? For others, the question is: how long does it take to get over this infection? And when can you interact with people without fear of making them sick?
We love Dr. Roger Seheult. We have never seen a physician explain complex medical issues as clearly and thoroughly as this man. His videos at www.MedCram.com are phenomenal.
His most recent YouTube video is Coronavirus Pandemic Update 42: Immunity to COVID-19 and is Reinfection Possible?
You will learn about how the immune system attacks SARS-CoV-2. It is a brilliant presentation. Even more relevant, however, is Dr. Seheult’s description of research on re-infection. Blood tests are being developed to look for antibodies to the coronavirus. Monkey research suggests that once a primate is infected and recovers, the immune system takes over and after four weeks there is no longer active virus in the system. In other words, the host develops immunity to the virus and reinfection is unlikely.
The antibody tests that are being developed will allow clinicians to quickly test for exposure to coronavirus and determine if there has been an immune reaction.
The People’s Pharmacy Perspective:
We are rapidly running out of time. We need highly accurate fast blood tests for the coronavirus. We need an effective medicine that is reasonably safe, and we need it yesterday. We need generic drug manufacturers to crank out massive quantities of hydroxychloroquine just in case this medicine turns out to be the game-changer everyone is hoping it might be.
To learn more about the benefits and risks of HCQ, click here.
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