Aditi Gupta, Life Sciences, April 5 2020
Figure 1. Despite President Trump’s claims, there is no approved treatment for coronavirus. The spread of such misinformation is costing lives.
(Cover Image of Coronavirus Research. Reprinted from Children’s Hospital Los Angeles. “What You Should Know About the Novel Coronavirus Disease (COVID-19),” March 25, 2020. Retrieved from https://www.chla.org/blog/health-and-safety-tips/what-you-should-know-about-the-novel-coronavirus-disease-covid-19.)
As the COVID-19 (better known as coronavirus) pandemic continues to overwhelm healthcare systems, governmental agencies, and the global economy, scientists and policy leaders are eager to advance research and implement policy measures that would slow its spread and improve patient outcomes. While many researchers around the world are racing to make a vaccine, a task which will likely take a year to develop, get approved, and mobilize, other scientists are working to find a treatment for patients who have tested positive for the virus. COVID-19 has claimed over 42,000 lives globally, including over 4,000 Americans, as of March 31st, 20201. On March 19th, 2020, President Donald Trump misleadingly announced that the Federal Drug Administration (FDA) essentially approved some existing drugs, specifically hydroxychloroquine, chloroquine, and remdesivir, to treat patients with COVID-192.
Immediately, FDA Commissioner Stephen Hahn clarified that these drugs – which are only approved to treat malaria, lupus, and rheumatoid arthritis – are not currently approved to treat patients with coronavirus. Now, the FDA has allowed a “compassionate use” pathway for doctors to prescribe experimental drugs to patients who have exhausted all other treatment options. And as of March 30th, the FDA granted emergency authorization for physicians to prescribe hydroxychloroquine and chloroquine3. So, doctors can legally prescribe anti-malarial drugs to COVID-19 patients. Indeed, some doctors in China, France, and South Korea have said that these treatments work,4 but the evidence to support the use of these drugs to treat COVID-19 is minimal. The President cited a French study, which found that a combination of hydroxychloroquine and azithromycin successfully treated patients with coronavirus, as evidence that the regimen could defeat the novel coronavirus.5 However, the French study came to this conclusion only after analyzing just twenty infected patients (a very small sample size) with a variety of symptoms, a range of disease severity, and other personal factors that may have confounded the results.4 What’s more, only six patients in the study group received the combination of hydroxychloroquine and azithromycin.4 And most importantly, just because this combination of drugs reduced the rate of virus detection does not mean that they will improve the recovery time or reduce the chance of illness. Dr. Scott Gottlieb, a former FDA Commissioner said, “It could very well be that the drug is reducing viral shedding (the spread of the virus from one cell to another] but having no impact on the clinical course of those patients.”5 Even if the anti-malarial drugs may slow down the spread of the virus, thereby reducing the rate of virus detection, there is no guarantee that they actually shorten the duration of the illness or improve the chance of survival for the patient. Remdesivir – another antiviral drug which may have the potential to treat COVID-19 – is currently being tested in randomized studies in Asia. While remdesivir is not approved for treatment anywhere in the world,6 it has been used via the compassionate-use pathway for some patients.4
Given the severe limitations of the French study and lack of evidence that hydroxychloroquine or remdesivir can actually improve patient outcomes, it is clear that the President has provided false hope for a miracle cure to the coronavirus. Until larger clinical studies (some of which are already underway) provide more definitive results for effective treatments to COVID-19, it is dangerous to overexaggerate the anecdotal evidence tying antimalarial drugs to coronavirus treatment. And the President’s exaggerations have proven dangerous. Already, pharmaceutical companies are scrambling to meet the demands for hydroxychloroquine and chloroquine globally for potential use to treat COVID-19 patients. Healthy people are hoarding hydroxychloroquine and pharmacies around the country are running low on supply, leaving lupus and arthritic patients in danger . Both lupus and arthritis are auto-immune diseases in which the body’s immune system attacks healthy tissue. So, if a patient with lupus or arthritis has an uncontrolled flareup, the patient is at a higher risk of serious complications from coronavirus because COVID-19 has a higher fatality rate for immuno-compromised patients7. Lupus patient Anna Valdez says, ““When I think about the other people out there with lupus and other autoimmune disorders, we’re all really scared right now. I haven’t left my house in nine days. I’m working completely remotely. If I get coronavirus, unlike someone else my age, almost 50 years old, who is likely to recover and will be fine, I will likely end up in the ICU.”7
Finally, the misinformation surrounding potential coronavirus treatments has panicked some Americans into taking “‘incredibly dangerous and foolish’” extremes, including an Arizona couple who ingested fish tank cleaner containing chloroquine phosphate to self-medicate against the coronavirus, though neither the husband nor wife had been tested for the virus.[1] The couple were quickly hospitalized; the husband later died of cardiac arrest, and his wife is expected to make a full recovery although she was initially in critical condition.8
The problem with creating false hope for treating COVID-19 is that it leads people to take dangerous actions, putting countless lives at risk. No drug has currently been approved to treat coronavirus, and as of now, there is no miracle cure to stop the pandemic. Instead of hoping for a miracle and acting on unproven potential treatments, we can take rational action, listening to non-partisan scientific experts and agencies to flatten the curve and limit the spread of COVID-19. Despite the chaos surrounding the pandemic, we must continue to exercise reason and patience, not only for our own health, but for our community’s as well.
Citations
[1] Johns Hopkins Center for Systems Science and Engineering, (2020). Coronavirus.COVID-19 Map. Johns Hopkins University, Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html.
[2] Folkers, K.M., Caplan, A. (March 20, 2020). “False Hope about Coronavirus Treatments.” Scientific American. https://blogs.scientificamerican.com/observations/false-hope-about-coronavirus-treatments/
[3] Sandler, Rachel (March 30, 2020). “FDA Approves Anti-Malarial Drugs Chloroquine And Hydroxychloroquine For Emergency Coronavirus Treatment.” Forbes. https://www.forbes.com/sites/rachelsandler/2020/03/30/fda-approves-anti-malarial-drugs-chloroquine-and-hydroxychloroquine-for-emergency-coronavirus-treatment/#55581b75e5d1.
[4] Grady, D., Thomas, K. (March 20, 2020). “With Minimal Evidence, Trump Asks F.D.A. to Study Malaria Drugs for Coronavirus.” The New York Times. https://www.nytimes.com/2020/03/19/health/coronavirus-drugs-chloroquine.html.
[5] Gautret et al. (2020). Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949.
[6] Marchione, M. (March 23, 2020). “Malaria drugs’ promise for coronavirus spurs hope, shortages.” AP News. https://apnews.com/2f3dd1099c6054bb5015391b9a6f3b0c.
[7] Ornstein, C. (March 22, 2020). “Lupus Patients Can’t Get Crucial Medication After President Trump Pushes Unproven Coronavirus Treatment.” ProPublica. https://www.propublica.org/article/lupus-patients-cant-get-crucial-medication-after-president-trump-pushes-unproven-coronavirus-treatment.
[8] Vigdor, N. (March 24 2020). “Man Fatally Poisons Himself While Self-Medicating for Coronavirus, Doctor Says.” The New York Times. https://www.nytimes.com/2020/03/24/us/chloroquine-poisoning-coronavirus.html.