Since my last article discussing experimental treatments for COVID-19, we have results from a clinical trial conducted in China on the effectiveness of Kaletra (published in the prestigious New England Journal of Medicine). Unfortunately, the study didn’t show any benefit from the drugs. This illustrates a crucial point for everyone to understand: wait for the research! Kaletra works against the virus in a test-tube and it seemed to have some benefit in a related coronavirus; it didn’t work against this coronavirus. It is important that the studies be designed well with clearly defined markers of success, otherwise the results may not be clear or offer the wrong answer to the question.
Along these lines, a couple weeks ago, the president touted the drug Chloroquine as a cure for COVID-19 and said that thousands of doses of the drug were being made. This was not true. Chloroquine has not been proven to be effective for this infection. As a result of the president’s claim, a person accessed some questionable source of Chloroquine and died. He hadn’t even been diagnosed with coronavirus.
Others have overdosed on the drug and are seriously ill. At this point, I really have to say that for your own safety, PLEASE do not follow the narrative coming out of the White House. There is a continuous flow of misinformation and outright lies that are confusing and dangerous. Absolutely DO NOT follow Fox News reporting or recommendations! These sources have a different motive that is not related to protecting your health.
It is a sad state of affairs when we cannot get clear guidance in the midst of a deadly crisis. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases is an expert infectious disease physician committed to telling the truth about the pandemic, which is often opposite of the messaging coming out of the White House.
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For accurate information, go to the Centers for Disease Control (CDC) website (https://www.cdc.gov/coronavirus/2019-ncov/index.html). Listen to your state public health officials and local medical and public health officials and course, your personal medical providers. Even some governors have politicized the pandemic and are not putting safety procedures into place. Consult with your local health departments and the CDC website.
So let’s go back to Chloroquine. What is it and does it have any potential against COVID-19? During intensive research for new drugs to fight malaria during World War II, Chloroquine emerged as the champion. Compared to an earlier drug, quinine, chloroquine was tremendously less toxic with fewer side-effects and easily taken as a pill. It was also effective in protecting people from getting infected with malaria (malaria prophylaxis). However, chloroquine was almost too good to be true and it was used extensively to treat malaria as a single drug allowing the malaria parasite to develop wide-spread resistance to chloroquine all over the world.
It turns out that chloroquine is no “One trick pony”. This drug has many different actions and in addition to its effects against malaria and other parasites, chloroquine and its cousin, hydroxychloroquine have anti-inflammatory properties. Hydroxychloroquine (Plaquenil) in particular was used for decades in treating rheumatoid arthritis and sometimes other inflammatory conditions like Lupus.
It is better tolerated than chloroquine. These anti-inflammatory effects of chloroquine and hydroxychloroquine may be of benefit in patients with COVID-19. They might suppress production of biological compounds that drive the inflammatory process in the lungs that can lead to pneumonia and lung damage. In addition, chloroquine and hydroxychloroquine have some specific effects that block viruses through the stages involved in infecting cells and tissues. Hence, there are scientific reports showing activity of chloroquine inhibiting the SARS-2 coronavirus in the test-tube.
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But there is cause for optimism since a recent study in France showed some benefit of Hydroxychloroquine combined with another antibiotic called Azithromycin. Adding Azithromycin seemed to boost the effect of hydroxychloroquine in clearing the coronavirus. Clinical studies are starting now to get solid evidence of the effectiveness of hydroxychloroquine, supported by different institutes at the National Institutes of Health (NIH). Just within the last 24 hours (3/30/2020), the Food and Drug Administration has approved the use of Hydroxychloroquine and Chloroquine for emergency use, but we still don’t know if they work against this infection!
While we are optimistic, we were also optimistic about Kaletra, as I discussed in the beginning, but it didn’t pan out. We will simply have to wait for the results of the studies. This treatment should only be accessed through a licensed health professional! But there are consequences to claiming benefits of drugs against COVID-19 that aren’t proven. People go out and hoard the drug for a disease that it isn’t proven to work making the drug unavailable to people with diseases for whom the drug definitely works. Literally as I sit writing this, I hear the report from a man who depends on hydroxychloroquine to control his Lupus who is no longer able to get it.
It’s because all the hydroxychloroquine has been sequestered for COVID-19, in spite of the fact it is unproven. Lupus is a nasty disease that can be deadly. Hopefully he will find a supply of the drug. A couple of other studies have already started and are enrolling patients. An investigational drug called Remdesivir has started at the NIH and is quickly enrolling patients. It is a drug that directly blocks the ability of the virus to replicate in a test tube.
Let’s hope it does the same in patients with COVID-19 and we get the results soon. Another approach is to utilize the blood of the tens of thousands of people who have recovered from a coronavirus infection. People who have recovered from the infections should have antibodies to the virus. Giving serum from a recovered person with antibodies to a sick patient who is struggling to make their own antibodies often provides the boost they need to fight off the virus. This is called convalescent serum and it is a sound clinical practice that has been used with other infections and was recently used to some success in the Ebola virus outbreak. Studies have started and are ongoing.
We are still early in this epidemic in the US cases will likely skyrocket before things start to get better. Sadly, there will be more deaths. This is why you must adhere to the social distancing and other self-quarantine guidelines. I see far too many people just totally ignoring the social distancing guidelines and congregating and interaction like all is well. The reality is that if you get sick, you may not be able to get tested, there may not be appropriate medical resources in the hospital for your emergency care and we still don’t have a confirmed treatment. Please follow the guidelines and stay safe.
