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Hydroxychloroquine: what is it and can it help fight Covid-19?

President Trump said he is taking the anti-malaria drug in an attempt to prevent being infected with coronavirus. Studies have shown no benefit.

Hydroxychloroquine: what is it and can it help fight Covid-19?

The coronavirus pandemic continues to paralyse much of the world, with many believing things will not go back to normal until there is a vaccine. Even the most optimistic time-scales for the production of a vaccine are looking at autumn 2020 at the very earliest.

Being a newly-discovered virus, scientists and medics have also not had time to come up with other drugs to treat the virus, with avoiding catching it through social-distancing, hand-washing and wearing masks the most effective treatment. Doctors are looking carefully, however, at other techniques, such as existing medicines, to cope with the pandemic, with advancements in this area being reported every day.

There is one drug in particular that has received huge attention, in part because of the insistent backing of  US President Donald Trump. The drug in question is called hydroxychloroquine, and on Monday Trump confirmed he is taking a daily dose of it in a bid to prevent infection with Covid-19.

What is it about hydroxychloroquine?

Administrator of the Centers for Medicare and Medicaid Services Seema Verma listen as US President Donald Trump speaks during the daily briefing on the novel coronavirus.
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Administrator of the Centers for Medicare and Medicaid Services Seema Verma listen as US President Donald Trump speaks during the daily briefing on the novel coronavirus.MANDEL NGANAFP

Sme initial anecdotal evidence suggested hydroxychloroquine might offer some effectiveness at alleviating some of the symptoms of coronavirus, despite the fact the drug is normally used to treat malaria sufferers. Malaria and coronavirus share various symptoms, both resembling the flu: high fever, muscle pain, chills, etc, but it is in no way clear whether the disease pathways are similar. Hydroxychloroquine has been shown to have a beneficial effect in treating these symptoms in malaria patients, as well as for lupus and rheumatoid arthritis.

Studies show no benefit

An early study, based on the clinical analysis of 130,000 cases from Germany, the United Kingdom, the United States and South Korea, indicated that the use of hydroxychloroquine for those infected with Covid-19 is generally safe. However the FDA, on 23 April, reported some "serious heart-related adverse events and death in patients" being treated with hydroxychloroquine for Covid-19. It is worth noting that hydroxychloroquine can cause severe side-effects, including death.

All the studies done so far, including two carried out in New York, each involving 1,400 Covid-19 patients, and another in France comparing 84 patients receiving the drug vs 97 receiving standard care, concluded the drug had no impact on the outcome of the disease.

"There are no proven therapies for Covid-19 unfortunately,” remarked Dr Daniel Sterman who is the critical care director at NYU’s Langone Health. “So we are doing the best we can with applying the best supportive care that we can. But there's a lot we don't know about this disease.

Coronavirus: the complete guide to the Covid-19 pandemic

 “This disease is unlike many other diseases that we've seen before,” he adds. “It has unique clinical characteristics. So we just don't know whether any drug therapies are effective." And despite accepting that it has been proven to be safe for malaria sufferers he cannot endorse Trump’s advice. “You can't say that because it works in malaria that it's effective in treating COVID-19."

The US has around 29 million doses stored and is looking for more while trials continue to assess the effectiveness of the drug. There have certainly been some risks associated with it related to heart problems, but a more pressing concern is that by Covid-19 patients being given hydroxychloroquine - despite it being unproven - patients with other conditions who need the drug may be left without it as supplies dry up.

In Spain, the Spanish Agency for Medicines and Health Products (AEMPS) issued a guidance note in response to an offer by a pharmacist to triple its production of the drug. “The efficacy of chloroquine and hydroxychloroquine is being evaluated in several clinical trials whose results have not been published at the moment. The amount of evidence is still low, although its use has generated expectations meaning that different authorities (Italy, France, China and Spain) have included both as one of the treatment alternatives in patients with the Covid-19 infection.”

Donald Trump’s potential conflict of interest

Although it is entirely possible that President Trump’s push to have millions of people around the world use hydroxychloroquine is, while somewhat reckless, with the best of intentions, another argument has been made. The New York Times recently published links between one of the pharmaceutical companies that would mass produce this drug with Trump.

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