Chloroquine for COVID-19 Patients |

The COVID-19 pandemic continues to rampage throughout the known world, killing thousands and ruining the economies of whole nations. There is no proven treatment, cure, or vaccine. This is a common but deadly problem whenever a new virus emerges. The lack of a therapeutic option leaves scientists scrambling to find a medicine that works.

The discovery of new preventive and curative treatments is the goal, but the development of such a drug could take a year or more before it is available to the public. In the meantime, medical workers watch COVID-19 victims filling their hospitals and, too often, requiring mechanical support just to breathe. Inevitably, a number will lose their battle with the virus. This grim reality forces scientists to look at current drugs that may have potential to be effective.

Enter chloroquine and hydroxychloroquine, approved for use in 1949 and 1955, respectively. These drugs are used in the prevention and treatment of malaria, replacing the older quinine, made from the bark of the cinchona tree. Hydroxychloroquine is used more often these days, as it is better tolerated with fewer side-effects. Hydroxychloroquine is also effective against Lupus, rheumatoid arthritis, and certain other medical conditions.

Areas where the chloroquines have been used, like South Korea, seem to have more of a handle on COVID-19 than the average hot zone. The use of a drug unrelated to its original purpose is called an “off-label” use. When I practiced obstetrics many years ago, a certain asthma drug was found to slow down or stop premature labor. We used that medicine successfully many times. As they say, necessity is the mother of invention.

The new treatment involving the chloroquines is another such off-label use. In this case, a combination of hydroxychloroquine and the antibiotic azithromycin, often with the addition of zinc supplements, is the treatment. It is thought by some to be the best hope (so far) in the treatment of COVID-19 patients. In the hope of slowing spread and decreasing the death rate, the FDA has issued an Emergency Use Authorization (EUA) for chloroquines on COVID-19 patients.

The decision to try the chloroquines is due to their ability to inhibit related coronaviruses, including SARS-CoV1 (the current virus is named SARS-CoV2). They work by blocking the virus from entering the cell. Viruses need a host cell to replicate; they can’t make new viruses if they can’t get in.

Several pharmaceutical companies have ramped up production in response to the demand for this new treatment. One donated 30 million doses to the Strategic National Stockpile.

The study that first suggested Chloroquines were effective was made by a Dr. Vladimir Zelenko in New York, who claimed 669 patients were 100 percent cured of COVID-19 by using a mixture of five days of hydroxychloroquine, azithromycin, and mega-dose zinc. He said there were no deaths, hospitalization, or intubations among those given this combination of drugs. It is important to note that Zelenko released no data, gave no explanation of the design of his study, and no analytics, so we are just taking him at his word.

I’m usually pretty skeptical of 100% success studies, and even Zelenko acknowledged that his treatment was new and untested, and that it was too soon to assess its long-term effects. He instead argued that the risks of waiting to verify its effectiveness were greater than the risks of trying the treatment. On that point, I agree.

There is more data: A French scientist named Didier Raoult revealed that almost all of 80 patients receiving a combination of hydroxychloroquine and azithromycin (no zinc) showed clinical improvement. The only exceptions were an 86-year-old patient who died and a 74-year-old patient who was still under intensive care at the time of his report. By day eight of the treatment, 93% of the patients showed a negative viral load. The paper noted that the treatment allowed patients to be discharged from the hospital after an average of five days.

Now, a new study done in China is showing promise. The difference here is that it is a randomized double-blind study more likely to stand up to scrutiny. 62 mild-case patients were split into two groups. One (the “control group”) received placebo and the other hydroxychloroquine. All had evidence of pneumonia on CT scan. Treatment lasted five days.

For those with cough and fever, the symptoms stopped one day earlier, on average, if they were given hydroxychloroquine than if they weren’t. Pneumonia improved in 81% of those who took the drug, as opposed to 55% of the control group. Four patients had bad outcomes; all of them were in the control group.

This was a small study, but it is part of the mounting evidence that there may be something to the use of chloroquines in treating COVID-19. Larger studies, including one from Oxford University involving 40,000 patients, are getting underway. These results will take a while to compile, however. Expect results in April….2021.

I would be remiss if I didn’t mention that other small studies haven’t always produced the same results. Larger studies are also calling into question the effectiveness of chloroquines.

The chloroquines aren’t without side-effects: If you have heart disease, they could make it worse.Some studies were halted due to heart issues. Headaches and nausea are seen in some patients.

As such, not everyone is on the chloroquine bandwagon. Before the recent randomized study came out, Dr. Anthony Fauci, the nation’s top infectious disease expert, stated that reports of hydroxychloroquine preventing COVID-19 were purely anecdotal (medical-ese for hearsay). and that more testing was needed.

That doesn’t mean the chloroquine regimen is a phony, however, just that it must be used judiciously and in conjunction with zinc, which seems to increase its effectiveness against COVID-19.

In drastic times, we have to remove the obstacles to any avenue of remedy. Chloroquine is only one of them, and if it could save even one life (without harming other lives), it is worth a shot.

Remember that using these medications without the close supervision by a medical professional is foolhardy at best and downright dangerous at worst. Discuss your options with the provider of your choice, do your own research, and reach your own conclusions.

Joe Alton MD