Is Hydroxychloroquine an Effective Treatment for COVID-19?

What's the story?

• As healthcare providers around the world scramble to find effective means of treating COVID-19 patients, one of the oft-mentioned potential treatments is the anti-malarial drug hydroxychloroquine.
• President Donald Trump and his allies have continued to tout the off-label use of this drug for COVID-19. However, it's still unclear just how effective and safe it is.
• The U.S. Food and Drug Administration (FDA) recently authorized the emergency use of hydroxychloroquine to treat COVID-19 patients who cannot participate in clinical trials.

Off-label use in COVID-19 patients

Based on some accounts, hydroxychloroquine does save the lives of COVID-19 patients.

• Michigan State Rep. Karen Whitsett (D-Detroit) credited hydroxychloroquine with saving her life after her health "plummeted" after contracting the novel coronavirus.
• In a Monday, March 6 interview with 'The Ingraham Angle," Whitsett said:

"I really want to say that you have to give [hydroxychloroquine] an opportunity. For me, it saved my life. I only can go by what it is that I have gone through and what my story is, and I can't speak for anyone else. So that's not what I'm trying to do here. I'm only speaking for myself."

• Recounting her experience with hydroxychloroquine, Whitsett said she felt much better within a few hours of taking the medication.
• In Texas, 60 hospitals and pharmacies have received over 550 bottles of hydroxychloroquine. In the Dallas-Fort Worth area, hospital systems confirmed on Tuesday, March 7, that they have already prescribed hydroxychloroquine to treat COVID-19 patients.

Touted by Trump

• Despite offering the disclaimer that he is "not a doctor," President Trump has repeatedly touted hydroxychloroquine in his daily briefings. He has called hydroxychloroquine used in combination with the antibiotic azithromycin "one of the biggest game changers in the history of medicine" and pushed for its immediate use.
• On Sunday, April 5, President Trump asked "What do you have to lose?" five times with reference to testing hydroxychloroquine.

Doubts and concerns in the medical community

• Despite the Trump administration's outward optimism and anecdotal evidence (like Whitsett's experience), some health professionals argue that hydroxychloroquine is unproven and carries multiple, significant risks.
• They also point out that Trump's promotion of its off-label use in COVID-19 patients could lead to a shortage of this essential medication for patients who normally use it for other illnesses, such as lupus and rheumatoid arthritis. In fact, according to some reports, lupus and arthritis patients are already facing hydroxychloroquine shortages.
• Crystal Howell, an infectious diseases pharmacist and assistant professor of pharmacotherapy at the University of North Texas Health Science Center, says she "personally would not take [hydroxychloroquine] for [COVID-19]" because the evidence for the drug's use is not strong enough.
• Howell added that she would not recommend hydroxychloroquine to all patients due to its side effects, which include abnormal heart rhythms (arrhythmias) that can be fatal, irreversible vision loss, and aplastic anemia (a rare condition in which the body stops producing enough new blood cells).
• In another sign of the medical community's skepticism over hydroxychloroquine, Michael Ackerman - a genetic cardiologist and director of the Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic - took the unusual step in late March of issuing guidance for physicians, advising them against prescribing hydroxychloroquine for COVID-19 patients.
• Even within the Trump administration, Dr. Anthony Fauci, the government's top infectious disease specialist, has warned against putting too much stock in hydroxychloroquine. In a Sunday, April 5, interview on CBS' "Face the Nation," Dr. Fauci said:

"The data [on hydroxychloroquine's use in COVID-19] are really, just, at best, suggestive. There have been cases that show there may be an effect and there are others to show there’s no effect. So, I think in terms of science, I don’t think we could definitively say it works.” 

Questionable motivation by Trump?

• President Trump may have personal financial interest in Sanofi, the French drugmaker that makes the brand version of hydroxychloroquine, Plaquenil.
• Based on President Trump's 2019 financial disclosures, three family trusts have investments in the mutual fund company Dodge & Cox, which include shares in a number of drug companies, including AstraZeneca, Novartis, Bayer, GlaxoSmithKline, and Sanofi.
• However, it's worth noting that President Trump's stake in Sanofi is fairly small and that Plaquenil is a very small part of Sanofi's business. In 2019, for example, the drug wasn't even broken out by name in its financial accounts, whereas 33 other medications were.
• Additionally, as Vox writer Emily Stewart points out, a president promoting a product made by a company they have only a very small stake in would be a very inefficient way of (corruptly) gaming the system:

What do you think?

Now that you've heard both sides: Would you consider taking hydroxychloroquine if you were sick with COVID-19? Should the president divest from Sanofi? Take action above and tell your reps, then share your thoughts below.

—Lorelei Yang

(Photo Credit: iStockphoto.com / BartekSzewczyk)