Coronavirus workers in Madrid respond to cheers from apartment dwellers. Internet photo.

By Paul Goldfinger, MD.

Hydroxychloroquine is an antimalarial drug which has been around for many years.  A long while ago it was suspected that the drug would work against killer viruses, and it has been looked at for that purpose as far back as 40 years ago.  Recent laboratory trials have produced discouraging results.  There are concerns about cardiac toxicity, but, in general, it has been safe, and the chances of a major cardiac rhythm disturbance are quite small.  Its approved uses include lupus, rheumatoid arthritis, and malaria.

It got into the news recently when some French doctors gave it to a small number of patients with Coronavirus, and some of them seemed to respond favorably.  Even though there are no scientific trials to prove the benefit in patients, doctors all over the world have been trying it along with an antibiotic, azithromycin.

The general attitude of doctors working in the trenches to combat the horrible COVID-19 disease has been “let’s try it, because our patients are dying.”  They have been giving the drugs “off label” and with the knowledge of patients and families. The usual routine is to give it early in the illness for a matter of days. There are many anecdotes describing  beneficial  results, but nothing has been proven, and some doctors refuse to use an unproven treatment.

Meanwhile the NIH and other academic institutions here and around the world have initiated controlled studies.

The President has jumped on the band wagon touting these drugs, and huge numbers of pills are being manufactured and distributed with the approval of the FDA.  This drug has not been officially approved by the FDA for this purpose, but doctors have the green light to try it.

Here are some quotes from a variety of solid sources, news and medical:

“Drug companies across the world have begun donating tens of millions of doses of hydroxychloroquine to the United States, and the President said on April 4 that 29 million doses had been added to the National Strategic Stockpile, a cache of medical supplies maintained by the government to respond to emergencies.”

“Studies of hydroxychloroquine in the past  have found that it failed to prevent or treat influenza and other viral illnesses.”

“Recent reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients.   Many hospitals around the world  are giving it to patients even though there  is no proven treatment, and they hope it will help.” Others are trying it as a preventive for exposed people.

” A nationwide clinical trial began on April 2 in the US. It is to enroll 510 patients at 44 medical centers.  Last month, the Food and Drug Administration issued an emergency use authorization, allowing health care providers to use the medicine for this  illness, even though the drug has not been approved as a specific treatment for COVID-19.”

American College of Cardiology:     “Hydroxychloroquine and azithromycin all prolong QT interval on the ECG, raising concerns about the risk of arrhythmic death from individual or concurrent use of these medications. We strongly encourage enrollment of patients in clinical research protocols, whenever available. All clinical use that occurs outside of a research setting should incorporate anticipated benefits balanced against risks.”

Currently, there is hope for benefit from hydroxychloroquine, yet there is little evidence. That is likely to rapidly change, given many pending clinical studies in the U.S.,  and some of those should produce results fairly quickly.

“Dr. Anthony Fauci continues to hold the same line as the rest of the medical community—cautious optimism.”

“Dr  Fauci, the country’s top infectious disease doctor, has repeatedly warned  that there is no conclusive evidence to support using the drug.  Asked whether it should be considered a treatment for Covid-19, he said on 24 March: “The answer is no.”

I heard him respond to a question at a press conference  as to whether he would take the drug if he had  Coronavirus, and he said, “Only if I could be part of a clinical trial.”

Would I take it if I were very ill with Corona, the answer is “yes.”