Clarifying the Hydroxychloroquine Hype Train

Photo by Hal Gatewood on Unsplash

Within these stressful times, it is not a stretch to say that there is a desire permeating society for this period of struggle to be over. All over the world there is a race to find a definitive answer to the chaos caused by Covid-19. Because of this pressure to find a cure, any possible proponent rises to the surface in the hopes of being “the one”. One most talked about is the drug Hydroxychloroquine (HCQ will be used for easier reading). Recommended by Donald Trump, it has had a hype like status amongst his followers. Mixed news and selective facts are dangerous and unfortunately overriding news sources. Dissatisfied with the information available, I decided to do some research to understand more about HCQ. Here is some clarification on why this drug is so popular. I hope this article can help readers form their own opinions.

Hydroxychloroquine (HCQ) Story Thus Far.

First, we need to settle some background facts. HCQ has been used to treat malaria, lupus and rheumatoid arthritis for decades. Its side effects include stomach pain, psoriasis, permanent vision loss and heart disease. HCQ reduces the impacts of symptoms such as inflammation, joint pain and skin rashes and helps prevent the disease from spreading to other organs, the brain and spinal cord. For many with lupus, it is not only a long term treatment, it is key to their survival.

Many HIV and anti-malarial treatments are being tested as a treatment for Covid-19. Azithromycin, an antibacterial, is also used to treat infections resulting from the virus. HCQ was an ideal candidate since it was less toxic Chloroquine (CQ) and already widely used. There is a rumor that individuals with lupus are not getting the disease because of their usage of HCQ. This an incorrect, unproven statement as “correlation does not equal causation”. However, this notion is still treated seriously. The COVID-19 Global Rheumatology Alliance was a recently effort to see if globally combined data show a connection.

What we do know is in isolation, HCQ was ineffective in treating patients with the disease. (Example: this article leads to two earlier studies — France Study and Chinese Study). It reduces physical symptoms but otherwise has no substantial effect on reducing Covid-19 within the body.

“The administration of HCQ did not result in a higher negative conversion rate but more alleviation of clinical symptoms than [standard-of-care] alone in patients hospitalized with COVID-19 without receiving antiviral treatment, possibly through anti-inflammatory effects.”

— Recent Chinese Study in Shanghai

HCQ is being studied in other drug combinations to see its potential effectiveness. One combination is HCQ and Azithromycin that while better than HCQ alone was also ineffective in treating severe cases of Covid-19.

What about Hydroxychloroquine and Zinc ?

Let’s talk about the usage of HCQ in combination with zinc. This is the main argument on the usage of HCQ as a cure for Covid-19. The real power would come from the Zinc and HCQ would be its aid. In lab studies, Zinc blocks a key enzyme, RNA polymerase, of Covid-19 from replicating in host cells. The theory is that HCQ will help carry zinc into the cell as an ionophore. There are two positive reported cases of this combination ( LA and New York ) in the United States. These reports were very small and the combination is still undergoing clinical trials. In the end, these are anecdotal and not backed by research and large test groups.

Warnings, Side Effects and Self-Medication

If HCQ has shown positive results, why are we not distributing it across the country? The FDA has approved HCQ only for emergency usage in hospitals for patient trials and clinical testing. They do not approve HCQ as a cure for Covid-19. Several side effects can occur from usage, as with most medicines. Most importantly to be noted are heart related issues. This is why doctors screen through several criteria before they provide a prescription. Example criteria would be heart health, g6pd deficiency and pregnancy. G6pd deficiency is typically seen in men of African or Mediterranean descent. Many are asymptomatic, or do not show any symptoms. Infection or drugs such as chloroquine can trigger the dormant deficiency and cause hemolytic anemia.

Azithromycin also has a side effect of QT prolongation that affects the heart rhythm. This is dangerous when placed along side the other factors involving the coronavirus. HCQ, Azithromycin and Covid-19 all have heart failure as potential outcomes.

Self-medication can still have very dangerous effects. Nigeria faced mass purchasing of the drug for those wanting to self-medicate, which led to three hospitalizations for poisoning. It is important to have a doctor’s approval based on your medical history before using these drugs. HCQ usage is only approved by prescription in the United States. Bypassing the law by acquiring HCQ from another country can also be dangerous. You would risk faulty products, contamination and incorrect dosage for yourself.

Hydroxychloroquine and Other Seen Effects

The recommendation of HCQ has shown an effect on a societal level as well. Increased testing has caused shortages for patients with FDA approved HCQ prescriptions. Pharmacies have recently put restrictions to avoid stockpiling. Prescription owners are seeing prices rise and have no option to buy in larger amounts.

This is a new virus that is being researched in labs across the world. Covid-19 causes the immune system to act in different ways not seen before. HCQ can treat some immune system problems. But without further testing the drug and its cocktail variations risk side effects. They could also introduce a new problem — such as malaria strains becoming resistant to chloroquine.

ICU doctors in New York City are seeing Covid-19 have different effects on people who vary in age, health and preexisting conditions. The virus can worsen the effects of conditions that were before under control. It is hard to say what will work for sure without extensive testing. However, it is clear that individuals should not attempt self-medicate. Instead, they should keep on top of the latest research and see what results from the clinical trials.

TLDR: Conclusions and Opinions on HCQ

• Hydroxychloroquine alone is not effective in treating Covid-19
• The combination of Hydroxychloroquine with Azithromycin is not an effective cure to Covid-19
• The combination of Hydroxychloroquine with Zinc and Azithromycin is still undergoing research
• Hydroxychloroquine can cause heart disease and vision loss. It should not be used without doctor approval. This is especially applies to patients with prior heart health issues
• Covid-19 can cause unexpected effects in patients’ immune systems including cardiac arrest. This was also seen in asymptomatic patients.
• Hydroxychloroquine is one of many anti-viral, autoimmune treatment drugs undergoing research. ex. Another is remdesivir
• The WHO and FDA have not approved hydroxychloroquine or chloroquine as Covid-19 cures. They have only allowed emergency usage in hospitals for clinical trials
• Those who need HCQ for long term treatment are experiencing difficulty in filling their prescriptions.

My opinion after research and contemplation about the usage of HCQ:

Many sections in this article address existing arguments from HCQ supporters. There are many battles to fight regarding this pandemic. While we want a cure as fast as possible we cannot forget that we are indeed dealing with people’s lives. The most important aspect of doctors applying treatment is “do not harm”. Research takes time, but it ensures whether something is definitive versus theory. Research also needs to have control groups to be able to say which factors worked and which didn’t. People in those groups would receive a placebo instead of the drug — lives that would have to be volunteered. This is a careful moral ground not to looked over.

The existing success cases do give a sign of hope. But they are anecdotal. Studies done in the lab and anecdotal cases without control groups are not enough to prove something works. This is why carefully controlled studies are critical. Without that we risk more lives than necessary.

Along with this, what is most important is that we be conscious of those who need this drug to survive. HCQ is imperative for long term treatment of lupus. It is important to control the purchasing of HCQ so those with preexisting conditions can get their prescriptions. If they do not receive their medication they risk flare ups and irreversible damage to their bodies. This also protects the public from possible misuse via self-medication. It is irresponsible, dangerous and inhumane to put more people at life-threatening risk.

Does HCQ work? We don’t know because tests are still occurring. It cannot be called a cure since data must back that up. Why is there not larger scale testing right now? There are many possible answers to that. One is money. Another is consideration for the lives of volunteers within these groups. Many are occurring only on severe cases of Covid-19 who otherwise risk death. Another is careful control of the existing supply for those who depend on the medication already. The last reason could be this is the natural process of research. Some studies are saying 3 to 6 months for some verified results.

If we compared this to other practices:

• the creation cycle of SEO practices taking 3 to 4 months
• a custom website taking anywhere from 2 months to 1 year
• a physical product can take 1 year.

These practices do not even have the same moral obligations of public health and wellbeing as a vaccine.

A cure for Covid-19 would be a victory for us all. Which is why it must be done right.

Ending Notes

To those serving on the front-lines and working tirelessly in the labswe thank you so much for your hard work and for protecting us all during this pandemic. As for us in the general public, it’s important to stay vigilant and informed during this time. There is nothing wrong with saying you do not have the amount of facts needed to determine an opinion. We not only need to follow best practices ( social distancing and hygiene ) we also need to do our own research. Information changes rapidly and is contorted to manipulate our emotions. Let’s all do what we can to support each other and stay safe.

This article was based on information existing since April 26, 2020

Dedicated to my dad who is currently on the hype train