Chloroquine: Do magic cures exist for COVID-19?

It’s the new drug everyone is talking about. A cure for COVID-19, something to put our hopes in. It was touted as the solution but does it hold up to the high expectations or are we getting too excited about an unproven, and potentially dangerous medication.

KEY POINTS

- chloroquine is a well-known anti-malarial drug

- Chloroquine and hydroxychloroquine are old drugs, used for lupus or rheumatoid arthritis

- The drug has harmful side effects and can even cause death.

- Some doctors have said it might help in treating COVID-19

- We don’t have much evidence

- We need evidence to make sure that the drug is safe to use in COVID patients

- Self-medicating on the drugs can cause serious harm or even death

- WAIT UNTIL DOCTORS RECOMMEND THE DRUG

- While we wait for an effective evidence-based anti-Corona drug, social distancing and personal hygiene remain the best bet.

WHAT IS IT

Chloroquine was discovered in 1934 as a potent anti-malarial, but one that has lost its efficacy due to overuse and subsequent resistance. Hydroxychloroquine is a derivative that is considered less toxic with fewer side effects.

It is commonly used in auto-immune disorders, where the body’s immune system starts attacking the body instead of harmful organisms such as bacteria and viruses. These diseases include lupus and rheumatoid arthritis. Hydroxychloroquine can be used to dampen the immune response, and help patients manage their symptoms.

It is therefore approved, and we know about its side effects. This does not mean it is safe to use in COVID.

WHY DO WE NEED EVIDENCE?

- Without evidence people can recommend useless or even dangerous drugs

In science we always look at evidence. Just because one person says something works does not mean it is true. The results may have been wrong or a chance accident, the interpretation of results may be misleading, the experiment may not have been set up correctly or the person touting the results may be straight up lying for their own benefit. This is why we run strict experiments with strict guidelines that can be checked by other scientists.

This is especially true in medicine — if something is recommended as a medicine without clinical trials it can cause serious harm or even death. A prime example is the drug thalidomide. Used in the UK for morning sickness in pregnancy, it did not go through any clinical trials before its use. The side effects of the drug were shocking. Babies born without hands, arms and legs, just because people wanted to avoid feeling sick.

WHERE IS THE EVIDENCE

- We are still looking. Clinical trials have started, and they show promise. But this doesn’t mean we recommend it.

What about hydroxychloroquine? We know it works in lupus and other auto-immune diseases. Why can’t we use it?

Hydroxychloroquine has shown promise in some reports and clinical settings. But there have not been any large scale trials. The evidence is anecdotal, letters written by doctors who have used the drug. This is not strong evidence. The patients may have improved by themselves without the drug, the patients may have had milder forms of the disease, they may have had other treatment as well that is not mentioned in the letters.

Laboratory studies show that chloroquine and a drug remdesivir might block the coronavirus infection. Studies under a microscope looking at single cells exposed to the virus shows that chloroquine and hydroxychloroquine can cause changes inside the cell that make it more difficult for the virus to attach and enter the cell.

https://www.nature.com/articles/s41421-020-0156-0

Is this the proof we need? Again, no. Laboratory studies do not always scale well to clinical efficacy. Under a microscope we look at just one cell and one type of cell. In the human body there are trillions with different functions, influenced by hormones, chemicals, reactions and other processes. We don’t know how all of this can alter the effects of the drug, and whether enough of the drug will reach the cells when taken in pill form. It is the same reason why so many miraculous cancer drugs discovered in labs end up being duds.

IS THERE HOPE?

- Yes there is hope. But we must be sensible. Panic buying and taking unproven drugs can be more harmful than the virus

This does not mean we should give up hope on this so quickly. Because it has shown promise, large scale clinical trials have been set up to see if the two drugs chloroquine and hydroxychloroquine are any better than giving nothing or giving the next best thing. New York has acquired 70,000 doses of hydroxychloroquine and 750,000 of chloroquine for these trials. Until then we should wait and see whether medical professional authorities recommend the medication.

Because we have to remember these drugs are not without side effects, and are actually lethal if not taken under the supervision of a clinician. 3 people in Nigeria have died after taking chloroquine to prevent COVID. 1 person in America has died after Trump’s speech, being so convinced by the presidents’ words he purchased industrial use chloroquine, only to die from the drug’s side effects.

We also have to remember the people who need the medication to control their autoimmune disorders, diseases that can leave them disabled and crippled.

IN SUMMARY

There is never a miracle drug, never a miracle cure. There has to be documented trial to support that. Common sense has to prevail. And until the pandemic is under control, we must follow these instructions:

- Wash your hands, sneeze into a tissue or crook of elbow

- Practice strict hygiene

- Stay indoors. Don’t meet with friends or go out if you don’t need to.

- Don’t panic buy items. Be sensible. Stocks will last

- DO NOT VISIT THE ELDERLY OR THOSE WHO HAVE SERIOUS ILLNESSES SUCH AS HEART DISEASE OR LUNG DISEASE

- Listen to government advice.

- If you exhibit symptoms, call your doctor.

Dr Rajan Choudhary UK,