Another article on Chloroquine

It Looks Like that Drug to Treat Coronavirus is the Real Deal

Watching the spread of the coronoavirus known as covid-19 moving from China to the United States and the rest of the world has been like witnessing a slow-motion train wreck coming right at you that you feel powerless to escape.

Older people are particularly susceptible to being killed by covid-19 – especially those over the age of 80. But no age group is immune. As of this writing, a study in England estimates that eventually the pandemic could kill more than 500,000 people in Great Britain and more than 2 million in the US.1

The epidemic has overwhelmed the hospitals and medical systems in some countries. This is significant because mortality rates appear to be under one percent if all the most serious cases can get access to intensive care – basically, a respirator.

But that is no longer the case in the hardest-hit countries. And in the absence of state-of-the-art care, death rates leap by a factor of two, three or even four times.

But now there’s a bright, shining ray of hope. You’ve probably heard of it, because it’s all over the news. It’s a drug to treat malaria that’s been around for years, and luckily it’s off-patent so any drug company can manufacture it if the bureaucrats will get out of the way.

These drugs are helping patients

Two medical doctors, writing in the Wall Street Journal (March 23), had this to say:

“Hydroxychloroquine is a common generic drug used to treat lupus, arthritis and malaria. The medication, whose brand name is Plaquenil, is relatively safe, with the main side effect being stomach irritation, though it can cause echocardiogram and vision changes.

“In 2005, a Centers for Disease Control and Prevention study showed that chloronique, an analogue, could block a virus from penetrating a cell if administered before exposure. If tissue had already been infected, the drug inhibited the virus.”

The two authors of the article are Jeff Colyer, a physician and chairman of the National Advisory Commission on Rural Health. He is also a former governor of Kansas (Republican), and Daniel Hinthorn, M.D., director of the Division of Infectious Disease at the University of Kansas Medical Center.

They say, “The federal government should immediately contract with generic manufacturers to ramp up production. Any stockpiles should be released.”

The Wall Street Journal article is just one small part of the media buzz about this treatment. It started a couple of weeks ago and hit the top of the news on Friday when President Trump said he was hopeful it might be a solution.

Clinical trials (meaning those on humans) are just getting started. Reportedly 10,000 doses have been shipped to New York for a trial there. New York is already threatened with the shortage of intensive care facilities I mentioned above.

Several studies provide the basis for all the hope and excitement. Let’s take a look…

A well-established drug

Chloroquine was first discovered in the 1930s and approved for use in the US in the late 1940s. Lab tests and some early treatments on people suffering from covid-19 show that while chloroquine might not be 100% effective, in many cases it should be able to produce significant benefits and save lives.

A 2005 study by the Centers for Disease Control showed that chloroquine could prevent a virus from entering a cell if patients received it as a preventative (as opposed to taking the drug after they’re already infected.) Among patients who were already infected, the drug inhibits the virus. (Viruses operate by penetrating a cell and taking possession of its machinery. It’s like the cell becomes demonically possessed.)

And now, research in China, just published on March 9, says that the drug’s properties when absorbed by cells in the body give it “potential broad spectrum anti-viral activities.”2 The study was conducted on lab-grown cells so it is not the last word on whether the drug will work in humans.

A small human study confirms these results

Fortunately, a small human study conducted in France is much more promising.

In this study, researchers administered the related drug hydroxychloroquine in combination with the antibiotic azithromycin to covid-19 patients (azithromycin is used to prevent bacterial pneumonia). The drug combo reduced infection in 75% of the patients and rendered them non-infectious after six days – meaning they couldn’t give the disease to other people.3 (Often people with covid-19 may remain infectious for up to 20 days.)

The antibiotic by itself apparently doesn’t help Covid-19. It takes the combo.

While the results of this French test have not been published in a scientific journal yet, the French researchers believe that if hydroxychloroquine proves effective against Covid-19 the way they believe it might, “the novel coronavirus-associated disease will have become one of the simplest and cheapest to treat and prevent among infectious respiratory diseases.”4

While such a small study is not conclusive, I’m very hopeful. And I do want to repeat that, among those already infected, it apparently relieves symptoms but is not a “cure.” But it’s also fair to say that for acute cases of people near death from Covid-19, symptomatic relief may be just what they need to pull through.

In addition to the American trials getting underway, there’s other chloroquine research to keep an eye on. In Australia, researchers are analyzing the benefits of the drug when dispensed with a combination drug called Kaletra which, itself, is a mixture of anti-HIV medications.5

Ebola and Covid-19

Another drug that shows promise in the fight against Covid-19 is remdesivir, a drug originally intended for treating the Ebola virus. Tests show that this drug’s anti-viral potential could help inhibit infections from Covid-19.6

Remdesivir fights viruses by interfering with enzymes that the pathogens use to reproduce themselves once they are inside infected cells. Previous studies have shown that remdesivir can help treat coronaviruses like those that cause SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome) and a few of the viruses that cause the common cold along with coronaviruses that infect bats.7 Researchers at the University of North Carolina Gillings School of Global Public Health are now testing it against Covid-19.

All of this research certainly looks promising in the fight against this burgeoning pandemic. So there may be light at the end of the tunnel for fighting this disease.

Will the FDA and the CDC blow it again?

My greatest fear is that the authorities will drag their feet about getting this drug into the hands of the thousands and perhaps hundreds of thousands of people who will need it now.

I’m all in favor of careful testing and ensuring safety, but this drug has been around for decades and we have a pretty good handle on the side effects. Yes, I guess it’s possible there may be new side effects unique to Covid-19 patients and not previously seen in malaria and arthritis patients.

But it seems to me patients should be allowed to assess that risk for themselves.

As the very least, I hope the authorities will ramp up production of the drugs while we await the outcome of the current trials. That way the drug can be rushed to patients as soon as we’re sure it’s safe.

The FDA has a heavy institutional bias toward avoiding downside risks as opposed to taking advantage of upside opportunities. Their attitude is that you can’t make a mistake by keeping a drug off the market. The only mistake you can make is to release a drug to the market that later turns out to have serious side effects.

I think that bias may steer us into an avoidable tragedy. I already see it reflected in the cautious public statements of people like Anthony Fauci.

In theory you can get the drug combo anyway

Can you get it now? In theory, yes. Treatment for Covid-19 is what is called an off-label use of chloroquine and hydroxychloroquine. The drug is not approved for that application but it’s perfectly legal for a licensed doctor to exercise his own judgment and prescribe it to whomever he wants.

The reality – I’d be willing to bet – is that most of the available supply of the drug has been snapped up by doctors who have already prescribed it to their desperate patients. That’s why it’s critical to ramp up production and be quick about it.

I’d be darned curious to know how many wealthy or well-connected people already have a bottle of these drugs in their pockets while the rest of wait for the outcome of the human trials.

Best regards,

Lee Euler,