The malaria drug hydroxychloroquine has become a political litmus test. But doctors on the front lines of coronavirus say it’s just another tool in desperate times.
Dr. Bushra Mina, chief of pulmonology at Lenox Hill Hospital in Manhattan. Credit … Gabriela Bhaskar for The New York TimesHis first encounter was with an older man whose health declined quickly. No drugs were approved to treat this highly infectious virus, and there was little Dr. Mina could do but provide supportive care.
Weeks later, Dr. Mina, the chief of pulmonary medicine at Lenox Hill, is on the 20 th revision of guidelines shared among doctors as they assess the ways the virus is emerging and advancing in patients, and what possible treatments should be applied. Now most Covid – 30 patients at Lenox Hill who are not on the verge of dying receive a five-day regimen of hydroxychloroquine, the long-used malaria drug that President Trump has repeatedly promoted as a “what have you got to lose” remedy. While his own top health officials are more cautious – noting there is limited evidence about the drug’s benefits – doctors across the country have been prescribing the drug for weeks.
Dr. Mina doesn’t know if the hydroxychloroquine is helping his patients. He is well aware that there are no rigorous clinical trials showing that the drug works. But he can’t wait for the evidence to come in, he said, when people are dying.
Hydroxychloroquine and a related drug, chloroquine, have been used for decades to treat and prevent malaria, and hydroxychloroquine has been used by people with lupus and rheumatoid arthritis because it is known to calm the immune system. In laboratory tests, it has been shown to block the coronavirus from invading cells, although it hasn’t been proven in human trials. The drugs are not recommended for people who have abnormal heart rhythms because it can make them worse.
- For weeks now, doctors around the country have been giving the drug to patients at various stages of the disease, and as a preventive measure to some if they’ve been exposed by family members or in health care settings. But even after treating hundreds of patients with the antimalarial drug, the doctors interviewed did not report clear results or remarkable recoveries that can be traced to the drug.
- “In many ways we feel driven to help patients who are in front of us – today – in the hour of their greatest need,” said Dr. Steven Kalkanis, the chief academic officer of Henry Ford Health System. “And there is a clamoring to use whatever we have at our disposal.”
- But outside of a clinical trial, it can be hard to assess the drug’s value, especially when it is being given to a variety of patients, of different ages and medical conditions, and at different points in their disease. Based on the hospital’s experience, Dr. Kalkanis said, the drug’s benefits do not appear to be a slam dunk.
- The (drug has generated excitement) because a laboratory study, with cultured cells, found that chloroquine could block the coronavirus from invading cells, which it must do to replicate and cause illness. But drugs that show promise in the laboratory do not always translate to success in the human body, and other studies have found that it failed to prevent or treat influenza and other viral illnesses. Early reports from doctors in China and (France) have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients. But the studies were small and did not use proper control groups – patients carefully selected to match those in the experimental group but who are not given the drug being tested. Research involving few patients and no controls cannot determine whether a drug works. At most hospitals in the Ochsner Health system in Louisiana, including those in New Orleans, infected patients are routinely given a course of hydroxychloroquine. Patients in the intensive care unit are also given the drug if they have not received it earlier in their illness.
- Dr. Leo Seoane, the chief academic officer at Ochsner Health, said the health system had declined to participate in research trials that included a placebo arm, in which some patients would be selected not to receive the drug. “We did think it was ethical at this point in the crisis to withhold the therapies that could be beneficial,” he said.
But he acknowledged that even though the hospital gives the drug to nearly everyone who is admitted, the percentage of people who end up in the intensive care unit – about a third of those admitted – is similar to reports in other places where the drug is not used. “From a gut feeling, it’s hard for me to know that it is having an impact,” said Dr. Seoane, who is also a pulmonologist and critical care physician.
- Those trials are getting underway now, with (more than) (studies of hydroxychloroquine) in patients with Covid – posted to a federal clinical trials registry. A placebo-controlled trial financed by the National Institutes of Health
- . David Boulware of the University of Minnesota, said enrollment is slowing in the national trial he (is) overseeing of up to 1, People to test whether hydroxychloroquine works preventively.
He does not know why participation is slowing, but he added that Mr. Trump’s message is not helping.
“He’s just saying, ‘You should take it, I should take it, everyone should take it, ‘”Dr. Boulware said. “If he was promoting science and promoting research, we would have had an answer weeks ago.”
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