What Is Hydroxychloroquine And Does It Really Work?

While President Trump has said there is nothing to lose by taking hydroxychloroquine to treat COVID-19, the truth is a lot more complex than that.
Army Spc. Daniel Fields, assigned to the 9th Hospital Center, takes a patient’s blood pressure reading in the Javits New York Medical Station (JNYMS) – March 30, 2020 (US Navy/Barry Riley/Public domain)

Army Spc. Daniel Fields, assigned to the 9th Hospital Center, takes a patient’s blood pressure reading in the Javits New York Medical Station (JNYMS) – March 30, 2020 (US Navy/Barry Riley/Public domain)

What is hydroxychloroquine?

Hydroxychloroquine, brand name Plaquenil, is produced by French drugmaker Sanofi, among other drugmakers.

The quick and clean? It’s an antimalarial drug that treats lupus and rheumatoid arthritis, and has been suggested as a treatment for COVID-19.

The thorough and keen? The drug’s side effects pose health risks and the studies aren’t clear, making press coverage controversial.

Now centering on those risks, studies, and controversies, this article aims to answer Trump’s otherwise rhetorical question: If you take the drug, “what do you have to lose?”

Does hydroxychloroquine treat COVID-19?

Why are we testing an antimalarial, which was approved by the FDA in the 1950s, nearly 70 years later and as a possible treatment for this novel coronavirus?

All seems to lie within the supposed mechanism: Hydroxychloroquine raises pH levels where the novel coronavirus needs lower pH levels to thrive. Put another way, the drug alkalizes what the virus wants as acidic.

This science inspired studies in China and France to investigate whether the drug would relieve COVID-19 symptoms. Both studies yielded mixed results, and weren’t performed under ideal experimental conditions. What’s more, France reported 43 heart incidents in coronavirus patients being treated with hydroxychloroquine.

Uncertainty still remains even in other, more well-established clinical uses; for example, the drug’s dosing for rheumatoid arthritis is still subject to review.

As of late March, hydroxychloroquine is only FDA-approved for treatment of COVID-19 in emergency use and clinical trials. That is, only for “adult and adolescent patients who weigh 50 kg or more and are hospitalized with COVID-19, for whom a clinical trial is not available, or participation is not feasible.”

Dr. Patrice Harris, President of The American Medical Association, said unapproved use of hydroxychloroquine in treating COVID-19 could lead to death, and that we should reserve it only for approved uses: “We need to make sure that those patients who need this medication now get it, and we have to let the process play out.”

In all cases, approved and not, concerns remain over complications related to retinal damage and heart problems, which can lead to blindness and death. That French study has been linked to four deaths since March 27.

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Why is hydroxychloroquine so controversial?

Because of its testing as a possible “cure” in these desperate times, hydroxychloroquine has garnered exciting attention. Health experts like Dr. Anthony Fauci seek to qualify any excitement, and has advised that the preliminary studies in China and France are “at best suggestive.”

Still, Dr. Fauci’s advice as national immunological expert didn’t prevent Trump from interrupting him, touting the drug and tipping off a misinformation storm that has been reported as a cause in at least four chloroquine-poisoning cases – one in the US, which ended in death, and three in Nigeria. Rantt reported on additional consequences of Trump’s uninformed promotion of the drug and the misinformation about the drug spread by multiple media outlets here and here.

Clearly, claims regarding the drug, such as “I feel good about it. That’s all it is, just a feeling – you know, I’m a smart guy,” make waves around the world when you’re President of the United States, regardless of your medical qualifications.

Overall, the drug’s mechanisms and efficacy aren’t clear, and are still in the speculation stages. As the American Council on Science and Health wrote in late March, “There is nothing encouraging here, at least so far.”

What are the FDA-approved uses of hydroxychloroquine?

Again, hydroxychloroquine and its related, but more toxic cousin chloroquine, are used to treat lupus and rheumatoid arthritis and malaria, respectively – serious and debilitating illnesses that these drugs are approved for.

Therefore, as we’ve seen our societies do with toilet paper, hoarding of these drugs is a concern. Since at least mid-March, it has been reported that many doctors are suspected to be hoarding the drugs and prescribing them to friends and family – an act their colleagues call “unethical.”

Patients with lupus and rheumatoid arthritis are already getting nervous, and rely on hydroxychloroquine just to get through the day.

Hydroxychloroquine’s origins and side effects.

The modern drug is linked to quinine, a chemical used from cinchona tree bark in Andean cultures, and identified by colonizers in the 1600s. Its name traces back to a Quechua word for bark, “kina.”

Later, synthetic forms were introduced to the drug market in the 1940s, thus making hydroxychloroquine a long-established drug in modern medicine. Because of this, its side effects are well-known–some considered more severe, especially concerning heart and vision problems.

Common side effects:

  • headache
  • dizziness
  • loss of appetite
  • nausea
  • diarrhea
  • stomach pain
  • vomiting
  • skin rash

Side effects that tell you to seek medical attention:

  • reading or seeing difficulties (words, letters, or parts of objects missing)
  • sensitivity to light
  • blurred distance vision
  • seeing light flashes or streaks
  • difficulty hearing
  • ringing in ears
  • muscle weakness
  • bleeding or bruising of the skin
  • bleaching or loss of hair
  • mood or mental changes
  • irregular heartbeat
  • drowsiness
  • convulsions

Sanofi, the French pharmaceutical company that produces the drug, may be of personal interest for Trump; The New York Times found that he had a “small” financial interest in the company.

At the same time, the conservative publication The National Review wrote that Trump’s investment is just that, small – around $1,000 – and therefore unrightfully hyped up by “liberal commentators.”

The Rantt Rundown

  • Hydroxychloroquine is an antimalarial drug approved to treat lupus and rheumatoid arthritis. It is not approved to treat COVID-19, although trials are underway.
  • Scientists started investigating the drug’s potential effects against the virus in trials, due to its alkalizing mechanisms.
  • The trials have led to media excitement, but are inconclusive.
  • Trump’s boasting of the drug can have devastating consequences, and has already led to at least four chloroquine-poisoning cases and one death.
  • Doctors may be hoarding the drug, which incapacitates people who regularly depend on the drug.
  • The drug’s side effects are well-established and aggravated in people with heart conditions.
  • Trump may have a small financial stake in Sanofi, the pharmaceutical company that produces the drug.
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Rantt 101 // Coronavirus / Health / Science