Over the past week, the drugs hydroxychloroquine and azithromycin have been in the spotlight thanks to press briefings and tweets by Donald Trump. Normally used to treat malaria, both have been touted as a potential treatment for COVID-19, the disease caused by the new coronavirus, by the President, despite a lack of medical evidence, and the potential to be dangerous if taken without medical supervision.
Experts – including Trump's coronavirus advisor Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr Stephen Hahn, Commissioner of the FDA – have called for caution against Trump's pronouncements (in Hahn's case, refuting Trump's claims hydroxychloroquine had been approved by the FDA for use against the coronavirus and would be available "almost immediately"), citing a lack of evidence.
The original French study that put the drugs forward as a potential treatment to fight against COVID-19 was on a very small number of patients, and though it warranted interesting results, it also required further study before a strong conclusion could be drawn.
Unfortunately, due to the President's wide platform, his unclear message has reached people far and wide with some tragic consequences. After Trump tweeted about hydroxychloroquine, attempts to buy the drug surged in Lagos, Nigeria, and two people were hospitalized with chloroquine poisoning. In Arizona, a man and his wife took chloroquine phosphate, a parasite treatment for fish, because it sounded like the drug they heard Trump say on TV was safe. The man died, and his wife was hospitalized.
Now, a second study, also on a small number of patients, has investigated hydroxychloroquine's potential as a treatment for COVID-19. The research found that the drug was no better than the current treatment of oxygen, fluids, antiviral drugs, and bed rest. The new study, published in the Journal of Zhejiang University, involved 30 patients suffering from COVID-19, half of which received current conventional care, while the other half received conventional care plus 400mg of hydroxychloroquine a day for 5 days.
In both groups, the timings of the disease's progression and recession were remarkably similar. Reductions in temperature, changes in CT scans, and the eventual removal of the virus from the body were consistent in the two groups. After a week, 13 people on the malaria drug treatment group and 14 people from the control group had recovered. The findings didn't show any additional benefit to using the malaria drug.
In the French study, 36 patients took part, 20 receiving a mixture of hydroxychloroquine or that drug and azithromycin, while the rest made up the control sample. The researchers found that after 6 days every patient on the double drug treatment no longer had the virus in their system, but only half the patients on hydroxychloroquine alone did, and just two of the control group, suggesting the combined drugs might make an effective treatment.
So, you might be wondering what is the truth? Given the small sample size, medically and scientifically both studies are considered little more than anecdotal. There might be many factors at play that both or neither have considered. The findings might look promising, and researchers around the world right now are slaving away trying to find treatments to fight the pandemic, but currently, the numbers are too low to confirm or deny whether the drug is effective.
The Chinese study does suggest that the prognosis for typical COVID-19 patients is good. That said, it shouldn’t make us complacent. It is vitally important to practice physical distancing to contain the spread, so that hospital and emergency services do not become overwhelmed and can continue to treat people effectively.