Hydroxychloroquine and COVID-19 Prevention

Updated: Aug 26, 2020

On May 18th, 2020, President Donald Trump reported that he has been self-administering hydroxychloroquine (HCQ), an anti-malarial drug, for approximately a week and a half (McCarthy & Greve, 2020). Shortly after, many studies on the efficacy of HCQ began to surface, causing a back-and-forth clash of information.

So, what exactly is HCQ? HCQ, also known as Plaquenil, is classified as a disease-modifying antirheumatic drug (DMARD), in other words, it reduces swelling caused by diseases such as arthritis. This is achieved by HCQ accumulating in lysosomes, which then stimulates an increase of lysosomal enzymes within the cell, thereby promoting immune activation (Schrezenmeier, 2020). In addition, HCQ prevents malarial parasites from breaking down the hemoglobin structure in red blood cells, which is why it is used to treat malaria (Schrezenmeier, 2020). Upon consumption of the HCQ tablet, the drug will be absorbed within the upper gastrointestinal tract. Within one hour, the drug will enter into the bloodstream of the individual. Due to its large distribution within the bloodstream, the half-life of HCQ is approximately 40-60 days, providing roughly 1,300 hours of resistance to malaria (Schrezenmeier, 2020). The consumption of HCQ is usually well tolerated by patients if administered with the correct dosage. In some cases, side effects such as nausea, diarrhea, rash, changes in skin pigment, hair changes, and muscle weaknesses may occur. In rare instances, mainly caused by overdose and/or existing health complications such as obesity, kidney, or liver disease, HCQ may cause anemia, loss of vision and changes in heart rhythm (Schrezenmeier, 2020).

With evidence demonstrating that improper consumption of HCQ, especially without guidance from physicians or professionals, may cause severe harm to an individual, the announcement made by President Donald Trump was careless and dangerous. The President’s announcement may lead individuals to consume HCQ in dangerous doses, which may result in irreversible health complications. There has been limited evidence on the efficacy of HCQ in COVID-19 prevention (Yazdany & Kim, 2020). Therefore, by taking upon himself to self-medicate, President Donald Trump directly undermined the expertise and authority of doctors and other professional organizations such as the CDC. This may reduce the public’s trust in doctors and experts, resulting in decisions that may not be evidence-based, and possibly dangerous to themselves and to those around them. The President’s announcement may also lead individuals to experiment with similar drugs such as methotrexate, sulfasalazine, and leflunomide, which are all used to treat rheumatoid arthritis (Johns Hopkins Rheumatology, 2012). Additionally, the U.S. Food and Drug Administration (FDA) revoked the use of HCQ as a treatment for patients with COVID-19. Their reasoning was due to the fact that the known potential risks outweigh the potential benefits due to the possibility of serious side effects (FDA, 2020).

I will say this again, President Donald Trump should not have promoted the use of HCQ for the purpose of preventing COVID-19. He is not a medical professional and studies on prevention of COVID-19 have been inconclusive. There are experts around the world who are working tirelessly in attempt to develop preventative treatments and medicine for COVID-19. It is not to say that HCQ is completely out of the picture; however, we need to wait until substantial information is released which indicates that this drug can effectively prevent COVID-19. In doing so, it will reduce the likelihood of developing health complications due to misuse of pharmaceutical drugs. Let us be patient and trust that our health care professionals and global health leaders will lead us out of this pandemic. We as the general public, also have the responsibility to ensure the safety of ourselves and those around us. By practicing physical distancing and proper hygiene measures such as handwashing, we are already preventing the spread of COVID-19 without the need of self-medication.

References

FDA. (2020). Coronavirus (COVID-19) Update: FDA revokes emergency use authorization for chloroquine and hydroxychloroquine. FDA. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-revokes-emergency-use-authorization-chloroquine-and

Johns Hopkins Rheumatology. (2012). Rheumatoid Arthritis Treatment. Johns Hopkins Medicine. Retrieved from https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/

McCarthy, T. & Greve, J. E. (2020, May 20). Trump is taking hydroxychloroquine, White House conforms. The Guardian. Retrieved from https://www.theguardian.com/us-news/2020/may/19/trump-hydroxychloroquine-covid-19-white-house

Schrezenmeier, E., Dörner, T. (2020). Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 16, 155–166. Retrieved from https://doi.org/10.1038/s41584-020-0372-x

Yazdany, J., & Kim, A. H. (2020). Use of hydroxychloroquine and chloroquine during the COVID-19 pandemic: what every clinician should know. American College of Physicians. Retrieved from https://www.acpjournals.org/doi/full/10.7326/M20-1334