Why are we having a "debate" over hydroxychloroquine?

Specifically, why are there angry confrontations happening during task force meetings over a drug that’s already being widely administered to coronavirus patients in New York? The University of Albany is tracking outcomes in NY and will have preliminary results in a few weeks. A hospital in Detroit also plans to try it on 3,000 patients and track results to see if it works.


No one, including “skeptic” Anthony Fauci, thinks hospitals should be withholding it from sick patients in lieu of any better option. Their concern is that it’s risky to recommend an unproven treatment to the general public, as Trump does every g-ddamned day, knowing that (a) hydroxychloroquine has side effects that can be life-threatening to some and (b) a run on the drug all but guarantees a shortage, which is a major problem for rheumatological patients. People with lupus need it to prevent their disease from damaging their internal organs. Those who’ve made the point since the lockdowns started that economic depressions have a steep human toll too should be especially sensitive to that. If we’re balancing human costs in the strategies we follow, start balancing the fate of 1.5 million Americans with lupus against the as yet unproven benefits of prophylactic hydroxychloroquine use by the general population against coronavirus.

Apparently Peter Navarro is tired of Fauci reminding him that there’s no hard science supporting the effectiveness of HCQ against COVID-19 and somehow isn’t satisfied by the fact that hospitals are using it anyway:

Fauci’s mention of anecdotal evidence “just set Peter off,” said one of the sources. Navarro pointed to the pile of folders on the desk, which included printouts of studies on hydroxychloroquine from around the world.

Navarro said to Fauci, “That’s science, not anecdote,” said another of the sources.

Navarro started raising his voice, and at one point accused Fauci of objecting to Trump’s travel restrictions, saying, “You were the one who early on objected to the travel restrictions with China,” saying that travel restrictions don’t work. (Navarro was one of the earliest to push the China travel ban.)

Fauci looked confused, according to a source in the room. After Trump imposed the travel restrictions, Fauci has publicly praised the president’s restriction on travel from China.


The tricky thing about hydroxychloroquine, said Sanjay Gupta yesterday on CNN, is that it’s an immunosuppressant. That seems counterintuitive for COVID-19: We want to boost people’s immune systems, not suppress them, right? Not necessarily. Some coronavirus deaths may be due to an overreaction of the patient’s immune system against the invading virus, in which case an immunosuppressant is helpful. In other cases, where the immune system is functioning normally in trying to repel the disease, giving them an immunosuppressant might backfire by allowing the virus to progress. You can see why recommending HCQ as a course for *all* COVID-19 patients might be a bad idea, then; the cause of death may not be one-size-fits-all in every patient, with some benefiting from the drug and others suffering from it. The president of the AMA said yesterday that she wouldn’t prescribe it for someone with coronavirus at this point because the side effects, although rare, can be scary, including “severe cardiac arrhythmias that can even cause death.”

Case in point:


Jeremy Faust is a doctor in Massachusetts who wrote a few pieces for Slate early last month suggesting that the death rate from coronavirus is overstated. He addressed hydroxychloroquine yesterday on Twitter, in particular speculation that lupus patients and other routine users of the drug for rheumatological reasons might not be contracting the disease because their HCQ course is helping to protect them. Not so, he claims.


Study the drugs. Hydroxychloroquine is being studied, as noted up top, but it’s not the only promising drug out there and Trump’s fixation on it may be drawing resources away from more promising treatments in development. Scott Gottlieb is all-in on the urgency of therapeutics for COVID-19 but the two he’s focused on are antiviral drugs like remdesivir by Gilead and antibody treatments from companies like Regeneron that could be available in the near term. (Antibody testing is coming in the near term too.) There needs to be “a strong sense of urgency” by manufacturers *and* regulators in order to get those drugs on the market ASAP, argues Gottlieb. But because cronies like Navarro and Rudy Giuliani are obsessed with hydroxychloroquine, Trump is too — which is forcing his subordinates to reprioritize:

“Everyone is getting ahead of their skis here,” said one senior Health and Human Services official involved in drug policy. “All this buzz is confusing the American public, it’s confusing doctors. There’s a ton of people involved in front-line response in the government … who are getting pulled into meetings to discuss this when the data doesn’t support it.”

This is “mindshare, time and energy being soaked up by a potential wild-goose chase,” said a second senior HHS official working on the coronavirus response. “We have no idea if this works, and the evidence suggests it doesn’t.”


Well, I don’t know about that last part…

…but again, the drug is already in use on the ground in New York with results coming. So why not shift focus from HCQ as a silver-bullet against the disease and start focusing on antibody treatments and antivirals instead? To repeat the question in the headline, what are we even arguing about here?

The “debate,” such as it is, seems to be nothing more than this: Fauci and the other experts think it’s unhelpful to keep mentioning hydroxychloroquine at briefings because it’ll cause a run on an unproven treatment and Trump insists on doing it anyway mainly just to remind everyone that he’s in charge. “Hydroxychloroquine has become yet another venue for Trump to demonstrate his mastery over the credentialed snobs,” says lefty Jonathan Chait. “The president can overpower the sniveling bureaucrats through sheer gusto.” Trump’s populist impulses haven’t served him well throughout the crisis. He shrugged off the virus for two months, treating it as a foreign problem that was well under control here; then, after finally being persuaded that it was time to lock down, he started chattering about “the cure being worse than the disease” and reopening for Easter, only to finally (thankfully) recognize what a bad idea that was. In both cases the eggheads were right to take the problem more seriously than he did. One small thing he can do to reassert his authority now is go all-in on hydroxychloroquine as a sort of miracle cure. If studies show the drug is effective against coronavirus then he can start crowing that he’s a genius. If studies show it isn’t then he’ll be on to some new miracle drug and everyone will be asked to move on, just like we’re supposed to forget that he spent all of February shrugging at early spread here in the U.S.


That’s what the argument about hydroxychloroquine is about, the idea that Trump knows best after all even when he’s engaged in the purest form of irresponsible wishcasting. Here’s Navarro arguing about the drug this morning on CNN.

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