It’s human nature during one of the bleakest moments in American history to lunge at promising news about drug treatments. We’d probably be in the midst of a public uproar about chloroquine even if Trump had never mentioned it; the encouraging anecdotal reports from China and France about its effect on coronavirus were destined to go viral among frightened people even if they weren’t mentioned by big fish like Tucker Carlson and small fish like me. We need hope.
But we also need perspective. The chloroquine hype comes at a cost, potentially. And that cost will be terrible if the drug turns out not to be effective against COVID-19 after all.
This isn’t perspective:
— Donald J. Trump (@realDonaldTrump) March 21, 2020
Why is he lobbying his own FDA publicly to approve chloroquine as a treatment? Fauci was clear about this yesterday: Promising treatments need clinical trials. Partly that’s to make sure they don’t end up doing more harm than good in patients. It’s one thing to give chloroquine to people who are at death’s door and have nothing left to lose by trying it, it’s another to encourage its use in patients who might recover from COVID-19 on their own without needing it. Beyond that, there’s a credibility issue. You don’t want the FDA or the president indulging in chloroquine mania without evidence that the drug is effective. It’ll piss people off and make them less willing to trust advice if they’re led to believe that this is the answer — and then it isn’t.
The potential human cost here lies in the fact that chloroquine (specifically its less toxic derivative, hydroxychloroquine) is a key therapy for people suffering from rheumatological disorders like arthritis or lupus. It’s not a one-time treatment for them; they’re on it forever, with lupus patients risking early death if they can’t get it. And so, guess what? Chloroquine mania vis-a-vis COVID-19 is already making the drug scarcer for them.
Mr. Trump’s boosterish attitude toward the drugs has deepened worries among doctors and patients with lupus and other diseases who rely on the drugs, because the idea that the old malaria drugs could work against the coronavirus has circulated widely in recent weeks and fueled shortages that have already left people rushing to fill their prescriptions.
“Rheumatologists are furious about the hype going on over this drug,” said Dr. Michael Lockshin, of the Hospital for Special Surgery in Manhattan. “There is a run on it and we’re getting calls every few minutes, literally, from patients who are trying to stay on the drug and finding it in short supply.”…
Hydroxychloroquine is especially important for people with lupus, which can be life-threatening, Dr. Lockshin said. The drug can lower the risk of dying from lupus and prevent organ damage, and is considered the standard of care. If patients stop taking it after using it regularly for a long time, they can gradually become quite ill. He said it was particularly disturbing to think that people known to benefit from the drug could lose access to it because it is being diverted to a disease for which there is no solid evidence that it actually works.
The shortage problem goes both ways. One doctor told the Times that some of his lupus patients have begun asking for 90-day instead of 30-day refills because they’re suddenly afraid that the drug will be hard to come by. If chloroquine does turn out to be a magic bullet against coronavirus, then, well, rheumatological patients will just have to learn to share while supply ramps up. But it’s foolish to put them at risk by triggering a run on the drug for COVID-19 before we even know it works.
None of the risks are hypothetical. China reportedly slowed its roll on chloroquine once it realized that a high dose would be dangerous:
China, where the deadly pathogen first emerged in December, recommended the decades-old malaria drug chloroquine to treat infected patients in guidelines issued in February after seeing encouraging results in clinical trials. But within days, it cautioned doctors and health officials about the drug’s lethal side effects and rolled back its usage.
This came after local media reported that a Wuhan Institute of Virology study found that the drug can kill an adult just dosed at twice the daily amount recommended for treatment, which is one gram.
That’s another reason to hold clinical trials, to try to gauge which dose is high enough to be effective without being so high as to kill you. As I write this, there are reports on the wires about two people in Nigeria getting sick from chloroquine poisoning because they started dosing themselves after Trump hyped the drug. No doubt we’ll see cases of that here too, along with examples of panicked well-connected people obtaining prescriptions for the drug and selfishly hoarding it while lupus patients search in vain for their monthly supply. The risks go on: Hydroxychloroquine is also known to interact with certain other drugs and isn’t recommended for use in people with heart arrhythmia or with impaired liver or kidney function. How many people dosing themselves right now in a panic about coronavirus are aware of that?
The more politicians hype it, the more intense these problems will be:
Friends who use chloroquine to treat lupus have already started to get in touch with my staff to report that they can no longer get their prescriptions.
Trump is jeopardizing the lives of people using a proven treatment. https://t.co/W7e4XdyWv7
— Senator Brad Hoylman (@bradhoylman) March 21, 2020
And the punchline is, Trump doesn’t need to hype it. Doctors are obviously going to try the drug on patients in the ICU who are at death’s door. They’re doing it already, in fact:
Some hospitals in the United States have already begun using the drugs for coronavirus patients, apparently reasoning that they may help and are unlikely to do harm. They are cheap and relatively safe. Laboratory studies have found that they prevent the coronavirus from invading cells, suggesting that the drugs could help prevent or limit the infection.
We’ll have lots more front-line anecdotal evidence about its effectiveness soon, unfortunately, before the first clinical trial is done.
Some Trump critics are citing his tweets this morning as a sign that he’s setting up the FDA to be the fall guy as the death toll rises, not unlike the way he’s prone to blaming economic problems on the Fed. (“We wouldn’t be seeing these numbers if the FDA had approved chloroquine.”) He does crave scapegoats. Others think his chloroquine mania is an act of desperation, pitching miracle cures to try to obscure the various catastrophic mistakes made by his administration in handling the epidemic, from the CDC’s testing fiasco to Trump himself allegedly not taking intel reports about the pandemic seriously enough back in January and February. Part of the reason we’re all hyped up about chloroquine and remdesivir is because the feds seem utterly unequal to this task. We need a magic bullet.
And so go figure that other politicians trying to manage the crisis have also begun name-checking chloroquine:
[Andrew] Cuomo requested four field hospitals and temporary hospitals from the Army Corps of Engineers. Several sites would be set up at the cavernous Javits Convention Center in Manhattan, he said.
The governor said he wanted to prioritize the use of drug therapies that might be useful for critically-ill New Yorkers, including a version of the anti-malaria drug chloroquine that Trump has touted. Cuomo said pharmaceutical and medical companies in New York were also working on other potentially useful therapies.
Maybe Cuomo’s also talking up chloroquine to distract from his own poor management of the crisis, but that seems unlikely since no politician in America has been praised more for his state’s response (with the possible exception of Mike DeWine). More likely it’s that the sudden public interest in chloroquine has left him feeling he has no choice but to mention it. It’s of a piece with commandeering the Javits Center to house patients, a signal to residents that authorities are doing everything humanly possible to beat this back. Use Madison Square Garden for hospital beds? Sure. Let doctors use hydroxychloroquine as a potential miracle cure? Sure, fine. It’s a war zone and we’ve been overrun. All options are on the table, including nuclear weapons.
But the point is we’ve been overrun, which is a result of a fearsome enemy matched with bad management of the initial response. Go look at this latest model of the epidemic’s spread and you’ll see that we absolutely have hope of holding down deaths from the disease — provided we practice “severe” control measures like social distancing for the next several months. How much sustained radiation can our economy endure in the name of treating this cancer before it effectively dies in agony from the treatment? This is why we’re already at the “magic bullet” phase of the response despite calm-sounding assurances from Fauci and Scott Gottlieb that we can contain this eventually by ramping up testing, developing serological treatments, and so on. There’s no reason to have any confidence in the feds’ ability to facilitate that before fall; there’s more reason to have confidence in the private sector, but lots of stuff — like getting doctors the equipment they need — needs to have happened yesterday in order to hold down the scope of the catastrophe. If there’s no med-tech nuclear weapon that’s able to be deployed soon to turn the tide, there’s every reason to think this is going to be excruciatingly bad for much longer than we think. And I think people sense it, even if authorities won’t admit that to them right now. Hence chloroquine mania.