The outbreak of the most recent iteration of coronavirus — COVID-19 — has experts scrambling to find effective methods of delivering supportive care and minimizing the effect of the illness. As Dr. Roger Seheult, co-founder of MedCram.com, explains in this short video, several factors have been responsible for the rapid spread.
One of the drugs currently under investigation is chloroquine, a treatment commonly used to keep malaria in check. Chloroquine is a synthetic derivative of quinine, which was once the only treatment for malaria. However, quinine is bitter and has significant side effects.1
Legend has it that to make it easier to drink, the British living in India mixed it with gin and lemon or lime.2 The British colonials grew to enjoy the taste, and soon afterward tonic water was granted a patent in 1858. Schweppes introduced tonic water in the U.S. nearly 100 years later and the gin and tonic has remained an integral part of British and American history.
However, while tonic water is flavored with quinine, it doesn't contain nearly as much as the medicine. Tonic water contains no more than 83 milligrams per 1-liter bottle (33.8 ounces), but the therapeutic dose of quinine is 500 mg to 1,000 mg.3
In remarks in a press briefing,4 President Trump said the U.S. Food and Drug Administration had approved use of the malaria drug chloroquine — which is not the same as quinine — to treat coronavirus. However, on the same day the FDA5 released a statement saying they were only “investigating” the drug “to determine whether it can be used to treat patients with mild-to-moderate COVID-19.”
“Studies are underway to determine the efficacy in using chloroquine to treat COVID-19,” the statement continued, with FDA Commissioner Dr. Stephen Hahn adding:
“At the same time, we will engage with domestic manufacturers to ramp up production of this product to mitigate any potential supply chain pressures. If clinical data suggests this product may be promising in treating COVID-19, we know there will be increased demand for it. We will take all steps to ensure chloroquine remains available for patients who take it to treat severe and life-threatening illnesses such as lupus.”
However, as one blogger website pointed out, “MDs can prescribe chloroquine and hydroxychloroquine for Covid 19 right now. The FDA doesn’t and can’t regulate off-label prescriptions.”6 And, apparently, many doctors not only know that, but are taking advantage of that loophole, according to The New York Times:7
"None of the drugs have been approved by the U.S. Food and Drug Administration for that use. Some of them — including chloroquine and hydroxychloroquine — are commonly used to treat malaria, lupus, rheumatoid arthritis and other conditions …
‘I have multiple prescribers calling in prescriptions for Plaquenil for themselves and their family members as a precaution. Is this ethical?' one person wrote on Sunday in a Facebook group for pharmacists, referring to a brand name of hydroxychloroquine.”
Pharmacists Urge: ‘Put the Brakes on’ Hoarding
Out of concern that doctors not only might be jumping the gun on whether the malaria drugs actually work for COVID-19, but also are denying patients who actually need it for chronic conditions like lupus and arthritis, state pharmacy boards are urging their members to restrict prescriptions for the drugs. Besides, these drugs also can have serious side effects, NPR notes:8
"Our members are definitely seeing more demand for this medication and possibly some people trying to hoard the medication," says Todd Brown, executive director of the Massachusetts Independent Pharmacists Association … Pharmacists are seeing an increase in requests and prescriptions for them in instances where it's not clear why the patient needs it at this time’ …
Brown is suggesting that pharmacists restrict prescription quantities and fill prescriptions only for patients with an active need for hydroxychloroquine … Michael Barnett, a primary care physician and assistant professor at the Harvard T.H. Chan School of Public Health, says that even if the drug turns out, from the clinical studies now in progress, to be effective against COVID-19, it must be saved for those most in need.
Barnett is sympathetic [to those who want to try everything they can to cure COVID-19], but he points out that this powerful medicine has serious side effects, so it should not be taken unless there's a known benefit.”
On a bizarre side note, another consumer warning made headlines after a husband and wife in their 60s decided to self-medicate with an aquarium cleaner that has a different form of chloroquine in it. Both were hospitalized within 30 minutes of ingesting the toxic substance, The Sacramento Bee reported;9 the husband later died.
The fish tank cleaner “has the same active ingredient as the drug chloroquine phosphate, which is used to treat malaria, but is formulated differently,” the medical director from a local poison control center explained. Unfortunately, at least three others made the same mistake in Nigeria, so it’s important to remember that you should not take any drug without your physician’s express direction.
Past Data Suggest Chloroquine Studies May Be Fruitful
Historically, there is strong evidence that chloroquine and hydroxychloroquine are effective in the lab against the SARS coronavirus that appeared in 2003.10,11,12 Laboratory testing also reveals chloroquine is effective in cell cultures against COVID-19 when combined with an antiviral drug, remdesivir.13 Hydroxychloroquine (Plaquenil) uses the same pathway as chloroquine, but with a safer side effect profile.14
These and other results have prompted scientists to call for further research into the use of the antimalarial drugs to stem the tide of COVID-19 infection.15 Recently, results of a very small clinical trial using Plaquenil alone for the infection have been announced in China, but access to the data was not initially released to other scientists for review,16 and then when it was the data showed very little difference between the drug and the control group.17
Similar studies have been ongoing for several years. For example, in 2009,18 one study evaluated the use of chloroquine in human coronavirus subtype OC43, known to cause severe lower lung infections.19 The researchers used an animal model and found pretreatment demonstrated the drug was highly effective against this subtype. Interest in antimalarial drugs highlights a unique distribution of the virus.
As noted in a preliminary paper currently undergoing peer-review, “Global Spread of Coronavirus Disease 2019 and Malaria: An Epidemiological Paradox”:20
“From the analysis of distribution data, the endemic presence of malaria seems to protect some populations from COVID-19 outbreak, particularly in the least developed countries. Of note, the mechanism of action of some antimalarial drugs (e.g. antiviral function) suggests their potential role in the chemoprophylaxis of the epidemic.”
Malaria is caused by a parasite passed to humans by infected Anopheles mosquitoes. The World Health Organization’s African region21 experiences a large proportion of the burden, with 93% of all cases worldwide and 94% of deaths related to malaria.
When you consult the Johns Hopkins Medicine’s22 user-friendly, interactive map to track the outbreak worldwide, it’s apparent the only other large land mass with fewer cases than Africa is Russia23 — which is indeed intriguing, if nothing else.