The media pounced on a study published in the British Journal Lancet on 96,000 hospitalized patients with COVID-19 who were treated with either chloroquine or hydroxychloroquine. This was a retrospective, non-controlled analysis of patient medical records but caught the media’s attention due to its negative findings. The drugs that President Trump suggested could be “game changers” were found to increase mortality over patients who were given neither of the two drugs. One of the chief risks of these drugs is a delayed repolarization of the heart (referred to a prolonged QTc interval). When combined with azithromycin or other antibiotics in a class known as macrolides that risk is even greater. This delayed repolarization can lead to an irregular (and potentially fatal) heart rhythm. The study noted that in patients who were given hydroxychloroquine, there was a 34% greater risk of death and a 137% greater risk of a serious arrhythmia. When a macrolide antibiotic was added there was a 45% greater risk of death and a 411% greater risk of serious arrhythmia. In patients who were given chloroquine the numbers were 37% greater risk of death and a 256% greater risk of a serious arrhythmia. When the macrolide was added to chloroquine the risk of death remained at 37% but the risk of a serious arrhythmia rose to 301%. Some cardiologists are declaring that the drugs fail to demonstrate benefit and have distinct potential for harm. I don’t know if the data obtained can be considered reliable since it was not gathered from a controlled study where patients are randomly assigned to different treatment groups. Despite the President’s faith in the efficacy of the medications in question, the Trump Administration has warned against the use of the drug outside of hospital settings or clinical trials. Hydroxychloroquine remains part of the treatment protocol for many medical centers and has been used successfully in China and Europe. The drug is generic and may be taken by mouth therefore some clinics are treating outpatients with the medication. There are currently multiple legitimate studies underway that should give us some answers as to the role (if any) of hydroxychloroquine in the treatment and prophylaxis of COVID-19.
Today’s brief national news conference consisted of Dr. Birx from the President’s COVID-19 Task Force providing the most positive news since the pandemic hit the U.S. There has been a consistent decrease in the number of new infections and deaths throughout the nation. Dr. Birx stated that the remaining “hot spots” were in Maryland, the District of Columbia and Northern Virginia. Dr. Birx answered several questions and one press corps member specifically asked her to address the negative findings with respect to hydroxychloroquine reported in the Lancet study. Dr. Birx pointed out that many of the patients who had arrhythmias or died during treatment had multiple co-morbidities. One chief co-morbidity was pre-existing heart disease. Diseased hearts (such as one with coronary artery disease) will already be oxygen-deprived and primed for disaster. We have evidence that the virus attacks the heart itself and it is a known fact that fatal arrhythmias are more likely to occur in a diseased-weakened heart. Researchers would have no way of knowing what led to the death in a patient with multiple co-morbidities. They may have died even if placed on a drug other than hydroxychloroquine. This was a flawed study and NO conclusions can be drawn from it. It is just another opportunity to take a cheap shot at the President. Hydroxychloroquine seems to have helped some pts; at this point we don’t yet have anything with proven 100% efficacy.