A malaria treatment first tested during World War II, and has since shown promise in limited trials in France and the U.S. has been banned for use on Coronavirus patients by the governor of Nevada, Steve Sisolak.
“While these drugs serve necessary medical purposes, this regulation protects the Nevadans who need them and prevents unnecessary hoarding,” Sisolak wrote on Twitter.
The problem here is most successful results rely on the drug being administered before the person shows up at the hospital. Before the antivirals are given, and before they end up on ventilators.
Limiting what doctors can do on their own will only prove to force people into the emergency room to get the care they need, further burdening an already stressed healthcare system.
Sisolak banned the prescription of the drugs to treat Covid-19. However, in a follow-up tweet, Sisolak noted that the emergency regulation does not apply to doctors who order the drugs for coronavirus treatment in an inpatient setting.
Meanwhile, WHO has launched an extensive trial of over four drugs that have shown promise against respritory diseases.
Does this go against the “Right to Try” legislation that Donald Trump enacted?
The available data are thin. The drugs work by decreasing the acidity in endosomes, compartments inside cells that they use to ingest outside material and that some viruses can coopt to enter a cell. But the main entryway for SARS-CoV-2 is a different one, using its so-called spike protein to attach to a receptor on the surface of human cells. Studies in cell culture have suggested chloroquines have some activity against SARS-CoV-2, but the doses needed are usually high—and could cause serious toxicities.
Encouraging cell study results with chloroquines against two other viral diseases, dengue and chikungunya, didn’t pan out in people in randomized clinical trials. And nonhuman primates infected with chikungunya did worse when given chloroquine. “Researchers have tried this drug on virus after virus, and it never works out in humans. The dose needed is just too high,” says Susanne Herold, an expert on pulmonary infections at the University of Giessen.
Results from COVID-19 patients are murky. Chinese researchers who report treating more than 100 patients with chloroquine touted its benefits in a letter in BioScience, but the data underlying the claim have not been published. All in all, more than 20 COVID-19 studies in China used chloroquine or hydroxychloroquine, WHO notes, but their results have been hard to come by. “WHO is engaging with Chinese colleagues at the mission in Geneva and have received assurances of improved collaboration; however, no data has been shared regarding the chloroquine studies.”
Researchers in France have published a study in which they treated 20 COVID-19 patients with hydroxychloroquine. They concluded that the drug significantly reduced viral load in nasal swabs. But it was not a randomized controlled trial and it didn’t report clinical outcomes such as deaths. In guidance published on Friday, the U.S. Society of Critical Care Medicine said “there is insufficient evidence to issue a recommendation on the use of chloroquine or hydroxychloroquine in critically ill adults with COVID-19.”