Stone Age Doc’s Pandemic Perspective #6
Wheat, chaff and hydroxychloroquine
There are two elements of the coronavirus pandemic that are not usually encountered in the world of medicine. One is the disturbingly rapid swings in the the opinions and conclusions of those that have the most experience with this particular disease. An example is the shift in intubation and ventilator strategy. Some practitioners have claimed that the use of ventilators actually increases mortality. In another example small trials of chloroquine/hydroxychloroquine (for simplicity I shall refer to them both as chloroquine although the hydroxy version appears to be somewhat safer) have given results that range from no effect to moderate improvement to lifesaving.
The other element is even more disturbing: the caustic, often vulgar attacks on the concept of using hydroxychloroquine, by the media, especially those directed against the president. My association with the medical field began 66 years ago, before I entered medical school. In more than six decades I have never witnessed such anger and hostility over a treatment regimen. Never.
Here are some things to consider as you try to make sense of this confusion. Chloroquine has been around since before the average American was born. It has two main uses, treatment and prophylaxis of malaria, and reducing the symptoms of several autoimmune conditions such as lupus and rheumatoid arthritis. Its ability to inhibit the replication of coronaviruses and thus to reduce viral load has fueled scores of studies, including a clinical trial initiated by the NIH and Vanderbilt University Medical Center. The fact that two reputable institutions as well as hundreds of hospitals throughout the world are applying clinical trials to this medication should have silenced the media’s singularly vitriolic criticism.
Many of you have probably Googled this topic. You might want to compare the headlines of entries that emanate from medical institutions and journals with those of the media. I will not name them but urge you to draw your own conclusions.
Chloroquine has an excellent safety record but NOT in persons with underling heart disease. As noted in the following paragraph, the people who need it the most are often those with sick hearts. Appropriate dosage for a short term in healthy individuals, such as those receiving it for malaria prophylaxis during travel very rarely causes problems.
More than 90 percent of persons who have died from COVID-19 (that’s not really the name of the virus but please accept my shorthand and that of most publications) have pre-existing medical problems. They include heart disease, high blood pressure, lung disease, kidney disease, immune deficiency, diabetes and obesity. The last is extremely common but rarely commented on in the media, as I noted in a previous blog. Obesity and diabetes both disrupt the immune system. The result is often cytokine storm, the outpouring of inflammatory chemicals from fatty tissue – and the more fat the more harmful cytokines – that literally destroys healthy organs. Those organs include the heart and the lungs that are already sick; MOST persons over the age of 70 have damage to one or both. Is it any surprise that the mortality in nursing homes is so terribly high? Do you really think that any medication can make much difference?
Although this virus began its devastating journey in the autumn of 2019 it is not yet three months since it began its rampage in the United States. I am therefore not surprised that there are so many unanswered questions. I am surprised at the remarkable speed with which our scientists and corporations have developed and distributed tests for the virus and viral antibody. I expect that a vaccine and an antiviral drug will be available sooner than most people think.
I welcome your feedback.