WASHINGTON — President Trump can’t seem to stop talking about hydroxychloroquine.
There is currently no proven treatment for the coronavirus and Covid-19, the respiratory disease it causes, leading political figures to grasp for potentially effective stopgap measures as the global death toll nears 100,000. Hydroxychloroquine, used for decades as a medication to treat malaria and lupus, has generated by far the most excitement — within the Trump administration in particular — despite a lack of scientific evidence that it’s effective against Covid-19.
On Sunday, the debate escalated when Trump effectively prevented Anthony Fauci, the nation’s top infectious disease researcher, from answering a question about hydroxychloroquine during a White House press briefing. And over the weekend, Axios reported Fauci was berated by Trump’s economic adviser, Peter Navarro, for calling evidence supporting hydroxychloroquine’s use “anecdotal.”
Trump, it appears, has sided with his economic adviser and has repeatedly contradicted Fauci, a physician-researcher who leads the National Institute of Allergy and Infectious Diseases. He even said he would consider taking the drug himself, as a preventive measure.
The president’s enthusiasm for hydroxychloroquine has also sparked a run on the drug, in some cases preventing patients with lupus, who have relied on the drug for years, from refilling their prescriptions.
There is also some evidence that some Americans have tried to self-administer chloroquine formulations in the wake of Trump’s comments. One eBay seller recently sold hundreds of packets of chloroquine phosphate — which is also marketed as an antiparasitic used in fish tanks — for hundreds of dollars apiece. And in Arizona, a man died after ingesting chloroquine phosphate to guard against the coronavirus.
Below, STAT fact-checks Trump’s full remarks on hydroxychloroquine from his Sunday briefing.
Trump: We bought a tremendous amount of … hydroxychloroquine, which I think is, you know, it’s a great malaria drug. It’s worked unbelievably, it’s a powerful drug on malaria. And there are signs that it works on [coronavirus], some very strong signs. And in the meantime, it’s been around a long time, and also works very powerfully on lupus. So there are some very strong, powerful signs, and we’ll have to see. Because again, it’s being tested now, this is a new thing that just happened to us, the invisible enemy, we call it.
… It’s a very strong, powerful medicine, but it doesn’t kill people. We have some very good results and some very good tests. You’ve seen the same test that I have. In France, they had a very good test. But we don’t have time to go and say, gee, let’s take a couple of years and test it out. And let’s go and test with the test tubes and the laboratories. We don’t have time. I’d love to do that.
STAT fact check: It is true that hydroxychloroquine is a drug shown to be effective at treating and preventing malaria, as well as lupus.
There is conflicting evidence as to whether hydroxychloroquine, or hydroxychloroquine combined with azithromycin, is effective at treating coronavirus symptoms. All the studies of the drug are small, and none are definitive. One French study seemed to show hydroxychloroquine is effective at reducing the amount of virus in Covid-19 patients. But a small randomized study in China appeared to show that patients who took the drug did not benefit substantially compared to patients who didn’t use it.
Later in his remarks, Trump also appeared to reference that French study, which was conducted by a group of doctors including the controversial Didier Raoult, a French researcher who has sparred with health authorities there over hydroxychloroquine in a fashion similar to Trump. That study concluded that hydroxychloroquine and azithromycin used in combination helped decrease patients’ levels of coronavirus, though the study was not randomized, and the science has since been criticized by other researchers.
Trump: I’m not a doctor. But I have common sense. The FDA feels good about it. As you know, they’ve approved it, they gave it a rapid approval, and the reason [is] because it’s been out there for a long time, and they know the side effects and they also know the potential.
STAT: The Food and Drug Administration has not approved hydroxychloroquine, or any other drug, as a coronavirus treatment. The FDA has, however, issued an emergency use authorization for the drug.
In press releases, the FDA has stressed that “there are no currently approved treatments for COVID-19.” However, the agency says both hydroxychloroquine and chloroquine phosphate “have shown activity in laboratory studies against coronaviruses,” referring to a broad category of illnesses known as coronaviruses, not the 2019 strain that causes Covid-19. A number of federal agencies are currently working to facilitate clinical trials to determine whether or not the drug is effective.
Trump: If you have no signs of heart problems, the azithromycin, which will kill certain things that you don’t want living within your body — it’s a powerful drug — if you don’t have a problem, a heart problem, we would say, let your doctor think about it. But as a combination, I think they’re going to be, I think there’s two things that should be looked at very strongly.
STAT: Trump has touted using hydroxychloroquine in combination with azithromycin (sometimes sold as Z-Pak), though he has cautioned that Americans with heart conditions should not use the azithromycin.
Cardiotoxicity, or damage to the heart, is a rare but documented side effect of hydroxychloroquine even when taken on its own. Trump is correct that azithromycin can be particularly dangerous for people with heart conditions, but it’s misleading to suggest that hydroxychloroquine alone doesn’t carry side effects.
“Both chloroquine and hydroxychloroquine can have side effects related to abnormal heart rhythms,” said Sunil Parikh, a Yale University physician and epidemiology professor. “While the incidence of cardiac side effects is low for each of these drugs, they can be significant, particularly since those individuals presenting with severe Covid-19 may have underlying comorbidities or drug-drug interactions that can place them at higher risk.”
Trump: We have purchased and we have stockpiled 29 million pills of the hydroxychloroquine, 29 million. A lot of drugstores have them by prescription — and they’re not expensive. Also, we’re sending them to various labs, our military, we’re sending them to the hospitals, we’re sending them all over.
STAT: Trump is mostly correct, but the units were donated by drug companies, not purchased by the federal government, and he’s actually underselling the number: It’s 31 million doses, not 29 million. Sandoz, the generic subsidiary of Novartis, donated 30 million doses of hydroxychloroquine sulfate to the Strategic National Stockpile last month, and Bayer donated another 1 million doses of hydroxychloroquine phosphate.
Trump: What do you have to lose? And a lot of people are saying that, and are taking it. If you’re a doctor or a nurse, a first responder, a medical person going into hospitals, they say taking it before the fact is good.
STAT: Given the surge in eBay sales of chloroquine phosphate, and the anecdotal reports in Arizona and Nigeria of patients poisoning themselves by self-administering chloroquine formulations, there’s concern throughout the public health community that Trump’s exhortations to try the drug could do more harm than good. Of course, Trump isn’t encouraging self-medication, telling Americans instead to “go through your medical people.”
So what do the medical people say? Jeremy Faust, an emergency physician at Harvard Medical School and Brigham and Women’s Hospital in Boston, has attempted to caution against the idea of hydroxychloroquine as a preventive medication. He tweeted Sunday: “Patients with lupus, arthritis, other conditions are *already* on hydroxychloroquine. And we are diagnosing them with Covid-19 LEFT AND RIGHT.”
Trump: I want them to try it, and it may work, and it may not work. What if it doesn’t work? It’s nothing lost by doing nothing. Because we know, long-term, what I want. I want to save lives. And I don’t want to be in a lab for the next year and a half as people are dying all over the place.
STAT: Trump seems to be referring to the roughly year-and-a-half timeline that Fauci has repeatedly outlined for developing a vaccine. Timelines for drugs to treat the disease are expected to be shorter, especially with major drug companies like Gilead and Eli Lilly racing to develop cures.
Trump, after a reporter asked Fauci what he thinks about using hydroxychloroquine: You know how many times he’s answered that question? Maybe 15. Fifteen times. You don’t have to ask the question. We’ve answered the question 15 times.
STAT: Here, Trump cut the reporter off and effectively prevented Fauci from answering the question. Fauci has repeatedly said there’s not enough evidence to support using hydroxychloroquine as a coronavirus treatment.
Trump: We passed something I’m very proud of, it’s called “right to try.” For 45, 50 years, they’ve been trying, it makes so much sense. … So a person would be diagnosed terminally ill from something. And in the old days, meaning before a year ago, they would say, “Do you think I could try this pill, this whatever, this medicine, that’s testing so well?” “No, you can’t do that. You can’t do that, under no circumstances.” They’d leave for Asia, they’d leave for Europe — if they had money. If they had no money, they’d go home and die with no hope.
STAT: Trump signed so-called right-to-try legislation into law in May 2018. But Trump is dramatically overselling its impact. Long before Trump signed that law, the Food and Drug Administration had established a clear, well-defined pathway for helping terminally ill Americans get access to unapproved, still-experimental treatments, and approved roughly 99% of those “compassionate use” requests. More than 30 states had also passed legislation similar to the 2018 law before the federal legislation advanced. Few patients have publicly announced that they’re pursuing unapproved drugs through the new pathway, though it’s unclear exactly how many have taken advantage of the new law.
Trump’s comments on the right-to-try legislation are telling, however. The president has made his broader philosophy clear, arguing that terminally ill patients should be given access to drugs almost regardless of potential consequences, since they’re likely to die if a dramatic intervention isn’t undertaken.