President Trump’s revelation this week that he’s taking hydroxychloroquine to ward off Covid-19 sent shivers down my spine and the spines of many others living with lupus because we actually need this problematic medication. His hype will almost certainly make the drug more difficult to get.

“I’m taking it,” Trump said. “Hydroxychloroquine. Right now. A couple of weeks ago I started taking it. Because I think it’s good; I’ve heard a lot of good stories.”

When I first heard the announcement, my initial concern was for the people who will rush to take a medication that I have avoided taking for as long as possible because of the numerous side effects it can cause.

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My concern turned to disbelief that the leader of our country would willfully ignore multiple studies showing that people with Covid-19 experience no benefit from taking the medication, and it may do more harm than good.

Finally, it occurred to me that my three-month supply is nearing its end and I may have to either scramble to get my next supply, pay more for it, or consider taking medications that will further compromise my immune system — during a pandemic — and may also damage my kidneys and liver.

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Yikes!

Hydroxychloroquine is not a miracle cure

Clinicians and researchers on the frontlines of Covid-19 were quietly exploring the usefulness of hydroxychloroquine, a drug initially used to treat malaria, as a treatment when President Trump thrust it into the national spotlight on it on March 19 with an overly rosy narrative. Yet the data behind its use for Covid-19 aren’t promising.

Researchers at the University of Albany recently reported that among 1,438 Covid-19 patients in New York state, those given hydroxychloroquine were just as likely to die from this viral infection as those not taking it. The findings were similar for people given both hydroxychloroquine and azithromycin, an antibiotic.

This lack of benefit, however, came with risks: Those on hydroxychloroquine were more than twice as likely to die from heart attacks during the study period as those not given the drug.

An evaluation of Covid-19 patients in U.S. Veterans Health Administration hospitals also found the drug to be ineffective and possibly linked to a higher death rate (although one could argue that the patients on the medication were likely immunocompromised to begin with). Questions about the effectiveness and risk profile of hydroxychloroquine were also raised in a review by researchers at Massachusetts General Hospital published earlier this month.

Still need more convincing that hydroxychloroquine isn’t the big cure for Covid-19 and may do more harm than good? Both the Food and Drug Administration and the National Institutes of Health have issued statements warning clinicians not to prescribe hydroxychloroquine for Covid-19 because of potentially fatal side effects.

Lupus and the medication cost-benefit analysis

Systemic lupus erythematosus is an autoimmune condition. My immune cells misread normal, healthy cells and attack them as if they were foreign. More than 5 million people worldwide live with lupus.

In the days before social distancing, if you met me on the street you wouldn’t know something is wrong with me. Yet I’ve woken up unable to get out of bed without help, experienced prolonged bouts of lung inflammation, suffered from gastrointestinal symptoms, and have dropped a large amount of weight and hair during particularly bad lupus flares — periods when symptoms worsen.

It started 13 years ago when I was 27.

In people with autoimmune diseases, hydroxychloroquine can reduce inflammatory responses by interrupting cell signaling between and within white blood cells. It has been shown to decrease the number of flares people experience.

Each time my rheumatologist and I discuss medications, we’re essentially having a risk-benefit conversation. We weigh whether a medication will cause more damage than letting my lupus rage on.

I put off starting hydroxychloroquine, even though it’s one of the safest drugs approved for autoimmune patients, because of the potential loss of color perception. This happens because the drug can build up in the macula and other parts of the eye, eventually causing blindness. Other side effects include depression, anxiety, skin rash, headache, dizziness, nausea, involuntary muscle twitches, and potentially fatal heart issues.

The fact hydroxychloroquine is considered the safest lupus treatment should tell you something about my other options.

During my last visit with my rheumatologist, we decided to cut my daily dose of hydroxychloroquine by 25% due to findings that the medication can cause dangerous irregularities in the heart rhythm or an unsafe increase in heart rate at the previously recommended dosages — which is one-fourth the recommended “corona” doses I’ve seen online.

How did the rumor start?

We will probably never know exactly how hydroxychloroquine came to Trump’s attention. But given his publicly preferred media sources and the timing of his first promotion of it, he likely picked up the tip while watching “Tucker Carlson Tonight” on Fox News. On the show, a lawyer who falsely claimed to be affiliated with Stanford University, said that a yet-to-be-published study in France found a “100% cure rate” with hydroxychloroquine.

Let’s ignore for a moment that neither the lawyer nor the study were actually affiliated with Stanford.

One day after the study cited in Carlson’s interview was published in the International Journal of Antimicrobial Agents, the International Society of Antimicrobial Chemotherapy (ISAC) issued an official statement casting doubt on its findings. “The ISAC Board believes the article does not meet the Society’s expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety.”

Will they listen?

With growing evidence that hydroxychloroquine does little for people afflicted with Covid-19 and comes with a whole set of possible harms, why would anyone use it?

The president’s off-the-cuff opinions are very influential.

After the initial buzz, Utah jumped the gun and prepared to make the medication available without prescriptions. It later course-corrected after an outcry from health officials. Following a spike in prescriptions and medication shortages, the American Medical Association issued a statement urging physicians to stop inappropriately prescribing hydroxychloroquine.

The calming voices from medical professionals made me hopeful that I may not be out of luck when my 90-day supply runs out in a few weeks. But after Trump’s latest statement, I’m not as optimistic.

If people will ingest bleach and other disinfectants after the president brainstorms ill-advised remedies on-air, hydroxychloroquine is going to be hard to find for the foreseeable future.

Surviving a pandemic with lupus

I work hard to be safe and not get infected by SARS-CoV-2, the virus that causes Covid-19. If I do, I likely won’t be one of the many asymptomatic carriers or develop a mild case with flu-like symptoms. With my weakened immune system and susceptibility to pneumonia, I worry I will be one of those on a ventilator.

My husband practices the same things the CDC recommends for high-risk individuals — even though he’s healthy — to minimize my potential exposure to the virus.

We get up at 5 a.m. to walk several miles without worrying about coming into contact with people who choose to ignore social distancing guidelines or not wear masks. People roll their eyes when I scramble to keep a distance when they crowd me on a path. We spend a premium but we’re lucky we can still afford to have groceries delivered. We eat a healthy diet in the hopes I can avoid the doctor for as long as practical.

At-risk people like me are warned to stay home while the rest of the population gets back to normal. I can accept that my freedom is being limited because people don’t understand the impact of their decisions. Yet I’m horrified that our president perpetuates the spread of misinformation — and is often the cause of it — as he willfully ignores advice from experts.

We deserve better.

While I fear for my own health, I also worry that people will die unnecessarily because our president doesn’t have the sense to recognize or care about science or the destruction he leaves in his wake.

Camela Thompson is a freelance writer based in the Seattle area.

  • Two things about the Lancet study. They did not include Patients treated with Zinc and HCQ. The authors essentially say in their conclusion that the study has limitations and should not be used to determine cause and effect.

  • Thank you, Ms. Thompson, for your informed and balanced reporting and point of view on SLE’s management properties of Plaquenil (and its generics). I am also an SLE sufferer, and supposedly, my great-aunt was the first Lupus patient studied by the National Institutes of Health!
    Too few people understand SLE because, as you undoubtedly know, nine of 10 sufferers are women. Heart trouble? No problem! Treatments of these conditions cater to male patients.
    Perhaps there will be more research into Lupus, and its treatments, now that scientists are becoming popular again. After all, Plaquenil is the only known management drug for this incurable condition–and its side-effects are no picnic. I have been on the drug for 22 years, and have to get an eye exam every six months because of the (admittedly rare) risk of blindness from taking it.
    Thanks again, great story!

  • To the author: I deeply appreciate the sources noted in this editorial. Thank you for backing up your claims with articles from respected sources. These days, no matter how good the writing, or how persuasive the language, if multiple reliable sources are not cited then I simply dismiss the article–even if I agree with it! Thank you for respecting the integrity of your readers in this way.

    • Hospitalised patients are generally the wrong patients to treat with hydroxychloroquine…

      They are very sick and many can indeed have added heart problems caused by the Covid19 disease eg myocarditis

      Further, their peak viral titres are behind them and now they are suffering largely from the ravages of hyperinflammation ( “cytokine storm”) including widespread micro-vascular and even macro-vascular blood coagulation

      All known antivirals work only at the early stages of disease when virus are rapidly multiplying ie in outpatients – the same has been reported with hydroxychloroquine, usually used best with added zinc plus either azithromycin or doxycycline ( which I would prefer as both azithromycin and hydroxychloroquine can have rare heart arrythmia issues by prolonging Q-T intervals, a feature of many, many drugs ). In the outpatient reports, with short term use ( (5 to 7 days) there have been only a few side effects reported

  • Times like this, I am glad I am an independent who doesn’t believe either party that much. If you are a leftie, you’ll listen to everything the currently biased media tell you. If you are a rightie, you’ll listen to everything Trump says. Just do your own research. For the lazy, here is the summary of what you should know. HCQ is not a miracle cure and no medicine in near future will be for any viral disease out there due to the nature of virus. HCQ does have long track record of relative safety and appears to be beneficial with covid patients. Other drugs on the list of possible medication have much shorter track record and costs alot more with possible unknown side effects. I don’t know about you, but if I get covid, I would try HCQ/AZ/Zinc first before trying other medicine and go down the list. If you are afraid of possible side effects, you won’t be able to take any medicine out there, period. Even a regular food like peanut which is harmless to most people can kill someone with allergy. If you have bad side effect, then take different medicine. Simple as that. It is your body so the final decision as to which medicine you want to take is up to you. That said, only thing that you can really count on will be your own immune system at the end. Do what you can to improve it as much as possible to lower the intensity and shorten the duration of the covid flu in case if you are to catch it down the line. (It will happen eventually in next few years since it will become one type of the flu you can get from now on along with influenza A&B among many others) So stock up on vit c, d, and zinc. Also exercise, get plenty of rest when possible, and avoid really crowded places when you can unless you are 100% confident about your immune system. Just remember, there is chance of you dying from an auto accident everyday because of that one DUI driver on the road but you don’t worry about that, right? Same thing with covid. You shouldn’t worry about it that much since most people will be fine. It just comes down to a bit of luck along with your immune system. Take care everyone.

  • Interesting read – the article as well as several comments and knowledge from well-educated responders. What I deduct is that HCQ combined with Zinc is effective early in Covid-diagnosed or C-symptomatic conditions, and that HCQ use by itself is not advised, and ineffective preventatively without Covid present. So Trumps HCQ-only use is useless, unless severe lack of linguistic skills turns out to be another Covid symptom. Get your Rx filled, as too many simpletons just eat this delusional man’s words without inquisition.

    • Richard, in all likelihood, it is probably the zinc alone, working in the mouth, nose and sinuses, that has whatever beneficial effect the combo might have. Despite the fact that HCQ is an ionophore, there is no evidence that zinc is effective as an antiviral agent when introduced in the body. It is, in fact, a cytotoxic combination, sometimes exploited in the treatment of cancer.

      Zinc works as an antiviral in petri dishes and test tubes, but not in complex biological environments, where the presence of heat, pH variance and the presence of certain metal-binding chemicals counteract it. This is why Zicam is effective at lessening cold symptoms when you allow it to dissolve in your mouth. But the makers of Zicam could never get FDA approval to make a zinc-based antiviral prescription medicine.

      Similar experience is seen with herpes simplex viral treatments. Standard treatment is a zinc-based “topical” ointment, not an injectable medication or pill to be swallowed.

      There is no science to support zinc works as an effective antiviral “in fauna.” There is no HCQ in Zicam, which goes to show that no “ionophore” is necessary in the “petri dish” to deliver a therapeutic dose of zinc.

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