Hydroxychloroquine is in the headlines again after President Donald Trump shared a video promoting the medication as a COVID-19 treatment.
In the video, physician Stella Immanuel, MD, pushed hydroxychloroquine and questioned the pandemic’s seriousness. The video quickly gained millions of views, though both Twitter and Facebook have deleted it due to “misinformation.” Tea Party Patriots, a conservative organization that has been vocal about various social distancing and lockdown policies, has ties to the video.
The Daily Beast investigated Immanuel after the video went viral, noting that she has previously claimed that alien DNA is regularly used in medical treatments and that “reptilian” aliens are associated with the U.S. government. Immanuel approved of the Daily Beast’s summary, saying the site “did a great job summarizing” her views.
When asked about sharing the video on Tuesday, July 29, Trump said he “thought her voice was an important voice.”
This represents the latest chapter in the unusual saga of hydroxychloroquine and COVID-19. So how did we get here? Why all the controversy?
Before 2020, hydroxychloroquine was simply a decades-old antimalarial medication, one categorized as an “essential medicine” by the World Health Organization (WHO). There was nothing necessarily political or controversial about it, and it’s likely that only healthcare providers and patients who have taken the medication had even heard of it.
But then, to use a phrase that will likely be used by historians for decades to come, COVID-19 happened.
Early research, Trump tweets & more
Early on, researchers were intrigued by the possibility that hydroxychloroquine may be able to treat the virus. In March, for example, Didier Raoult, MD, PhD, a French infectious disease specialist, shared findings in the International Journal of Antimicrobial Agents that suggested the combination of hydroxychloroquine and azithromycin could effectively treat COVID-19. As reported in Forbes, however, peers have called out Raoult’s research as “irresponsible,” noting that no control group was used and the trial only lasted a total of six days.
Raoult’s study, it is believed, is when Trump first heard of the potential of hydroxychloroquine. Just days after the research was first published, he said on Twitter that the combination of hydroxychloroquine and azithromycin could potentially be “one of the biggest game changers in the history of medicine.”
At this point, the medication became politicized. How one felt about the validity of hydroxychloroquine often came down to how they feel about Trump.
His supporters, for instance, said he simply wanted to share a bit of hope and show that progress was being made. He saw an opportunity to save lives, so he took it. Trump’s critics, on the other hand, believed he was rushing too fast, desperate to share a cure and put COVID-19 in his rearview mirror. Some even wondered if he had a financial connection to the medication, though multiple investigations found that he did not.
In late March, the FDA issued an emergency use authorization for the use of hydroxychloroquine sulfate and chloroquine phosphate products to treat COVID-19 patients. The agency then issued another statement in April that warned against treating COVID-19 with hydroxychloroquine “outside of the hospital setting or a clinical trial” due to significant cardiovascular complications.
“The FDA is aware of reports of serious heart rhythm problems in patients with COVID-19 treated with hydroxychloroquine or chloroquine, often in combination with azithromycin and other QT prolonging medicines,” the agency said at the time. “We are also aware of increased use of these medicines through outpatient prescriptions. Therefore, we would like to remind health care professionals and patients of the known risks associated with both hydroxychloroquine and chloroquine. We will continue to investigate risks associated with the use of hydroxychloroquine and chloroquine for COVID-19 and communicate publicly when we have more information.”
News related to hydroxychloroquine, chloroquine and azithromycin continued to roll in, including new studies and various industry statements.
The American Heart Association, American College of Cardiology and Heart Rhythm Society issued a statement in early April, for example, warning physicians to use caution when treating COVID-19 patients with hydroxychloroquine and azithromycin.
Studies released at this time suggested taking hydroxychloroquine, alone or in combination with azithromycin, could increase a patient’s risk of QTc prolongation or death. And research published in the New England Journal of Medicine found that the medication made no real impact as a COVID-19 treatment. The authors tracked data from more than 14,000 patients hospitalized with the virus, concluding that “the risk of intubation or death was not significantly higher or lower among patients who received hydroxychloroquine than among those who did not.”
Another study, published May 22 in the Lancet, found associations between treating COID-19 with hydroxychloroquine and drops in in-hospital survival. However, the analysis gained mainstream attention when a backlash from hundreds of researchers resulted in four corrections being issued. Three authors went on to retract the paper altogether.
As these studies came out, the Trump administration emphasized the benefits of hydroxychloroquine less and less. Then, on May 18, Trump announced he had been personally taking hydroxychloroquine to help prevent a COVID-19 infection. It was another chapter in the continued saga.
A whistleblower comes forward
Rick Bright, PhD, filed an official whistleblower complaint in early May after being fired as the head of the Biomedical Advanced Research and Development Authority. Bright was let go, he claimed at the time, because of his doubts related to hydroxychloroquine.
“We have seen anecdotal evidence from different physicians that they believe they have seen benefit or patient improvement with this drug … but there was never sufficient evidence from a randomized controlled study that show its benefits actually outweigh the potential risks,” he would go on to tell lawmakers.
A video of Bright’s comments is available here.
On Twitter, Trump commented on Bright, describing him as “a disgruntled employee, not liked or respected by people I spoke to.”
Epidemiology professor speaks out in favor of hydroxychloroquine
Another significant moment in the hydroxychloroquine debate came on July 23 in the form of an opinion piece. Harvey A. Risch, MD, PhD, a professor of epidemiology at Yale School of Public Health with years of healthcare experience, wrote in favor of the medication, calling it “highly effective” and describing physicians who use it “in the face of widespread skepticism” as heroes.
In his opinion piece, Risch listed several studies that have pointed to the benefits of treating COVID-19 with hydroxychloroquine. He also wrote about how the medication has been politicized and said it “has not been used properly in many studies.”
“In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence,” he concluded. “But for now, reality demands a clear, scientific eye on the evidence and where it points. For the sake of high-risk patients, for the sake of our parents and grandparents, for the sake of the unemployed, for our economy and for our polity, especially those disproportionally affected, we must start treating immediately.”