By Erik Sass, Editor-in-Chief
The U.S. debate over chloroquine (CQ) and hydroxychloroquine (HCQ) has become highly politicized. Ever since President Trump first mentioned the drugs on March 19 as a potential treatments for COVID-19, views of the issue have been polarized along familiar partisan lines.
This may be due to Trump using a heretofore unproven treatment possibility to beat his own chest, or his opponents’ attempt to beat him up and make him look bad, or both. Regardless, these drugs should be off-limits to the partisans and left to the scientists and doctors to sort out.
This partisan haggling over treatment poses a problem for American patients. Anecdotal reports about the therapeutic effects of HCQ in particular — relieving symptoms as early treatment, and potentially working as prophylaxis — have steadily grown. Meanwhile, skeptics are exaggerating negative research outcomes and supply shortages in a rush to cast it aside. There is a real risk that in this environment, any positive results from the 150+ trials underway worldwide will be downplayed.
In all this sound and fury, the press — lining up behind the pundits and the partisans — has overlooked or deliberately ignored an elephant in the room. Dozens of countries around the world have already adopted CQ or HCQ as the recommended treatment for COVID-19. The pandemic surged in many of these countries well before it hit the U.S.
A review of the timeline shows that the members of Trump’s team who brought this to his attention were firmly in step with the global medical mainstream. By March 19, CQ or HCQ had been endorsed by advanced healthcare systems — including in South Korea, Italy, Spain, and Turkey.
The origins of HCQ as a treatment for COVID-19 are still obscure. According to one account, after COVID-19 emerged in Wuhan in early January a panel of Chinese scientists used artificial intelligence to screen thousands of drugs as potential treatments for the disease. The list included CQ phosphate, an older version of HCQ, in part because in the early 2000s in vitro laboratory tests of that substance had previously demonstrated efficacy against the first SARS coronavirus, a close relative of COVID-19.
By early February, Chinese studies showed that CQ also worked against COVID-19 in vitro. On February 15, HCQ was included in the sixth version of the COVID-19 treatment guidelines issued by the National Health Commission of the People’s Republic of China at Wuhan.
As the disease fanned out across the world, interest in CQ or HCQ as a treatment for COVID-19, frequently in combination with other drugs, also spread to neighboring countries.
South Korea detected its first case on January 20. By February 8, that nation was already considering CQ or HCQ as a treatment for COVID-19. And on March 12 – a full week before Trump’s first mention – South Korea’s version of the CDC officially recommended HCQ, in combination with lopinavir and ritonavir, as treatment for COVID-19. Almost two months later, it remains the recommended treatment.
Other countries with reputable medical establishments followed suit. In Turkey, doctors began prescribing HCQ on March 5, followed by Spain on March 16 and Italy on March 28 (though the medicine was authorized for regional use as of late February). Poland approved a chloroquine-based drug for COVID-19 on March 13.
Meanwhile, a number of smaller countries were even earlier adopters. Malaysia began using chloroquine against COVID-19 during the first wave of the disease there in January and February, and Bahrain began using it February 26.
In addition to those named so far (South Korea, Italy, Spain, Turkey, Poland, Malaysia, and Bahrain), the list of countries currently recommending the drugs as treatment for COVID-19 also includes Russia, Iran, and Egypt. A number of others, including Pakistan, India, and the Philippines, allow doctors to prescribe them but are not officially recommending it.
It’s worth noting that in some of these places doctors are prescribing HCQ on an outpatient basis – something vehemently discouraged by our FDA, largely due to concern over potential heart damage.
To cite just one example, an Italian doctor, Luigi Cavanna, has treated hundreds of patients at home with HCQ, reportedly with some success. In some countries it may also be prescribed prophylactically to prevent infection in the first instance – again on an outpatient basis, still strongly discouraged by American health officials.
By now it’s a commonplace in American political discourse that HCQ is “untested” and “unproved,” with some deferring a final verdict on the results of clinical trials still underway, and others ready to pronounce that the treatment doesn’t work.
Anecdotal evidence isn’t proof – we all understand that – and no one is suggesting the U.S. blindly take its lead from foreign governments.
But surely it’s relevant that dozens of countries, including a number with modern healthcare systems and extensive experience of COVID-19, have endorsed the drug. The political class and their partisan food fights on HCQ have obscured the fact that much of the world has already embraced it.
Without a cure or vaccine, HCQ represents one of our best hopes against COVID-19. We can’t allow the political class to control what should be a scientific discourse. Let’s let the science lead the way. Patients’ lives may depend on it.
Erik Sass is Editor-in-Chief of The Economic Standard and author of several popular history books.