Hydroxychloroquine (HCQ) and chloroquine (CQ) have become part of the international conversation on coronavirus cures after US President Donald Trump began singing their praises, small studies in China and France showed positive results and Morocco bought the entire stock produced by local manufacturer Sanofi. 

What do we know about the drugs?

HCQ and CQ are part of a family of antimalarial drugs used to treat acute attacks of the mosquito-borne infectious disease for over 70 years.

The two drugs also have anti-inflammatory properties and are used to treat chronic-autoimmune disease lupus and rheumatoid arthritis. Both medications are widely available internationally and are relatively inexpensive. 

China and France have conducted limited clinical trials of hydroxychloroquine, a less toxic derivative of chloroquine, as a COVID-19 treatment. A larger trial will begin in New York today, Governor Andrew Cuomo said. 

The World Health Organisation’s (WHO) ‘SOLIDARITY’ mega-trial will also include HCQ and CQ alongside HIV drugs, lopinavir, and ritonavir as the global health body attests “robust data is needed to show which treatment is effective.”  

In China, an in vitro study found both compounds had coronavirus-fighting properties, while clinical trials involving over 100 patients revealed chloroquine was effective in controlling COVID-19 associated pneumonia and shortening the disease’s course.

Importantly, the larger human study did not observe “severe adverse reactions” to CQ, leading a team of Chinese pharmacologists investigating COVID19 treatments to conclude, “in light of the urgent clinical demand, chloroquine phosphate is recommended to treat COVID-19 associated pneumonia in larger populations in the future.”

A Chinese study published in the journal Nature on March 18 discovered, “HCQ can efficiently inhibit SARS-CoV-2 (COVID-19) infection in vitro,” but the researchers reiterated that, “whether HCQ is as efficacious as CQ in treating SARS-CoV-2 infection still lacks the experimental evidence.”

Off the back of the available information, Chinese authorities have recommended CQ be added as a treatment for COVID-19 there, and a number of national health bodies around the world have since followed suit. 

Meanwhile, the French study reported that “despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.” 

There’s growing political will to expand use of HCQ and CQ in France on the back of those results and testimony from people who have benefited from the treatment like Mayor of Nice Christian Estrosi who said after six-days of use he had “the sense I’ve been cured.

At present, it is clear that there is not sufficient quality scientific evidence to suggest that hydroxychloroquine and chloroquine can cure or prevent COVID-19.

The lack of evidence, however, has not stopped governments around the world including Moroccan and Algerian health authorities, approving the drug for use to fight coronavirus. 

Health Ministry spokesperson Dr Soraya Ayoub announced on Monday March 23 that the Algerian government has approved chloroquine as a coronavirus treatment. Morocco’s Ministry of Health also decided to approve the use of CQ and HCQ and said they will be distributed to health facilities across the country in coming days to treat COVID19. 

The Moroccan government reportedly purchased the entire stock of ‘Nivaquine” (CQ) and Plaquenil (HCQ) manufactured locally by French pharma company Sanofi on March 18, to sure-up its stocks of the drugs. 

In the US, interest in the drugs sparked by Trump’s comments has led to alleged stockpiling by citizens and health professionals alike, the US’s National Public Radio reports. The move raised concerns amongst lupus and arthritis advocates that sufferers will no longer be able to access the drug leading to calls for the government to ensure their access to the vital medication.

What has Trump said about HCQ and CQ?

President Donald Trump debuted the idea of using the drugs to fight COVID19 during a Whitehouse press conference on March 19. 

“It (chloroquine) is known as a malaria drug, and it’s been around for a long time and it’s very powerful.  But the nice part is, it’s been around for a long time, so we know that if it — if things don’t go as planned, it’s not going to kill anybody.”

Trump added that, “normally the FDA would take a long time to approve something like that, and it’s — it was approved very, very quickly and it’s now approved, by prescription.”

The U.S Food and Drug Administration (FDA) responded quickly to Trump’s comments and issued a statement advising there “are no FDA-approved therapeutics or drugs to treat, cure or prevent COVID-19.”

“We understand and recognize the urgency with which we are all seeking prevention and treatment options for COVID-19. FDA staff are working expeditiously on that front,” the drug administrator emphasized.

Trump exalted the virtues of CQ for fighting COVID19 again during his Tuesday, March 24 virus update. He cited the recovery of a man who “said goodbye to his family” but made a miraculous recovery and is now “in good shape,” thanks to chloroquine. 

“I’m pleased to report that clinical trials in New York will begin existing for existing drugs that may prove effective against the virus.  At my direction, the federal government is working to help obtain large quantities of chloroquine,” Trump boasted. 

Are HCQ and CQ dangerous?

The short answer is yes, these medications are not the harmless pill that Trump makes them out to be. Unfortunately, self-medication against coronavirus with hydroxychloroquine has already proved deadly for one American who died from taking a version of the drug. Three people in Lagos, Nigeria also ended up in hospital after overdosing.

Anyone who has taken antimalarials knows they can cause some pretty unpleasant reactions. Subcontinent news agency India Today highlighted the dangerous side-effects of the antimalarial drugs after the  Indian Council for Medical Research (ICMR) recommended it for use as a COVID-19 preventative for high-risk individuals, on March 23. 

The drugs were widely prescribed in India during the late 1980s to combat a dangerous malaria outbreak where they gained a reputation for nasty side-effects as well as their efficacious antimalarial properties.

“It is like swallowing death,” former drug-user C. Bangee told India Today. “It leaves a horrible bitter taste in the mouth. I remember taking it and feeling faint, nauseous and terribly unwell. I hope the drug is different now,” the 69 year-old Dehli local said.

Side-effects listed for Hydroxychloroquine the U.S National Library of Medicine’s ‘Medline’ database include, “headache, dizziness, loss of appetite, nausea, diarrhea, stomach pain, vomiting, skin rash, mood or mental changes and reading or seeing difficulties.”  The database also warns that children are at high risk overdosing and the medication can cause serious vision problems. 

There is still a worrying lack of evidence on the efficacy of Hydroxychloroquine and chloroquine in the treatment or prevention of COVID-19. The drugs have been in use for many years and their side-effects are well documented, but so is their potential toxicity if taken incorrectly.  

In light of this, everyday citizens should not rush to pharmacies and try to purchase the antimalarial or self-medicate. The best way to prevent coronavirus from spreading, remains a combination of hand washing, avoiding touching your face, social distancing, covering your mouth to cough or sneeze, and staying home if you feel unwell.