HCQ is a medication which has come under intense scrutiny in the early days of the coronavirus outbreak, but much more recently after a group of doctors in the USA came out in public and the media to say how good it is at reducing deaths of those in hospital and infected with this virus. These doctors, and many others, have said that they have treated hundreds of people with HCQ (together with other prescriptions) and their patients recovered quickly and they had no deaths.
Since then the social media censors have gone into overdrive and have removed all mentions of the doctors' media interviews, posts and articles. These platforms have banned or silenced many high profile accounts of people who shared the videos of these doctors, including President Trump! Some of the doctors who took part in the recent video have since been fired for speaking out about the benefits of using HCQ.
What is hydroxychloroquine used for?
HCQ is mainly used to treat malaria, a parasitic infection which is very common in many parts of the world. Malaria causes symptoms of fevers, chills, fatigue, and flu-like symptoms - similar to COVID. HCQ has also been prescribed for Rheumatoid Arthritis and Lupus (SLE). This drug has been used for 65 years, but recent speculation for using it against COVID-19 threatens its availability for those taking it for valid conditions. Its precise method of action is "unknown", according to the product's manufacturer! (Sanofi-Aventis, 2020).
What do the studies say about hydroxychloroquine?
HCQ was suggested as a possible coronavirus prevention and treatment as a result of a similar drug, chloroquine, was researched as a treatment after the 2002/3 SARS pandemic. A key study found that chloroquine has strong antiviral effects on the SARS coronavirus by preventing the virus binding to the ACE-2 receptors (which the new coronavirus also uses to infect cells), in monkey cell cultures (Vincent et al., 2005). But HCQ and chloroquine are different drugs, with similar chemical structures. Both are used for similar conditions, such as malaria, and have similar actions and side effects too. But this study on chloroquine in 2005 doesn't prove that HCQ would work on the new coronavirus, hence why new studies were needed. Note that studies on cell cultures often do not reflect reality of how cells (or medications) work in the WHOLE body! Similarly, animal studies also aren't always reflective of how effective a medication will be in humans. Many further studies over a long period of time are required to determine if a drug will be effective in humans, but overall the incidence rates around the world are decreasing while studies are ongoing for HCQ.
The SARS coronavirus, and the MERS coronavirus pandemic in 2012/3 both died out on their own, without any widespread use of HCQ or chloroquine, and no vaccine has been able to be produced since then.
In April 2020, The Qld Government and University of Queensland announced a clinical trial of HCQ for people with a COVID-19 infection. Due to very low numbers in Qld, finding suitable candidates for the study has proven difficult. In the meantime, the Qld government made it illegal for doctors to prescribe HCQ, with a $13,000 fine if they did (Queensland Times, 2020). Similarly, other state governments (such as Victoria) also banned prescribing of HCQ, as did the federal government's medicine regulator, the TGA. In June 2020, the WHO and UK discontinued using HCQ in trials for its effectiveness against the coronavirus, as no benefit was found for people severely affected with the virus, as well as its many risks (WHO, 2020). Why is time and money being wasted on yet another study on HCQ, when there have been many other such tests around the world?! There are over 140 other trials investigating the use of HCQ in coronavirus cases, which is a huge waste of effort and money (ABC News, 2020).
Will HCQ benefit everyone? (Side effects, contraindications and cautions)
HCQ is not for everyone, especially not for children under 6 years, and those with some specific health conditions. The medication should not be used in those with severe gastrointestinal, neurological or blood conditions, as explained on the drug's Product Information insert, but not detailing what these conditions actually are. If you are using this medication, periodic blood tests are recommended, so that any issues from taking it can be seen, and the medication stopped if so. The medication may exacerbate some conditions, such as with psoriasis. Caution is advised in those with liver and kidney conditions (Sanofi-Aventis, 2020).
There are many side effects of taking HCQ, so it is not an entirely safe medication, but then again no medications are. The most serious concerns are with it causing chronic heart toxicity and death. The drug also has other side effects affecting the heart, if one has pre-existing heart conditions such as heart disease, arrhythmic conditions, or low potassium or magnesium levels. The medication can cause severe low blood sugar levels and loss of consciousness that can be life threatening, especially in those on diabetic medications. Irreversible eye damage and vision disturbances can occur in some people on long term or high dose HCQ therapy, which can also cause kidney damage. Many people have experienced skin rashes and lesions, itching and dryness, and increased pigmentation. Other side effects include low white cell counts (and therefore reduced immune system function), muscle weakness, gastrointestinal disturbances (nausea, low appetite, cramps, vomiting), vertigo, tinnitus, deafness, headache, nervousness, mania, vivid dreams, and suicidal behaviour. There are many more side effects available on the Product Information insert (Sanofi-Aventis, 2020).
HCQ has many interactions with other medications. Check with your Doctor or Pharmacist before taking this medication. The drug has NOT been tested for its effects on fertility, nor in pregnancy. However the drug does cross the placenta, and hence should be avoided in pregnancy. HCQ is also secreted in breast milk, and as infants are very sensitive to this medication, together with no safety data in infants, this medication should also be avoided if breastfeeding.
People taking this medication also need to be aware of it causing visual disturbances when driving or operating heavy machinery.
So do you still want to take this medication?!
HCQ is also known in studies to cause gene mutations and chromosomal and DNA breaks, which can lead to cancers.
More recent studies on HCQ
In April 2020, a study was published in The Lancet, a prestigious medical journal, on the use of HCQ on COVID-19 patients. The study looked at medical data of 96,000 coronavirus-affected patients, and claimed that those who were treated with HCQ or chloroquine had a higher risk of death and heart rhythm problems than those who did not receive these drugs. The authors concluded that they were unable to confirm a benefit of using HCQ to improve survival rates from the virus (Mehra, Desai, Ruschitzka & Patel, 2020). The study had a huge impact, with the WHO and other scientists stopping their trials of HCQ for COVID-19 patients. Intense scrutiny of the study started, and shortly afterwards, claims of many discrepancies and accusations of the data being falsified to reach its conclusions. An independent investigation started, and the company that provided the data for the research failed to prove that the data was accurate, and as a result, the authors of the study retracted it (Mehra, Ruschitzka & Patel, 2020).
One of the problems with this study and many others on HCQ that show little or no benefit is that the research studies were only looking at using this drug as a monotherapy, or on its own. This is a very reductionist approach to research, and one of the major problems with researching medications, and medicine in general. There is never just one cause of a disease or infection, and similarly there is never just one solution for any treatment. The doctors in the USA who came out in public promoting HCQ were also prescribing zinc and azithromycin, an antibiotic, TOGETHER, to get their alleged good outcomes.
The trouble with some scientific research is that scientists are not always trying to prove something works, but many studies are deliberately designed to show that something does NOT work, even though other studies show it does work. This corruption of science is based on bias and competition for money for research funding or profits has been happening for many decades. Good quality scientific studies are hard to find these days, and just because a study has been published doesn't mean that it is good, or that you can believe the conclusions. Hence why there are some studies showing the benefits of HCQ, and some that don't because of bad study design, incorrect dosing (too little to have any effect, or too high a dose to cause increased side effects), or just using the drug on its own.
There are many published studies on HCQ being used on its own, with some showing benefits, and others highlighting the risks of its use or showing no benefit. There are fewer studies showing the use of HCQ together with azithromycin, and less again on the triple therapy of HCQ, azithromycin and zinc. A pre-published study found that the addition of zinc sulphate to the HCQ and azithromycin combination reduced mortality by about 50% compared to the double therapy (Carlucci, Ahuja, Petrilli, Rajagopalan, Jones & Rahimian, 2020).
Alternatives to HCQ
Studies show that HCQ appears to work by increasing the uptake of zinc and increases the effects of chloroquine against virus infected cells (Xue et al., 2014). Zinc is a major mineral that is needed for the immune system, so a deficiency in zinc will increase your risks of contracting the virus (or a cold or flu). Zinc also has anti-viral actions against coronaviruses, anti-inflammatory activity and many other benefits (te Velthuis et al., 2010). Eating zinc-rich foods or supplementing with zinc (together with other nutrients) can be done without taking a drug which has a long list of interactions, cautions and side effects.
Again, zinc shouldn't be taken alone, similar to taking HCQ alone. I have written before on using natural, safer and more effective methods, such as zinc, vitamin C, vitamin D, herbal remedies and others, before the TGA banned such recommendations and advice. Since then, there have been a lot of studies showing the effectiveness of these natural supplements against the coronavirus to reduce risks of getting the infection and severity of symptoms because they improve your immune system function. The dosing of these supplements is very important to getting the best benefits from them.
Some doctors have said HCQ is a safe and effective "cure" for the coronavirus. It's not. It cannot or should not be used as a monotherapy, as it needs other treatments to work effectively. And it's not suitable for everyone either... So we should not be relying on this medication alone, or even at all, at this time. There are justified reasons why HCQ should not be freely available, and it should only be prescribed for its intended uses and conditions for which it has more thorough testing and research.
Luckily there are many other better and safer natural preventatives and treatments which can help your immune system to better protect you against the coronavirus. But sadly, I've not seen any government health department or doctor recommend these simple and effective preventatives or treatments.
Don't wait for your health departments or regulators to change their rules on HCQ to save you, because that won't happen quickly enough. Don't wait for the vaccine either, as previous coronavirus vaccines have never been able to be made or were effective. But you CAN reduce your risks and severity of this infection in other better ways.
ABC News. (2020). How did The Lancet's now-retracted study on hydroxychloroquine make it through peer review? Retrieved 30th July 2020 from https://www.abc.net.au/news/2020-06-05/hydroxychloroquine-study-the-lancet-peer-review-coronavirus/12324118
Carlucci, P., Ahuja, T., Petrilli, C.M., Rajagopalan, H., Jones, S., & Rahimian, J. (2020). Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients. medRxiv, 20080036; doi: 10.1101/2020.05.02.20080036
Mehra, M.R., Desai, S.S., Ruschitzka, F., & Patel, A.N. (2020). Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet, Published online May 22, 2020 from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext. Doi: 10.1016/S0140-6736(20)31180-6
Mehra, M.R., Ruschitzka, F., & Patel, A.N. (2020). Retraction—Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published online June 5, 2020 from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext
Queensland Times. (2020). Queensland to join trial of virus drugs but state needs more patients. Retrieved 30th July 2020 from https://www.brisbanetimes.com.au/national/queensland/queensland-to-join-trial-of-virus-drugs-but-state-needs-more-patients-20200421-p54lsu.html
Sanofi-Aventis. (2020). Australian Product Information - Plaquenil (Hydroxychloroquine Sulphate). Retrieved 30th July 2020 from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-05655-3
te Velthuis, A.J.W., van den Worm, S.H.E., Sims, A.C., Baric, R.S., Snijder, E.J., & van Hemert, M.J. (2010). Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. PLoS Pathogens, 6 (11):e1001176. doi: 10.1371/journal.ppat.1001176
Vincent, M.J., Bergeron, E., Benjannet, S., Erickson, B.R., Rollin, P.E., Ksiazek, T.G., Seidah, N.G., & Nichol, S.T. (2005). Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virology Journal, 2, 69. doi: 10.1186/1743-422X-2-69
World Health Organisation (WHO). (2020). WHO discontinues hydroxychloroquine and lopinavir/ritonavir treatment arms for COVID-19. Retrieved 1st August 2020 from https://www.who.int/news-room/detail/04-07-2020-who-discontinues-hydroxychloroquine-and-lopinavir-ritonavir-treatment-arms-for-covid-19?fbclid=IwAR1b2TQqt03QpQO0e-UmjsnsAss8gapc9SlfGxqspoG8mYDbFuXZkSfqrbQ
Xue, J., Moyer, A., Peng, B., Wu, J., Hannafon, B.N., & Ding, W-Q. (2014). Chloroquine Is a Zinc Ionophore. PLoS One, 9 (10): e109180. doi: 10.1371/journal.pone.0109180