There is no proof that any drug can cure or prevent infection with the coronavirus. But in the face of an exploding pandemic with a frightening death toll, people are desperate for a bit of hope, a chance to believe there is something that will help.
The drug that has received the most attention is hydroxychloroquine, which President Trump has recommended repeatedly, despite warnings from his own health officials that there is little data to support its widespread use as a treatment against the virus.
Drug companies across the world have begun donating tens of millions of doses of hydroxychloroquine to the United States, and the president said on April 4 that 29 million doses had been added to the National Strategic Stockpile, a cache of medical supplies maintained by the government to respond to emergencies.
What is hydroxychloroquine?
Hydroxychloroquine is a prescription medicine that was approved decades ago to treat malaria. It is also used to treat autoimmune diseases like rheumatoid arthritis and lupus. It is sometimes referred to by its brand name, Plaquenil, and is closely related to chloroquine, which is also used to treat malaria.
Why has hydroxychloroquine even been considered as a possible treatment for the coronavirus?
There are several reasons. A promising laboratory study, with cultured cells, found that chloroquine could block the coronavirus from invading cells, which it must do to replicate and cause illness. However, drugs that conquer viruses in test tubes or petri dishes do not always work in the human body, and studies of hydroxychloroquine have found that it failed to prevent or treat influenza and other viral illnesses.
Reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients. But those studies were small and did not use proper control groups — patients carefully selected to match those in the experimental group but who are not given the drug being tested. Research involving few patients and no controls cannot determine whether a drug works. And the French study has since been discredited: The scientific group that oversees the journal where it was published said the study did not meet its standards.
A recent study from China did include a control group, and suggested that hydroxychloroquine might help patients with mild cases of Covid-19, the disease caused by the coronavirus. But that study had limitations: It was also small, with a total of only 62 patients, and they were given various other drugs as well as hydroxychloroquine. The doctors evaluating the results knew which patients were being treated, and that information could have influenced their judgment. Even if the findings hold up, they will apply only to people who are mildly ill. And the researchers themselves said more studies were needed.
Another reason the drug has been considered for coronavirus patients is that it can rein in an overactive immune system, which is why it is used to treat lupus and rheumatoid arthritis. In some severe cases of Covid-19, the immune system seems to go into overdrive and cause inflammation that can damage the lungs and other organs. Doctors hope hydroxychloroquine might calm the condition, sometimes called a cytokine storm, but so far there is no proof that it has that effect.
Can hydroxychloroquine protect you from catching the virus?
There is no evidence that hydroxychloroquine can prevent coronavirus infection. However, researchers at the University of Minnesota are testing the drug in people who live with coronavirus patients to see whether it can protect them.
Is hydroxychloroquine approved by the Food and Drug Administration?
Yes, but for malaria, lupus and rheumatoid arthritis, not for Covid-19. For decades, doctors have been legally allowed to prescribe it for any condition they think it might help, a practice called off-label use. However, because of hoarding and high demand for hydroxychloroquine, some states like New York have ordered pharmacists to fill prescriptions only for F.D.A.-approved uses of the drug or for people participating in clinical trials.
In late March, the F.D.A. granted emergency approval to allow hospitals to use hydroxychloroquine from the national stockpile to treat patients who would not otherwise qualify for a clinical trial. Under the approval, patients and their families will receive information about the drug, and hospitals have to track information about the patients who received the drug, including their health condition and serious side effects. But that F.D.A.’s authorization for emergency use is not equivalent to meeting federal requirements, including scientific evidence through trials, that would deem hydroxychloroquine a proven treatment against the virus.
Is hydroxychloroquine being given to coronavirus patients now?
Yes. Many hospitals are giving it to patients because there is no proven treatment, and they hope it will help. Clinical trials with control groups have begun across the world. A nationwide trial began on April 2 in the United States; it is to enroll 510 patients at 44 medical centers.
Researchers say those studies are essential to find out whether the drug works against the coronavirus. If it does not, time and money can be redirected to other potential treatments.
Is there any danger in taking hydroxychloroquine?
Like every drug, it can have side effects. It is not safe for people who have abnormalities in their heart rhythms, eye problems involving the retina, or liver or kidney disease. Other possible side effects include nausea, diarrhea, mood changes and skin rashes.
The leaders of three professional societies in cardiology warned on April 8 in the journal Circulation that hydroxychloroquine and azithromycin can each cause dangerous disruptions in heart rhythm, and they wrote, “There are very limited data evaluating the safety of combination therapy.”
Overall, it is considered relatively safe for people who do not have underlying illnesses that the drug is known to worsen. But it is not known whether hydroxychloroquine is safe for severely ill Covid-19 patients, who may have organ damage from the virus.
If I can get hydroxychloroquine, should I take it to prevent coronavirus infection?
No, especially not without consulting a doctor who knows your medical history and what other medications you are taking. There is no proof that it works. And if it is being sold on the street or via the internet, it may be fake or unsafe.
An Arizona man in his 60s died last month after swallowing an aquarium cleaning product that had chloroquine on its label. He and his wife, who also became critically ill, had thought the product would protect them from the virus.
At this point, the best way to avoid infection is to practice the social-distancing and quarantine measures recommended by public health authorities. The Centers for Disease Control and Prevention also recommends that people wear cloth masks in public and wash their hands regularly.
Updated April 11, 2020
When will this end?
This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.
How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. More than 30,000 coronavirus-related GoFundMe fund-raisers have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
How does coronavirus spread?
It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.
Is there a vaccine yet?
No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.
What makes this outbreak so different?
Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.
What if somebody in my family gets sick?
If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.
Should I stock up on groceries?
Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Should I pull my money from the markets?
That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.
What should I do with my 401(k)?
Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “free money.”
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