Hydroxylated chloroquine entered the market in the mid 1940s. This drug is the less toxic form of chloroquine which continues to keep it relevant in clinical practice in treating multiple diseases apart from malaria.
So how did hydroxychloroquine (HCQ) all of a sudden return to the market when the novel SARS COV-2 came into the scene? This drug has shown in vitro properties of stopping viral replication. In vitro means, outside the human body. In prior viral outbreaks like SARS and MERS, this drug was tried. Yet, in vivo, that is within live humans, there has been no proof of this drug actually stopping viral replication.
So what prompted this drug to break into the scene? In the scenario of a new outbreak, the novel nature of the infective agent, and initial analyses of the nature of it, gives clues of what drugs might be effective. In an epidemic (or pandemic), the rate of spread of infection (infectivity) determines how quickly we can standardize treatment protocols.
Numerous studies have already proven how this RNA virus, has an infectivity rate much higher than its predecessors like SARS and MERS. Whilst the latter two turns out to be more fatal, the novel virus emphasizes on spreading fast rather than terminating hosts into which it settles.
So one fine day, the President of United States, relaunches this drug combined with an antibiotic azithromycin as ‘potentially’ the life-saver. This came at a time of mounting pressure on the government if it had really anticipated the gravity of disease burden in their country.
Within a matter of days the Indian Council of Medical Research (ICMR), brought out recommendations for use of HCQ as ‘prophylaxis’ for healthcare workers and patient carers. There have been many scenarios in prior pandemics where in the absence of scientific evidence, measures were implemented to save lives. The confidence of both the FDA (which eventually approved it as an emergency drug) and the ICMR in entrusting a drug cocktail with no proven benefit was an entirely unscientific move.
As days passed, the infections swamped the world, and in approved countries, trials also were conducted. The most recent one outright dismisses any relevant effect (good or bad) in administering HCQ to a COVID19 patient.
When the US FDA and Indian ICMR recommend drugs with no scientific basis for treatment, other countries directly ordered for immediate arrangement for this drug. So much so that the US which had red flagged an Indian Pharma for not meeting drug standards, was provided temporary permission to make and ship HCQ to the States.
Scoring political points does not have a time or place when it comes to India. The ruling party followers and pliant Indian media houses celebrated the rise of India as a nation that provides HCQ to save the world.
While the economy was in the dumps, shares of big Indian Pharma making and exporting the drug, soared.
Now that the dust has settled, the US FDA and Indian ICMR, should be bold enough to withdraw the touted drug and prevent any person from succumbing to side effects of using a drug that is known to cause significant cardiac morbidity.
Radiologist l Cyclist l Blogger