On Thursday morning, Donald Trump dropped in at the FDA to stage yet another of the coronavirus task force praise sessions that have replaced his campaign rallies as his primary source of ego-boosting. But in between Trump explaining how great he is—really, really, great—and having others step forward to explain how great Trump is, there was an announcement.
Trump named a particular drug, known both as hydroxychloroquine and chloroquine, as a possible miracle cure for COVID-19. This is a widely available drug, one that’s already in wide use in treatment of malaria. The safety and side effects of the drug are already well understood. Better still, the drug is available around the world in quantities that could likely address the demand almost immediately. If it actually represents an effective treatment for COVID-19, that would be fantastic. But no one, absolutely no one, should be claiming victory.
In addition to hydroxychloroquine, there was discussion of other drugs, including remdesivir, a broad-spectrum antiviral that has been in trials since 2015, which is going to be made more available to doctors. These are just two of at least half a dozen drugs or drug combinations that have already been reported as having some effect on COVID-19, from minor to fantastic. But it’s far too soon to embrace any of them as the solution.
In any emerging disease, doctors on the front line hurl the kitchen sink at the problem. Despite the way that Trump presented it, no one watching dozens or hundreds or thousands of patients die ever wrung their hands over “red tape” if they felt there was even a chance something they had on their shelves would help.
- It is extremely common for doctors in an epidemic situation, facing a novel illness, to confront that illness with “off-schedule,” experimental, or in-development treatments. Or combinations of treatments. Or with what amounts to little better than home remedies. Doctors do this because they are determined and desperate to help their patients, and unwilling to surrender so long as there is some perception of a chance.
- It is extremely common for doctors to report success with these treatments. This can happen for a number of reasons. First, it can be the result of a statistical fluke resulting from a small number of patients or special selections; in the case of hydroxychloroquine and COVID-19, the only paper that seems to have been submitted to peer review at this point involved just six patients. Secondly, this kind of information is often subject to intentional or unintentional self-selection. Doctors may give their experimental treatment to patients already on their way to a better outcome, not because they’re trying to be deceptive, but because they simply want it to work.
- It is extremely common for these good results to evaporate in the face of broad trials and controls. This can be frustrating to the point that people do not want to believe it, especially if they’ve bought into news that a cure is at hand. It’s important not to put too much hope, and especially not to base government planning, on the basis of drugs where even the mechanism by which they might work involves a lot of hand-waving. Like hydroxychloroquine.
That doesn’t mean one of these drugs under consideration might not be effective. Hydroxychloroquine might work in fighting COVID-19. So might remdesivir or another antiviral from Japan, favipiravir, which appears to have been effective in improving outcomes from COVID-19 in a mid-scale trial.
These therapeutics are not a replacement for a vaccine. But they could be a tremendous benefit in reducing the effect of the pandemic until a vaccine becomes available. They might even go a long way toward allowing life to return to something closer to normal … if they are effective. We don’t know that yet. We will not know for weeks.
So hope for the best, but don’t count on miracles.
