Argentina’s Minister of Health, Ginés González García, announced yesterday that the country is beginning clinical trials of a drug to see if it can cure or improve outcomes of patients with Covid-19. The drug, hydroxychloroquine, has been much in the news recently due it being touted by Donald Trump but its usefulness for this new disease is undetermined, at best.
A French researcher in infectious diseases, Dr. Didier Raoult, treated a group of 26 patients with it (plus azithromycin — AZT, an antibiotic) in an uncontrolled experiment — that is, an experiment without the normal rigorous methodology required for submitting the results as evidence to respected professional organizations and publications. Raoult claimed good results from his work but the majority of experts in this field are skeptical.
Nevertheless, that hasn’t prevented Trump from repeatedly making claims or implications that it’s practically a miracle cure and will be used any moment to successfully eradicate the disease. Even if we despise Trump, I think we would all welcome such an outcome … but wishes aren’t horses and medicinal unicorns don’t appear just because we hope they exist.
According to Minister García and Argentina’s president, Alberto Fernandez, the World Health Organization (WHO) has asked cooperating nations and medical institutions in them to open controlled, methodical studies of hydroxychloroquine with Covid-19 patients. The selected countries include Norway, Canada, Switzerland, France, Bahrain, Iran, Spain, South Africa, and Thailand, along with Argentina.
While we can certainly hope, there is a lot of reason to take this with a grain block of salt. Dr. Raoult has something of a reputation of being a maverick and blusterer about his work and its results. Authorities in France have been reluctant to treat patients without verifying his results: thus he brusquely claimed this week that
"I have a cure for coronavirus, that they do not want to accept or use my treatment is immoral." [1]
Dr. Lautaro De Vedia, one of the preeminent infectious disease specialists in Argentina, gave an opinion of Dr. Raoult in an interview in Clarin (equivalent to the NYT or WaPo in Argentina):
“He does not publish scientific studies in The Lancet or Science. as usually happens, but letters from readers, at the rate of 500 per year, in which he claims to have the cure of almost everything.” [1]
Still, no one wants to ignore any reasonably possible treatment. Another noted Argentine researcher, Fernando Polack, said:
“This anecdote, reported by the French researcher, is based on an untested experience of 26 people, which is very little. Not tested against any other intervention. Anyway, I understand that it will be formally evaluated by the World Health Organization in the Solidarity study, a study of thousands of patients worldwide where different treatments against coronavirus are going to be tried. The drugs proposed by this doctor are known and can be used in certain cases, but their result is uncertain.” [1]
In addition to the hydroxychloroquine, the international trials will also test several other drugs that have been discussed as possible treatments:
- chloroquine — a chemical relative of hyddroxychloroquine, developed to fight malaria
- remdesivir — originally developed for Ebola
- ritonavir/lopinavir — a combination of protease inhibitors developed to combat HIV
- ritonavir/lopinavir with interferon-beta — a drug that suppresses inflammation
These clinical studies are likely to involve thousands of patients around the world, giving us a broad sample of cases that should make the results — positive or negative — authoritative. Instead of relying on Donald Trump’s hunches, doctors and scientists will know for sure what works and what doesn’t. As the Director-General of WHO, Tedros Adhanom Ghebreyesus, said when announcing this project,
“This large, international study is designed to generate the robust data we need to show which treatments are the most effective.” [2]
Let’s cross our fingers but no one should get overly hopeful … and certainly nobody should attempt to dose themselves with these or any other prescription medicine.
Even if the results are negative, it advances our knowledge and will free up researchers to test other drugs. Every fact we learn brings us closer to a solution.
Personal update
We’re now in Day 8 of our national lockdown in Argentina … originally scheduled to last through March 31. The government is debating extending it so it would last 23 days instead of 12, as first planned.
Some of our “hotspots” (like Greater Buenos Aires) are continuing to report growing numbers of cases. But in other areas, the quarantine is working. Many provinces report just 1 or 2 new cases per day ...and some, like mine, regularly report zero new cases (we have had 1 active case for the past 10 days).
I think a lot of us here are going a bit stir-crazy. I think of my village as being quiet and sleepy but now I realize just how busy it normally is — lots of people out walking to and from the dozen or so assorted shops; families of 5 or 6 whizzing by, all precariously perched on a motorcycle; the produce vendor who comes by in a horse-drawn cart and calls out his offerings; the kids yelling as they play soccer in the field on the corner — all of that has disappeared.
I see and hear occasional cars go by. Once in a while I see someone walking to or from home (we are allowed to make brief forays to local shops for food and medicine). But it’s all just too, too quiet. It’s eerie.
I feel like I really am inside one of those zombie apocalypse movies, an isolated survivor cut off from the world — even though I have internet and cell service. It’s a strange feeling.
I hope you’ll experience it too. Soon.
Not because I want you to go through anything unpleasant but because I think, at this point, that it’s the safest thing we, as communities, can do. We need to buy time for cures and vaccines. We need to slow the spread to keep the hospital and medical loads manageable.
So yes, I want everyone to go into quarantine. I want you all to be safe and buy us all some time.
Sources
[1] Argentina es uno de los diez países elegidos para probar una droga contra el coronavirus at Clarin
[2] UN health chief announces global ‘solidarity trial’ to jumpstart search for COVID-19 treatment at United Nations News
Coronavirus: la Argentina, elegida por la OMS como uno de los diez países que buscarán la cura at La Nación
Coronavirus: el Hospital Posadas empezó a probar una droga para tratarlo at La Nación
WHO launches global megatrial of the four most promising coronavirus treatments at Sciencemag, a journal of the American Association for the Advancement of Science