The World Health Organization has warned that neither hydroxychloroquine (HCQ) nor chloroquine (CQ) are proven drugs in treatment or prophylaxis for Covid-19. The adverse effects, on the other hand, are well documented, it said.
The warning comes two days after US President Donald Trump said he is on the drug, and at a time when India is going through heated discussions within the government on whether to reconsider the use of HCQ in the light of emerging evidence or whether to extend the prophylactic use to include the vulnerable population such as the elderly.
On Wednesday, Dr R R Gangakhedkar, director of epidemiology and infectious diseases at Indian Council of Medical Research (ICMR), said, “We will review the evidence (on HCQ) and take a call.”
India has in the past discussed population-level prophylactic use of the drug. There have also been recent discussions whether to advise its use by vulnerable populations once lockdown is lifted. However, the adverse cardiac reactions are a big concern.
WHO executive director Dr Michael Ryan said during the daily Covid briefing on Wednesday: “Every sovereign nation with effective regulatory authorities can advise citizens on the use of any drug…hydroxychloroquine and chloroquine are already licensed products. But they have not as yet been found to be effective in Covid-19 or in prophylaxis…. There are warnings by many authorities on potential side effects.”
He said many countries have limited HCQ to clinical trials under supervision of clinicians in hospital settings, “however, it is for each national authority to weigh and assess the evidence.”
HCQ and CQ, along with beta interferons, form one arm of the multi-country solidarity trials that are being carried out under the aegis of the WHO. Among countries which have allowed use of HCQ are the US (where it has been allowed for emergency use in hospital), France (on prescription), Brazil, Russia, South Korea etc. India has exported the drug to 55 countries.
India currently advises use of HCQ and CQ —- a combination made famous by Trump’s high praise —- for patients in ICU. However, it is not advised for children below 12 years, pregnant and lactating women. It is also advised for use in healthcare workers involved directly in Covid care and family members of confirmed Covid patients involved directly in their care.
Among known side effects of HCQ are alterations in heart rates, intestinal problems, headache, dizziness, hallucinations, etc. That is one of the reasons why the government scientific community in India has been divided on the advisability of wider prophylactic use of HCQ.
“There are some suggestions to broaden the prophylactic use of hydroxychloroquine to vulnerable populations such as the elderly and those with comorbidities, especially since lockdown and closure of schools colleges, etc, cannot continue indefinitely. However, there are also fierce oppositions to that —- the problem is hypertension and diabetes are known comorbidities and one of the documented side effects of HCQ concerns the heart,” a source said.
On Thursday, 5,609 fresh coronavirus cases were reported across the country, taking the total to 1,12,359 cases; 132 deaths have been reported in the last 24 hours.
In an observational study funded by the NIH, HCQ was not found to be very effective in reducing COVID severity.
However, there have been studies comparing deaths in countries that have allowed HCQ with those that have not to claim that the former showed lower death rates.