Intended for healthcare professionals


Covid-19: cases grow in US as Trump pushes promise of a malaria drug

BMJ 2020; 368 doi: (Published 20 March 2020) Cite this as: BMJ 2020;368:m1155

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  1. Janice Hopkins Tanne
  1. New York, USA

President Trump has told Americans that the covid-19 threat is serious, reversing his earlier position of telling Americans to relax because the coronavirus threat would soon pass. He called himself a “wartime president” and invoked an old defence production act to direct factories to produce protective equipment for healthcare workers and ventilators.

On 19 March, Johns Hopkins Center for Systems Engineering and Science reported that the US had 13 678 cases of covid-18 and 200 deaths. The states of California, New York, and Washington are most affected.1

New York City’s mayor, Bill de Blasio, asked for military aid to help deliver 15 000 ventilators and millions of surgical masks, gowns, coveralls, gloves, and face masks. On 19 March, the number of confirmed cases in the city almost doubled in a day to 3615. The city has seen 22 deaths from the virus, which de Blasio described as “nothing short of staggering.”

The State Department advised Americans not to travel outside the country and told those abroad to return home. The US and Canada closed their border.

Before the epidemic, the US government ignored warnings, including a project named “Crimson Contagion” from last October that contemplated a respiratory virus from China that quickly spread internationally, according to the New York Times.2

But a warning went out to well connected people, according to National Public Radio (NPR). Republican senator Richard Burr of North Carolina, chair of the Senate Intelligence Committee, warned a small group three weeks ago “to prepare for dire economic and societal effects of the coronavirus,” according to a secret recording obtained by NPR. The senator helped write a preparedness act that is the framework for the government’s response.3 Pro Publica reported that the senator sold $1.7m (£1.5m; €1.6m) in stocks on 13 February after reassuring the nation that it was prepared.4

To help California, New York, and Washington state fight their outbreaks, Trump said that two US Navy hospital ships with 1000 beds each would be dispatched to New York Harbor and to the west coast to accommodate overflow patients with the usual illnesses from local hospitals. However, it will take about a month for the ships to arrive.

The president said at a press conference that the Food and Drug Administration (FDA) had approved an old antimalarial drug, chloroquine (hydroxychloroquine) for use against covid-19. Shortly afterwards the FDA commissioner Stephen Hahn said the president had directed FDA to take a closer look at the drug and that the agency would do that in a clinical trial.5

The governor of California put the state on lockdown, ordering its 40 million residents to stay at home. Many schools, universities, theatres, museums, concert halls, bars, and restaurants have closed and sports events have been cancelled.

Meanwhile hotels have closed for lack of customers, including the Midtown Hilton in New York, with 1879 rooms. Such hotels might be repurposed for hospital use, although no one has mentioned that yet.

Congress is in the process of passing several bills to provide immediate cash and sick pay. Many Americans don’t have enough cash to go a week or so without pay, let alone paying medical bills. Congress seems to be saying that testing for the virus will be free for all—when it becomes available, and with a doctor’s prescription—but has not committed to paying for care of uninsured people who develop covid-19.

Nationwide, test kits and supplies of protective equipment and masks for healthcare workers remained a problem, leading to pleas from doctors for immediate help. “The sky is falling,” a New York doctor wrote in the New York Times.6


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