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Chloroquine and hydroxychloroquine in covid-19

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1432 (Published 08 April 2020) Cite this as: BMJ 2020;369:m1432

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Rapid Response:

Re: Chloroquine and hydroxychloroquine in covid-19

Dear Editor,

I am extremely troubled by the contamination of politics into the arena of science in general and medicine specifically. Everyone of us should be. COVID-19 has challenged the world by its rapid ascent to pandemic status, initial and to this date unknown mortality risk and severe global economic impact. Naturally, world scientists and political leaders are scrambling to reverse its deleterious course, rapid and widespread as it has been. Time stress often does not bring out the best in us. Methodical and slow, careful study designs and evaluation of methodology is ideal, but not affordable with this epidemic. People are dying quickly.

Sadly, and I believe I am not the only physician in this camp who tries to analyze and make use of medical research, I am left uncertain as to the study analyses and expert opinions regarding treatment options for COVID-19. Many commentaries reek political bias. Front and center are the strong political opinions from the world of the president of the United States, Donald Trump. Three years of multi-pronged attempts to oust him from office provides the backdrop for suspicion that anything he may opine or support initiates frantic attempts by his detractors to refute, often at all costs.

Which brings us to this article and the potential benefits of hydroxychloroquine. I emphasize that I do not know the heart, political tilt or intention of this author but the point is suspicion of political bias cannot be helped. Trump is mentioned specifically. My criticism is this: reference to the dangers of hydroxychloroquine. The two references mentioned, ventricular arrhythmias and hepatic failure are so weak that this article in general cannot be taken seriously. Corrected QT prolongation isn’t always a straightforward measurement and besides, the point of assessing this measurement when using drugs known to prolong it is to discontinue the medication to avoid arrhythmia development. This is standard fare and increases the safe use of such drugs when monitored.

Regarding the reference to hepatic toxicity...I’m shocked such a reference is even mentioned. Even the reference states that severe hepatic toxicity hasn’t been reported in its widespread use since 1963.

The conclusion: I am left suspicious that the author is grasping desperately to suggest that proponents of hydroxychloroquine are being reckless and creates yet another criticism of Mr Trump. For those of us personally and our patients particularly who fall prey to rapidly worsening symptoms from COVID-19, an illness thus far without a definitive cure, denying any reasonable attempt at today’s “possible “ treatment modalities that statistically are clearly low risk is, in my opinion, reckless and irresponsible. Ask yourself this question, posed to you on this date, May 2, 2020: if you were COVID-19 positive, febrile and developing worsening dispensa or already hypoxia, would you consent to therapy with hydroxychloroquine, remdesivir, neither or both?

Competing interests: No competing interests

02 May 2020
Thomas Salvucci
Cardiologist
Lake City, FL