Hydroxychloroquine: Drug that could be our virussaviour
A divisive drugtouted by Donald Trump may hold the secrets to stopping the spread of COVID-19,and its potential is absolutely huge.
Each morning before Claire Lobb setsoff to work on the frontline of Victoria’s coronavirus second wave crisis, shepops a mysterious pill.
There’s a 50-50 chance that what shetakes is hydroxychloroquine, a controversial drug touted by Donald Trump, that couldpotentially stop millions of people around the world getting COVID-19.
Alternatively it could be just anextra dose of sugar as a late garnish for her breakfast. She has no way ofknowing.
But the simple act she undertakeseach morning has the potential to change the world.
It’s part of a groundbreaking trialof the hotly-debated drug here in Australia that has the potential to be a“game-changer” in the global battle against COVID-19.
The cheap and readily available drughas been used for more than 30 years for a variety of reasons. Now researchersbehind the trial say it could potentially stop people getting the virus andultimately save lives.
If successful, it could be used bypeople who want to travel overseas. They would just have to take it duringtheir trip.
It could protect people who may notbe able to take a COVID vaccine for health reasons, or those in countries wherea vaccine could take a long time to reach.
It could protect Australians, andpeople around the world, who are most at risk from COVID-19 including aged careresidents and staff, meatworks staff and healthcare workers.
Ms Lobb understands what that meansas much as anybody.
As a nurse practitioner atMelbourne’s Alfred Hospital Emergency Department she has been on Australia’sfrontline against the coronavirus.
Every day, she is tasked withadmitting Melburnians who may or may not have the disease.“We don’t always know and it can bequite confronting at times not always knowing what we’re dealing with,” shetold news.com.au.
With mental health issues in patientsspiking and a massive rise in healthcare worker infections in recent weeks, shesaid work has been “intense and stressful”.“It hasn’t always a great time to beworking just because of the intensity of the situation,” she said.
So given the stress of her work life,why would she want to take part in an experiment on a drug that was endorsed bythe same US President who appeared tosuggest injecting bleach could be a coronavirus cure?
To understand why, you have to lookat a key difference in what Mr Trump said about hydroxychloroquine and whatthis new study in Australia is looking into.
The drug is cheap and widely available. Picture: AFPSource:AFP
In late March and early April, MrTrump repeatedly proclaimed that hydroxychloroquine could prevent or treatCOVID-19.
Within days, the number ofprescriptions for the drug skyrocketed even though evidence it could treat thedisease was non-existent.
However, the Australian trial, led bythe Walter and Eliza Hall Institute, is looking at it from a different angle.
The trial’s lead researcher ProfessorMarc Pellegrini told news.com.au there has been a storm of confusion loomingover hydroxychloroquine ever since the US President’s comments.
However, he believes that should beput to one side and the science should do the talking.
His team started testing healthcareworkers in early June in a clinical trial in hospitals along Australia’s eastcoast – which have been hardest hit by COVID-19.
The aim is simple, to see whether thedrug can stop people getting the virus.“It’s been highly politicised but wethought it’s best to use proper science to understand whether it plays any rolein preventing people getting COVID-19,” he said.
There are now roughly 200 medicalworkers using hydroxychloroquine as part of the trial, and by January next yearthe results will be in.
It’s too early to say what thoseresults could look like, but Prof Pellegrini says the science already tells usthe drug doesn’t work as a treatment for coronavirus.
However, his team is looking atwhether it can be used as something called a pre-exposure prophylaxis, whichmeans it could work as a preventive before someone comes into contact withsomebody with COVID-19.
Professor Marc Pellegrini says the potential for the drug is enormous.Source:Supplied
“The rationale behind this is thatmany drugs work very well in preventing people from getting a disease, but whenthey have it, it fails to work,” he said.
“Two of our best flu drugs work likethat. The anti-HIV drugs work incredibly well at preventing people from gettinginfected.”
He said it has been proven thathydroxychloroquine works against COVID-19 in a test tube, but there is noevidence it works clinically.“It obviously became divisive becauseit was highly politicised,” he said. “Obviously when politicians who are verypolarising make an opinion, which is not based on good science, then itobviously dilutes the potential merit of the drug.
“It’s really important to dissociatethe hearsay and the politicisation of the drug from the real evidence. Theevidence is in the test tube, but we really need it tested on people.
“It would be very remiss of us topotentially throw away a drug that could potentially be a game-changer inCOVID-19 based on the opinions of a few people who have polarised large partsof society.”
Because of the political debatearound the drug, he says very poorly-done studies were carried out to show thepeople weren’t tolerating the drug – which were later disproved and evenretracted.
The divisiveness also left peopleunsure as to whether the drug was safe.
However, Prof Pellegrini assurednews.com.au that hydroxychloroquine is safe when taken under a degree ofmedical supervision. He even compared it to Panadol or Nurofen.“It’s a drug that’s been around for30 years and it’s used routinely, so we know all the side effects,” he said.
“If you give it to the wrong personthey could get into trouble. But obviously we’re being incredibly careful inmaking sure we’re giving the drug under the strictest medical supervision. Thereason being is that we haven’t proven the drug works.”
He said there were fears the drug maycause abnormalities in the heartbeat, however there is no evidence to back thisup.“It can cause tummy upsets as can anydrug, but the main concern was its effect on the heart and it’s beencategorically shown in the big treatment studies that the drug simply doesn’thave the capacity to cause any major untoward effects in causing heartdisease.”
Trial participant Ms Lobb said themedia storm over the drug has made getting real evidence about it difficult.“That politicisation of the drughasn’t been helpful at all,” she said. “The most important thing we need hereis evidence-based therapy and that’s why we’re having a clinical trial.
“It’s been very difficult because alot of people don’t understand, they hear hydroxychloroquine and think it’s astupid drug because it was supported by Donald Trump.”
However, as a nurse practitioner, MsLobb said she’s too qualified to pay attention to the media rhetoric,especially since she has dealt with the drug over many years.“We’re health care professionals andwe’re guided by evidence-based practice, so a rhetoric in the media is notgoing to influence my decision to do a drug trial or not,” she said. “In factit reinforces the need to do it even more.”
The incentive to discover whether thedrug works against COVID-19 is huge given it is cheap, readily available andshows good signs of working against virus.
Prof Pellegrini said there were manydifferent scenarios the drug could be used in to prevent infection, fromoverseas travel to protecting workers and staff in aged care homes.
“For example if there was a case in ameatworks or an aged care, you’d go there and give the drug to all theresidents or workers to try to prevent them getting COVID-19,” he said.
“And people who are travelling forwork in an area where there is a lot of COVID-19, they could take this drug forthe time that they’re in these high-risk zone.”
However, even if the drug works, hesaid it will not be a replacement for a vaccine.
He says a vaccine will take a longtime to test – up to a year or more – and there’s no guarantee it will be 100per cent effective.“So if there’s a drug that’s readilyavailable and clinically well-tolerated then it would probably be best to startusing that drug to prevent people getting infected while we’re waiting for avaccine,” he said. “Also, no vaccine is 100 per cent effective, so we willalways need a back-up.”
Ms Lobb, meanwhile, is abouttwo-thirds of the way through her four month trial and there have been no sideeffects so far. She also hasn’t contracted COVID-19, although it’s worthpointing out again that she could be on a placebo.
All she does is take the pill eachmorning and fill a short survey on her phone.
She see it as just one small way shecan help the world beat this virus. She wants more people to get involved.“It could be really important becausewe don’t know when a vaccine’s coming along and not all countries are going tohave access to the vaccine,” she said.
“We’ve got to think about our ThirdWorld colleagues who won’t be able to have access or afford a vaccine.”
The trial is a randomised,double-blind, placebo-controlled study – the gold standard – and has beenreviewed by the Human Research Ethics Committee at Melbourne Health andmultiple NHMRC-accredited bodies.
The trial is open to any healthcareworker in Australia who is at risk of contracting COVID-19.To find out more, visit the institute’s website.
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