So that would be what is called anecdotal evidence. Which means it hasn't caused a problem in a limited number of people without comparing it to anyone else. It is great that Hydroxychloroquine may be effective in treating Covid. It's great that the drug has been around previously so we know that patients can tolerate it.
However, just because "they said no side effects listed bother them at all" as if it is a justification that it is safe for everyone is rubbish. Plaquenil would not be what I would call a "safe" medication. It has very real risks albeit in the setting of long term use of
macular degradation (see blindness, rarely) for which many patients are routinely monitored by an ophthalmologist with routine special testing. I think the bigger concern acutely would be in patients having the cardiac arrhythmia I previously mentioned and it would probably be prudent to monitor most patients with serial EKGs to watch their QT interval and thereby try to identify higher risk patients and discontinue their therapy if necessary. I fully admit that this is all uncharted territory in many ways but scientific evidence is the foundation of medicine and the only reason we aren't constantly plagued by the legions of infectious disease that our ancestors were forced to accept. If we abandon it now to appease fear, it will not lead to better outcomes.
All that is to say that the practical considerations involved in implementing new treatments are much less straightforward than "Trump says it works and the bureaucrats are in the way." In a case by case basis we are certainly at the point where individual providers and patients can enter into shared decision making regarding whether to utilize the treatment or not. In patients with more severe disease and lower chances of survival it's also likely a reasonable option. I fully support a provider using the medication on that basis and there is no impediment to that at this time that I am aware of. The FDA is not simply signing off on the medication because that adds no value in this situation. The medication can already be used by providers "off label"! But, there is not good evidence behind it and a rubber stamp from the FDA will not change that.
In "normal life" different providers have different requirements for evidence (studies) and guidelines before directing new care for their patients. The FDA is very often far behind on these issues because their job is to primarily assess safety. That does not stop people from utilizing treatments when there is good data (insurance coverage often does, as an aside). Physicians will use their "common sense" as everyone is fond of saying which they will balance between the data available and each individual patient they see. The only reason it's being pushed as "an issue" so heavily in press conferences, in my opinion, is because the administration can set up a scenario where it is ostensibly fighting to get people treatment that science and medicine is "afraid" to provide. Somehow clearing the way for the magic bullet treatment. Meanwhile, they neither discovered the medication nor made it more accessible. All the practical public health benefits that should have been provided (masks, testing) were not done and it's an attempt to rewrite history to put them in a positive light that they frankly do not deserve. Providers can use this already when they deem it appropriate. It is inappropriate to endorse it on a national level tantamount to "a cure" because the data doesn't support it and the risks are unknown. Just like we all want Tennessee to win the NC for the next 10 years, unfortunately, we can't just proclaim it preseason and hoist the trophy. You have to prove it on the field.
To be clear, I believe the medication has promise. However as a cure all that everyone should stockpile, take daily, or utilize for mild cases likely to recover on their own, the benefits begin to be more questionable with the risks. If your 18 year old daughter without co-morbidities is diagnosed with Covid 19 but feeling well and asymptomatic should she get the drug? I would argue that given the extremely limited evidence, no she is not a good candidate.
More specific to Covid, if the very small trial is wrong and it actually does more harm than good then we could potentially be hurting patients by giving them the drug. There has been some postulation that many of the severe cases are related to acute respiratory distress in the setting of a "
cytokine storm" which is an autoimmune reaction. If this is the case, will utilizing an antibiotic like Azithromycin (in the same French study with increased efficacy in combination with Hydroxychloroquine) expose the body to more "foreign stuff" when it breaks down bacteria and
increase the immune response that is already in overdrive? That's just a hypothesis that could sound good but may be complete garbage. The point is we don't know until we look at studies. I believe and am hopeful that the studies will pan out. Don't put the cart before the horse, though. And please don't disparage the people who are out there in the field trying to make these difficult decisions with real people, not statistics who know the potential burden of a misstep. The people working now are doing it because they care and because they believe in their responsibility. No provider is trying to deny treatments that can be beneficial, there is a burden to temper hope with reason.
