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Coronavirus treatment

French doctors renew bid to clear HCQ to treat Covid-19 ahead of lockdown exit

Doctor Widad Abdi, 42-year-old, wearing a protective face mask, works in the Intensive Care Unit (ICU) for coronavirus disease (COVID-19) patients at the Clinique de l’Estree private hospital in Stains near Paris as the spread of the coronavirus disease continues in France, April 20, 2020.
Doctor Widad Abdi, 42-year-old, wearing a protective face mask, works in the Intensive Care Unit (ICU) for coronavirus disease (COVID-19) patients at the Clinique de l’Estree private hospital in Stains near Paris as the spread of the coronavirus disease continues in France, April 20, 2020. REUTERS - Benoit Tessier

With less than a week to go before France starts easing lockdown measures, a group of doctors has again urged the government to clear unproven anti-malarial drugs, including the controversial hydroxychloroquine (HCQ), as a Covid-19 treatment to avoid a second wave. Critics are worried it may trigger more deaths. 

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As France scrambles to prepare to lift its 2-month lockdown from 11 May, a group of doctors has published a new study they say proves the efficacy of the controversial malaria drug hydroxychloroquine, combined with the antibiotic azithromycin, in treating Covid-19.

The trial carried out on nearly 100 infected doctors and their families found that a HCQ and azithromycin combination at the first sign of symptoms, substantially reduced the viral load of Covid-19.

The results smack of déjà vu, after another promising study by French virologist Didier Raoult, who drew sharp criticism in March for touting unproven medicines as a potential cure to the worsening coronavirus pandemic.

The new study has renewed hope in nearing an end to the coronavirus crisis – but it has also renewed concerns.

“I don’t know M. Raoult,” hastens to point out the report’s lead author and endocrinologist, Dr Violaine Guérin, acknowledging that the controversial researcher’s work is “not irreproachable”, but has merit.

Early treatment

“Taking hydroxychloroquine and azithromycin on the outset of flu symptoms can prevent Covid-19 from getting worse,” she tells RFI. “We can treat people now before they end up on a ventilator.”

Hydroxychloroquine is typically used to treat lupus, an auto-immune disease, and other chronic ailments such as rheumatoid arthritis and malaria.

Guérin now wants it to be prescribed to health workers infected by the coronavirus outside of its approved uses, on compassionate grounds.

“From the very beginning, doctors have been calling for the right to self-prescribe because they are the ones on the frontline of the coronavirus battle,” explains Guérin, also a member of a doctors’ collective called "let us prescribe".

Health unions on Monday warned that almost 12,000 health care professionals out of 550,000 – roughly a quarter of the country’s health force – were sick with Covid-19. 

“We cannot waste time when we can treat Covid-19 now, as long as this is done in the early stages of the virus and patients are screened for pre-existing medical conditions,” she insists.

Doctors as guinea pigs

Guérin's retrospective study, released last Thursday, was carried out on 3 groups and found that people taking the combined anti-malarial drugs recovered within 9 days instead of 25 for those taking a standard treatment of paracetamol.

Relatively small in design, she admits the trial was limited, but blames a government decree restricting sales of hydroxychloroquine and its related compounds to test trials, hospital care or to people with a valid prescription. 

“Our general practitioners were stopped from treating themselves because their access was taken away,” regrets Guérin, who says infected doctors are willing to act as guinea pigs to prove that HCQ is safe when used correctly.

Not everyone is so sure.

A small study in Brazil using chloroquine – a more toxic version of hydroxychloroquine – was halted in April after patients experienced heart rhythm problems.

Around the same time, reports emerged in New York that a 65-year old woman had died after being prescribed the controversial cocktail of HCQ and azithromycin, renewing warnings about the serious heart risks associated with taking the drugs.

No silver bullet

In the United States, the ongoing uncertainty has begun to erode demand in hospitals and has taken the sheen off Donald Trump’s claims the drug was a “game changer”.

The unprecedented spread and severity of Covid-19, which has killed over a quarter million people globally and more than 25,000 people in France, has left everyone scrambling to find a solution.

Countries like Senegal, India and Italy are putting their hopes in hydroxychloroquine, marketed under the trade name Plaquenil by pharmaceutical giant Sanofi, despite its risks.

“This medicine was never fabricated for the treatment of Covid-19,” cautions Jean-Baptiste Froville, a Sanofi spokesperson.

“When hydroxychloroquine is given to long-time sufferers of rheumatoid disease, it is prescribed at lower doses. When it is used to test for its efficacy against Covid-19, the doses may vary and that is what can cause side effects,” he tells RFI.

The pharmaceutical company has pledged to deliver 100 million doses of HCQ to some 50 countries to “meet demand”, says Froville, all the while warning against an irrational use of the product.

“We are providing the drug to hospitals and doctors to enable them to carry out clinical trials to determine whether hydroxychloroquine is effective or not, but not to treat Covid-19,” he said.

Dilemma

Dr Didier Raoult and his supporters have accused big pharmaceutical companies like Sanofi of blocking HCQ because it is cheap, being out of patent.

Froville says the group is not opposed to selling hydroxychloroquine but wants to wait for the results of global clinical trials before touting it as a Covid-19 miracle drug.

For Guérin, there is no time to lose: “Before France lifts the lockdown, it must incorporate treatment into its exit strategy. Protecting, testing and isolating is not enough. It needs to treat as well.”

But doctors who prescribe HCQ to patients in hospitals in the context of the coronavirus pandemic are liable to prosecution if the patient dies.

Guérin says this can be avoided if the drug is taken early, and regrets that current French studies, which discredit hydroxychloroquine, have only been carried out on severe Covid-19 patients.

“We must free up the sale of Plaquenil to prevent a second wave of Covid-19 when the lockdown ends,” she insists, even as critics warn that prescribing unproven drugs to treat the coronavirus may do more harm than good.

For the government, it will be a question of sifting through the hype and promise of hydroxychloroquine and saving lives. The intractable debate will continue well beyond 11 May.

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