Hydroxychloroquine Is Not a Key to Defeating COVID-19 | Opinion
Everyone understands the urgency to control the COVID-19 pandemic. Recently, there have been arguments claiming hydroxychloroquine is the solution to control this pandemic, in the form of published opinion pieces and online videos. As a pharmacist, I study everything about drugs, write treatment guidelines, practice evidence-based medicine and serve as the last line of defense between drugs and patients. I strongly disagree with these claims. In fact, these claims are working against our efforts to defeat COVID-19.
When we evaluate data in clinical settings where patient care and health interventions are present, we need to examine the quality of the data. We look at whether studies were designed and done well, and we update ourselves with the most recent data. What we have been calling for is randomization and control. Randomization assures each individual has an equal probability to be in any group, and that groups are as balanced as possible. Control reduces the influence of factors outside of what we want to study.
On July 15, Oxford University reported in a randomized and controlled study that hydroxychloroquine did not reduce 28-day mortality after randomly allocating 1,561 patients to receive hydroxychloroquine and 3,155 patients to receive standard care. On July 23, The New England Journal of Medicine published a study of 667 patients, who were randomly given hydroxychloroquine, hydroxychloroquine and azithromycin or standard care, with a 1:1:1 ratio. This study found that the use of hydroxychloroquine, either alone or with azithromycin, did not improve outcomes. Cardiac side effects, however, were more frequent in individuals receiving hydroxychloroquine. Other well-designed studies published earlier have all shown that hydroxychloroquine has no benefit in managing COVID-19. Earlier observational studies have also pointed out the lack of benefits and safety profile when treating COVID-19 patients with hydroxychloroquine.
Considering the replicable evidence from multiple studies showing no benefits but safety concerns, it is not surprising to see health authorities all around the world, as well as the World Health Organization, halt hydroxychloroquine studies and recommend against its use.
However, articles mentioned by those who support hydroxychloroquine cannot go through the same level of robustness and quality check. Some frequently cited studies, include Gautret et al., have been criticized for flaws and poor research design. Ninety-five percent of the patients in the Million et al. study had a low degree of clinical illness, and authors had no control groups or attempts made for comparisons. Another widely mentioned one was a Google Document made by Zelenko; his original online work does not exist anymore, but a screenshot of what it looked like did not present solid evidence at all. Some also draw conclusions from a study done in Brazil, available only in Dropbox and on WordPress. This work not only had no formal research design, but did not even confirm whether enrolled patients actually had COVID-19. Many other studies used by hydroxychloroquine supporters should all be taken with multiple grains of salt because they are all poorly designed, inconclusive and outdated.
Back in March, when hydroxychloroquine first became a star, I wrote an op-ed to urge cautious prescribing and better quality data before affirmatively recommending any therapy. Four months later, I am reiterating the importance of evidence-based medicine and responsible health communication to the public, especially in the midst of a pandemic.
I do agree that this medication has been politicized. Politicians and political parties have taken advantage of uncertainty in this pandemic to gain political interests. This has been observed not only in the case of hydroxychloroquine, but in social distancing, masks and school reopening. We, as medical and public health professionals, promise to help the sick, do no harm, and rely on evidence. And that is exactly why we must stand against discordance and be meticulous about our comments to ensure the best quality of information and foster trust between the public and health authorities. We must stay united to serve the public and advise our decision-makers to walk the right path in a challenging time like this.
The keys to defeating COVID-19 are solidarity, leadership, transparency and collaboration. Hydroxychloroquine is not one of them, and wrongfully promoting this drug is not protecting our lives.
Jon Zhou is a doctor of pharmacy, a practicing health care professional and a graduate of master of public health/global health from Yale School of Public Health.
The views expressed in this article are the writer's own.
