Why chloroquine isn’t routine therapy in COVID-19

It’s the first time I write something medical on my website, but there is an ugly virus pandemic ravaging the world, and it is the enemy of all humans. The question about chloroquine you see in the title has been posed to me a lot, so I have written a summary that I hope is understandable to everyone. When I posted it on my personal social media, I found it was met with a lot of appreciation. I hope that after reading this, you will feel appropriately informed.

Here’s why

Here’s why (hydroxy-)choloroquine isn’t yet advised for widespread use – some more background on the topic:

1. No randomized controlled trial results yet for chloroquine treatment (this is a certain type of research that is required to provide sufficient evidence) – but it is ongoing, and results may be available within a few weeks.

2. Inappropriate prescription or random use can be dangerous: three reports already of death (two from Nigeria and one from Arizona) by self-medication with chloroquine. Another problem with inappropriate prescription (as in: ‘just in case’) is that it may deplete the stocks of the medicine, depriving those who really need it from access to the drug.

3. Aminoquinolines (the chemical ‘family’ of chloroquine) were successfully used on SARS and MERS, because of their anti-inflammatory activity. They are immuno-modulators (they modify/suppress parts of the immune system), and were previously used against malaria and for controlling lupus and rheumatoid arthritis (those last two are disorders of the immune system).

4. The theory of their effectiveness against COVID-19 is based on their assumed suppression of the cytokine-storm that occurs in the late phase of the disease, in critically ill people.
Cytokine-storm: white blood cells release huge amounts of cytokines (these are proteins that are vital in fighting infection, but when their levels are too high, they become toxic), which in turn activates more white blood cells, so it becomes a destructive vicious cycle.

5. One of the safety risks is that it can prolong the QT-interval (this means it may disrupt the heart rhythm of patients).

Hopeful expectations

6. There is such a large volume of patients with COVID-19, that research trials are being set up in many places, which is why it is expected that it will soon be known in which patients specifically hydroxychloroquine can be used as treatment.

I hope I wrote the above in such a way that both those with a medical background and those without, can understand it. Please stay safe, and stay home, as much as you possibly can! I have a new album out, especially designed for giving you a good mood during your lockdown, and it’s free! Prevention is always better than treatment.

Dr. Tariq Shadid, aka Doc Jazz
Consultant General Surgeon