April 7, 2020
By Mark Flatten
Sometimes it’s hard to tell whether political junkies are so obsessed with gaining some rhetorical edge that everything has to be couched as us vs. them.
Take, for example, the COVID-19 virus and whether a pair of decades-old drugs are an effective treatment against it. Last month, President Trump called chloroquine and the related hydroxychloroquine potential game changers in battling the virus. That set off a firestorm of political rage.
What is Chloroquine—and Does it Work?
Chloroquine, whether alone or taken in combination with a popular antibiotic, has never been “approved” or “proven” as an effective treatment for COVID-19, the argument from critics goes. And that’s true. Chloroquine has been around since before World War II, and is typically used to treat malaria, lupus, and rheumatoid arthritis. We don’t know yet whether it will be effective against COVID-19, but early international studies and anecdotal evidence shows that chloroquine and hydroxychloroquine are, at this point, the most promising drugs readily available to combat the pandemic.
They may not work. Other treatments may be more effective. And, importantly, there are no other “approved” treatments. What that means is that the U.S. Food and Drug Administration (FDA) has not officially declared chloroquine effective. That doesn’t mean it does or does not work. It only means that the FDA has not done the kind of controlled studies and statistical analysis to officially approve it for use on COVID-19 patients. It did recently issue an emergency use order authorizing the release of this treatment from the national stockpile to facilitate its use for adolescent and adult patients hospitalized with the disease who do not have access to clinical trials. Even that is seen by many as more of a political concession to the President than a medical one.
A Partisanship Peak
The strange part about all of this is the rabid certainty from both supporters and critics of the President as to whether chloroquine will be an effective treatment. Fox News recently published something of an “I told you so” rebuke of the media for its earlier headlines, stories, and Twitter feeds branding chloroquine as nothing more than “snake oil,” “risky,” “hype,” and the tamer “false hope.”
There are other media reports out this month showing an international poll of more than 6,200 doctors in 30 countries found about a third of them rate hydroxychloroquine as the most effective therapy in treating the disease. That is the most of any drug.
What these headlines seem to miss is the President has nothing to do with whether chloroquine is effective. The fact that President Trump early on endorsed its use does not prove it works. It does not prove it doesn’t. It does not have any impact on whether it works or not. Similarly, whether the FDA grants its approval to the use of chloroquine as a treatment for COVID-19 months, or more likely years, from now has nothing to do with whether it works.
It should be noted that doctors are normally free to prescribe any FDA-approved medications to treat any condition as they see fit, even those for which they are not approved, in what is called off-label use. So absent orders to the contrary, there is nothing to prevent doctors from using chloroquine, hydroxychloroquine, or any other treatment they believe will help their patients.
State Governments are Weighing in
Last month, Democratic governors in New York, Nevada and Michigan effectively blocked the off-label use of chloroquine or hydroxychloroquine to treat COVID-19 patients.
On March 23, New York Governor Andrew Cuomo issued a broad order that, among other things, limited the use of chloroquine and hydroxychloroquine as a treatment against COVID-19 to patients in a state-approved clinical trial. “No other experimental or prophylactic use shall be permitted,” Cuomo said in his order, which makes exceptions for those with conditions such as lupus or other ailments for which the drugs had previously been approved. Cuomo later amended the order to allow the drugs to be used on patients in hospitals, emergency rooms, nursing homes, and other limited settings. (On April 6, Cuomo said that early responses “anecdotally” show that the use of chloroquine has been “effective” in fighting COVID-19.)
On March 24, shortly after the President touted the drugs, Nevada Governor Steve Sisolak issued an emergency directive that prohibited dispensing chloroquine or hydroxychloroquine for COVID-19 patients. His office later walked that back and clarified the order did not apply to hospitalized patients. Sisolak later said the purpose of the order was to prevent hoarding of the drug and was not intended to prohibit doctors from treating their patients. While stockpiling was mentioned in the initial press release, the thrust of it was that the order was needed because “there is no consensus among COVID-19 experts or Nevada’s own medical health advisory team that the two drugs provide treatment for COVID-19 patients.”
Also on March 24, Michigan Governor Gretchen Whitmer’s Department of Licensing and Regulatory Affairs sent a letter threatening “administrative action” against doctors who prescribed either of the chloroquine drugs to COVID-19 patients. That order did pin the action on the need to prevent shortages of the drugs, but also suggested skepticism about doctors using them to treat COVID-19 patients. “Prescribing any kind of prescription must also be associated with medical documentation showing proof of the medical necessity and medical condition for which the patient is being treated,” the order states. “Again, these are drugs that have not been proven scientifically or medically to treat COVID-19.”
Earlier this month, Whitmer seemed to reverse her distaste for trying chloroquine to fight the virus. Her administration requested an emergency supply of chloroquine and hydroxychloroquine from the Strategic National Stockpile so doctors could begin using it in her state to treat COVID-19 patients.
The partisan divide over chloroquine reached its peak, at least for now, over the weekend when a Democratic state representative in Ohio threatened to refer President Trump to the International Court of Justice for committing “crimes against humanity” for his advocacy for the use of chloroquine and hydroxychloroquine.
The bottom line in all of this is that whatever you think of the President has nothing to with whether chloroquine and hydroxychloroquine are effective treatments against COVID-19. The virus doesn’t care about politics. When it comes to finding a treatment or cure, neither should anyone else.
Mark Flatten is the National Investigative Journalist at the Goldwater Institute.