On Monday, the National Task Force constituted by the Indian Council of Medical Research that is tackling the novel coronavirus, COVID-19, has recommended the use of hydroxychloroquine for prophylaxis of SARS-COV-2 infection for people with a high-risk of contracting the disease.
The following people have been categorised as high-risk population: asymptomatic healthcare workers, as well as asymptomatic household contacts of laboratory-confirmed cases.
In case of suspected or confirmed cases, the dose, according to the task force, comprises 400 mg twice a day on Day 1, followed by 400 mg once week for the next seven weeks. In case of asymptomatic household contacts of laboratory-confirmed cases, the dose is 400 mg twice a day on Day 1, followed by 400 mg once weekly for the next three weeks.
Hydroxychloroquine, which is primarily used in treating malaria, has been suggested by a few infectious disease experts from across the world.
On March 22, US President Donald Trump advocated the use a cocktail of hydroxychloroquine and azithromycin to treat coronavirus. However, despite both President Trump and the Indian government endorsing it, there is no concrete scientific proof to back the use of the drugs. A New York times report, quoting Dr Anthony S Fauci, an infectious disease expert, said that there is only anecdotal proof that hydroxychloroquine can be used to treat coronavirus. However, two people who tested positive for COVID-19 used President Trump’s recommended treatment and have said that it ‘saved their lives.’
Besides India, who is the latest to use the drug, Jordan and France have advocated the use of hydroxychloroquine. The French study suggested that if hydroxychloroquine may be beneficial if taken with an antibiotic mechanism for fighting the infection. However, the French research involved a sample size of 24 people, which is too small a sample size given how far this pandemic has spread across the world.
The World Health Organisation had originally decided to rule out hydroxychloroquine during its trial, but had a change of heart after several nations began advocating it. Many studies on the drug have said that the drug does have some activity against COVID-19, but the high doses could cause ‘serious toxicities in the body.’
One of the side effects of high doses of the drug is a condition called retinal toxicity. According to the American Academy of Ophthalmology, retinal toxicity form hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and continue to progress.
Speaking to The Free Press Journal, Dr Deepak Chaturvedi says that the dosage isn’t a problem, as it was treated during the SARS epidemic. “Early literature in medical textbooks has also shown that hydroxychloroquine can be treated as an anti-viral,” he says.
However, Dr Chaturvedi has cautioned that there isn’t a mass purchase and self-medication of the drug. “When the coronavirus pandemic broke out, there was a mass purchase of masks. The authorities finally put out guidelines stating that not everybody need not buy a mask,” he said.
He added that the use of hydroxychloroquine made sense, as the nation needed to use something available rather than go for R&D.
But the biggest challenge is the availability of the drug. Government authorities in their circular have said that only high-risk cases need to buy the drug. Dr Chaturvedi adds that with monsoons approaching, overconsumption of hydroxychloroquine – which is predominantly a drug used to treat malaria – may develop a resistance against the disease. “If this happens, not only will we have a coronavirus pandemic, but also rise in the number of malaria cases due to the drug resistance.”
The other challenge the government faces is India’s fragile public health system. India has 1 doctor for 1,445 patients, according to a WHO report released in November last year. This number suggests that the number of COVID-19-infected individuals is far greater than what the Government of India has listed, given the inability to test everyone at a rapid pace. With the number expected to rise in the coming days, expect to see a decline of the tablet from your medical store shelf.
Dr Chaturvedi says, " The biggest concern is “Mass Hysteria”. People are considering it as a protection against Corona Covid 19 , buying it and using it inadverently. This is giving them false assurance about the protection and this may lead to weakening of the basic concept of “Breaking of Transmission Chain” by social distancing, Quarantine and Isolation. The government should make it “prescription only drug” now."