POSTSCRIPT / May 21, 2020 / Thursday


Philippine STAR Columnist

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Trump taking HCQ pills to block Covid

WE were watching President Trump on TV last Monday when he jolted us with a revelation that he has been taking hydroxychloroquine, a controversial drug that a New York doctor uses successfully to treat patients with symptoms of the coronavirus disease (Covid-19).

The President was meeting with restaurateurs and his suddenly changing the topic from their business concerns to the Covid-19 pandemic that had killed at least 93,533 Americans had me reaching for the remote to raise the volume.

He mentioned receiving a letter from a New York doctor who I guessed was Dr. Vladimir Zelenko, about whom I wrote on April 9 and his cocktail of hydroxychloroquine, azithromycin, and zinc sulfate that he gives to his Covid-19 patients.

Hydroxychloroquine is available in the Philippines under the Plaquenil brand of Sanofi, and as a generic product of the Indian company IPCA. Registered with the FDA in Manila even before the Covid-19 outbreak, it is mostly used by lupus patients.

Trump has been pushing for the open use of HCQ at least as prophylaxis against Covid-19, but Monday was the first time he went as far as saying that he himself has been taking it for several days already.

Many US doctors and scientists have argued against the off-hospital use of HCQ against Covid-19, which reportedly has side effects on the heart. Dr. Anthony Fauci, an immunologist and head of the US National Institute of Allergy and Infectious Diseases, does not recommend it.

In March, the US Food and Drugs Administration authorized emergency use of HCQ against Covid-19 but later warned against using it outside of clinical trials, citing potential “life-threatening” heart problems.

As Trump is taking HCQ with the permission of his doctor, does that mean he has shown Covid-19 symptoms? Some White House insiders, including his valet and the media aide of Vice President Mike Pence, reportedly have tested positive for Covid-19.

The President explained: “The White House doctor, he didn’t recommend — no, I asked him, ‘What do you think?’ He said, ‘Well if you’d like it.’ I said, ‘Yeah I’d like it. I’d like to take it.’”

The White House released that evening a memo from the presidential physician, Dr. Sean Conley, saying that Trump “is in very good health and has remained symptom-free,” and that he receives “regular Covid-19 testing, all negative to date.”

Trump said he was not experiencing any adverse effects of the drug: “All I can tell you is, so far I seem to be OK, I’m still here.”

He told reporters: “I want the people of this nation to feel good. I don’t want them being sick, And there is a very good chance that this has an impact, especially early on. But you look at front-line workers. You look at doctors and nurses. A lot of them are taking it. As a preventative.”

• Hydroxychloroquine sold in Phl as Plaquenil

THE US market is being monitored if Trump’s apparent endorsement will spike demand for hydroxychloroquine, sold as Plaquenil, which is mostly used to treat malaria, lupus, and rheumatoid arthritis.

Plaquenil made by Sanofi is also available in the Philippines. There is a cheaper generic product of the Indian company IPCA. Both have been registered with the local FDA even before the Covid-19 crisis and are being used by lupus patients.

United Laboratories Inc. (Unilab) has donated 5.6 million HCQ 100mg tablets to the government specifically for off-label use of Covid-19 patients. Intended for outpatient use only, the drug is prescribed for moderate to severe cases or for those with comorbid conditions.

Industry sources said there will be enough HCQ stocks in the country, and that its Covid-related use is limited to hospitals because it is still classified as an off-label (i.e., experimental) drug.

The use of hydroxychloroquine for treating Covid-19 has to be guided by physicians. Doctors have told us that HCQ is not recommended for prophylactic use, like how Trump appears to be using it.

Dr. Zelenko, who was apparently the one cited by Trump, gained attention when he wrote an open letter March 23 “to all medical professionals around the world” and sent the President a copy. Part of his letter said:

“As of today my team has tested approximately 200 people from this community for Covid-19, and 65 percent of the results have been positive. If extrapolated to the entire community, that means more than 20,000 people are infected at the present time. Of this group, I estimate that there are 1500 patients who are in the high-risk category (i.e. >60, immunocompromised, comorbidities, etc).

“Given the urgency of the situation, I developed the following treatment protocol in the pre-hospital setting and have seen only positive results:

1. Any patient with shortness of breath regardless of age is treated.

2. Any patient in the high-risk category even with just mild symptoms is treated.

3. Young, healthy and low-risk patients even with symptoms are not treated (unless their circumstances change and they fall into category 1 or 2).

“My out-patient treatment regimen is:

1. Hydroxychloroquine 200mg twice a day for 5 days.

2. Azithromycin 500mg once a day for 5 days.

3. Zinc sulfate 220mg once a day for 5 days.

“The rationale for my treatment plan is. I combined the data available from China and South Korea with a recent study published from France (sites available on request). We know that hydroxychloroquine helps Zinc enter the cell. We know that Zinc slows viral replication within the cell. Regarding the use of azithromycin, I postulate it prevents secondary bacterial infections. These three drugs are well known and usually well-tolerated, hence the risk to the patient is low.

“Since last Thursday, my team has treated approximately 350 patients in Kiryas Joel and another 150 patients in other areas of New York with the above regimen.

“We have had ZERO deaths, ZERO hospitalizations, and ZERO intubations. In addition, I have not heard of any negative side effects other than approximately 10 percent of patients with temporary nausea and diarrhea.”

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(First published in the Philippine STAR of May 21, 2020)

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