Covid-19: The race for a cure

Updated: Jul 31

It is everywhere, cures exist for Covid-19!

And these cures are chloroquine and hydroxychloroquine.


1. What are chloroquine and hydroxychloroquine?


Chloroquine and hydroxychloroquine are these molecules:


doi:10.3762/bjoc.14.45


They are most well-known as treatments against malaria, since 1950. But today they make front page news because they are supposedly going to save us from Covid-19.


2. Can (hydroxy)chloroquine be considered today as THE cure?


According to Pr. Didier Raoult, director of the Infectious and Tropical Emergent Diseases Research unit in Marseille (France), yes, especially when used in combination with azithromycin.


Chloroquine is a substance used for the treatment of malaria, lupus erythematosus, and rheumatism.



Commercial use of (hydroxy)chloroquine


My problem here is that Professor Raoult’s conclusion is based on fewer than 30 people, which is not exactly a lot.[1]


In addition, no critical cases were included.


Furthermore, Professor Raoult’s data is subject to bias as patients received various other medication at the same time.


Another study has been made with 80 patients by the same professor and his team.[2]


But again, the study was neither randomised nor controlled.


So how do we interpret the results?


Is one Active Pharmaceutical Ingredient (API) responsible for their remission? Is it the combination of two molecules? Three?


Why were critical patients excluded? Because if they die, it will ruin the statistics?


In China, the treatment has been tested on 135 patients. [3]


96% had mild symptoms, 4% had severe symptoms.

Among the severe ones, all have improved.


However, this study too has its flaws as the experiments were not controlled, the patients were treated in different hospitals in Beijing and in the province of Guangdong, and all patients received other medication.


3. Clinical trials exist for a reason




Let’s start by the beginning : What is a clinical trial?


Put briefly, in a clinical trial a novel API is given to a number of patients while a second number of patients receive placebos (blanks).


The results are then analysed statistically in order to determine the efficacy of the treatment (or lack thereof, as the case may be).


Additionally, it is important to remember that the trials conducted in a way that’s called ‘double blind’, which is to say that neither the doctor knows whether the patient receives the drug or the placebo, nor does the patient.


This is done to exclude bias.


Clinical trials are a cumbersome and time-consuming business, however, they are done for very good reasons:


  • To understand common and severe side effects, and to determine a safe dose in order to achieve a successful treatment.


  • To understand the effect of the treatment on this disease


  • To compare the new treatment with existing ones and be sure that it acts similarly with respect to different populations, age groups, geographies; and to understand the different dosage and combination of drugs.


  • To ascertain that the risks involved with this cure are worth taking because the benefits outweigh the side-effects.


  • To understand the new treatment in combination with other drugs.



4. The situation with Chloroquine


The number of accidents that we hear about today where people self-medicated with hydroxychloroquine or patients were prescribed some and had to endure serious side effects [4] makes me shout and loud :


Clinical trials have a purpose!”

And the purpose is not to slow down the introduction of a medicine that could save lives!


We obviously live in times where there is tremendous pressure on the medical profession to come up with a cure and a good plan today is better than a perfect plan tomorrow.


It is equally true that the public demands transparency from the ‘gods in white’.


A professor found holding back a possible cure on grounds of what will be regarded as useless red-tape by many people will quite possibly have to fear for his life.


And finally it is true that in every crisis there are those who wish to profit from it.


Crises are the “raison d’être” of the whole pharmaceutical industry.


Nonetheless, at present we do not have enough data of sufficient quality to present (hydroxy)chloroquine as the cure! But hope is permitted.


People, however, who self-medicate with (hydroxy)chloroquine reduce themselves to being lab rats.

In fact to something less than a lab rat because the result of their ‘treatment’ will be meaningless because nobody will know under which additional set of circumstances the results were obtained.


In a proper clinical trial, volunteers play the role of the lab rats.


They agree to do so on their own free volition in order to be part of something bigger (and they receive some remuneration as well).


Their reaction to the novel pharmaceutical being tested is strictly controlled so as to be able to be determine the effects (positive and negative) of a possible new cure.


As of today, no such clinical trials have been conducted, so people self-medicating with a untested cure serve neither themselves nor society as a whole.


The search for new effective drugs requires valid clinical trials, prospective, randomized, placebo-controlled trials! Some good science would be desirable.


And yes a Medical Doctor is a scientist, and he should act like one.



5. Other treatments are being tested as we speak


Did you know that more than 60 other treatments are as encouraging but they do not get the as much light because their inventors are less attracted by sensationalism? [5,6]


Did you know that treatments based on Covid-19 survivor blood plasma or an ebola treatment or a combination of Lopinavir–Ritonavir (usually used to treat HIV), are under investigation?


Probably not.


(And please don’t rush out now to get your hands on some Lopinavir–Ritonavir just because you’ve read here that some people seem to think that it might be a cure for Covid-19.)


To make one thing clear:


We do not judge anyone for clutching at straws such as hydroxychloroquine because they are in alarmingly poor health or a loved one is dying.


We would, however, expect all members of the medical profession to exercise a little more care in handling the media!


6. The importance of sustainable leadership



In term of crisis, a leader should act like one.


How well leaders react to crises is in no small way a measure of how good they are at thinking out of the box and how quickly they come up with solutions (or at the least: possible solutions).


However, a good leader will also warn people if the solution might not be all that is hoped for.


And that makes you a leader I want to follow.


Sensationalism has never been the key to long term solutions!


Leadership is the key to end this crisis, in a way that the entire world can profit.


In term of crisis, we need sustainable leadership, and it has to start with the scientists.



__________________________________________________________

[1] Liberation — 24 mars 2020

[2] https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf [Last accessed on March 31th]

[3] Le monde — 24 mars 2020

[4] Le soir — 29 mars 2020

[5] Le journal du médecin (Dr Jean-Louis Vincent, 27 mars 2020)

[6] https://plus.lesoir.be/291151/article/2020-03-30/coronavirus-essai-clinique-cet-automne-pour-un-vaccin-de-johnson-johnson?referer=%2Farchives%2Frecherche%3Fdatefilter%3Dlastyear%26sort%3Ddate%2520desc%26word%3Dchloroquine%22 [Last accessed on March 31th]


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