Hydroxychloroquine expert fact-checks President Trump's claims about drug as coronavirus treatment

President Trump continues to endorse the drug hydroxychloroquine as a treatment for the coronavirus. Experts urge more caution.
There are many topics that President Donald Trump returns to in his daily coronavirus task force briefings — ventilator stockpiles, hospital ships, governors who are flattening the curve — but few have been as vigorously endorsed as the anti-malaria drug hydroxychloroquine.

On Monday, Trump announced that his administration had ordered 29 million doses of the drug as a treatment option for the more than 387,000 Americans who have tested positive for the virus. His plan stems from a March 20 study out of the U.K., which found positive effects among COVID-19 patients who took a combination of hydroxychloroquine and the antibiotic azithromycin.

Although the study garnered international attention, many have since criticized the small sample size (26 people) and the fact that it was non controlled (the patients were all at different hospitals).

In the absence of more evidence, however, Trump has continued to tout the anti-malaria drug, saying in a briefing over the weekend that he “may take it,” and that it’s both “powerful” and “profound.” In a Tuesday press conference, he cited a Democratic lawmaker in Michigan who believes the drug saved her life — and thanked Trump for pushing to make it available.

While the president’s confidence about the drug may be comforting, experts continue to urge caution when discussing its potential — among them, Anthony Fauci, MD, director of the National Institutes of Allergy and Infectious Diseases. “I think we’ve got to be careful that we don’t make that majestic leap to assume that this is a knockout drug,” Fauci said Friday on Fox News. “We still need to do the kinds of studies that definitively prove whether any intervention ... is truly safe and effective.”

As the drug enters clinical trials in the U.S., many experts are speaking out about the need for more testing before conclusions are drawn. Christopher Plowe, PhD, a professor of global health at Duke University and a world-renowned expert on malaria drugs (including hydroxychloroquine), is one of them. Here, he helps fact-check some of the president’s recent declarations.

Trump claim: The benefits of hydroxychloroquine outweigh the risks

At a press briefing Tuesday, Trump suggested the risks associated with hydroxychloroquine are not an issue to be concerned with. “The side effects are the least of it, there are people dying all over the place — and generally the side effects are really with the Z-pack having to do with the heart,” Trump said. “The Z-pack. That's the antibiotic, not with hydroxychloroquine.”

Trump spoke of the issue more bluntly on Sunday, encouraging Americans to take the drug by saying: “What do you have to lose? What do you have to lose?”

Fact: Hydroxychloroquine has side effects, one of which can be fatal

According to Plowe, who has been studying the drug for decades, Trump’s statements are misguided. “You can lose your life. That's pretty clear. This is a drug that can cause serious side effects. The eye issues tend to be people who've taken it for a long time. But the really serious cardiac issues — the potentially fatal cardiac arrhythmias — those can occur the first time you take the drug,” Plowe tells Yahoo Lifestyle. “And it's not just older people who have heart issues, who are at risk. It can even occur in people with normal hearts, so that's a real concern.”

The most common side effects associated with hydroxychloroquine are headache, dizziness, nausea and vomiting, but cardiotoxicity — “medication-induced damage to the heart” — has been documented as a “rare but serious complication” of the drug. Z-packs, as Trump mentioned, have also been tied to deadly heart complications, also in rare cases.

Trump claim: Doctors suggest healthy people start taking the drug

In the press briefing on Tuesday, Trump said that healthcare workers are beginning to take the drug prior to getting sick. “They also say it's good for the hospital workers to take them that it keeps it away, it keeps it out of your system,” Trump said. It’s a claim he also raised over the weekend: “They say taking [hydroxychloroquine] before the fact is good,” he said, adding that he “may take it.”

Fact: There are no studies showing that the drug prevents COVID-19

“I have not seen any such evidence,” says Plowe. “We use chloroquine for malaria prophylaxis, but ... it’s just one pill a week basically.” Plowe explains that taking hydroxychloroquine as a preventative would require a completely different dosage and schedule. “Even if there was strong evidence — which we don't have — even if there were strong evidence that it was beneficial at higher treatment doses until you have a randomized controlled trial with a prophylactic ... I don't even know what dose he would take if he was going to take it,” says Plowe. “I am not aware of any evidence about prevention or prophylactic doses for this indication.”

Trump claim: Hydroxychloroquine is showing “great results”

After sharing the story of the Democratic lawmaker in Michigan on Tuesday, Trump said there are “many stories” like that one and reiterated to Americans that the drug is working. “I'm not a doctor, I'm just saying we hear great results and some people say, let's go to a laboratory. Let's test it for a couple of years now,” Trump said. “We got people dying in this country and all over the world right now, not in a couple of years. There are people dying and I really think it's a great thing to try just based on what I know.”

Fact: It’s too soon to know whether the drug can treat COVID-19

Plowe says it’s too early to make a call on whether or not the drug will work. “I think Dr. Fauci is right on target, that the only way we're going to have confidence that would warrant recommending this is going to be a randomized controlled trial. And there's a bunch of those in progress,” says Plowe. “There's just so many ways that you can have a bias in [an uncontrolled] trial. Until you do the randomized controlled trial, you just don't have the results.”

Much of the discussion surrounding the drug’s success has been anecdotal, but in Plowe’s experience, even that is unimpressive. “My son is the emergency room resident in a hospital in Brooklyn and he has seen people who have been taking hydroxychloroquine and Z-packs in the community and his anecdotal impression is that it’s making no difference whatsoever,” Plowe says. “And he's seeing patients day in and day out. So that's my anecdotal evidence that clinicians on the front lines — at least the one that I'm talking to — [are] not seeing any suggestion that this is making a difference.”