A poll of more than 6,000 physicians from 30 countries found that 37% rated hydroxychloroquine (HCQ) as the best treatment for novel coronavirus disease (COVID19). Yet, during a recent webinar on COVID-19, doctors across the U.S. described threats from many governors and state medical boards for prescribing HCQ and azithromycin "off-label" for nonhospitalized COVID-19 patients.
It was shocking to hear that our front-line warriors not only are having their medical decisions blocked, but are being threatened with disciplinary actions, including loss of license in some states.
The international poll conducted by Sermo highlighted crucial differences between the U.S. and other countries. Many fewer U.S. physicians (23%) had prescribed HCQ, while 72% of Spanish physicians used it as their first choice against COVID-19. Also, in the U.S., it most commonly was utilized for hospitalized high-risk patients with severe symptoms, while in other countries it was equally used for outpatients with mild symptoms at onset of disease.
HCQ has been FDA-approved for malaria since World War II, and now also is approved for treating lupus and rheumatoid arthritis.
These findings mean the U.S. lags behind other countries in using HCQ to prevent infection, to reduce the time that a person sheds virus and can infect others, and to keep patients out of hospitals and off ventilators.
Basic science and clinical outcomes studies from more than 10 countries show that HCQ works both before and after COVID-19 enters the cells. It increases zinc transport across the cell membrane, and the two work together to keep the virus from multiplying itself using our own cells' machinery.
It is the viral multiplication or replication that triggers the inflammatory cascade, or cytokine storm that damages organs, especially the lungs, leading to the acute respiratory distress syndrome and deaths.
Adding the antibiotic azithromycin, or possibly doxycycline for elderly with contraindications, shows a synergistic effect, as reported from France, China, and several clinical outcomes studies in the U.S.
A 2020 study shows an additional way that HCQ works: it prevents the virus from attaching to host cell surface molecules. The authors conclude: "Our data do support the use of chloroquine and preferentially hydroxychloroquine as a first intention therapy for patients infected with SARS-CoV-2 (COVID-19)."
On March 28, 2020, the Food and Drug Administration issued an Emergency Use...