Viewpoint: Quackery Might Stall Progress Against COVID-19

November 6, 2020
Kevin Kavanagh, MD

The worst-case scenario is that if an effective and safe COVID-19 vaccine is found, a large segment of our population will elect to use hydroxychloroquine or another ineffective treatment instead, allowing the virus to continue to thrive, and devastate our nation.

The one lesson that the coronavirus disease 2019 (COVID-19) pandemic has taught me is that mankind has not changed that much. My delusions that we evolved into an enlightened society have all but been shattered. We desperately need to join together to fight COVID-19 under a coherent and united federal strategy.

Here is what Dr. Hunter Maguire, president of the American Medical Association, stated: “…that one of the most important questions of the hour was quarantine… A difficulty in dealing with infectious disease in America was the rooted dislike to the curtailment of the personal liberty of the citizens for the benefit of the people at large.” He then called for the federal government to invoke its powers to protect its citizens and aid in repelling the epidemic, similar to an invading army.

There are two profoundly disturbing truths regarding this statement. The first is that this even needs to be stated. We are floundering in hostile waters without a coordinated national response. The second was that this passionate appeal was given in 1893 regarding cholera and yellow fever outbreaks. Things have not changed much.

Centuries ago, trephination for headaches, a medieval practice of drilling holes in the skull, was a widely accepted treatment and miraculously had a 90% survival rate. Bloodletting was used to treat a wide variety of maladies by rebalancing body “humours,” a practice which spanned some 2000 years up to the late 19th century. These treatments demonstrate both bias, since once your skull has been drilled without anesthesia you are probably biased against having another procedure; and the placebo effect of bloodletting, a very dramatic procedure which everyone states will help so you believe it does help.

That being said, I still had a hard time imagining how mass hysteria and false beliefs in pseudoscience could overwhelm a culture to the point of widespread acceptance of these practices, until I witnessed the hydroxychloroquine (HCQ) phenomena. This issue should have died long ago but an October 20, 2020 survey by IPSOS found that 28% of the public still believed hydroxychloroquine is effective.

The passionate and continued obsession we as a society have over HCQ has its roots in the intense fear of a pandemic, misinformation provided by what looks like an organized foreign intelligence campaign and laboratory research which demonstrated this drug literally annihilates the SARS coronavirus. A very toxic mix which has inhibited our public health mix-messaging.

There are now eight prospective randomized controlled trials which have found hydroxychloroquine to be ineffective. The trials cover the range from prophylaxis (prevention) to mildly and severely sick patients. Hydroxychloroquine was found not to be effective.

Still there are the encouraging laboratory data findings that HCQ blocks the SARS coronavirus in cell cultures. A 2020 highly quoted study demonstrated that 99% of the virus was blocked, a phenomenal result. Why the contradiction? The answer lies in the extrapolation of results between animals and humans. This phenomenal result was obtained in green monkey kidney culture cells (VERO E6) not human cells.

A recent study published in Nature, demonstrated that HCQ blocks the enzyme needed to permit the virus to enter the monkey cell, but it does not block viral entry into human lung cells. The reason is simple, a different enzyme (TMPRESS2) is responsible for viral entry in humans.

Thus, HCQ appears to work in monkeys, not humans.

What is truly mind boggling is that there is sort of an analogy, a drug approved for another use by the FDA, which blocks the human enzyme. It is nafamostat mesylate (Fusan), which is currently used in the treatment of pancreatitis and as a short-term anticoagulant for pancreatitis. This drug is currently in clinical trials to determine if it is efficacious in treating COVID-19.

The cocktails which are promoted combine HCQ with the antibiotic Azithromycin have an additive cardiac toxicity and deadly results can be seen when used in patients with severe COVID-19, many of whom have viral heart damage. I find it hard to believe that anyone would even think of administering these two medications to a patient at the same time.

And this is what is at the root of the current healthcare debacle. Not only are patients who need HCQ having a hard time finding it but those who use it may acquire a false sense of security and not wear masks or socially distance as religiously as they should. The worst-case scenario is that if an effective and safe vaccine is found, a large segment of our population will elect to use HCQ or another ineffective treatment instead, allowing the virus to continue to thrive, and devastate our nation.

As a nation, we can easily defeat this virus, but it requires us to trust modern science and embrace a national strategy coordinated by public health officials and our federal government. Let’s not embrace attitudes and views of the 1800’s.