Besides the fact that US president Donald Trump believes it to be a cure for Covid-19, hydroxychloroquine is mainly used to treat or prevent malaria.  

Chloroquine and hydroxychloroquine are synthetic forms of quinine, which for hundreds of years was a known anti-malarial treatment. Quinine is a compound that comes from the bark of the cinchona tree which is native to parts of West Africa and central and South America. 

From the 1940s to the early 2000s chloroquine and hydroxychloroquine were widely prescribed for Malaria, both as prevention and cure. 

Dr Joel Oliviera, a GP who practises in Cape Town’s southern suburbs confirms that hydroxychloroquine, drug class aminoquinoline, is however no longer used in Africa due to the high resistance of the main form of malaria found in Africa – plasmodium falciparum. The drug was still widely used and prescribed for malaria in Africa up until the early 2000’s. 

In South Africa, says Oliviera, hydroxychloroquine is mainly used for auto-immune conditions like systemic lupus erythematosus (SLE) and rheumatoid arthritis. This is true internationally as well, with many studies around the “repurposing” of medications showing how drugs originally developed to combat one thing, are now being used to even more successfully combat something else. Or a number of something elses.  

So while they started out being used for malaria, hydroxychloroquine and chloroquine are now more widely used for a variety of other conditions and are known to have “anti-inflammatory, immunomodulating, anti-infective, antithrombotic and metabolic effects… and… anti tumoral properties”. It is also effective for the treatment of intestinal amebiasis, a parasitic infection in the gut and another reason not to underestimate the power of good hand hygiene.  This parasite thrives in unsanitary conditions and human faeces and lives in the large intestine. More on this parasite here: HarvardHealth. 

In the US, hydroxychloroquine as Plaquenil is widely used for arthritis and as a treatment for lupus. A recent study on its use against Covid-19 which declares that it is not peer reviewed, concludes that: “we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalised with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before  widespread adoption of these drugs.  Also see the New England Journal of Medicine. 

The side-effects of hydroxychloroquine are many and well documented and include headaches, dizziness, vomiting, hair loss, stomach pain, depression, anxiety, skin rashes – people who have psoriasis are warned not to take it. It can also cause corneal changes and when it is prescribed for people with arthritis, they are first sent to an opthalmologist to test the condition and health of their eyes. Doctor Oliveira says, “it causes visual defects” which would be due to the corneal changes and present as blurred vision, photophobia or haloes. Other serious side effects, adds Oliveira, are “bone marrow suppression and cardiac arrhythmias… it has a narrow therapeutic range so it can be toxic if the dosing is too high”. 

Website www.drugs.com says it can also cause “large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet and sex organs” as well as “loss of hearing… unusual bleeding or bruising… unusual facial expressions…”  Clearly a drug not to take if one does not absolutely need to deal with an issue that is worse than all of the above. 

As US president Donald Trump announced on Monday, 18 May that he is taking hydroxychloroquine to ward off the coronavirus, medical experts have gone out of their way to ask people not to take it. They also commented on the example he was setting. 

On Thursday, 21 May, when asked what he would do if there was a second wave of coronavirus in the country –which has started opening states and relaxing restrictions aimed at halting the spread of Covid-19 – Trump responded: “We’re not going to close the country.” The US president was touring a Ford facility in Michigan when he made the comments. He was also not wearing a mask, as required by state law in Michigan, and has consistently refused to wear one. 

Mask wearing has been a huge cause of confrontation and even death in the state of Michigan where a security guard was killed and people working in stores have been attacked for asking shoppers to wear masks. Some seven states have made mask wearing in public mandatory, including; New York, New Jersey, Connecticut, Hawaii, Maryland, Rhode Island and Pennsylvania. 

US states started opening towards the end of April, with almost all states open by 20 May. Despite a number of states reporting rising numbers of cases, and health experts warning that a second wave could be worse than the first, the opening shows no sign of slowing. US Health experts are predicting that in the next two months, deaths could exceed current numbers which on Thursday, 21 May were 95,000 deaths and over 1,5 million infections: coronavirus-us-maps-and-cases.  

In the midst of all the unknowns and fear about the virus and in the face of a president “pushing a cure”, it is understandable that some people will want to try it. But while sales and requests for the drug are on the increase, your best protection is still in washing your hands, not touching your face, adhering to sneeze etiquette and maintaining a safe distance from others.  

Dr Oliveira says if you think you have the virus or are afraid of getting it: “In terms of chloroquine/hydroxychloroquine – don’t take it. If you have Covid-19 you need rest, fluids, paracetamol and self-isolation. You need to seek medical attention if your lower respiratory symptoms worsen, ie shortness of breath and cough. Or if your general state deteriorates.” DM