I also want to say that I sincerely hope and pray that we find a treatment that is effective against COVID-19. If that turns out to be chloroquine and hydroxychloroquine, well that would be just great. But Republicans, and Donald Trump in particular, are pushing this drug as a miracle panacea for COVID-19. They're doing this based on very little scientific evidence. That is, Republicans are trying to convince low information voters that it is ok to end state-imposed restrictions on the economy because we now have a miracle of modern medicine that will protect us all.
Why? Well, they really need a miracle cure, or the thought of a miracle cure, to support their policy choices. Specifically, they don't like the fact that we have had to shut down the economy to fight the novel coronavirus that causes COVID-19. Trump believes that his re-election prospects are tied to the economy. History tells us that Presidents who face re-election in the midst of a recession generally lose. In addition, the Republican's strongest supporters, big business, can't stand the idea that their quarterly reports are being spoiled by slowed sales. Trump needs to convince you that re-opening the economy in the face of a new contagious virus taking its toll on the public is a good idea. So, he has to convince you that something, anything, is a miracle cure that makes re-opening the economy less risky.
The logical policy right now would be to discourage unnecessary contact to slow the spread of the virus so as to alleviate the pressure on our healthcare resources, at least until we can find an effective treatment or vaccine. Because this involve encouraging large portions of the economy to close down, it may also involve the Government assisting those hurt financially from enforced isolation through direct payments to allow people who can't work to pay their rent, pay for their health insurance, and feed their family.
Yet, some Republicans conveniently become deficit hawks when it means criticism of policies championed by Democrats. Funny, Mitch McConnell wasn't that concerned with the federal budget deficit when it came to tax reform, and providing big corporations with nice tax breaks. But when you have the need for social distancing and stay-at-home orders, coupled with an attempt to try to alleviate the economic impact on regular people with the so-called "stimulus checks," McConnell suddenly becomes a deficit hawk again.
This is why Trump and his supporters are so desperate to have the states lift their stay-at-home orders. He and his supporters need to have the economy restarted before November. They honestly don't care about the potential death toll that could result from re-opening the economy too early. If Trump can convince his followers that there is a miracle cure, then he can manipulate low information voters to act against their own interests.
It's funny. I actually believed that we had put the chloroquine debate to rest. We had that study from National Institutes of Health that followed patients in the Veterans Administration hospitals. The study indicated a correlation between the use of chloroquine in COVID-19 patients, and a higher mortality rate. Keep in mind, correlation does not necessarily mean causation. Plus, we must consider that the use of chloroquine as a COVID-19 treatment has only bee approved as a palliative measure. That means it has only been approved to be used when other treatments have failed, and the patient is close to death. So, you need to consider that when evaluating this study.
In fact, the Food and Drug Administration currently cautions against the use of chloroquine and hydroxychloroquine as a COVID-19 treatment outside of a clinical trial, due to the potentially dangerous side effects, such as how it could affect the heart.
Nonetheless, the NIH study is still a more comprehensive study than the French one that the chloroquine peddlers have been pointing to. That study involved less than forty patients, and was not a randomized clinical trial. To be blunt, the French study didn't use currently accepted scientific methodology.
And that is key. Real science takes time. You have studies that document experiments. Experiments need control groups for a valid comparison. You need the right number of participants so you can show that your results aren't random, and that they are statistically significant. And then, you need the studies to be reproducible. They need to be peer-reviewed, which means other doctors and medical researchers need to examine the methodology and the results to make sure no mistakes were made and that the results are accurate. Why? Because there is a lot at stake. The Hippocratic Oath that doctors take says, first, do no harm. And when you are putting chemicals in your body, there is a potential that these chemicals can affect your health in a bad way.
That's why studies take time. That's why it normally takes years for vaccines to be developed for newly discovered viruses. Sometimes, vaccines aren't developed for a particular virus. Think about HIV. We have nown about this virus and how it causes AIDS for about forty years now. We still don't have an AIDS vaccine. Why? In part, because once we eventually took notice of the suffering that AIDS caused, we discovered some effective treatments. Also, with appropriate safeguards, the transmission of HIV can be prevented. But, the point remains, we don't have an HIV vaccine. It is possible that we may never develop a vaccine to counter the novel coronavirus.
And rushing a vaccine can prove ineffective. During the 1918 influenza pandemic, for example, the first attempts to rush a flu vaccine into production failed miserably. We don't want that to happen here. That's why valid scientific methodology is so important.
But many Americans don't understand science, and this is where Republicans and their allies in the media try to manipulate low information voters. They were promoting stories of individuals who said that they took chloroquine or hydroxychloroquine and got better. This is called anecdotal evidence. It is the weakest evidence a scientist can rely on. Remember how Rush Limbaugh addressed it? "Anecdotally, it worked," is what Rush proclaimed. To the uneducated, you hear these stories, and you might conclude, hey this seems like a good idea. But, anecdotal evidence presents several problems.
First, you need to verify the anecdotes. Did it really happen? Then you need to know all of the facts and circumstances of the particular anecdote. Was there something about that particular case that made it special, or calls into question the conclusion? You need to remember, correlation does not necessarily mean causation. The result could be coincidental. Maybe the body's own defenses finally kicked in just as the patient began taking chloroquine. To reach the right conclusion, we need to know all of the factors involved. It's complicated and the process takes time.
But right now, time isn't on Trump's side. He needs to restart the economy now. He needs the states to re-open so we aren't in a recession come November, science be damned.
So, on Monday, May 18th, he revealed a very astonishing fact. He revealed that he had been taking hydroxychloroquine as a prophylactic measure. He's testing negative for COVID-19. He has no symptoms. He claims that he has been taking the drug anyway.
Now, we need to take this news with grain of salt. Trump's penchant for lying is documented and notorious. Nonetheless, his assertion still raises a number of questions.
Why now? We haven't heard him peddle chloroquine and hydroxychloroquine for weeks. Well, intellectual giant, Laura Ingraham, has been pushing a study. It's a study that say chloroquine can inhibit the infection and spread of the SARS coronavirus. She's pushing this study, and retweeting it, claiming "the left" has not been doing its research.
There are just a few problems. First, the study was published in 2005. We're facing a pandemic caused by a novel coronavirus. The word "novel" meaning that the virus is new. The current virus didn't exist until 2019. A study from 2005, then, is not directly relevant because it could not have involved the same virus that is currently causing the pandemic.
But, she's counting on the ignorant and uneducated getting confused by the terminology. The term "coronavirus" refers to a family of viruses. It is a generic term, that refers to the shape of the virus. Coronaviruses generally look like crowns. Because something is a coronavirus doesn't mean that they all have the same DNA or RNA make-up. They just look alike.
We've known about coronaviruses for years. You may see people who don't know any better pointing to disinfectant labels, and claiming this virus isn't new because the label says that the disinfectant is effective against coronaviruses. Yes, but there are different types of coronaviruses, and they all act differently.
SARS, severe acute respiratory syndrome, was a coronavirus that first appeared in 2002. It was contained, and no known transmissions have occurred since 2004. The official name of that virus is SARS-CoV1, for SARS, coronavirus one, the first of that kind that we discovered.
The official name of this new virus is SARS-CoV2, or SARS, coronavirus two. Why? It causes similar symptoms to SARS. It's genetically related to SARS. Much like humans are genetically related to chimpanzees. But they are different viruses. They act differently. They have similar symptoms, but they also have different symptoms. Just because chloroquine may have been effective inhibiting SARS does not mean it will have the effect on COVID-19. It may. It is worth investigating. But it's no guarantee.
To be clear, the idea is that cholorquine may affect the pH of the recipient's blood to such as degree that it inhibits the virus from reproducing. There is some information from India that may support this hypothesis. But, again, these are not clinical studies being conducted using modern scientific methodology. It would be foolhardy to press for the widespread use of the drug as a prophylactic measure based on such information, without confirming the hypothesis with a study using accepted scientific principles.
Nonetheless, Ingraham is counting on the uneducated seeing the similarity in names, SARS-CoV1 and SARS-CoV2, and therefore concluding that this must mean chloroquine is an effective treatment for COVID-19. Unfortunately, once again, it's just not that simple.
Plus, the President likes to downplay the potential side effects of chloroquine and hydroxychloroquine. We have been using chloroquine as a treatment for malaria and lupus for decades. We know these drugs have the potential to affect the heart. So, doctors need to careful when prescribing it and in monitoring the patients taking it. When Trump says, "What do you have to lose," potentially an awful lot. Like, your life. Especially, if you take the medication as a prophylactic measure, when you've tested negative and show no symptoms.
Still, Trump has been pushing this as a potential miracle cure for some time now. And he doesn't tolerate dissent, even if that dissent is based on science. Rick Bright, for example, is a scientist who was in charge of the Biomedical Advanced Research and Development Agency (BARDA). He refused to tow the party line, and push chloroquine consistent with the President's wishes. Bright tried to get his political bosses to pay attention to the risks. He was ignored. So, he helped corroborate information on the risks of the drug to a reporter writing about the subject. When the article was published, even though Bright was an unnamed source, he says that he was demoted. Bright has filed a whistleblower complaint over his demotion.
So science that goes against the President's chosen course of policy is under attack. Which is typical of the Trump Administration.
Now, I have to wonder about the ethics of a doctor who may have prescribed Trump hydroxychloroquine as a prophylactic measure, when the President has tested negative for COVID-19 and has no symptoms, keeping in mind the potential side effects. Remember, first, do no harm. By prescribing hydroxychloroquine in this situation, the doctor may have violated his ethical rules. If Trump is telling the truth, then the alternative explanation to the doctor violating the Hippocratic Oath is equally troubling. That would mean that the doctor is giving Trump a placebo marked as hydroxychloroquine, just to placate him. That possibility also raises ethical concerns for me.
When it comes down to it, I honestly don't care if Trump wants to risk his own life by taking hydroxychloroquine. His body, his choice. And if his core followers want to take that risk, and wind up harming themselves, well that's their own fault. But, I do worry about the low information voters who are scared, who follow the President's lead, not truly understanding the risks, or that the evidence supporting its possible benefits is sketchy at best. This is where Trump really has a responsibility to be careful in what he says. The voters he targets are vulnerable. By manipulating these voters and valuing his re-election strategy over the health of the American people, he shows his moral failing.
By: William J. Kovatch, Jr.
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