A former Army doctor who has spent a career helping veterans who believe they were permanently harmed by malaria drugs said two medications being considered to treat the COVID-19 coronavirus could cause brain damage and other long-term health problems in some "susceptible individuals."
A small French study on the use of hydroxychloroquine to treat COVID-19 garnered attention last week when President Donald Trump touted its results and promised to make the drugs "available almost immediately."
The non-clinical trial found that hydroxychloroquine, a derivative of chloroquine, lowered the virus counts of 20 patients with COVID-19 within six days of it being administered. When used together with the antibiotic azithromycin, it cured six individuals of the coronavirus within a week.
"HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine," Trump tweeted March 21.
Trump announced Monday that 10,000 "units" of hydroxychloroquine and azithromycin will be distributed tomorrow morning in New York City to patients with COVID-19.
"It would be a gift from God if it worked, a real game changer," Trump said.
The president's support prompted a run on chloroquine and hydroxychloroquine: The hospital purchasing organization Premier said orders for chloroquine spiked by 3,000% this month while those for hydroxychloroquine increased 260%.
According to the Centers for Disease Control and Prevention, physicians in the U.S. have been using it "off-label" -- for use other than what is recommended by the Food and Drug Administration -- to treat patients hospitalized for COVID-19.
But Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said research is needed to determine whether the medications are safe and effective for treating COVID-19.
"We are trying to strike a balance between making something with the potential of an effect to the American people available while at the same time doing it under the auspices of a protocol to determine whether it is truly safe and effective," Fauci said during a press briefing March 20.
He added that, although chloroquine has been used safely as a treatment for malaria, what "we don't know is when you put it in the context of another disease whether it is safe."
"Any drug has some toxicities. The decades of experience that we have in this drug indicate that the toxicities are rare and they are in many respects reversible," Fauci said.
On Monday, Phoenix-based Banner Health hospital said a man died and a woman is in critical care there after ingesting chloroquine phosphate, a chemical used to clean fish tanks.
The health company urged patients not to ingest chloroquine or any household products to prevent COVID-19.
"Given the uncertainty around COVID-19, we understand that people are trying to find new ways to prevent or treat this virus, but self-medicating is not the way to do so," Dr. Daniel Brooks, Banner Poison and Drug Information Center medical director said in a release. "The last thing that we want right now is to inundate our emergency departments with patients who believe they found a vague and risky solution that could potentially jeopardize their health."
According to the Food and Drug Administration, chloroquine and hydroxychloroquine can cause mild side effects such as headache, stomach aches, loss of appetite and diarrhea, and more serious issues including blurred vision, tinnitus, muscle weakness and irregular heartbeats.
The drugs are not recommended for patients who are prone to arrhythmia or taking other medications that can cause irregular heart beats or those who are immuno-suppressed or have kidney conditions.
They also can cause "irreversible brain and brain stem dysfunction, even when used at relatively low doses" in some patients, according to former Army preventive medicine officer Dr. Remington Nevin, who now serves as executive director of The Quinism Foundation, an advocacy group that supports research on quinoline drugs, including chloroquine, hydroxychloroquine and mefloquine -- a malaria prevention medication once taken by U.S. troops that the FDA says can cause lasting mental health problems.
"These are not safe drugs," Nevin said in a statement Monday. "Drug-induced dysfunction causes a disease of the brain and brain stem ... which can be marked acutely by psychosis, confusion and risk of suicide and by lasting psychiatric and neurological symptoms."
He said some of the side effects seen in veterans who have taken quinoline medications to prevent malaria include symptoms that can mimic post-traumatic stress disorder or traumatic brain injury.
Nevin added that he is concerned about the increase in interest among the general public in obtaining chloroquine or hydroxychloroquine without a doctor's prescription, primarily via the internet "without proper oversight."
He also told Military.com that he has received emails asking whether quinine, the flavoring in tonic water derived from the cinchona tree, will prevent COVID-19.
"Drinking several bottles of tonic water will result in consuming pharmaceutical quantities, and therefore potentially harmful, amounts of these drugs," Nevin said. "Tonic water is a prescription medication masquerading as a cocktail mixer."
The FDA announced last week that it will launch a large clinical trial to determine whether chloroquine or other drugs work to combat COVID-19.
Working with researchers across the globe, scientists at Quantitative Biosciences Institute (QBI), a research arm of University of California San Francisco, have identified 69 existing drugs that work on genetic material similar to SARS-CoV-2 coronavirus, the official name of COVID-19.
Nearly 30 have already been approved by the FDA.
"The team of 22 labs ... is working at breakneck speed -- literally around the clock and in shifts -- seven days a week. I imagine this is what it felt like to be in wartime efforts like the Enigma code-breaking group during World War II," UCSF professor and QBI Director Nevan Krogan wrote at theconversation.com.
-- Patricia Kime can be reached at firstname.lastname@example.org.
Read more: The Military's COVID-19 Response