This Thursday (Mar. 19) during the White House press briefing on coronavirus Covid-19 in the United States, US president Donald Trump surprised some observers in the medical sciences world when he revealed the US Food and Drugs Administration had approved the use of chloroquine and hydroxychloroquine for the treatment of the coronavirus in patients.
This wasn’t totally accurate, but the FDA had indeed approved coronavirus patient trials of the drugs, which are best known for the treatment of malaria and arthritis. The decision came after early studies showed that chloroquine and Hydroxychloroquine are effective in inhibiting the disease when tested in vitro with primate cells.
During the conference, FDA commissioner Dr. Stephen Hahn said the regulator is preparing to test the drug in a clinical trial with coronavirus patients. There are already clinical trials in China and more scheduled to start in several other countries.
SARS and the novel coronavirus infect humans when protein spikes on the virus’s surface bind to special receptors on the surface of human cells. Chloroquine worked against SARS by interfering with those receptors, thereby reducing the virus’s ability to bind to cells. Researchers believe there is a chance Chloroquine can do the same against Covid-19. However, Hahn pointed out some concerns about the drug as a possible treatment for the virus. “We may have the right drug, but it might not be in the appropriate dosage form right now, and it might do more harm than good,” he warned.
Unfortunately, the cat was out of the proverbial bag. Earlier this week, Google Trends identified “chloroquine” as the second most searched coronavirus-related term in the US.
Mentions of chloroquine have also been trending on Twitter in Nigeria and Ghana. Why? Africa accounts for 92% of malaria cases in the world and chloroquine-based drugs are very familiar medications on the continent. As soon as rumors started circulating of a possible Covid-19 “cure” with chloroquine, it went viral on Nigerian social media. Many Nigerians have reportedly started to stock the drug. Trump’s comments led to a rapid increase in the price of the drug and to pharmacies running out of stock.
There’s also a downside to chloroquine, which many Africans have sometimes used reluctantly because of its side effects. Some have been sharing their “chloroquine experience” on social media. Other than its very bitter taste, the most talked-about experience is the “pruritus and paresthesia” it causes. These are stinging, burning, or prickling sensations which worsen with age and can last for hours or even days as the most common side effects.
Chloroquine was discovered in 1934 at Bayer Laboratories, which named it Resochin. It was ignored for a decade because it was considered too toxic for human use. During World War II, US government-sponsored clinical trials for antimalarial drug development showed unequivocally that chloroquine has a significant therapeutic value as an antimalarial drug.
It was introduced into clinical practice in 1947 for the preventive treatment of malaria. The disease is caused by the protozoan parasite plasmodium, which often grows in the liver before infecting red blood cells. With malaria, chloroquine works by interfering with the growth of the parasite in the cells.
However, the use of chloroquine for treating malaria has dropped over the years; other drugs are used more often today. Dr. Chimaobi Nwokeocha, a medical doctor at a private hospital in northern Nigeria, says many doctors stopped using chloroquine because patients complained of side effects, and because the resistance of the malaria parasite towards it increased. But he acknowledges chloroquine is still widely used.
Some of the side effects also include chloroquine retinopathy (damage to the retina) and insomnia, but of even more concern is that the drug can also be deadly if abused. In Nigeria, due to a lack of enforced regulation, it is fairly easy to get prescription medicine over the counter at local pharmacies. Since Trump’s announcement, there have been two cases of chloroquine poisoning reported in Lagos. “It is not advisable for anyone to buy chloroquine over the counter without a doctor’s prescription,” says Nwokeocha.
Hydroxychloroquine, the less toxic derivative of chloroquine, appears to be the drug of choice for large-scale use compared to other drugs with similar capacity, due to its availability, proven safety record, and a relatively low cost.
There has been much talk and concern over Africa’s “fragile health systems” as the coronavirus spread picks up speed across the continent, where it is now in more than 30 countries with over 800 cases. That’s why if chloroquine is proven to indeed be an effective Covid-19 treatment, many Africans will be relieved as a familiar and accessible drug might just be able help prevent a catastrophe on the continent.
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