As the world continues to fight the novel coronavirus and its resulting illness COVID-19, governments and the scientific community are racing to identify new and existing drugs that might help to flatten the curve and save lives. As of Wednesday, March 25, 2020, the CDC reports there have been a total of 54,453 individuals in the United States infected with COVID-19 and 737 deaths. Worldwide, the virus has infected 416,916 individuals, resulting in nearly 19,000 deaths, according to the European Centre for Disease Control and Prevention, posing a serious global health threat.
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While there are no drugs approved to treat, cure or prevent COVID-19, at this time, there are several potential treatments that may help ease the symptoms from a supportive care perspective, according to the U.S. Food and Drug Administration in a March 19 press release. The organization says it is working closely with the scientific community around the world and several clinical trials are underway.
Among the most highlighted of the potential candidates, has been the anti-malaria drug, hydroxychloroquine (HCQ, Plaquenil), which experts and the president have highlighted for both post-exposure prophylaxis and treatment of COVID-19.
In a recent post on the Maui Derm for Dermatologists event site, George Martin, M.D., program director, along with colleagues Ted Rosen, M.D., Sheila Fallon-Friedlander, M.D., Albert Yan, M.D., and James Treat, M.D., shared summaries of data that provide evidence of the drug's use, dosing, as well as epidemiology of COVID-19 infections (bit.ly/MauiDermHCQdata). The single best epidemiology modeling data, they note, is a commentary published on the website Medium, that shows the speed at which the virus is replicating around the world, and it is with this urgency in mind that they compiled what they viewed as the most impressive data they say may save lives.
“The number of cases reported daily grossly underestimates the true number of cases and many asymptomatic but infected individuals are unknowingly spreading the disease,” Dr. Rosen says in the summary.
Isolated quarantines will likely be insufficient, Dr. Martin says. According to a letter they cite, which was published in the New England Journal of Medicine, March 17, 2020, the virus remained stable on various surfaces for several days. The virus had the ability to remain airborne for up to three hours, and it could survive on plastic for up to three days and on steel for up to two days.
HCQ is a drug already approved by the FDA for the treatment of malaria, discoid and lupus erythematosus and rheumatoid arthritis. Therefore, it may be prescribed off-label.
While President Donald Trump announced March 19 that he’s pushing FDA to eliminate barriers to make HCQ available, FDA Commissioner Stephen Hahn says the organization will remain responsible in its evaluation of potential therapeutic options, including those that are already approved for other indications, “to make sure that patients receive the right dosage at the right time,” according to CNN politics.
Following the president's comments that HCQ could treat COVID-19 and a series of studies indicating its potential benefit, hospitals began purchasing large quantities, pharmacists reported depleted supplies and manufacturers reported back orders.
"As a result of hydroxychloroquine and chloroquine being explored as a potential treatment for COVID-19, patients currently taking these medications are having difficulties filling their prescriptions to treat their conditions," AAD president Bruce Harris Thiers, M.D., FAAD, says.