Why are COVID-19 patients being given HCQ which was dropped by WHO?

Updated: Jun 30, 2020, 07:57 IST | Vinod Kumar Menon | Mumbai

Experts question the continued use of Hydroxychloroquine for COVID treatment despite WHO dropping it from its list

As per norms, health workers have to take regular doses of Hydroxychloroquine Sulfate as a preventive treatment. Pic/Satej Shinde
As per norms, health workers have to take regular doses of Hydroxychloroquine Sulfate as a preventive treatment. Pic/Satej Shinde

The anti-malarial drug, Hydroxychloroquine Sulfate (HCQ), which was dropped by the World Health Organization from its list of clinical trials for COVID-19 on June 17, continues to be prescribed for frontline warriors and Stage-1 COVID-19 patients in India. The drug is being given despite the knowledge of its serious cardiac side-effects. It is not to be given without a mandatory cardiac evaluation and to patients who have a deficiency of enzyme glucose-6-phosphate dehydrogenase (G6PD)."

A Senior BMC doctor, who recently recovered from COVID-19, was shocked when she learnt that she is G6PD deficient. She had been regularly taking HCQ as directed by civic authorities as a precaution. The medicine could have caused severe cardiac risk and sulfate reaction in her body.

Experts say a G6PD test and monitoring of cardiac activity is a must for patients and health workers being administered HCQ. File pic
Experts say a G6PD test and monitoring of cardiac activity is a must for patients and health workers being administered HCQ. File pic

A highly-placed civic doctor told mid-day, "Most of the frontline workers are being given HCQ as a prophylaxis (preventive treatment) on the basis of a baseline ECG. No G6PD blood test is done. As per norms, a health care worker is expected to take two 200-mg tablets in the morning and two in the evening on day one, and thereafter two tablets of 400 mg weekly, for either five weeks or till the pandemic lasts.

Cardiac and other health experts claim that the dosage is high to start with and taking it without regular monitoring could be a huge risk. Dr Wiqar Shaikh, senior asthma and allergy specialist, said, "If such a high dosage of HCQ is given to frontline warriors, chances of side-effects are immense and it is risky, especially when the screening for G6PD is not done, along with cardiac evaluation."

"If HCQ is given to a G6PD deficient patient, it will lead to haemolytic anaemia, which leads to the destruction of red blood cells causing increase in indirect bilirubin, thereby resulting in jaundice. In addition, a serious side effect of HCQ is irregular heartbeat (cardiac arrhythmia)," Dr Sahikh said.

'Does not work on inflamed lungs'
"HCQ is mainly used as an anti-inflammatory treatment for rheumatoid conditions such as arthritis (joint pain). It has no anti-inflammatory action in the upper and lower respiratory tracts which get inflamed due to COVID-19. Hence, it is of no value in COVID-19 treatment. In fact, there has been no successful trial yet," said Dr Shaikh.

This concern was echoed by a senior doctor attached to a leading pharma company. "A recent international study published in the New England Journal of Medicine on April 4 says that administering HCQ to COVID-19 patients also increased the need for escalated respiratory support. There were no benefits of HCQ on mortality, lymphopenia, or neutrophil to lymphocyte ratio improvement," the doctor said.

Dr Virendra Singh, senior pulmonologist, Rajasthan Hospital, and an advisor to the Rajasthan government on COVID-19 said, "The WHO presents the global data. As compared to the US or European countries, the mortality rate in India is lesser and moreover, the ICMR's recent data shows that HCQ has benefitted Indian patients. Since our data supports the drug's effectiveness, we should continue with it." He added, "A new study on its usage is expected to be released soon. Until then, instead of following the global data, we should stick to the local one and continue our fight with COVID-19."

A cardiothoracic surgeon's view
Dr Ajay Chaughule, a consulting cardiothoracic surgeon, said, "We are still using the trial-and-error method to treat COVID-19 patients as the virus is very new. It is being given as a prophylaxis to health workers and to patients with a milder level of COVID-19 even though it can cause cardiac complications. It is believed that it can be used as the first line of treatment to provide protection. However, we are not sure how effective it would be for moderate to severe infection."

Dr Chaughule added, "The WHO dropping it from its list had led to confusion. It is a fact that HCQ, if taken without baseline checkup, that is ECG and G6PD blood test, can cause serious side effects. Its usage is slowly being done away with. This magic drug did not do any wonders in the US either."

"We must also understand that the virus will live with us, gradually it will be like any other virus in the air. Until a vaccine is developed, the treatment that works for our people will be used. The situation was similar when tuberculosis was a challenge in India until drugs were found to fight the Mycobacterium causing it," he said.

The other side
Dr T P Lahane, director, Directorate of Medical Education Research and a member of the state task force on COVID-19, said, "We are aware of WHO directing not to use HCQ but as per the Indian government's and ICMR's guidelines, HCQs is very much a part of our first line of prophylaxis and treatment for the first stage of COVID-19." Dr Lahane added, "In case of patients above 55 years, we ensure that their ECG QT level is monitored and only then do we administer HCQ. Patients below the age of 55 years can be given HCQ as their lungs have a milder infection".

However, Dr Shaikh countered the claim, saying, "Administering HCQ without testing G6PD levels, irrespective of the age, is a wrong practice. G6PD deficiency is very well documented in India. Besides, there is no internationally published data that says HCQ is beneficial to COVID-19 patients.

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