President Trump Says Frontline Workers are Taking Hydroxychloroquine to Prevent Coronavirus—But Are They?
Under very specific, controlled circumstances, some health care workers are taking the drug to see if it can impede COVID-19. But it's absolutely not available for the general public.
President Trump made the surprising claim on May 18 that he had been taking the anti-malarial drug hydroxychloroquine. He later told Sinclair Broadcast Group in an interview that he had "just finished" his course of treatment. No, he does not have COVID-19 but reportedly began taking the drug in an attempt to stave off a possible infection.
Trump disclosed that the drug was not recommended by his doctor but that he requested it from White House Physician Sean Conley, DO, who said in a statement per the Associated Press that after “numerous discussions” with Trump about evidence for and against using hydroxychloroquine, “we concluded the potential benefit from treatment outweighed the relative risks." Trump mentioned that he's also taking zinc along with his hydroxychloroquine, and that he took a dose of azithromycin.
Trump had been touting hydroxychloroquine for months; during a White House Coronavirus Task Force briefing in March, he called it a "game-changer" in the battle against coronavirus. But the news that he'd been taking hydroxychloroquine himself was surprising, to say the least. And in explaining his reasons for taking the drug, one stood out among the others: That it's reportedly being used by frontline workers, like doctors and nurses, in health care settings. "You'd be surprised at how many people are taking it, especially the frontline workers," he said. He reiterated that point again later on, saying "you look at frontline workers—you look at doctors and nurses—a lot of them are taking it as a preventative."
While it needs to be said up front that, under no circumstances should someone take it upon themselves to take hydroxychloroquine as a preventative for COVID-19, the fact that the president said this needs some fact-checking. Here's what's really going on with frontline workers and hydroxychloroquine—and what you need to know about it.
Are frontline workers taking hydroxychloroquine to prevent COVID-19?
First, it'd be remiss not to mention that there's been a lot of controversy around hydroxychloroquine and COVID-19 in general—primarily linked to Trump publicly championing the drug and ultimately leading to its scarcity for those who take it as prescribed to treat lupus or rheumatoid arthritis.
Overall, while there are currently clinical trials being conducted into whether the drug can safely and effectively treat COVID-19, the jury is still officially out. In April, the Food and Drug Administration issued a warning about the drug, noting reports of “serious heart rhythm problems” in some patients with the virus, many of whom were also taking the antibiotic azithromycin (commonly referred to as Zithromax or a "Z-Pack").
There is at least some truth to Trump's statement that frontline workers are taking hydroxychloroquine—but it's not as simple as doctors doling out dosages of the drug for their own benefit.
Throughout the US, there are several studies taking place in hospitals to test the efficacy of hydroxychloroquine as a preventive measure for COVID-19 in health care workers. One of those studies—at Henry Ford Health System—began in April. The study, aptly called “Will Hydroxychloroquine Impede or Prevent COVID-19,” or WHIP COVID-19, is looking at 3,000 health care workers and first responders in Michigan and is entirely volunteer-based. Researcher and interventional cardiologist William O'Neill, MD, the study's principal investigator, confirmed to Health on May 26 that the hospital was continuing to enroll volunteers in the trial. Preliminary results are expected in "about four months" from the April press release date.
Adrian Hernandez, MD, a professor of medicine in cardiology at Duke University is spearheading another study to determine if hydroxychloroquine can effectively prevent coronavirus infections in health care workers. The study—officially called the Healthcare Worker Exposure Response and Outcomes (HERO) research program—will consist of two parts, according to a Duke Clinical Research Institute press release: a national registry and then a clinical trial. The clinical trial—which was set to launch in late April, according to the April 1 press release—plans to identify 15,000 health care workers on the registry to participate, and "will randomize participants to either one month of hydroxychloroquine or one month of placebo and will examine whether hydroxychloroquine is effective in decreasing the rate of COVID-19 infection."
David Boulware, MD, MPH, an infectious disease doctor at the University of Minnesota, revealed on Twitter recently that he, too, is part of a clinical trial—led by his colleague, Radha Rajasingham, an assistant professor of medicine at the institution's Division of Infectious Diseases and International Medicine—testing hydroxychloroquine as a possible preventative measure against COVID-19. "There are no data that pre-exposure prophylaxis is effective to prevent coronavirus," he said in a tweet. "It may be. It may not be. We do not know. The only way I would recommend taking #hydroxychloroquine is within a clinical trial."
So does that mean hydroxychloroquine can be used as a preventive measure?
No, no, no, definitely not. This is precisely why clinical trials are taking place: To see if hydroxychloroquine could be used as a preventive measure—but it has not been proven yet.
"There is no scientific evidence for any medication including hydroxychloroquine, that if taken, can prevent one from becoming infected with COVID-19,” Jaimie Meyer, MD, a Yale Medicine infectious disease doctor and assistant professor at Yale School of Medicine, tells Health. “The only effective measures for preventing COVID-19 thus far are really behavioral. So they include things like social distancing, hand hygiene, cleaning and disinfecting practices, and other behavioral measures.”
Several other health care workers across the country echoed Meyer's statements that hydroxychloroquine is not to be used as a preventive treatment in those who are not specifically involved in a clinical trial. Their resounding reasoning? There's just not enough scientific data to back it up (again, that's where the clinical trials come into play). “We have never recommended this drug as a preventative as there are no data (and never has been) to support that it helps to prevent the virus,” LeeAnn Miller, MS, PharmD, vice president, chief pharmacy officer, Yale New Haven Health System, tells Health.
Despite the clinical trials currently taking place, some health care workers still strongly disagree with even the chance of the drug being used as a preventive method, due to the lack of clinical evidence of the drug as a treatment. "While hydroxychloroquine is under investigation as a possible treatment option for COVID-19, it is not an FDA-approved treatment,” Jessica Nouhavandi, PharmD , co-founder of Honeybee Health, tells Health. “Due to the lack of sufficient clinical evidence for the safety and efficacy of hydroxychloroquine in treating COVID-19 patients, the WHO and CDC have also refrained from endorsing this treatment option.”
Nouhavandi, along with many other physicians, is also incredibly concerned with the “serious side effects” of hydroxychloroquine, especially when taken in combination with azithromycin. “Several reports have been made of fatal overdoses of the drug in coronavirus patients around the world. And it is irresponsible to overprescribe an unproven prescription medication ‘just in case’ in response to pressure from patients,” she says. “We should—and do—expect better from healthcare professionals."
In Trump's case specifically—as an extremely public figure who has access to a wider range of health care professionals at a moment's notice than almost anyone else—Dr. Hernandez doesn't believe taking hydroxychloroquine as a preventive measure would pose any real danger, "assuming he is not taking any drugs that would interact with hydroxychloroquine and doesn’t have a significant history of ventricular arrhythmias." Dr. Hernandez reiterates, however, that Trump "[is] in a highly supervised area with access to immediate clinical care. Whether the benefits outweigh any known risks even if small is unknown.”
That said, beyond his own health risks, experts worry that his messaging around hydroxychloroquine has the potential to harm other people, says Aragona Giuseppe, GP (equivalent of an MD in the US), a medical advisor for Prescription Doctor. "With Trump saying that he is taking it, there is of course [the] risk that many doctors and nurses may follow suit and also start taking the drug," she says.
So we'll leave you with this: Under no circumstances, should anyone take hydroxychloroquine, chloroquine, or azithromycin for COVID-19—either to prevent or treat it—without specific recommendations from a doctor, or unless they're involved in a controlled study done through a reputable medical organization.
The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.
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