Hydroxychloroquine shows promise as a treatment for COVID-19. It’s now routinely used on hospitalized patients nationwide, and we hope ongoing clinical trials in New York will confirm a therapeutic effect. But too many restrictions remain.
Doctors need flexibility to treat documented and suspected cases and protect those most at risk of infection: themselves. More than 9,000 health care workers have been infected with the coronavirus, and at least 27 have died. A coming surge in supply means we can balance other needs for this drug with the pursuit of its promise against the pandemic.
Gov. Andrew Cuomo has restricted doctors to prescribing hydroxychloroquine only for people who’ve tested positive for the virus. This needs to be reconsidered. Across the nation, doctors want the ability to treat patients who haven’t had access to a test but show signs of infection. Requiring a positive test isn’t appropriate, especially with testing still too limited.
Even with access to testing, results can take over a week, while the patient becomes more ill, infects others and drains resources. Doctors should be able to base prescriptions on reliable signs of infection and illness. Physicians have long used this approach for critically ill patients.
Many want to prescribe hydroxychloroquine prophylactically, to protect themselves and other health-care workers from getting and spreading the infection. Some physicians are on prophylaxis already. Unfortunately, New York doesn’t allow prophylactic use for our indispensable front-line health care workers — even as personal protective equipment remains in short supply.
It isn’t just the Empire State. More than 20 states have issued guidelines restricting the use of hydroxychloroquine. Idaho requires a written diagnosis “consistent with the evidence for its use” and limits prescriptions to a 14-day supply. Ohio does the same and, if the prescription is to treat COVID-19, also requires evidence of a positive test result.
Just as we shouldn’t forbid treatment for untested but obviously sick people where tests are limited, we shouldn’t leave our most-exposed heroes unprotected. We can extend access to health-care workers ethically. They’re more informed than the general public of the occasional risks of taking hydroxychloroquine, such as heart arrhythmia. Any decision to use the drug for prophylaxis must be strictly voluntary. There should also be guidelines to prevent abuse.
To be clear: Our knowledge regarding hydroxychloroquine is preliminary, and more study is urgently needed. Nor can we forget that numerous other potential treatments are now the subject of urgent consideration, any of which could prove to be a breakthrough, either alone or in combination with each other.
But the FDA’s emergency authorization is based on data showing therapeutic and potential prophylactic effects. And it’s being studied right now at leading medical facilities here in New York and around the world. Clinical trials are ongoing, and we’re learning more every day about the potential of this treatment and the best way to apply it.
Supply concerns, while justified, are being addressed. We must ensure that people living with the chronic illnesses treated by these medicines — such as lupus and rheumatoid arthritis — can continue to access them without interruption.
Fortunately, aggressive actions are underway to this end. Our strategic national stockpile of hydroxychloroquine has topped 29 million doses, and FEMA has distributed over 19 million tablets to government agencies and major US cities — including New York.
Novartis has committed to donating up to 130 million doses, Bayer another million and Israeli firm Teva up to 10 million. Mylan will donate 10 million tablets, and Amneal Pharmaceuticals 400,000.
We should be confident that we can pursue the use of these drugs against COVID without surrendering our other responsibilities. Sick patients and exposed workers, people living with chronic illness and those with COVID-19 are all in this together. When supplies are limited, the sickest should be treated first.
As we wait for clinical studies, front-line health workers should also have access, to protect those most in harm’s way. The pandemic’s horrors have unleashed an outpouring of appreciation for our medical heroes. It would be illogical to deprive them of protection as they fight on our behalf.
Joseph Brewer is an infectious disease physician. Mark P. Goodman is an internal medicine physician.
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