If all drugs that had shown promise in the laboratory could be used for treating infectious diseases, we would not have a shortage of antibiotics/antivirals.
I am always sceptical when scientists hold news conferences, announcing ‘fantastic results that should immediately be disseminated to the public’. We have had the outcomes of these non-peer-reviewed studies before, but those who do not learn from history will repeat it.
Some examples: French scientists announced a breakthrough in the treatment of HIV at a news conference convened by the French president. The fantastic discovery? Sirolimus (an immunosuppressant used in organ transplantation) turned out to be completely nonsensical.
In 2017, a small trial on the use of thiamine, vitamin C, and steroids in ICU patients treated for sepsis showed a massive improvement in survival. Despite the single small core trial and numerous methodological flaws, it gained huge traction. A large, properly designed, and randomised conducted trial eventually showed no difference in outcomes.
Chloroquine (hydroxychloroquine/plasmoquine/Nivaquine) is no stranger to this controversy. An ancient malaria drug, also used as an immune modulator in systemic lupus erythematosus (SLE) and other autoimmune diseases, it has a long history of studies showing some laboratory evidence of antiviral effects, with numerous basic scientific studies to explain the biological plausibility of these effects.
Therefore, it is not surprising that every time we are confronted with a new viral disease without any effective chemical treatment, someone digs up the old literature, touting chloroquine as the newly discovered cure-all.
In 2000, chloroquine was announced as the ‘new’ compound that would help cure HIV infections. Numerous studies followed, with multiple publications concluding that it is actually harmful and should not be used at all.
Fortunately, the Ebola outbreak in 2014 (a lethal disease with no proven cure) gave the chloroquine pundits a new lifeline. After the chaos subsided and rational thinking prevailed again, it was proven that there was no benefit in using chloroquine for Ebola infections.
With COVID-19, it seems that we need to start from square one to learn how to properly evaluate scientific evidence and stay away from populist/social-media/etc., opinions to push a specific agenda. It has not been five months since the first cases appeared, and the available evidence seems to show that not only is there zero benefit in using chloroquine for this specific disease, it may even be harmful. Those most likely to die from COVID-19 are the elderly with underlying cardiovascular disease, and they are thus more susceptible to the cardiotoxic side-effects of this ‘wonder’ drug.
High-dose steroids in COVID-19 have been aggressively promoted by eminent physicians, based on sound interpretation of biological plausibility. However, the clinical data now seems to show that high-dose steroids is harmful and should be avoided in COVID-19 management.
If any drug currently on trial shows any benefit, it will be very modest at best and will definitely not be a game changer.
Our best defence remains non-pharmaceutical interventions (NPI) for those most at risk – social distancing, hand-washing, face masks, prohibiting large gatherings (church services, spectators at sporting events, concerts, nightclubs, etc.).
I think it is imperative that, in times of chaos and uncertainty, we resort to rational thinking and evidence-based medicine to steer us through this battle.