American Thoracic Society Suggests Hydroxychloroquine For Hospitalized COVID-19 Patients

An international emergency task force led by the American Thoracic Society (ATS) has updated its interim COVID-19 guidelines to include a recommendation to use hydroxychloroquine (or chloroquine) for hospitalized patients on a case-by-case basis who have evidence of pneumonia. 

The medication, which was originally developed as an anti-malaria drug, has been touted as a possible treatment of COVID-19 by both President Trump and even some doctors who have claimed it has helped some infected patients.

Here Is What The ATS' Interim Guidelines Say

Currently, there isn’t enough evidence for anyone to definitely say that hydroxychloroquine or chloroquine works as a treatment against COVID-19. In the absence of clear guidelines to follow for treatment, clinicians still need to make decisions right now, so the task force was created to help make suggestions on “controversial topics” such as hydroxychloroquine. 

Here is a summary of what the ATS guidelines state, 

• In the interim COVID-19 guidelines, the ATS makes it clear that its suggestions are based only on “scarce” direct and indirect evidence, along with clinical observations, and that they aren’t official positions of the American Thoracic Society or any organization represented. 
• The task force listed its rationale for recommending hydroxychloroquine and chloroquine because it has been shown to have in vitro activity against SARS‐CoV‐2, with hydroxychloroquine being more potent. 
• In addition to the use of hydroxychloroquine or chloroquine for hospitalized patients with evidence of pneumonia, the guidelines also recommend the use of prone ventilation and ECMO in patients with refractory hypoxemia due to COVID‐19 pneumonia. 
• Despite the recommendations, the task force guidelines also state that they are not mandates, that individual clinical circumstances should always be considered, and that the guidelines are subject to change as more evidence is gathered. 

thoracic.org

The Hydroxychloroquine Controversy

Hydroxychloroquine has been a source of controversy, after President Trump faced backlash for several comments publicly supporting the drug, as White House health advisor Dr. Anthony Fauci warned that more studies are needed to know if the medication is even safe or effective.

The drug first gained attention based on a French study that found that the medicine, when used in combination with the antibiotic azithromycin (z-pack), could be used to treat coronavirus, but subsequent studies have been conflicting. 

What Does The CDC Say About Hydroxychloroquine? 

On the CDC web-page titled, Information For Clinicians on Therapeutic Options for Patients With COVID-19, Hydroxychloroquine is listed,

Hydroxychloroquine and chloroquine are oral prescription drugs that have been used for treatment of malaria and certain inflammatory conditions. Hydroxychloroquine and chloroquine are under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19. More information on clinical trials can be found at ClinicalTrials.gov

FDA issued an Emergency Use Authorization (EUA) to authorize use of chloroquine and hydroxychloroquine from the Strategic National Stockpile for treatment of hospitalized adults and adolescents (weight ≥50 kg) with COVID-19 for whom a clinical trial is not available or participation is not feasible. 

Some Hospitals Are Already Administering Hydroxychloroquine 

However, some hospitals have administered Hydroxychloroquine for COVID-19 patients. For example, Jim Santilli, a 38-year man from Macomb, MI, says he was treated with both hydroxychloroquine and azithromycin at Henry Ford Macomb during his hospitalization for COVID-19. He has claimed that an infectious disease specialist at the hospital prescribed the combination and that the medication was a “turning point” that relieved his symptoms within hours.  

Other Treatment Options for COVID-19

Although treatment options for COVID-19 are very limited at the moment and only time and more testing can determine if hydroxychloroquine is effective, scientists and doctors are working to find possible treatment options that may help patients. For instance, one promising therapy is infusing the plasma of people who have recovered from COVID-19 into infected patients currently in severe condition from the virus. 

The FDA has said that the treatment is “promising,” because it may deliver COVID-19 antibodies directly to the infected patient, but notes that it is not clear just how effective the immunotherapy is just yet. However, hospitals, such as Mt. Sinai in New York City, have already started implementing the therapy to its most critical COVID-19 patients.  

And on that note, if you or someone you know has recovered successfully from COVID-19, the Red Cross is accepting plasma donations to collect for therapy and testing to increase the efficacy of the treatment.