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COVID19

Could the low rate of Coronavirus in Sub-Saharan Africa be from Chloroquine use?

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As of March 19, 2020, COVID-19 has spread to 178 countries and territories. The death toll in Italy has surpassed that of China where the first case was reported. In the United States, the number of cases is now over 11,000. As the world struggles to contain the spread of the virus, President Trump on Thursday during the White House press conference announced that chloroquine would be made available by prescription. Speaking about the drug, the president said,

“Chloroquine or hydroxychloroquine, this is a common malaria drug. It’s also a drug used for strong arthritis… It’s been around for a long time, so we know if things don’t go as planned it’s not going to kill anybody… [Chloroquine has shown] very, very encouraging early results, and we’re going to be able to make that drug available almost immediately.”

President Trump Tips Chloroquine For The Fight Against Coronavirus

However, the statement by President Trump has thrown up another controversy concerning the efficacy and safety of the drug. There has been wide condemnation of the Trump administration concerning the slow response to the pandemic particularly the shortage of testing kits. Minutes after the President’s speech, the commissioner of the Food and Drug Administration, Stephen Hahn took the microphone with a slightly different view. He said,

“[Chloroquine is] a drug that the president has directed us to take a closer look at… to actually see if that benefits patients. Again, we want to do that in a setting of clinical trial, a large pragmatic clinical trial to actually gather that information and answer that question that needs to be asked and answered.

Recent Findings on the use of Chloroquine to Treat Coronavirus

Chloroquine is a widely prescribed anti-malaria drug. Its use in the United States dates back to 1949. Countries like Belgium, China, and South Korea have added it to their COVID-19 treatment guidelines. Early laboratory tests and anecdotal reports suggest chloroquine has positive signs in fighting the virus. In a publication on the International Journal of Antimicrobial Agents, a group of French researchers said,

“If clinical data confirm the biological results, the novel coronavirus-associated disease will have become one of the simplest and cheapest to treat and prevent among infectious respiratory diseases.”

One of the three authors of the article was Didier Raoult, The early report from the researcher’s trial was positive. According to Raoult, it appears chloroquine shorten the infectious time of COVID-19 patients. According to Medscape, including Azithromycin may help reduce viral load. Also, Azithromycin helps to fight lung infections that come along with COVID-19.

Earliest mention of chloroquine as having ‘fairly good inhibitory effect’ on COVID-19 was by China News Service in late January. It was one of the three drugs (chloroquine, ritonavir/lopinavir, and remdesivir) out of 30 selections that showed great promise.

Doctors in Marseille, France claim chloroquine successfully used to treat coronavirus patients. In a study with 36 patients, 20 were given the drug. Subsequently, 70% of the patients that received chloroquine were cured after six days. However, in the control group success was only 12.5 percent. Also, doctors in China and Australia are reporting similar successes.

Could the low rate of Coronavirus in Sub-Saharan Africa be from Chloroquine use?

Malaria is endemic in sub-Saharan Africa. For many years, chloroquine was the first drug for treating patients with malaria. However, the causative agent of malaria soon became resistant to chloroquine. The region was forced to switch to artemisinin-based combination therapy (ACT). Consequently, sub-Saharan African countries adopted policies with the recommendation of the World Health Organization to stop the use of chloroquine in 2007.

Malawi was the first African country to discontinue the use of chloroquine in 1993. However, the 2008 World Malaria Report showed that only 3 percent of children suspected to have malaria got ACT treatment. Up until the beginning of the last decade, many African countries continued to use chloroquine for malaria treatment.

Shortly after the report that chloroquine may be an effective treatment for coronavirus, many African took to Twitter to express their views. A few were of the opinion that chloroquine use may be the reason there are low cases of the virus in sub-Saharan Africa.

During the heat of the debate late last month, the Nigerian Medical Association (NMA) president, Dr. Adebayo Faduyile told The PUNCH that chloroquine was not yet an established remedy. According to Dr. Faduyile, the drug is not in the country since its use has been stopped many years ago.

Weighing the Good and Bad Side of Chloroquine

Available data suggest that chloroquine work by inhibiting the chemical transformation of the proteins in the outer shell of the virus. This process is known as glycosylation. It’s an important process in viral infection. However, inasmuch as chloroquine shows lots of promise, it is important to bear in mind that it also has side effects. A pulmonologist and internist at Lenox Hill Hospital in New York City, Dr. Len Horovitz said,

“There is evidence that chloroquine is effective when they looked at SARS in vitro with primate cells. The way that it worked against SARS was by preventing the attachment of the virus to the cells. Chloroquine interfered with the attachment to that receptor on the cell membrane surface. So it’s disrupting a lock and key kind of mechanism of attachment. The principle side effects reported were headaches, gastrointestinal side effects like nausea, diarrhea and hair loss, primarily.”

Also, researchers at the University of Queensland in Australia recently reported that the combination of Kaletra (an HIV drug) and chloroquine led to the complete recovery of some of the first COVID-19 patients. However, more people on Twitter are objecting to the use of chloroquine because of possible serious side effects.

Can anyone Use Chloroquine Now for Coronavirus Prevention and Treatment?

Inasmuch as there are records of successful tests, there is still not enough data to support the use of chloroquine for coronavirus treatment. However, what the president and the FDA are trying to do is to approve the use of chloroquine for trial in severe cases of coronavirus infection. Also, this will allow the FDA to gather more data on the efficacy of the drug as well as determine the proper dosage.

Results from successful trials are usually conducted among a very small number of patients. However, to be scientifically convincing, the same result needs to be replicated on a larger scale. A lot of people may be wondering why a malaria drug was considered for COVID-19. However, the answer lies with the Severe Acute Respiratory Syndrome (SARS) outbreak about 10 years ago. Dr. Andrew Preston, reader in microbial pathogenesis at the University of Bath explains,

“[Chloroquine] received relatively little attention as the Sars outbreak died away. Recognizing that the current Covid-19 virus is a close relative, several researchers have already tested whether chloroquine might be a therapeutic for the current pandemic.”

How easy is it to get Chloroquine?

It is possible that you may be able to get chloroquine in some drug stores. However, it is still unclear when FDA approval for use in coronavirus treatment will happen—or whether it will ever happen. Chloroquine is cheap and relatively easy to manufacture. Sanofi, a French pharmaceutical firm says it has enough to treat 300,000 patients. However, with the ongoing pandemic, the number of prescriptions has spiked—and the price too. Consequently, patients who depend on the drug for arthritis or lupus treatment are struggling to get it. Reacting to the increasing demand for the pill, the founder and CEO of Rx Savings Solutions, Michael Rea said,

“The fear, the chaos, and the panic is a far greater threat to humanity than a virus, especially for a therapy that may or may not work.”

Mary Louise Luczkowski has been using chloroquine for lupus medication. However, on Tuesday when she called her longtime pharmacist for a refill, she could not get it. She has been using the medication since 2010. Nevertheless, this was the first time she is struggling to get it. Speaking to Pulse Business Insider, she said,

“That’s the panic mentality. As we’ve seen with the toilet paper hoarding, but this one matters. You can always use Kleenex or paper towels. There are other creative ideas. For this, there really isn’t.”

The shortage happened so fast that manufacturers across the globe are struggling to meet the demand. Rising Pharmaceuticals, a New Jersey-based company that makes chloroquine has raised the price by almost 100%. However, the price hike and shortages are becoming a global problem. Across different social media platforms, people are reporting the same problem.

 

Growing COVID-19 Cases in Africa

The number of coronavirus cases is racing towards a quarter of a million. Also, the death toll has surpassed 10,000. More African countries have reported cases of coronavirus in the last 7 days. New entrants into the list include Togo, Eswatini, Somalia, Niger, Gambia, Zambia, Chad, Central African Republic, and Liberia.

The top three worst-hit countries in Africa are Egypt, South Africa, and Algeria. However, only South Africa out of the three is yet to record any deaths from the virus. Inasmuch as Algeria has the least number of cases out of the three, it has recorded 9 deaths. This makes it the country with the most deaths.

While the world continues to work towards the development of a cure or vaccine, social distancing, self-isolation, self-quarantine, and increasing personal hygiene (particularly frequent hand-washing) is important to stop the spread of the pandemic. How is your country working to contain the spread? We would like to hear your views in the comment box below. 

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