Death By Tweetstorm: a Win-Win for Trump

Photograph by Nathaniel St. Clair

For lack of respirators, patients with severe respiratory distress from COVID-19 will die as the epidemic unfolds. A drug to treat the disease is urgently needed. But the US press subjected news about hydroxychloroquine, a potential treatment, to an excess of caution in response to a Trump tweetstorm. Journalists and health care professionals alike were whipsawed by the president’s irresponsible ballyhooing of the drug amid deprecatory assertions of “anecdotal” evidence by Anthony Fauci at the CDC.

This fast-moving story started picking up steam with results from a small trial of hydroxychloroquine to treat COVID-19 out of Marseilles, France, by a well-known infectious disease specialist, Didier Raoult. It follows upon another small study from China, also promising. The drug has been used to treat immune-related disease for more than 60 years. It deserves the serious consideration it’s getting from the Europeans and Chinese.

The French trial included 36 patients, 16 of whom were controls who did not receive the drug. The 20 remaining patients, all with confirmed COVID-19 infection, were treated with hydroxychloroquine for 14 days. Some were asymptomatic, others had symptoms. Six of the patients also received an antibiotic, azithromycin.

The striking result was diminished viral load in the treated patients. As Raoult and colleagues put it in their as-yet unpublished paper, “70% of hydroxychloroquine-treated patients were virologicaly cured comparing with 12.5% in the control group.” Although the mechanism of action with this virus is not known, it’s been biochemically well-characterized; it’s not snake oil.

In that context, Trump’s endorsement, laced with ignorance, made things worse. In response came Anthony Fauci’s March 20 mischaracterization of the data as “anecdotal.” He was soon more concessional in his comments but Trump’s words met their mark. The next day the New York Times reported that the drug was “being prescribed right and left.”

Trump’s tweets sewed confusion and nixed hopes for a rational scenario. Concern about insufficient supply, unruly demand, and hysteria are well-placed. A rational approach would have been for the government to ensure provision for hydroxychloroquine to coincide as much as possible with the certain-to-come spike in severe cases. On global stage, this is already happening.  Drug makers are ramping up production. Novartis says it’s donating up to 130 million doses of the drug to the global pandemic.

As with any potential treatment, results from a couple of small trials warrant caution. In the case of hydroxychloroquine, the drug has been around since 1955. It has well-known adverse effects in some patients — those with heart disease, for example. But its safety profile would not be a problem for most.

It should be added that calls for huge trials ahead of approving this drug are misplaced. Based on their results, Raoult and colleagues have calculated that just 48 patients would be required to further test hydroxychloroquine, 24 to receive the drug and 24 controls. That’s a small number, but large enough.  Eighty years ago, penicillin required just about 5 patients for the decision to scale up manufacture.

The news out of Raoult’s laboratory is possibly nothing, possibly game-changing; It could have given patients, doctors, and especially hospital administrators much-needed mental room for organization and thoughtful emergency planning. The drug could have been an antidote to fear that “the sky is falling,” as Cornelia Griggs wrote in The Times (Op-Ed, March 19). Now, as far as it concerns panic, it’s too late.

Trump’s tweetstorm about hydroxychloroquine during a medical emergency of historic proportion will cost lives. But for Trump himself, there’s no downside. If the drug works, he will cover himself in glory. If it doesn’t — well, his friend Fauci told you so.

John Galbraith Simmons is author, in collaboration with Justin A. Zivin MD, PhD, of tPA for Stroke: The Story of a Controversial Drug (Oxford Univ Press, 2010).