Author: AFP

On Thursday, the White House took notice.

President Donald Trump said he had directed the Food and Drug Administration to investigate whether chloroquine, which is available by prescription only, should be given to patients with the virus. Bayer, the international drugmaker, then noted in a press release that it would donate 3 million tablets of the drug Resochin, or chloroquine phosphate, to U.S. patients. Trump also pointed to another existing drug, remdesivir, an anti-viral developed by drugmaker Gilead, which is already being used in China to treat COVID-19.

Neither drug is currently approved by the FDA to treat the coronavirus. So it is important “not to provide false hope,” FDA Commissioner Stephen Hahn said at the White House’s daily press briefing. But Trump has “asked us to be aggressive” and “break through exciting, lifesaving treatment, and we’re doing that at the FDA,” he added.

Early promising data
So what is chloroquine, and why is it considered so promising by the scientific community?

The drug has been around since the 1940s and is known for being generally safe and well tolerated in mild to moderate doses, although it can be toxic in high doses. It has been used to treat malaria, in addition to some autoimmune disorders. It is available as a generic, which means it could be a scalable and potentially affordable treatment.

“Nothing is definitive yet, but chloroquine is a drug used for more than 70 years with minimal side effects at a modest dosage,” said Pellini.

Malaria is caused by a parasite, not a virus. But some studies have found that chloroquine has been effective at treating a virus that causes severe acute respiratory syndrome, or SARS, a close relative of COVID-19. It is also being studied at research labs throughout the world as a way to alleviate symptoms for patients diagnosed with COVID-19.

“It has been found in mice to be effective to treat a variety of viruses,” noted Dr. Kristian Olson, an associate professor at Harvard Medical School and internal medicine physician at Massachusetts General Hospital. “It also appears it’s active in vitro (via test tube experiments) against COVID-19.”

Some of the early data is promising. A group of researchers in France are testing a less toxic derivative of the chloroquine drug called hydroxychloroquine on a few dozen patients with COVID-19, and early reports of the trial indicate that the drug might help shorten the amount of time that people with the disease are infectious.

Because of these early signs, some biotech experts say it’s worth putting more research dollars into studying the drug.

“I don’t see Trump’s willingness to jump into humans quickly (to test the drug) as a panicked response,” said Vas Bailey, a life sciences-focused investor at Artis with a Ph.D. in biomedical engineering from the Johns Hopkins School of Medicine. “It could be a potentially efficient way of using real-world evidence to help us triage which of these safe drugs will work in alleviating symptoms and treating COVID-19.”

Lack of concrete evidence and lots of unknowns
But we’re still far from having an approved treatment for COVID-19, and the evidence behind chloroquine is not firm.

As Bailey points out, there is no data yet from a randomized clinical trial, which is considered the gold standard to minimize the possibility of bias in the findings. One of the biggest problems, scientists say, is that the tests have not been blinded. If physicians have prior knowledge of the intervention, that might influence how to treat the patient. That introduces other variables that are hard to separate from the effect of the drug.

There’s also further work needed to understand whether the drug reduces hospital time and mortality rates, and whether it impacts ventilation use. There are also some big unknowns about when, how and to whom the drug should be administered.

“What I don’t know, and I don’t think anyone knows is the degree of anti-viral activity and if it can be used to treat the most critical patients,” said Olson.

“We still also don’t understand the optimal dose treatment for covid-19, and whether it might be used at a lower dose for prophylaxis (meaning to take preventatively) than for treatment.”

As Olson points out, there are still side effects, like nausea and vision issues, and it remains to be seen whether the drug will be tolerated well in very sick patients. Furthermore, overdosing on the drug in high doses can cause serious health outcomes.

Because of these gaps in understanding, the World Health Organization said last month that there is “no proof” the drug is effective in treating the coronavirus.

Overall, however, some biotech experts say there’s some reason for optimism that the drug can help. “You wouldn’t see qualified medical professionals from China, France, and Korea looking into this if there wasn’t something to it,” Bailey said.

From Southeast Asia to Europe to the Americas, people found their lives upended by lockdowns and social distancing.

Shoppers in Malaysia stood in long lines to stock up at picked-over supermarkets. Commuters in the Philippines waited in huge traffic jams at checkpoints set up to take their temperatures before entering the capital of Manila.

Seven counties around San Francisco issued a sweeping shelter-in-place mandate, ordering millions to stay at home and go outside only for food, medicine and essential outings.

Spain, now the fourth-most infected country, saw infections rise Tuesday by more than 2,000 in one day to 11,178 and virus-related deaths jump by almost 200 to 491. Only China, Italy and Iran had more infections.

With the number of cases worldwide topping 183,000, a surge of patients in Madrid’s hospitals has fueled worries across Europe of what lies ahead. Please went out to send masks and ventilators to places like Italy and Spain that are struggling with soaring caseloads.

“There is no easy or quick way out of this extremely difficult situation,” Mark Rutte, the Dutch prime minister, said in the first televised speech by a Dutch leader since 1973.

Iran state TV warned the virus could kill “millions” in the Islamic Republic if the public keeps on traveling, ignoring health guidance. World Health Organization officials have said the number of cases there — nearly 15,000 with 853 deaths — have been sharply underreported.

Airlines across the world have slashed flights due to a plunge in demand but also because many countries have been barring foreign arrivals.

Turkey planned to evacuate 3,614 citizens stranded in nine European countries after flights were suspended, Foreign Minister Mevlut Cavusoglu said Tuesday.

Germany launched a 50 million-euro ($56-million) effort to bring home thousands of tourists stranded in popular winter vacation spots across the globe, including up to 5,000 in Morocco alone.

“Even if we will do everything humanly possible, we cannot in every case provide a solution within 24 hours,” Foreign Minister Heiko Maas warned.

In Lithuania, trucks seeking to enter Poland backed up in a line 60 kilometers (37 miles) long after Poland closed its border to foreigners due to the new coronavirus.

German police organized a convoy to help stranded citizens from Baltic states get back home by ferry after the Poland closure.

Italy reported another jump in infections, up to 27,980. With 2,158 deaths, Italy now accounts for well over a quarter of the global death toll.

The cascade of event cancellations continued, with Thailand calling off its water festival in April and the Kentucky Derby reportedly prepared to delay the famous U.S. horse race for the first time since World War II. India shut down the Taj Mahal.

Some bright spots emerged. Wuhan, the central Chinese city where the virus was first detected late last year and which has been under lockdown for weeks, reported just one new case Tuesday.

The virus causes only mild or moderate symptoms, such as fever and cough, for most people, but severe illness is more likely in the elderly and people with existing health problems. COVID-19 has killed over 7,100 people so far but more than 79,000 have recovered.

The economic toll from the crisis to both companies and individuals was only escalating. Shares reversed early losses in Asia on Tuesday after the U.S. stock market plunged to its worst day in more than three decades. Huge swaths of many economies have come to a standstill as businesses and travel shut down due to the outbreak.

In the United States, officials urged older Americans and those with chronic health conditions to stay home, and recommended all group gatherings be capped at 10 people. Americans returning from abroad encountered chaotic airport health screenings that clearly broke all virus-fighting rules against crowds

School closings in 56 countries kept more than 516 million students home, the United Nations said. New York City joined those ranks Monday, closing a school system with 1.1 million students.

Some countries that had resisted more stringent measures snapped into action, too.

British Prime Minister Boris Johnson told people to eliminate unnecessary contact with others, working from home where possible and avoiding bars, restaurants, theaters and other venues. Schools remained opened for the time being.

Some scientists, and many worried Britons, have said the government should have taken tough action sooner.

Britain’s dramatic escalation of social restrictions to fight COVID-19 was sparked by new scientific evidence suggesting that 250,000 people in the U.K. and more than 1 million in the U.S. might die if the country did not suppress the spread of the new coronavirus.

The analysis, published by Imperial College London epidemiologists, drew on the latest data from Italy. It found that a strategy of “mitigation” — slowing but not stopping the spread of the virus while protecting vulnerable groups like the elderly — would still lead to a huge number of cases that would overwhelm the health care system.

The scientists said a tougher “suppression” strategy would sharply reduce deaths but would “need to be maintained until a vaccine becomes available (potentially 18 months or more).”

As the virus ebbed domestically, China promoted its efforts to help other virus-stricken countries, including Italy, South Korea and Iran.

“When everyone needs to work together to fight the epidemic, no country can stand aloof, and we all must work together to get over the difficulties,” Foreign Ministry spokesman Geng Shuang Geng told reporters.