I remember the spring of last year when COVID surged in Italy and then New York. I attended conference calls and web seminars where the presenter began with, "Well, in our limited experience..." We took the advice and suggestions with a grain of salt. Unfortunately, at the start of an outbreak, there isn't time to evaluate things methodically, systemically, and scientifically. That comes later.
So early on, clinicians were trying all sorts of things. Some of those interventions turned out to be efficacious, and we continue them today, like non-invasive positive pressure ventilation and prone positioning. Others ended up being soundly disproven and are no longer used, like hydroxychloroquine.
The debacle with hydroxychloroquine disappoints me even today. At the beginning of the pandemic, based on limited evidence, Chinese, South Korean, and Italian health authorities suggested the use of chloroquine (and hydroxychloroquine) for COVID-19. Recognizing that data were limited, the WHO proposed studying it through a multinational large clinical trial. These were appropriate steps at this time.
Nevertheless, in mid-March, the President of the United States, arguably the person with the largest megaphone and biggest impact, started touting hydroxychloroquine without a strong scientific basis for doing so. This caused massive shortages of the medication, leading to problems for those with diseases that are actually treated by the drug. This problem worsened when he advocated using hydroxychloroquine as a prophylactic, for which there was even less evidence. The medication has many side effects, and without doubt, harm was caused to some of those who took it.
Furthermore, these statements confused clinicians and health authorities. I remember wondering whether there was something I was missing since hydroxychloroquine's poor evidence could not justify the daily news articles about it. The CDC gave it Emergency Use Authorization. At the same time, the Internet saw a surge of reports, videos, anecdotes, and stories championing the drug. The mass confusion that resulted, I believe, caused significant fallout in the loss of trust in governmental health agencies, media reports, the health care system, and clinicians.
Most of this happened in late March and early April, at which time a VA study showed that patients receiving hydroxychloroquine were more likely to die. By early June, a larger UK trial showed that it did not help, and subsequently, its emergency authorization was revoked. A trial in Brazil in July corroborated this data. Yet, the U.S. President still continued to promote the drug, and viral posts on the Internet propagated beliefs that it was beneficial. (There is further scandal with potentially inaccurate data in a WHO trial involving a company called Surgisphere). The harm of the whole to-do lasted far longer than it should have.
All this to say that hydroxychloroquine began as a reasonable hypothesis that quickly escalated into a Pandora's box opened by a President, media, and Internet that amplified a message unsupported by science. When appropriate scientific study debunked the utility of the drug, it was too late. I believe this caused real and material harm to patients, physicians, and our healthcare system.
I'm dismayed we aren't talking about it anymore. I'm not interested in assigning responsibility or blame. As we liked to say at the time, this was an "unprecedented crisis." Information was limited, people were scared, and we wished desperately for a solution. But I recall these events because we could have done better. We need to learn from what happened.
And this is not an isolated incident. There are actually many wrong and harmful messages that got propagated this past year. I think of all the controversy over masks (that children can't wear masks or carbon dioxide will accumulate, etc.), and I lament the loss of lives that occurred because of spread which could have been curtailed. Even now, there is confusion over the need and utility of masks in the face of the Delta variant, which is causing spikes in parts of the country rivaling the winter surge. We need less spread of inaccurate, harmful, and wrong messages, and more propagation of appropriate, measured, and scientific responses. (And in that respect, I think of the tremendous good done by Dr. Fauci and his unflagging efforts and messages). Viral spread of messages can have as big of a public health impact as the virus itself.
