Why was Donald Trump not given hydroxychloroquine?

October 8, 2020
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ON Friday, President Donald Trump, who has frequently dismissed the significance of the COVID-19 pandemic and rarely wears masks in public, announced that he had contracted the coronavirus and was quarantine.

Over the weekend, his medical team revealed that he had been put on a course of dexamethasone, which became the first drug scientifically proven in June to benefit people with COVID-19.

The steroid is said to only work on severely ill coronavirus patients, who were on the verge of needing mechanical ventilation, sparking confusion about the true nature of the US President’s condition.

Before President Trump was admitted to Walter Reed Hospital near Washington with the virus on Friday, he had a high temperature — one of the tell-tale signs of the infection and had since been given oxygen at least once.

On Monday, Mr Trump’s doctors claimed he was symptom-free and could even be discharged from hospital, but this was contradicted by White House chief of Staff, Mark Meadows, who described the president’s illness as ‘very concerning’.

Mr Trump, although a proponent of hydroxychloroquine was given dexamethasone, that scientists in the UK and US described as potentially ‘dangerous’ because it has no effect on people with mild illness and may even make their condition worse.

Deputy Chairman, Oyo State COVID-19 Task Force, Professor Temitope Alonge stated that Trump’s treatment also included Vitamin D and Regeneron, a cocktail of antibodies to help him to come out and fight the virus. He was also put on oxygen.

He added, “nobody has full knowledge of what to expect from the dexamethasone, a synthetic hormone that he is given.”

The steroid reduces inflammation in the lungs triggered by an overreaction by the immune system. It does this by suppressing the immune system and preventing it from going into overdrive. Inflammation is a COVID-19 complication that makes breathing difficult. In seriously unwell patients, the lungs become so inflamed they struggle to work.

Professor Alonge, however, declared that hydroxychloroquine or chloroquine was not mentioned as a drug Trump  took.

“They did not mention hydroxychloroquine or chloroquine. These are not antiviral drugs. There is a lot of mix up, people should understand the difference. Hydroxychloroquine or chloroquine has been found in the past to stop SARS and MERS, which are similar viruses, from entering into the cells in humans. If the virus does not enter the cell, then they will not damage it,” he added.

He explained that his protocol of treatment was to help the body reduce the viral load while boosting the body immunity to be able to curtail the virus as much as possible.

Professor Alonge declared that President Trump and his wife had succumbed to the virus due to exposure to a high coronavirus load, adding, “if for any reason the viral load they are exposed to is high, there is the possibility that they can test positive for the virus.”

Training Coordinator and clinician at the Nigerian Institute for Medical Research (NIMR), Lagos, Dr Greg Ohihoin said although there are some medications that have gone through some clinical trials, including remdesivir, an antiviral agent and been found to reduce hospital stay and morbidity in individuals infected by COVID-19 infection, there are no clear cut guidelines to say this is the treatment for COVID-19.

Dr Ohihoin declared that these antiviral drugs are also not part of the treatment regimen for the treatment of many Nigerians infected with COVID-19.

“We don’t have access fully to that drug yet, so what we have is what we use,” he added

Dr Ohihoin declared although some people use chloroquine in the treatment of COVID-19, a clinical trial is going on the country to ascertain its effective.

He, however, said an antibiotic is part of medicines used in the management of COVID-19 treatment because such individuals with severe forms of COVID-19 infection are more predisposed to developing other bacterial infections.

Moreover, Dr Ohihoin added that many asymptomatic Nigerians with COVID-19 beat the virus without taking any drug.

“They recover without any intervention, the body immune system responds to fight it,” he added.

He, however, assured that the fact that President Trump is 74 years old and obese may not necessarily mean that his COVID-19 case will be severe.

According to him, “it is not in every situation, there are people that are older that have recovered fully. Of course, there can be underlying complications like blockage of small blood vessels of the brain that can lead to stroke or that of the heart and other long term complications of the infection. But generally, they tend to recover and do well if the disease does not kill them.

“From the current picture of him that we see, he does not have any significant features that show severity, so we expect him to get better. He doesn’t need any high intensive care, so we expect him to recover.”

Moreover, Professor Phillips Olatunji, a consultant haematologist, said there is no definitive curative treatment for COVID-19; hence people resort to the use of any drug that holds some form of hope for coronavirus infection treatment.

Professor Olatunji, however, declared that antiviral drug is not used routinely in the management of individuals with the infection in Nigeria being that many cases are mild.

He added, “antiviral drugs particularly in their environment had become necessary for them but in our environment where we have generally a mild disease, many of them did not use antiviral drugs and had overcome the virus. So you cannot say that every treatment is either too much or too mild, because we have not identified any drug that we can say is a specific treatment for coronavirus.”

Dr Brian Garibaldi, one of the doctor’s on Trump’s team, said Trump would continue taking doses of Remdesivir, a broad-spectrum antiviral medication, and dexamethasone, a steroid, whether he remains at Walter Reed or is transferred to the White House.

Oxford University researchers in June announced steroid drug dexamethasone — which costs just over $3 for a course of treatment — cut the risk of death by up to 35 per cent for infected patients on ventilators and by a fifth for anyone needing oxygen at any point.

Researchers estimated that the drug would prevent one death for every eight patients treated while on breathing machines and one for every 25 patients on extra oxygen alone.

One in 10 symptomatic COVID-19 patients is thought to suffer from acute respiratory distress syndrome (ARDS). ARDS causes the immune system to become overactive and attack healthy cells in the lungs. This makes breathing difficult and the body eventually struggles to get enough oxygen to vital organs.

The president has been taking other treatments including zinc, vitamin D, famotidine, melatonin and aspirin.

However, it is the cocktail which experts hope will be the key to his recovery, with Regeneron’s latest data from the ongoing trials showing the drug drove down the viral loads of patients who were not hospitalised, and cut their recovery times by nearly half.

It contains an antibody made by the company from mice, and another isolated from a recovered COVID-19 patient – each of which may help to neutralise coronavirus.

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