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Coronavirus and chloroquine: Has its use been approved in US? Coronavirus and chloroquine: Is there evidence it works?
(14 days later)
President Trump claims a drug used against malaria has been approved in the United States to treat the new coronavirus. There has been a global surge in demand for drugs normally used against malaria to tackle the coronavirus, as governments urgently seek out treatments for the new disease.
Chloroquine is one of the oldest and best-known anti-malarial drugs. Chloroquine, and a related derivative, hydroxychloroquine, have gained attention - despite the World Health Organization (WHO) saying there is no definitive evidence they work.
So is the president right and what is known about its effectiveness? So what is the current evidence of their effectiveness as a treatment for the coronavirus, and who is using them?
Chloroquine has been around for decades. It's no longer recommended in much of Africa because of the resistance built up to it by the malaria parasites. What do we know about these drugs?
Some countries have introduced regulations to curb the use of the drug, but it has remained popular in those with an active private-sector drug market and is sold widely. President Trump has frequently referred to the potential of hydroxychloroquine in White House briefings. At a recent press conference, he referred to it and said: "What do you have to lose? Take it."
This is especially true in Nigeria where there have been reports of high demand for chloroquine in pharmacies leading to shortages, in part fuelled by Mr Trump's statement. In a video removed by Facebook for breaching its misinformation guidelines, Brazilian President Jair Bolsonaro claimed "hydroxychloroquine is working in all places".
Chloroquine has not been approved for coronavirus Tablets containing chloroquine have long been used in the treatment of malaria to reduce fever and inflammation, and the hope is that they can also inhibit the virus that causes Covid-19.
President Trump, at his daily press briefing, claimed that chloroquine had been approved for use in treating the coronavirus by the US Food and Drugs Administration (FDA). That is the body in charge of licensing medicines in America.
"We're going to be able to make that drug available almost immediately. And that's where the FDA has been so great. They've gone through the approval process - it's been approved."
However, the FDA has made it clear it has not been approved for treating those infected with the Covid-19 coronavirus.
"There are no FDA-approved therapeutics or drugs to treat, cure or prevent Covid-19."
However, the FDA does say that studies are under way to see if chloroquine can be effective in the treatment of Covid-19. It also says it has been directed by Mr Trump to set up a large clinical trial to investigate the drug.
Mr Trump later said chloroquine had been approved for "compassionate use". This is where a doctor can give a drug that is yet to be cleared by the government to a patient in a life threatening condition. Doctors are able to prescribe chloroquine in these circumstances, as it's a registered drug.
He has subsequently announced that New York state would be starting a trial combining both the anti-malarial and an antibiotic known as Zithromax for treatment for Covid-19 patients.
What is the status of global research?
It's no surprise that chloroquine has been part of the search to help coronavirus patients.
It's well-known, and cheap and easy to produce. In treating malaria patients, the drug has been used to reduce fever and inflammation.
"Chloroquine seems to block the coronavirus in lab studies. There's some anecdotal evidence from doctors saying it has appeared to help," says James Gallagher, BBC health correspondent."Chloroquine seems to block the coronavirus in lab studies. There's some anecdotal evidence from doctors saying it has appeared to help," says James Gallagher, BBC health correspondent.
But crucially there have been no complete clinical trials which are important to show how the drug behaves in actual patients, although they are under way in China, the US, UK and Spain. There is insufficient evidence at the moment from current trials as to their effective use in treatment of patients with Covid-19.
The World Health Organization says that so far there is no definitive evidence of its effectiveness, but it is part of the continuing trials. There are also risks of serious side effects, including renal and liver damage.
"In order to know which therapies could work to treat the viral infection we need to undertake clinical trials to gain the full evidence to know whether they work or not," says Prof Trudie Lang, director of The Global Health Network at Oxford University. "We need larger, high-quality randomised clinical trials in order to better evaluate their effectiveness," says University of Oxford 's Kome Gbinigie, author of a report on anti-malarial testing for Covid-19.
Interest in the drug had already been gaining traction online. More than 20 trials are being carried out, including in the US, UK, Spain and China.
Searches for chloroquine have spiked in the past week, according to Google Trends data, and entrepreneur Elon Musk caused a stir when he tweeted out some research into it. Cabinet Office Minister Michael Gove says the UK is "conducting rapid clinical trials on anti-malarials" to assess if they are able to reduce the impact of Covid-19 on those affected.
Panic-buying in Nigeria In the US, various trials are under way for a combination of drugs including chloroquine, hydroxychloroquine and an antibiotic called azithromycin, for treating Covid-19 patients.
The coronavirus pandemic is on the lips of every Nigerian at churches, mosques and schools, reports Daniel Semeniworima, of the BBC's Pidgin service in Lagos. Which countries have authorised their use?
Many Nigerian households still use tablets containing chloroquine for treating malaria even though it was banned in 2005. The US Food and Drugs Administration (FDA), the body in charge of licensing medicines in America, has granted "emergency use" authorisation for these drugs in the treatment of Covid-19 for a limited number of hospitalised cases.
News of a February study in China about the use of chloroquine for the coronavirus had already sparked lively debate in Lagos, so people were stocking up. That does not mean the FDA is saying they definitely work. But it does mean that in specific circumstances, hospitals can request and use the medicines from government stockpiles for use in Covid-19 treatment.
Following Mr Trump's reference to chloroquine as a coronavirus treatment, this ramped up and shops and chemists sold out of the drug very quickly. The US government has said that 30 million doses of hydroxychloroquine have been donated to the national stockpile by a German-based pharmaceutical company.
But the Nigerian Centres for Disease Control has told people to stop taking it. Other countries are also deploying these anti-malarial drugs to varying degrees.
"The WHO has NOT approved the use of chloroquine for #COVID19 management." France has authorised doctors to prescribe them for patients with Covid-19, but the country's medical watchdog has warned of side effects.
Daniel Semeniworima says people are taking uninformed decisions to stay safe but this is having serious medical consequences. India's health ministry has recommended the use of hydroxychloroquine as a preventative treatment for healthcare workers, as well as households in contact with confirmed cases if they have a prescription from a doctor.
It's been reported that Lagos is now dealing with a spate of people being poisoned from overdoses of chloroquine. However, India's government research body has warned against the unrestricted usage of the anti-malarial drug and said it was "experimental" and only for emergency situations.
Several Middle Eastern countries have authorised its use or are conducting trials. This includes Bahrain (which claims it was one of the first countries to use hydroxychloroquine on coronavirus patients), Morocco, Algeria and Tunisia.
Is there enough chloroquine available?
As interest in these drugs has grown as a potential treatment for Covid-19, many countries have seen high demand and shortages.
Chloroquine and its derivatives have long been widely available in pharmacies, particularly in developing countries, for the treatment of malaria.
This is despite their declining efficacy against malaria, as the disease has become increasingly resistant.
Jordan has banned the sale of hydroxychloroquine in pharmacies to prevent stockpiling. Similarly, the Kuwaiti Health Ministry decided to withdraw all medicines containing the drugs from private pharmacies and limit them to hospitals and health centres.
Kenya has banned over-the-counter sales of chloroquine, so it is now only available on prescription.
India is a major producer of these antimalarial drugs, and has imposed a ban on exports.
President Trump has made a personal plea to India's Prime Minister, Narendra Modi, for access to the drugs for use in the United States. It has been reported that India is considering this request.
Unregulated use can be unsafe
In Nigeria, households still regularly use tablets containing chloroquine for treating malaria, even though it was banned in 2005 for first-line use because of its declining effectiveness.
News of a February study in China about the use of chloroquine for the coronavirus had already sparked lively debate in Lagos, so people began stocking up.
Following Mr Trump's reference to it as a coronavirus treatment, this ramped up, and shops and chemists sold out of the drug very quickly.
But the Nigerian Centres for Disease Control has told people to stop taking it. "The WHO has NOT approved the use of chloroquine for #COVID19 management."
Officials in Lagos state say there have been a number of people poisoned from overdoses of chloroquine.
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