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| Ignoring Expert Opinion, Trump Again Promotes Use of Hydroxychloroquine | Ignoring Expert Opinion, Trump Again Promotes Use of Hydroxychloroquine |
| (2 months later) | |
| President Trump doubled down Sunday on his push for the use of an anti-malarial drug against the coronavirus, issuing medical advice that goes well beyond scant evidence of the drug’s effectiveness as well as the advice of doctors and public health experts. | President Trump doubled down Sunday on his push for the use of an anti-malarial drug against the coronavirus, issuing medical advice that goes well beyond scant evidence of the drug’s effectiveness as well as the advice of doctors and public health experts. |
| Mr. Trump’s recommendation of hydroxychloroquine, for the second day in a row at a White House briefing, was a striking example of his brazen willingness to distort and outright defy expert opinion and scientific evidence when it does not suit his agenda. | Mr. Trump’s recommendation of hydroxychloroquine, for the second day in a row at a White House briefing, was a striking example of his brazen willingness to distort and outright defy expert opinion and scientific evidence when it does not suit his agenda. |
| Standing alongside two top public health officials who have declined to endorse his call for widely administering the drug, Mr. Trump suggested that he was speaking on gut instinct and acknowledged that he had no expertise on the subject. | Standing alongside two top public health officials who have declined to endorse his call for widely administering the drug, Mr. Trump suggested that he was speaking on gut instinct and acknowledged that he had no expertise on the subject. |
| Saying that the drug is “being tested now,” Mr. Trump said that “there are some very strong, powerful signs” of its potential, although health experts say that the data is extremely limited and that more study of the drug’s effectiveness against the coronavirus is needed. | Saying that the drug is “being tested now,” Mr. Trump said that “there are some very strong, powerful signs” of its potential, although health experts say that the data is extremely limited and that more study of the drug’s effectiveness against the coronavirus is needed. |
| “But what do I know? I’m not a doctor,” Mr. Trump added. | “But what do I know? I’m not a doctor,” Mr. Trump added. |
| “If it does work, it would be a shame we did not do it early,” Mr. Trump said, noting again that the federal government had purchased and stockpiled 29 million pills of the drug. “We are sending them to various labs, our military, we’re sending them to the hospitals.” | “If it does work, it would be a shame we did not do it early,” Mr. Trump said, noting again that the federal government had purchased and stockpiled 29 million pills of the drug. “We are sending them to various labs, our military, we’re sending them to the hospitals.” |
| Mr. Trump, who once predicted that the virus might “miraculously” disappear by April because of warm weather, and who has rejected scientific consensus on issues like climate change, was undaunted by skeptical questioning. | Mr. Trump, who once predicted that the virus might “miraculously” disappear by April because of warm weather, and who has rejected scientific consensus on issues like climate change, was undaunted by skeptical questioning. |
| “What do you have to lose?” Mr. Trump asked, for the second day in a row, saying that terminally ill patients should be willing to try any treatment that has shown some promise. | “What do you have to lose?” Mr. Trump asked, for the second day in a row, saying that terminally ill patients should be willing to try any treatment that has shown some promise. |
| When a reporter at Sunday’s briefing asked Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, to weigh in on the subject, Mr. Trump stopped him from answering. As the reporter noted that Dr. Fauci, who has been far more skeptical about the drug’s potential, was the president’s medical expert, Mr. Trump made it clear he did not want the doctor to answer. | When a reporter at Sunday’s briefing asked Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, to weigh in on the subject, Mr. Trump stopped him from answering. As the reporter noted that Dr. Fauci, who has been far more skeptical about the drug’s potential, was the president’s medical expert, Mr. Trump made it clear he did not want the doctor to answer. |
| “You know how many times he’s answered that question? Maybe 15 times,” the president said, stepping toward the lectern where Dr. Fauci was standing. | “You know how many times he’s answered that question? Maybe 15 times,” the president said, stepping toward the lectern where Dr. Fauci was standing. |
| Even as Mr. Trump has promoted the drug, which is also often prescribed for patients with lupus, it has created rifts within his own coronavirus task force. And while many hospitals have chosen to use hydroxychloroquine in a desperate attempt to treat dying patients who have few other options, others have noted that it carries serious risks. In particular, the drug can cause a heart arrhythmia that can lead to cardiac arrest. | Even as Mr. Trump has promoted the drug, which is also often prescribed for patients with lupus, it has created rifts within his own coronavirus task force. And while many hospitals have chosen to use hydroxychloroquine in a desperate attempt to treat dying patients who have few other options, others have noted that it carries serious risks. In particular, the drug can cause a heart arrhythmia that can lead to cardiac arrest. |
| Dr. Megan L. Ranney, an emergency physician at Brown University in Rhode Island, said in an interview on Sunday night that she had never seen an elected official advertise a miracle cure the way Mr. Trump has. | Dr. Megan L. Ranney, an emergency physician at Brown University in Rhode Island, said in an interview on Sunday night that she had never seen an elected official advertise a miracle cure the way Mr. Trump has. |
| “There are side effects to hydroxychloroquine,” Dr. Ranney said. “It causes psychiatric symptoms, cardiac problems and a host of other bad side effects.” | “There are side effects to hydroxychloroquine,” Dr. Ranney said. “It causes psychiatric symptoms, cardiac problems and a host of other bad side effects.” |
| Dr. Ranney said that the drug could be effective for some patients, but that there was not nearly enough scientific evidence to support Mr. Trump’s claims. | Dr. Ranney said that the drug could be effective for some patients, but that there was not nearly enough scientific evidence to support Mr. Trump’s claims. |
| “There may be a role for it for some people,” she said, “but to tell Americans ‘you don’t have anything to lose,’ that’s not true. People certainly have something to lose by taking it indiscriminately.” | “There may be a role for it for some people,” she said, “but to tell Americans ‘you don’t have anything to lose,’ that’s not true. People certainly have something to lose by taking it indiscriminately.” |
| Hydroxychloroquine has not been proved to work against Covid-19 in any significant clinical trials. A small trial by Chinese researchers made public last week found that it helped speed the recovery in moderately ill patients, but the study was not peer-reviewed and had significant limitations. Earlier reports from France and China have drawn criticism because they did not include control groups to compare treated patients with untreated ones, and researchers have called the reports anecdotal. Without controls, they said, it is impossible to determine whether the drugs worked. | Hydroxychloroquine has not been proved to work against Covid-19 in any significant clinical trials. A small trial by Chinese researchers made public last week found that it helped speed the recovery in moderately ill patients, but the study was not peer-reviewed and had significant limitations. Earlier reports from France and China have drawn criticism because they did not include control groups to compare treated patients with untreated ones, and researchers have called the reports anecdotal. Without controls, they said, it is impossible to determine whether the drugs worked. |
| But Mr. Trump on Sunday dismissed the notion that doctors should wait for further study. | But Mr. Trump on Sunday dismissed the notion that doctors should wait for further study. |
| “We don’t have time to go and say, ‘Gee, let’s take a couple of years and test it out,’ and let’s go out and test with the test tubes and the laboratories,” Mr. Trump said. “I’d love to do that, but we have people dying today.” | “We don’t have time to go and say, ‘Gee, let’s take a couple of years and test it out,’ and let’s go out and test with the test tubes and the laboratories,” Mr. Trump said. “I’d love to do that, but we have people dying today.” |
| Mr. Trump is typically joined at his briefings by top medical advisers, including Dr. Fauci and Dr. Deborah L. Birx, his coronavirus coordinator. But the president does most of the talking, and has told several advisers that the briefings give him free airtime and good ratings. | Mr. Trump is typically joined at his briefings by top medical advisers, including Dr. Fauci and Dr. Deborah L. Birx, his coronavirus coordinator. But the president does most of the talking, and has told several advisers that the briefings give him free airtime and good ratings. |
| A day earlier, Dr. Fauci had privately challenged rising optimism about the drug’s efficacy during a meeting of the coronavirus task force in the White House’s Situation Room, according to two people familiar with the events who spoke on the condition of anonymity to describe a conversation in a sensitive setting. The argument was first reported by the website Axios. | A day earlier, Dr. Fauci had privately challenged rising optimism about the drug’s efficacy during a meeting of the coronavirus task force in the White House’s Situation Room, according to two people familiar with the events who spoke on the condition of anonymity to describe a conversation in a sensitive setting. The argument was first reported by the website Axios. |
| The meeting’s agenda included the question of how the administration would discuss chloroquines. Dr. Stephen Hahn, the Food and Drug Administration commissioner, gave an update on chloroquines, and what various tests and anecdotal evidence had shown. Peter Navarro, the president’s trade adviser who is overseeing supply chain issues related to the coronavirus, asked to join the meeting, said the people briefed on what took place. | The meeting’s agenda included the question of how the administration would discuss chloroquines. Dr. Stephen Hahn, the Food and Drug Administration commissioner, gave an update on chloroquines, and what various tests and anecdotal evidence had shown. Peter Navarro, the president’s trade adviser who is overseeing supply chain issues related to the coronavirus, asked to join the meeting, said the people briefed on what took place. |
| Mr. Navarro, who has been pushing to secure chloroquines at the president’s request to provide to caregivers, walked in with a sheaf of folders he had placed on a chair next to him, plopped them on the table and said he had seen studies from various countries, as well as information culled from officials at the Centers for Disease Control and Prevention, showing the “clear” efficacy of the drug in treating the coronavirus. Mr. Navarro also argued that the medicine was being used by doctors and nurses on the front lines of the coronavirus fight. | Mr. Navarro, who has been pushing to secure chloroquines at the president’s request to provide to caregivers, walked in with a sheaf of folders he had placed on a chair next to him, plopped them on the table and said he had seen studies from various countries, as well as information culled from officials at the Centers for Disease Control and Prevention, showing the “clear” efficacy of the drug in treating the coronavirus. Mr. Navarro also argued that the medicine was being used by doctors and nurses on the front lines of the coronavirus fight. |
| Dr. Fauci pushed back, echoing remarks he has made in interviews in the past week that rigorous study is still necessary. Mr. Navarro, an economist by training, shot back that the information he had collected was “science,” according to the people familiar with the episode. | Dr. Fauci pushed back, echoing remarks he has made in interviews in the past week that rigorous study is still necessary. Mr. Navarro, an economist by training, shot back that the information he had collected was “science,” according to the people familiar with the episode. |
| Vice President Mike Pence tried to tamp down the debate, and as emotions calmed, Mr. Trump’s son-in-law and senior adviser, Jared Kushner, advised Mr. Navarro to “take yes for an answer.” The president went to the briefing room lectern a short while later and glowed about chloroquine use, suggesting he might even take it himself despite not having symptoms or evidence of the virus. | Vice President Mike Pence tried to tamp down the debate, and as emotions calmed, Mr. Trump’s son-in-law and senior adviser, Jared Kushner, advised Mr. Navarro to “take yes for an answer.” The president went to the briefing room lectern a short while later and glowed about chloroquine use, suggesting he might even take it himself despite not having symptoms or evidence of the virus. |
| Katie Miller, a spokeswoman for Mr. Pence, declined to comment, saying the administration does not discuss events in the Situation Room. | Katie Miller, a spokeswoman for Mr. Pence, declined to comment, saying the administration does not discuss events in the Situation Room. |
| Last month, an Arizona man died and his wife was hospitalized after officials said they treated themselves with a deadly home remedy for the coronavirus — a popular fish tank additive that has the same active ingredient as an anti-malaria drug. | Last month, an Arizona man died and his wife was hospitalized after officials said they treated themselves with a deadly home remedy for the coronavirus — a popular fish tank additive that has the same active ingredient as an anti-malaria drug. |
| Medical professionals are also concerned that a run on hydroxychloroquine for potential coronavirus treatment could create shortages for people who need it for its traditional uses. | Medical professionals are also concerned that a run on hydroxychloroquine for potential coronavirus treatment could create shortages for people who need it for its traditional uses. |
| In a March 25 joint statement, the American Medical Association and two pharmacists’ associations noted that doctors and pharmacists have been prescribing the drug for their families and colleagues and that some pharmacies and hospitals had purchased “excessive amounts of these medications in anticipation of potentially using them for Covid-19 prevention and treatment.” | In a March 25 joint statement, the American Medical Association and two pharmacists’ associations noted that doctors and pharmacists have been prescribing the drug for their families and colleagues and that some pharmacies and hospitals had purchased “excessive amounts of these medications in anticipation of potentially using them for Covid-19 prevention and treatment.” |
| Updated June 5, 2020 | |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | |
| “The organizations strongly oppose these actions,” the statement said, citing potential “grave consequences for patients with conditions such as lupus or rheumatoid arthritis if the drugs are not available in the community.” | “The organizations strongly oppose these actions,” the statement said, citing potential “grave consequences for patients with conditions such as lupus or rheumatoid arthritis if the drugs are not available in the community.” |
| Since patients with heart troubles and other underlying conditions are more likely to be severely affected by the coronavirus, they may also be at higher risk of dangerous side effects from hydroxychloroquine, said Dr. Kenneth B. Klein, a consultant who works for drug companies to design and evaluate their clinical trials. | Since patients with heart troubles and other underlying conditions are more likely to be severely affected by the coronavirus, they may also be at higher risk of dangerous side effects from hydroxychloroquine, said Dr. Kenneth B. Klein, a consultant who works for drug companies to design and evaluate their clinical trials. |
| “What have we got to lose?” Dr. Klein said, echoing Mr. Trump’s remarks. “We’ve got patients to lose from dangerous side effects.” | “What have we got to lose?” Dr. Klein said, echoing Mr. Trump’s remarks. “We’ve got patients to lose from dangerous side effects.” |
| Mr. Trump did mention the potential risks to patients with heart troubles, but Dr. Klein said that even people with normal hearts are at risk for developing a fatal arrhythmia. And he said other medications could interact with hydroxychloroquine and cause serious medical complications. | Mr. Trump did mention the potential risks to patients with heart troubles, but Dr. Klein said that even people with normal hearts are at risk for developing a fatal arrhythmia. And he said other medications could interact with hydroxychloroquine and cause serious medical complications. |
| “Then the doctor would have to spend time thinking, could this drug be playing a role, either directly or indirectly?” Dr. Klein said. | “Then the doctor would have to spend time thinking, could this drug be playing a role, either directly or indirectly?” Dr. Klein said. |
| Other researchers have noted that while future trials may show a benefit, hydroxychloroquine has disappointed in the past, even though it has been tested as a treatment for other viruses, including influenza. | Other researchers have noted that while future trials may show a benefit, hydroxychloroquine has disappointed in the past, even though it has been tested as a treatment for other viruses, including influenza. |
| “Hydroxychloroquine has been studied as a possible antiviral therapy for many decades,” said Dr. Luciana Borio, who oversaw public health preparedness for the National Security Council in Mr. Trump’s White House and was the acting chief scientist at the F.D.A. under President Barack Obama. | “Hydroxychloroquine has been studied as a possible antiviral therapy for many decades,” said Dr. Luciana Borio, who oversaw public health preparedness for the National Security Council in Mr. Trump’s White House and was the acting chief scientist at the F.D.A. under President Barack Obama. |
| “Despite showing evidence of activity against several viruses in the laboratory, it never showed success in randomized clinical trials.” | “Despite showing evidence of activity against several viruses in the laboratory, it never showed success in randomized clinical trials.” |
| Michael D. Shear and Neil Vigdor contributed reporting. | Michael D. Shear and Neil Vigdor contributed reporting. |