Professor Les Schrieber
Recent Senior Physician, Virtual COVID Unit Royal North Shore Hospital

I viewed the recent session on “COVID-19 Treatment- Have We Found It?” with interest. Unfortunately the presentation was unbalanced and did not paint an accurate picture of the current role of Hydroxychloroquine as a treatment for COVID-19.

Hydroxychloroquine, an old drug, is widely used in the treatment of autoimmune rheumatic diseases including rheumatoid arthritis and lupus.

A French group has shown in a small number of cases that Hydroxychloroquine is effective in treating COVID-19 patients. President Trump picked up on this article and went public. He stated that Hydroxychloroquine was the cure for COVID-19 and that he was taking it himself. As a result of this the world supply of Hydroxychloroquine became exhausted-and the subject became politicised.

Subsequent large clinical trials of hospitalised patients with COVID-19 treated with either Hydroxychloroquine or placebo failed to show any benefit in either severely or mildly affected patients. There was a higher rate of cardiac irregularities in those taking Hydroxychloroquine.

It has been proposed that Hydroxychloroquine be used earlier, in out-patients, to prevent more serious features of the disease developing. Dr Zelenko is reporting that this approach is effective in preventing COVID-19 infection-particularly when combined with the antibiotic azithromycin and magnesium. However, these studies have no placebo group for comparison making the validity of the claims uncertain.

In Australia there is an ongoing study in health care workers in which they are randomised to receive either Hydroxychloroquine or placebo. This study should help answer whether early use of Hydroxychloroquine can prevent the development of COVID-19 infection.

In summary the place of Hydroxychloroquine in the treatment of COVID-19 remains clouded in controversy. While it has little role in patients with established disease the jury remains out on its use as a preventative measure against COVID-19 infection.