The world is seeing a pandemic at such a massive scale after 1918 Spanish Flu. While the scientist and researchers all over the world are engrossed in inventing a vaccine or a treatment for COVID19, it is our moral responsibility to keep things in order to stop its expansion. In doing so, we may feel perturbed and many things may go wrong although they are not intended to. This so called collateral damage needs to be surveyed and controlled. For times like these WHO designed MEURI in 2018 after Ebolavirus outbreak.
In our study majority of participants worked in large tertiary hospitals. Almost all of them had heard about HCQ/CQ use as prophylaxis against covid19 infection but their source of information was vague and unreliable. Even though the participants belonged to specialized group, their knowledge of this trial drug was insufficient. Most of them were aware that the research data on HCQ/CQ use as prophylaxis is very limited but they still took the prophylaxis. One of the reasons could be the bold statements made in news media by the concern authorities and the national and state guidelines recommending the same. The fear of acquiring the infection by this high risk group led to the widespread use of HCQ/CQ, even by their family members overlooking the harm the drug may cause.
We observed that 36 2% participants who took the prophylaxis developed the side effects. Only few of them got tested for taking the medication, which could have lead to deleterious effects. Most of the participants self prescribed in order to be safe during the pandemic crisis.
After studying these results, we were paralysed with fear that a drug with serious side effects is being taken by HCWs without adequate evidence, prior investigations, supervision and follow-up. In some countries, before conducting clinical trial on humans, HCQ/CQ was already recommended by the national guidelines. No separate guidelines were stated for people who had co-morbid conditions. Even some hospitals who followed use of HCQ/CQ prophylaxis protocol to combat COVID 19 did not conduct baseline investigations before giving the medication. Majority of HCWs were not briefed by hospital authorities about HCQ/CQ which is of utmost priority especially during this time of pandemic when there are only drug trials in the name of treatment.
Almost all HCWs who took HCQ/CQ prophylaxis were aware of the side effects but still very few of them did baseline investigation like ECG, to rule out prolonged QT, which is the common adverse effect of the drug.
The social trepidation around COVID19 is so dreadful that the HCWs who are expected to be sane and rational in these difficult times have lost the credence in medicine. This panic has put the HCWs at the risk of self immolation. There are quite good number of cases reported where the false assurance of HCQ prophylaxis has led to mortality in general public as well as HCWs. This falsification has increased the demand of HCQ to such an extent that American college of Physicians has published their concerns and opinions to overcome the scarcity of HCQ for those patients who are already on treatment for illnesses other than COVID19.
Not to mention that in vitro studies[10-12] supported by a small study of France have led to this perplexity. Sun Hee Lee, Hyunjin Son, and Kyong Ran Peck conducted a study on post exposure prophylaxis (PEP) using hydroxychloroquine (HCQ) on 211 persons, whose baseline polymerase chain reaction (PCR) tests for COVID-19 were negative. PEP was completed in 184 (97 4%) patients and 21 (95 5%) care workers without serious adverse events. At the end of 14 days of quarantine, follow-up PCR tests were all negative. Based on their experience, they implemented PEP with HCQ safely under proper monitoring.
A systematic review of 45 articles on prophylaxis of HCQ/CQ in COVID-19 pandemic published by Sanket Shah, Saibal Das, Avinash Jain, Durga Prasanna Misra, and Vir Singh Negi concluded that although pre-clinical results are promising till date, there is dearth of evidence to support the efficacy of CQ or HCQ in preventing COVID-19. Considering potential safety issues and the likelihood of imparting a false sense of security, prophylaxis with CQ or HCQ against COVID-19 needs to be thoroughly evaluated in observational studies or high quality randomized controlled studies.
The above mentioned figures show lacunae in the guidelines and recommendations. Some of the sincere question arises are- “Why was informed consent advisory not followed as per MEURI? Why not all HCWs were were investigated before starting of the HCQ prophylaxis? What are the recommendations for the participants who were hypertensive and diabetic or who were already on HCQ treatment for other illnesses? Why there were no strict guidelines for the hospitals to educate about HCQ and monitor its usage? After starting of prophylaxis why the HCWs were were not tested for COVID19, to see if it really works as prophylaxis? ”
Finally, after the cacophony created by these events , clinical trials are conducted from United States of America ( NCT04308668), Spain ( NCT04304053), Europe and Asia (NCT04303507) to name a few. But we are still unsure and blind about it, just hoping once again science saves the world.