Rio de Janeiro – Brazilian President Jair Bolsonaro neatly sums up how thoroughly politics has hijacked the debate over using malaria drugs against the new coronavirus: “Right-wingers take chloroquine.”
The far-right leader made the remark Tuesday, a day before his government recommended widespread use of chloroquine and a less-toxic derivative, hydroxychloroquine, to treat COVID-19 even in mild cases, despite questions about their safety and effectiveness.
The “Tropical Trump,” as Bolsonaro has been called, shares his U.S. counterpart’s enthusiasm for the two drugs, as well as his tendency to disregard scientific evidence that contradicts him.
Based on preliminary studies in China and France — and, apparently, a heavy dose of hope for something other than economically painful lockdowns to contain the pandemic — U.S. President Donald Trump and Bolsonaro have been touting chloroquine and hydroxychloroquine as potential wonder drugs against COVID-19, despite scientists’ insistence that further testing is needed.
Trump even revealed Monday he has been taking hydroxychloroquine daily as a preventive measure.
But he has not been able to do what Bolsonaro has done: get national health authorities to expand the recommended use of the drugs from clinical testing and severe cases to the entire infected population, starting with the onset of symptoms.
“There is still no scientific proof, but (chloroquine) is being monitored and used in Brazil and around the world,” Bolsonaro tweeted Wednesday.
“We are at war. ‘Worse than defeat is the shame of never having fought at all,'” he added.
“God bless Brazil.”
With Trump up for re-election in November and Bolsonaro determined to fight what he has called the “hysteria” around the pandemic, the chloroquine debate has turned intensely political.
Brazil’s former health minister Nelson Teich resigned last week after less than a month on the job, reportedly after clashing with Bolsonaro over the president’s insistence on expanding the use of chloroquine against COVID-19.
Political analysts predicted Bolsonaro, now on his third health minister of the pandemic, would seek a pliable replacement willing to ignore the lack of scientific evidence on chloroquine.
Indeed, after interim minister Eduardo Pazuello signed off on the new treatment guidelines, Bolsonaro said he planned to keep him in the post “a very long time.”
The new guidelines recommend doctors in the public health system prescribe either chloroquine or hydroxychloroquine from the onset of symptoms of coronavirus infection, together with the antibiotic azithromycin.
Patients will be required to sign a waiver acknowledging they have been informed of potential side effects, including heart and liver dysfunction, retina damage “and even death.”
They leave the final decision on using the drugs up to doctors and their patients.
The health ministry acknowledged that “there are still no meta-analyses of randomized, controlled, blind, large-scale clinical trials of these medications in the treatment of COVID-19.”
However, it said the government had a responsibility to issue guidelines using the information currently available.
“Brazilians are asking to receive this medication, which has shown positive results in various clinical studies. And we need to give them that right, even if the number of studies is still scarce,” health ministry official Mayra Pinheiro told a news conference.
Chloroquine and hydroxychloroquine are typically used against malaria and to treat certain auto-immune diseases, including lupus.
COVID-19 is another matter.
“Chloroquine has clearly shown it does not do what we wanted it to in terms of treating the coronavirus. On the contrary, it leaves a legacy of side effects,” said infectious disease specialist Jean Gorinchteyn of Albert Einstein Hospital in Sao Paulo.
He also worried the illusion of a treatment could make people less inclined to observe stay-at-home measures.
“When you say there’s a treatment, people let their guard down … and think it’s OK to go to work. And the more people circulate, the more the virus circulates.”
There is also concern that widespread use of the drugs against coronavirus will create shortages for other patients who need them.
Many pharmacies in Brazil say they have already run out of both drugs.
“Before the pandemic, we sold one box a month, maximum. Then in late March demand started to increase, and now we can’t even get it in stock,” one pharmacist in Rio de Janeiro said.
Amid the government’s disjointed response, Brazil has emerged as the latest hot spot in the pandemic.
The country has registered more than 290,000 cases and nearly 19,000 deaths so far, and the increase in infections is not expected to peak until June.
Experts say undertesting means the real figures are probably much higher.
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