What should I do if I have COVID-19?

A treatment or vaccine makes you feel better protected against an unseen viral killer, much as a fortified entrance or a guard dog makes you feel protected against a prowler. Knowing that the anti-viral drug remdesivir and the steroid dexamethasone have emerged as effective in-hospital treatments for COVID is of some comfort, but people across the country want to know what they might take as a preventative, or for early treatment in case they got sick. This is especially important as we wait for a vaccine to emerge, hopefully by the beginning of next year.

Convalescent antibodies (taken from recovering patients) have provided early treatment for many conditions, dating back to the late 19th century. They have been useful before vaccines became available for typhoid, polio, measles and hepatitis B. Nowadays we have the option of targeted synthetic antibodies which are generally more potent and more effective and they are currently being studied for use against the SARS-CoV-2 virus that causes COVID-19.

Another promising treatment under investigation is the inhaled steroid ciclesonide, which has been found to have anti-viral properties against this coronavirus and also acts as an anti-inflammatory agent. Pulmonologists already use it all the time to treat asthma and allergic rhinitis. The effectiveness of COVID-19 is largely anecdotal, but clinical trials are ongoing.

Speaking of anecdotal, that brings me to hydroxychloroquine, which has been used widely around the world as both a preventive and early treatment against COVID-19. Studies have been mostly performed on hospitalized patients, despite the fact that by the time patients are in the ICU, they are frequently suffering from lung and other organ inflammation and blood clotting problems. 

There is no convincing reason to believe that hydroxychloroquine would work at this point, and multiple studies have confirmed the ineffectiveness of the drug, while others are still ongoing. Its potential side effects in terms of cardiac arrhythmias have long been known, as the drug has been on the market (as prophylaxis against malaria and treatment for lupus) for over 60 years

A recent study from the University of Minnesota did not show that hydroxychloroquine was useful as post-exposure prophylaxis, but a large retrospective study from the Henry Ford Health System did show effectiveness when given very early in the hospital course. The gold standard of medical research, double-blinded prospective randomized trials, is still ongoing. 

The latest one from Brazil just published in the New England Journal of Medicine showed no effect against COVID-19 in mild to moderate hospitalized patients. And another placebo double-blind randomized study just released by the University of Minnesota published in the Annals of Internal Medicine also showed that hydroxychloroquine did not work to decrease symptoms in mild to moderate cases among outpatients. 

Considering hydroxychloroquine as a preventive or early treatment for COVID-19 appears to be almost over except among heretics or outliers. Its use has been tainted not just by negative research and by the FDA withdrawing its Emergency Use Authorization (which has made doctors afraid to prescribe it for fear of lawsuits), but by the politicization of the drug over President Trump’s endorsement and subsequent admission that he was taking it.

Back in March, things were different. A study out of China showed the effectiveness of hydroxychloroquine as an anti-viral agent against this coronavirus and there was every reason to study it further. A top pulmonologist I work with took it when he got COVID, and he was not alone. 

He felt better but didn’t know if it was the drug or not. My father, who is in his 90s, felt very fatigued one day, had a fever and said he didn’t think he could get up from the couch. His cardiologist prescribed hydroxychloroquine and azithromycin and by the next day, he felt much better.

It was hard for me to believe it wasn’t the treatment working, in fact, it is still hard for me to believe it, though I realize now that we were treating our fear of the virus as much of the virus itself. Back in March, we had nothing else to offer. Now we are more inclined to wait patiently for the science to back up our choices, even though, as the virus continues to spread, the tendency to give into our fears recurs.

Marc Siegel M.D. is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent. Follow him on Twitter: @drmarcsiegel.