Doctors at Rutland Regional Medical Center and Central Vermont Medical Center say they are using hydroxychloroquine to treat patients for COVID-19. But, they say, the drug is not for every patient with COVID-19 and is being given in circumstances where the patient can be observed during treatment.
Dr. Jessie Leyse, infectious disease physician at Central Vermont Medical Center, said “it’s not a medication that people should just seek out and take if they think they may have COVID-19.”
“Because this is such a new virus, we don’t have a lot of good studies about (the drug) yet. The studies we do have are presenting some conflicting data about whether or not the hydroxychloroquine helps in COVID-19 illness. Because it can cause harm, it’s not a benign medication, it can cause heart problems, kidney problems, liver problems, it really needs to be given in a monitored setting,” she said.
At Rutland Regional Medical Center, Dr. J. Gavin Cotter, infectious disease physician, said the drug has been used to treat a number of different diseases like lupus, malaria and sarcoidosis.
Hydroxychloroquine is still being tested as a treatment for COVID-19 but Cotter said some of the theories being pursued are the possibility in could inhibit viral entry, reduce the maturation of the virus so a patient who takes the drug is not as affected. The drug could modify a patient’s immune system to reduce inflammation.
Cotter said doctors treating a patient with COVID-19 would have to check the patient for an allergic reaction to hydroxychloroquine, but there were other potential risks.
Many of the potential problems are associated more with long-term use of hydroxychloroquine but the side effects can include cardiovascular problems or irregular heart rhythms, known as arrhythmias.
In some unusual cases, and again, when used in a longer-term treatment, the drug could cause muscle atrophy, psychiatric effects or retinal toxicity, Cotter added. Medical providers would watch to see how it might interact with other drugs.
Leyse said while the benefits remain unproven, medical providers need to be cautious about how much they’re promoting the medication because of the potential for harm.
Cotter said the drug was available at RRMC because of its use in treating patients with other diseases. However, the interest caused by some national figures who are promoting hydroxychloroquine resulted in shortages, although Rutland Regional has enough supply to treat the patients who need it.
“We have to be prudent stewards of it. We don’t want to give it to people who don’t necessarily meet criteria, or we don’t necessarily feel they gain a benefit from it and that goes into how we developed a treatment algorithm here, drawing upon what other institutions have done,” Cotter said.
Leyse said CVMC also has an algorithm they use to find the patients who might benefit but said it’s not handed out to every person who tests positive for COVID. She said the algorithm basically helps to determine “if it’s worth the risk.”
There is some concern that patients or their loved ones, hearing prominent figures call the drug a “game changer,” will want to to try it whether it’s appropriate to the patient or not.
“I completely appreciate people’s anxiety. I have family and friends. I’m lucky in what I do, I kind of have a different perspective, but I can appreciate how these anxieties keep going up and up and it deals with families and kids. Everything’s changed, we’re in a post-COVID-19 world. I get that,” he said.
Cotter said he’s heard those concerns before, raised by patients during other health crises, but said he is steered by his oath to do no harm.
“There is no proven treatment. The last thing I want to do is give people false hope,” he said. Leyse pointed out that most people will find their immune system can deal with COVID-19 and, while they may feel sick for a few weeks, they will have a “mild course and won’t even be sick enough to require hospitalization.”
Patients and loved ones who have heard the explanation about why a particular patient is not getting hydroxychloroquine have been understanding, she added.
Cotter said his experience in his field has prepared him to work with patients to develop an understanding about the right course of treatment.
“Medicine is always moving. This is moving faster than most people are used to it, but this kind of ‘You’ve got to think two or three steps ahead?’ To tell you the truth, it’s where an ID (infectious disease) doctor lives,” he said.
Leyse said she wanted to remind Vermonters that COVID-19 is a viral illness, so the best way to treat it would be as other viruses are treated. A patient with a COVID-19 diagnosis should get lots of fluids, lots of rest, acetaminophen — like Tylenol — for fevers and continued social distancing to keep the virus from spreading.