Spikes in the number of COVID-19 cases around the country are driving a rush for effective treatments for the infection.
A statement from the heads of the National Academies of Science, Engineering and Medicine put it plainly: "It is essential to explore a wide range of options for treating the increasing numbers of very ill patients with COVID-19 respiratory illness."
But as more potential treatments surface, others in the fields of medicine and science, including a Portland physician and medical school professor, are urging caution and patience.
In a paper published by the American College of Cardiology, Oregon Health & Science University electrophysiologist Dr. Eric Stecker warned that a combination of medication being used in certain hospitals could pose a cardiac risk to patients. He said the medicines' benefits to COVID-19 patients are still unknown.
“What is out there is somewhat promising, but it's really very small studies with very limited number of patients,” he said. “So if we don't really know the benefits, I think it's important to seriously contemplate what the potential risks are.”
The potential treatments brought forward range from treating coronavirus-infected patients with antibodies (disease-fighting proteins produced by the immune system) from people who have recovered from COVID-19 to repurposing malaria medications chloroquine and hydroxychloroquine for coronavirus treatment, which received federal approval March 29.
The frenzy around the malaria medicines nationally was so great that the Oregon Board of Pharmacy adopted an emergency rule in late March prohibiting the dispensing of both chloroquine and hydroxychloroquine for COVID-19 prevention or suspected cases of the disease.
Along with hydroxychloroquine, the antibiotic azithromycin has gotten a lot of national attention. In late March, President Donald Trump tweeted: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.”
The concern, according to Stecker, is that both of these medications are known to occasionally cause abnormal heartbeats, which could lead to cardiac arrest. And it’s unknown how combining the two will change that risk.
In addition, the people most likely to experience this side effect from the medications are the same people who are at greater risk of complications from coronavirus: those over the age of 65 with preexisting conditions, including those related to the heart. This inherently creates a dilemma that gets worse as the new coronavirus spreads and COVID-19 infection increases.
“Unfortunately, the sicker the patient, the higher the risk of the medications. And of course, those are the circumstances in which providers are going to want to use the medicine because they're really grasping at anything they can do to help the patient,” he said.
As of Saturday, Oregon had nearly 1,000 cases of COVID-19 and more than two dozen people had died. Nationally, more than a quarter-million people have been verified as infected, with more than 6,500 people dead.
Stecker and his paper co-authors from Indiana University do not say health care providers should avoid using the medicines in combination. Instead they advise that measures should be taken to monitor the patients for specific heart problems linked to the medicines.
But even monitoring comes with a cost, including the need for personal protective equipment (PPE) that’s already in short supply, medical equipment that may be needed elsewhere, and the risk of COVID-19 exposure to health care workers who would be doing the monitoring.
Stecker said he is working to establish specific treatment guidelines for OHSU hospital staff for when and if they see a surge of COVID-19 cases.
“How do we implement this practically? How do the nurses deal with it? ... And what should we do if there's too much risk to personnel from infection?” he said.
The combination of hydroxychloroquine and azithromycin was used to treat a portion of patients at the Oregon Veterans’ Home in Lebanon during a COVID-19 outbreak in mid-March. Others testing positive for COVID-19 were not administered the drugs because of preexisting heart conditions that put them at higher risk for complications.