SA tests chloroquine

US President Donald Trump has been pushing it as a remedy for Covid-19, with zero evidence. Now, SA is taking part in a global trial to see if the antimalarial drug chloroquine can protect doctors and nurses at the frontline from contracting the coronavirus.

The trial will test the drug, or a placebo, in 55,000 doctors and nurses in SA, Zambia Ireland, the UK and the US over five months. Where they do get Covid-19, the study aims to assess whether they get a milder form of the disease.

This comes as evidence is emerging that chloroquine might help stop the coronavirus from entering certain cells in the lungs, where it infects humans.

Tens of thousands of doctors and nurses worldwide have been infected with the virus, despite wearing protective gear. In Italy, more than 17,000 health workers fell ill — 10% of the country’s infections in mid-April.

SA hasn’t been spared this trend. In the Western Cape, as of last week, there were 1,010 cases of doctors, nurses and hospital staff testing positive for Covid-19, with six deaths and 462 known recoveries, according to the provincial health department.

Finding a way to help them would have a double benefit: if a health worker is infected, it means they have to quarantine, which means there are fewer staff to deal with real cases

Wits intensivist Prof Guy Richards says that as specialised doctors and intensive care unit (ICU) nurses got sick, it would strain the health system.

“SA is short of intensivists and ICU nurses, and as more of these staff [get Covid-19], so the fall-out rate for quarantine or illness compounds the problem.”

Prof Bruce Biccard, deputy head of the department of anaesthesia at the University of Cape Town, who is involved in the trial, says: “If we can prevent Covid-19 infection or decrease the severity of the infection in health-care workers, it means we can ensure that our health-care workforce can continue to provide care during this pandemic.”

And chloroquine is a cheap and widely available drug.

“This trial is important for many reasons. It repurposes a drug which has a long track record of safety in the management of malaria.”

One group of health workers will get a placebo and three groups will get different doses of chloroquine to see what the lowest dose that may be effective is. The lower the dose, the lower the chances of side effects.

The new trial comes after one part of the Solidarity trial to test chloroquine for treatment in very sick people with Covid-19 was “temporarily paused” by the World Health Organisation (WHO).

This was after a report in The Lancet journal showed that sick Covid-19 patients treated with the drug were more likely to die. The WHO said the safety data on the chloroquine trial is being reviewed by the trials data safety monitoring board.

But this new global trial differs as it is using chloroquine for prevention and the dose is far lower and it is given to healthy people. Using low-dose chloroquine is low risk.

Chloroquine was used as a malaria prevention pill for years and while mosquitoes are resistant to it now, it is used as a treatment by some people with autoimmune disorders including lupus and rheumatoid arthritis.

Biccard says the trial “has ethics approval in SA, the US, the UK, Ireland and Zambia presently. It is ethical as there is no signal of harm in prophylaxis [prevention] trials and the dose is low. The drug has a very plausible mechanism to mitigate the effects of [the coronavirus], blocks some of the viral entry pathways into the cell and concentrates in the lungs.”

Prof Helen Rees, executive director of the Wits Reproductive Health & HIV Institute at Wits University says that preventing illness in doctors and nurses could prevent a health system collapse.

“If an inexpensive drug such as chloroquine could help protect our health workers, it would provide important insurance for many countries whose health-care systems could collapse if large numbers of health-care workers were to become infected.”

Laurence Lovat, a professor of gastroenterology at University College London says: “With its anti-inflammatory properties, chloroquine might dampen the exaggerated and unregulated immune response in the host, which often is responsible for the unpredictable and severe complications of Covid-19​.​”