Why US President Trump thinks “Hydroxychloroquine” as a ‘game-changer drug’ against COVID-19 and asks India to lift the ban on export of the drug?





Corona VIrus





On 5th April 2020 US President Donald Trump had called Indian Prime Minister Narendra Modi to lift ban on export of Hydroxychloroquine as India announced the ban on export of the drug on 4th April “without any exception”.





India being one of the largest manufacturers of Hydroxychloroquine has added the drug to the restricted list to make it available for domestic use during the COVID-19 global pandemic, while President Trump has required to export the drug on case by case basis.





India may lift the ban on export of the drug, while still keeping it in the restricted list and only exporting it to pharmaceutical companies only after getting a no objection certificate and permission from the authorities.

This followed after the World Health Organization (WHO) named Hydroxychloroquine as a possible treatment for COVID-19.

Reports from France and China show that the use of Hydroxychloroquine has been an effective treatment against COVID-19, that said, being one of the reasons why Trump touted it as a ‘game changer drug’ and wants to stockpile it.





FDA has approved “compassionate use” of the drug which means that the doctors can prescribe it as a treatment to the patients who are in a life threatening situation.





To understand the reasons why it is being considered a ‘game-changer drug’ by many, first one should understand the mechanism of COVID-19 and how Hydroxychloroquine might be helpful in the treatment of it.









What is COVID-19?





Corona Virus Disease-2019 is a infectious respiratory disease caused by Severe Acute Respiratory Syndrome Corona Virus -2 (SARS CoV-2).





It broke out in December 2019 in Wuhan, Capital of China’s Hubei province.

It is similar to the SARS which broke out in 2005 caused by one of the coronaviruses.





WHO declared it as a global pandemic on 11 March 2020.









Mechanism of action of COVID-19:





It is spread through respiratory droplets which get released from people when they talk, sneeze or cough.

It gets released while breathing also, but the corona virus is a heavy virus and hence it is not airborne and does not get transmitted to log distances, instead it gets settled on the surfaces.





The virus then gets transmitted from touching the surfaces on which the respiratory droplets have settled and consequently touching the face.

The virus can live on surfaces for as long as upto 72 hours

Once it comes in contact with the mucous membranes in mouth, nose, eyes, it finds way to the type-2 alveolar cells in the respiratory tract.





The lungs has 2 types of alveolarcells





1. Type 1 alveolar cells- help in the absorption of air (gas exchange in the lungs during breathing).

2. Type 2 alveolar cells- produce surfactants which serve to keep the lungs fluid, clean and infection free.

So, once the virus comes into contact and adheres with the surfactant producing type-2 alveolar cells, it reproduces inside it killing the cell.

Every alveolar cell when it gets ruptured and dies, creates an extreme immune reaction causing secretion of excessive fluids.

The fluid, pus and the dead cell material flood into the lungs causing respiratory illness which may lead to pneumonia and even death in severe cases.









Symptoms of COVID-19:





For most cases, the symptoms are mild to moderate respiratory illness and they get cured without the need of any special treatment.





Common symptoms are

· Fever

· Cough

· Shortness of breath





Other symptoms are

· Fatigue

· Muscle pain

· Diarrhea

· Sore throat

· Loss of smell

· Abdominal pain





But in older people who already have a history of diabetes, chronic respiratory disease, diabetes, or cancer, they develop a serious illness which ends up in pneumonia and multi-organ failure.









Why Hydroxychloroquine?





So why is Hydroxychloroquine being touted as a game changer in a situation like this?





Hydroxychloroquine is most commonly known as Hydroxychloroquine sulphate sold under its brand name “Plaquenil” among others.

It is extracted from the Cinchona tree along with several products such as quinine, choloroquine etc.





It is widely used as a medication to prevent and treat malaria.

It is and oral medication and is taken by mouth as a tablet.

It has been used as a medicine since 1940s for fighting several auto-immune disorders such as rheumatic arthritis (auto-immune disorder affecting the joints), lupus (auto-immune disorder attacking healthy tissues) and porphyria cutanea tarda (causing blisters in the skin).









Mechanism of Action of Hydroxychloroquine:





The drug gets rapidly absorbed by the gastrointestinal tract, and is eliminated by the kidneys.





The chemical increases the pH from 4-6 (lowering the acidity) in the antigen presenting cells, which is the corona virus in this case.

This prevents the virus from breaking into the cell membrane, it blocks the toll-like receptors in the dendritic cells.





These cells recognizes the DNA containing immune complexes which causes the innate immune system in the body to fight back the virus causing inflammatory reaction.





These inflammatory reactions by the immune system cause increased secretion of fluids in the respiratory tract, causing respiratory illness.





Hydroxychloroquine in a way inhibits the innate immune response by the body and by preventing the entry of virus into the human cells by lowering the acidity.





While the effectiveness of the drug against the novel COVID-19 is still under testing and is not proven yet, the term “game-changer drug” might be too early and the side effects of the drug are to be considered before declaring it as a treatment against the disease.









Side Effects of Hydroxychloroquine :





Even a slight increase in dosage of the drug causes several side effects such as





· Vomiting, nausea

· Headache

· Changes in vision

· Muscle weakness

· Diarrhea, reduced appetite

· Heart problems

· Severe allergic reactions etc





Due to the several side effects caution is required while prescribing to patiends that have a history of heart conditions, diabetes, etc.

Also, it transfers to breast milk and should be used with care while prescribing to pregnant women to prevent risk of overdosing infants.





The research on the effectiveness of Hydroxychloroquine is still in the premature stage and too early to be considered as an effective treatment of the corona virus disease.









Preventive treatment for COVID-19





As the novel corona virus does not have a vaccine or an effective treatment medication once it is infected, the best move is to follow preventive procedures to avoid contracting the virus.





· Follow social distancing by maintaining at least a gap of 1 meter to prevent the virus getting transmitted through respiratory droplets while talking, coughing or sneezing.

· Practice respiratory etiquette by coughing or sneezing into a flexed elbow to prevent dispersing respiratory droplets

· Avoid touching surfaces with the hands and avoid touching your face, that is, the eyes, nose and mouth. The virus makes way to the respiratory tract once it comes into contact with the mucous membranes.

· Wash your hands frequently with soap or alcohol based hand sanitizer to keep the hands clean.

· Respiratory masks are to be worn by

o People who have contracted the virus already,

o People who are suspected to have contracted the virus.

o Medical practitioners or caregivers who take care of the patients.





Conclusion:





· There is no vaccine or medication available for the treatment of novel Corona Virus Disease (COVID-19).

· The usage of Hydroxychloroquine as a game-changer drug might be too early as it has not yet been clinically proven to be effective against the novel corona virus disease (COVID-19).

· India might lift ban on the export of the drug on a case by case basis as the manufacturing capacity is so high to meet the domestic demand and also to export to other nations.

· Social distancing and other preventive measures as instructed by the World Health Organization (WHO) are to be followed.





Please leave comments below regarding the spread of the disease, preventive strategies or helping the community that you live in.