South Africa

SA hospitals’ stance on the controversial hydroxychloroquine drug as Covid-19 treatment

Johannesburg - The Department of Health says it does not recommend the use of the controversial anti-malarial drug hydroxychloroquine as a Covid-19 treatment.

At least two major hospital groups agree with the department on their stance.

This comes after a viral video of Dr Stella Immanuel advocating for the use of the drug went viral last week.

The viral video, which was taken outside the steps of the Supreme Court in Washington, courted controversy after all major social networks removed took a decision to remove the video on their platforms last week.

US President Donald Trump is a fan of the drug, despite US disease chief Dr Anthony Fauci warning about the effects of using the drug as a Covid-19 treatment. Fauci has consistently argued that valid scientific data shows the drug is not effective in treating the novel coronavirus.

The clampdown on Immanuel’s video by social media networks has angered some, who still take to social media to advocate for the drug as a Covid-19 ailment, despite several medical journals and the World Health Organisation saying there is no conclusive evidence of the positive effects of hydroxychloroquine.

In early July, WHO announced it was discontinuing hydroxychloroquine and lopinavir/ritonavir treatment arms for Covid-19.

“The International Steering Committee formulated the recommendation in light of the evidence for hydroxychloroquine vs standard-of-care and for lopinavir/ritonavir vs standard-of-care from the Solidarity trial interim results, and from a review of the evidence from all trials presented at the 1-2 July WHO Summit on Covid-19 research and innovation.

“These interim trial results show that hydroxychloroquine and lopinavir/ritonavir produce little or no reduction in the mortality of hospitalised Covid-19 patients when compared to standard of care. Solidarity trial investigators will interrupt the trials with immediate effect.

“For each of the drugs, the interim results do not provide solid evidence of increased mortality. There were, however, some associated safety signals in the clinical laboratory findings of the add-on discovery trial” the World Health Organization said.

PUBLIC HOSPITALS

Popo Maja, a spokesperson for the Department of Health, said South Africa has never recommended hydroxychloroquine as a Covid-19 treatment, but it had been used as a clinical trial under conditions where patients were carefully monitored for any adverse effects.

“The National Department of Health regularly reviews evidence from clinical trials and adjusts guidelines accordingly,” it said.

The department, however, did advocate for the use of dexamethasone, which it said had reduced mortality rates among patients who were severely infected with Covid-19.

“Dexamethasone has been shown to reduce mortality amongst patients with severe Covid-19 disease, and all patients requiring oxygen should receive a 10-day course of dexamethasone.

“Patients who are admitted to hospital should also receive treatment to reduce the risk of complications related to clotting abnormalities.

“We do not currently recommend that any other medicines are given routinely. Some patients may require additional treatment as part of supportive care or to treat complications,” said Maja.

Asked about the private sector, the department said it did not monitor the prescription practices of hospitals in the private sector, and could therefore not comment.

We fielded questions to the Life Healthcare and Netcare Group to find out if they were dispensing hydroxychloroquine as a Covid-19 treatment to patients.

NETCARE

Dr Anchen Laubscher, Netcare’s group medical director, said doctors who practised at their facilities were independent practitioners who had the responsibility to make clinical decisions regarding the treatment of Covid-19 patients.

However, said Laubscher, the Netcare Group had designed an observational study and obtained ethics approval, in line with recommendations (NDoH) to ensure that any therapeutics used for the treatment of Covid-19 infections were in line with the Monitored Emergency Use of UnRegistered Interventions (MEURI) framework as set out by WHO.

“This Netcare Covid-19 MEURI framework was developed for access to investigational therapeutics for individual patients outside of clinical trials in pandemic type settings, with the aim of having in place a standardised process for monitoring the safety of patients diagnosed with Covid-19 and treated with investigational therapeutics in Netcare hospitals and Medicross.

“Doctors practising at Netcare hospitals and Medicross facilities are encouraged to participate and enrol patients into the study so that Netcare and doctors practising at the group’s facilities can collectively ensure the safety and appropriate monitoring of patients receiving off-label treatment for Covid-19 infection,” said Laubscher.

The hospital group said the dispensing of medication for patients remained a decision for individual medical practitioners and that the Netcare Group did not recommend to doctors what drugs should be used..

“A doctor’s decision on the treatment of a Covid-19 patient will obviously take into consideration that specific patient’s condition, the severity thereof and any complications the patient may have developed, and any comorbidities the patient may have, as well as latest research and comment from across the world on treatment modalities,” he added.

LIFE HEALTHCARE

Meanwhile, at the Life Healthcare Group, Dr Charl van Loggerenberg, the general manager for emergency medicine, said the hospital had taken a decision not to dispense chloroquine and hydroxychloroquine as a form of Covid-19 treatment.

“In April 2020, Life Healthcare took a decision not to dispense chloroquine as a form of Covid-19 prophylaxis unless on the recommendation of a multidisciplinary team treating a critically ill Covid-19 patient.

“The decision is evidence based as per the South African NICD (National Institute for Communicable Diseases) guidelines and still stands

“In this time of highly abnormal and challenging circumstances, we remain committed to being a clinician lead organisation and will constantly revise our clinical policies based on emerging evidence.

“You may wish to refer to the Critical Care Society and Gauteng ICU group as well as provincial DOH clinical protocols for more information on the use of hydroxychloroquine,” he said.

IOL

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