A few days ago, Andreas Voss, the President of the International Society of Antimicrobial Chemotherapy, posted an advisory1 stating the controversial paper published in IJAA on the favorable effects of Hydroxychloroquine and Azithromycin in patients with COVID-19 infection2 did not meet the journal’s scientific standards. Meanwhile, countless physicians on the frontlines prescribe these drugs. Many also prescribe hydroxychloroquine for their friends and families. Others take it prophylactically. Last week, The Medical Board of California issued a statement reminding doctors that “inappropriately prescribing or dispensing medications constitutes unprofessional conduct in California”3.
I do not advocate for or against uncertain treatment strategies in these tenuous and rapidly fluid times. After all, COVID-19 also prompts debate about issues such as management algorithms for ventilatory failure, indications for intubation, frequency of diagnostic testing, triage protocols, handling non-COVID-19 patients, and which personal protective equipment is most reliable.
The terrain is challenging, in part because this is the first time practitioners, regulators, and hospital administrators face a crisis of this magnitude. Those of us who were on the front lines throughout the AIDS epidemic have retired or are close to retirement. Some who knew the uncertainties of newly discovered diseases such as Hantavirus in the American West, contamination of our hospitals’ water systems with Legionella, and the surprising outbreak of Cholera in 1990s’ Latin America may now be in leadership positions with different agendas. Others might have been relegated to jobs with lesser responsibility or removed from decision-making positions where they can make a difference in today’s epidemics.
How else might we explain why many recommendations provided after the global health care threats of SARS, H1N1, and MERS pandemics earlier this century were ignored and underappreciated. And 40 years ago, AIDS also taught us a painful lesson that has been only partially learned; that a deadly disease somewhere can quickly spread everywhere.
There is no doubt our international community has made great strides since then. We have improved in regards to predictions and disease modeling, risk assessments and surveillance, outbreak detection, containment strategies, pathogen characterization, and public health interventions, but we have far to go.
Let’s hope the COVID-19 pandemic serves to overcome whatever uncertainties exist in our ranks. Then, health care providers in the front lines can take a greater role in persuading hospital administrators and government officials to invest more in protecting our future.
2. Gautret P, Lagier JC, Parola P et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Mar 20:105949.
3. Medical Board of California, April 2, 2020. Statement Regarding Improper Prescribing of Medications Related to Treatment for Novel Coronavirus (COVID-19.
4. United Nations Coordinated Appeal. Global Humanitarian Response Plan: COVID-19, April-December, 2020.