RUTHFULLY YOURS

Fielding questions from reporters on Monday after a roundtable with restaurant executives and industry leaders, President Trump casually announced that for the past week-and-a-half, he had been taking one hydroxychloroquine tablet daily, along with a zinc supplement (HCQ+Zn). Given the media reaction, you’d have thought the president admitted to . . . oh, I don’t know, something really out there, like he’s eaten dog meat.

Asked about Department of Health and Human Services whistleblower Rick Bright’s criticism of the administration’s response to the COVID-19 pandemic, the president said:

He’s the one that signed the [emergency use authorization] application. . . . Now, if he doesn’t believe in it, why would he sign it? . . . You’d be surprised at how many people are taking [hydroxychloroquine], especially the frontline workers—before you catch it. The frontline workers—many, many are taking it. I happen to be taking it. I happen to be taking it. . . . Right on “The View” now. Yeah. A couple of weeks ago, I started taking it.

Then, President Trump dropped this bombshell when asked if the president’s physician, Dr. Sean Conley, recommended that he take HCQ+Zn:

A White House doctor—didn’t recommend—no, I asked him, “What do you think?” He said, “Well, if you’d like it.” I said, “Yeah, I’d like it. I’d like to take it.” . . . I was just waiting to see your eyes light up when I said this, but—you know, when I announced this. But, yeah, I have taken it for about a week and a half now, and I’m still here. I’m still here.

Pressed repeatedly by reporters on whether he was taking HCQ+Zn because he tested positive for COVID-19 or was experiencing symptoms, the president clarified:

Zero symptoms. . . . [E]very couple of days, they want to test me, you know, for obvious reasons. I mean, I am the president, alright? . . . So every couple of days, I get tested, and I’ve been—I’ve shown always negative. . . . Totally negative. No symptoms. No nothing. . . . I take it because I think—I hear very good things. Again, you have to go to frontline workers. Many frontline workers take it and they seem to be doing very well.

A few minutes later, Fox News host Neil Cavuto lost his Shinola over the revelation:

If you are in a risky population here and you are taking this as a preventative treatment to ward off the virus—or, in a worst-case scenario, you are dealing with the virus and you are in this vulnerable population—it will kill you. I cannot stress enough: This will kill you. So, again, whatever benefits the president says this has—and, certainly, it has had for those suffering from malaria, dealing with lupus—this is a leap that that should not be taken casually by those watching at home or assuming, “Well, the president of the United States says it’s OK.”

Interviewed by CNN’s Anderson Cooper, House Speaker Nancy Pelosi (D-Calif.)—who claims to pray for the president—expressed her “concern” that he has comorbidities putting him at risk of dying from taking HCQ:

I would rather he not be taking something that has not been approved by the scientists, especially in his age group and in his, shall we say, weight group, what is morbidly obese, they say.

Conley provided a follow-up statement to White House Press Secretary Kayleigh McEnany for release to the media:

As has been previously reported, two weeks ago one of the president’s support staff tested positive for COVID-19. The president is in very good health and has remained symptom-free. He receives regular COVID-19 testing, all negative to date.

After numerous discussions he and I had regarding the evidence for and against the use of hydroxychloroquine, we concluded the potential benefit from treatment outweighed the relative risks.

OK, let’s all take a deep breath and go through the facts—and the science—about prophylactic use of HCQ, a topic we first discussed in March, and the relative risks and potential benefits to the Leader of the Free World.

As of President Trump’s last complete physical exam on February 14, 2019:

• Based on his weight (243 pounds) and height (6 feet, 3 inches), his body mass index—a weight-to-height ratio—was 30.4 (obese). A BMI above 40 is considered extremely obese, and morbidly obese is being 100 or more pounds overweight.
• Blood pressure was measured at 118/80—a normal reading, not indicating hypertension.
• Like many Americans, he is taking the cholesterol-lowering drug, rosuvastatin (brand name: Crestor). His total cholesterol was measured at 196 mg/dL. Optimally, total cholesterol should be below 170 mg/dL, but anything above 200 mg/dL is considered high. The president is already taking the maximum dosage of rosuvastatin (40 mg daily), so losing 10-15 pounds would help bring his total cholesterol level closer to optimal.

Can taking HCQ+Zn kill President Trump?

Highly unlikely.

There is no excess risk of severe adverse effects associated with short-term use of HCQ, which is how the drug is used to treat COVID-19. And U.S. Representative Mike Kelly (R-Pa.) did not report any ill effects from HCQ+AZ (azithromycin) when he discussed his COVID-19 symptoms on “The View,” and how the treatment helped him recover.

Taking hydroxychloroquine while on rosuvastatin does carry a risk of a moderate (not life-threatening) adverse drug interaction, as each drug by itself can potentially cause weakness, numbness, pain, burning, or tingling in the hands, feet, or limbs. There is no known interaction between rosuvastatin and zinc. It is safe to assume that Dr. Conley was aware of all adverse drug interactions involving rosuvastatin when he gave the go-ahead to President Trump to take HCQ.

Critics of HCQ point to a Veterans Affairs study of 68 male patients hospitalized with confirmed COVID-19 at VA hospitals nationwide that found that taking HCQ did not reduce a patient’s chances of needing to be intubated, and HCQ with or without AZ was associated with a higher risk of a fatal outcome. As President Trump has not tested positive for COVID-19, shows no symptoms, and is not hospitalized, these results do not apply to him—his age and weight notwithstanding.

A prospective, randomized controlled clinical trial undertaken by the University of Alberta at Calgary involving 1,660 immunocompromised Canadians may clarify matters for patients at highest risk of dying.

Over the course of five days, study participants will be given HCQ or a placebo, beginning within 96 hours of a positive COVID-19 test result, and within 12 days of symptom onset. The clinical study is expected to be completed by the end of September.

It would be unethical for researchers to administer HCQ to this highly vulnerable patient population if there was a large body of evidence the drug would kill them—and such a study would not get federal funding.

Can taking HCQ+Zn prophylactically help the president avoid contracting COVID-19 if exposed to an asymptomatic carrier or to someone showing clear signs of infection?

Possibly, but the jury is still out—though not for long:

• The Duke Clinical Research Institute launched a $50 million double-blind placebo-controlled study to evaluate whether HCQ can prevent COVID-19 infections in frontline healthcare workers. The Healthcare Worker Exposure Response and Outcomes (HERO) study will enroll 15,000 healthcare workers nationwide, who will randomly receive either HCQ or a placebo for one month to evaluate whether the anti-malarial drug has a protective effect against COVID-19, and can prevent them from unintentionally infecting other people. Preliminary results could be available as early as July or August.
• The Medical University of Vienna is conducting a similar study of 440 healthcare workers. Preliminary results could be available as early as August or September.
• Detroit’s Henry Ford Health System is also conducting its own randomized, double-blind “Will Hydroxychloroquine Impede or Prevent COVID-19?” (WHIP COVID-19) study to see whether prophylactic administration of HCQ can prevent infection with the novel coronavirus. Preliminary results from the study, which has enrolled 3,000 healthcare workers and first responders (EMS, firefighters, police, bus drivers), may be available in four months.

It’s worth noting that some doctors in the United States are not waiting for the results of clinical trials and are taking HCQ prophylactically, and that India and Turkey are among the countries already administering the drug as a preventive measure to medical personnel and contacts of infected people.

Recently, New York Governor Andrew Cuomo marveled that antibody testing showed that healthcare workers, transit employees, police, firefighters, and EMTs had lower rates of having contracted COVID-19 than the general population. He attributed these results to healthcare workers and first responders wearing masks and gloves, but it doesn’t appear that any of them were asked whether they had been proactively taking HCQ.

Could contracting COVID-19 kill President Trump? Again, unlikely.

Available data suggests those at highest risk of serious and life-threatening complications are above the age of 65; male; black or Latino; immunocompromised (perhaps because of chemotherapy or taking a biologic for an autoimmune disease); or have comorbidities that include serious heart disease (for example, heart failure, coronary artery disease or pulmonary hypertension), diabetes, chronic respiratory illness (such as asthma or COPD), high blood pressure, or BMI above 40. President Trump is in overall good health, his age and weight notwithstanding, and doesn’t have the comorbidities associated with developing severe COVID-19 complications or with the highest risk of dying from the disease.

The president comes into contact with large numbers of people daily, and the decision to take HCQ prophylactically is between him and his doctor.

That said, a plethora of clinical trials worldwide are looking at the safety and efficacy of HCQ in combination with such drugs as lopinavir, an antiviral drug used to treat HIV; clevudine, an antiviral used to treat hepatitis B; and rheumatoid arthritis drug baricitinib. Within months, we’ll have plenty of science regarding HCQ’s place in the COVID-19 armamentarium. And perhaps, the inexplicable media vendetta against this therapy will end.