FORT LAUDERDALE, Fla. — The CEO of a South Florida-based chain of primary care clinics says he’s convinced that the anti-malarial drug chloroquine can help reduce the coronavirus’ attack on patients’ respiratory systems, or prevent symptoms altogether.
Dr. Marlow B. Hernandez, CEO of Miami-based Cano Health, is advising more than 100 doctors who work for Cano to prescribe the drug to patients who have COVID-19 symptoms but test negative for the regular flu, and as a preventative treatment for high-risk patients.
“I think we can make a big impact if we use this medicine in the right clinical context,” Hernandez said in an interview Tuesday, “while continuing to enforce social distancing and keeping people out of the hospital in combination with other measures.”
Cano Health, specializing in care for the elderly, serves about 60,000 patients at clinics in Broward, Palm Beach, Miami-Dade, Hillsborough, Orange and Osceola counties.
Chloroquine, an antiviral, burst into public consciousness at a news conference Thursday that included President Trump and Stephen Hahn, who oversees the U.S. Food and Drug Administration. At the news conference, Trump said chloroquine and remdesivir, which was developed to treat Ebola and Marburg virus, would soon be approved for treating COVID-19.
Hahn corrected Trump’s statement, saying the drugs are approved for “compassionate use” — meaning that under current FDA rules, they can be prescribed when other treatment options aren’t available. They have not been specifically approved for COVID-19.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Friday that more data is needed on the drugs before they can be approved as safe and effective for COVID-19 patients.
Chloroquine and a similar less toxic version, hydroxychloroquine, are derivatives of quinine, which was developed in 1820 as a treatment for fevers. Along with remdesivir, they are among a handful of drugs undergoing clinical tests in numerous countries based on small studies that showed positive results when given to COVID-19 patients, according to a recent advisory by the U.S. Centers for Disease Control and Prevention.
Chloroquine has been used to treat malaria while hydroxychloroquine has been used to treat rheumatoid arthritis, the autoimmune disease lupus, and a blood disorder, porphyria, that affects the skin, the advisory states. Based on limited patient and lab testing, chloroquine and hyroxychloroquine are recommended in several countries for treatment of hospitalized COVID-19 patients, the advisory states.
Remdesivir is an intravenous drug that suppresses viral replication. It can help reduce contagion levels of COVID-19 within carriers. The drug is currently undergoing several clinical trials in the U.S. and might be proven effective in combination with chloroquine, Hernandez said.
A COVID-19 treatment guidance sheet from Massachusetts General Hospital lists hydroxychloroquine and remdesivir, among other drugs, as recommended treatments for patients with moderate or severe forms of the disease.
Hernandez said Cano Health doctors have prescribed chloroquine to “a few dozen” patients in recent days, including at-risk elderly patients with preexisting conditions and patients experiencing early-onset COVID-19 symptoms such as difficulty breathing, muscle aches, dry cough and loss of appetite.
“One was a 91-year-old female with moderate to persistent asthma, trouble breathing, cough and a fever,” Hernandez said. “The risk of admitting her to the hospital outweighed the benefits. We don’t know definitively whether she has COVID-19, but we put her on the therapy and she’s done very well.”
The patient started taking the drug about a week ago. Today she has a lingering cough “but that’s not uncommon,” he said.
Only a couple of the patients have tested positive for COVID-19, he said. Most haven’t been tested at all because Cano Health clinics have no tests, he said. Patients who present flu symptoms are given a test for the normal flu. If they test positive, they are given over-the-counter Theraflu. If they test negative for the normal flu, Cano Health doctors assume the patients have COVID-19 and offer chloroquine, Hernandez said.
But he emphasizes that Cano Health doctors will not prescribe the drug for people with severe symptoms, including fever that doesn’t break or worsening shortness of breath. Those patients should go to a hospital, he said.
Also, healthy people with no symptoms and no reason to presume they’ve been exposed should not use the drug or try to get it prescribed so they can hoard it for later, he said. They might have other conditions or be taking other medicines that could react in a dangerous way with chloroquine, he said. “It should not be taken without clinical supervision.”
Potential side effects can be serious, including damage to the heart or cardiovascular system, if taken incorrectly or in combination with other medicines.
An example of the danger of self-treatment emerged on Monday, when an Arizona man died after giving him and his wife chloroquine phosphate, a chemical used to prevent aquarium fish from getting parasites, as a preventative measure. The man died and his wife is hospitalized in critical condition.
Hernandez said Cano Health workers have been reaching out to all 60,000 of the chain’s patients and asking about their current status.
Along with patients who report potential COVID-19 symptoms, patients identified as “high risk” are offered, if appropriate, a preemptive chloroquine treatment regimen — usually two pills a day for five days. High risk typically means the patient is elderly with at least two chronic conditions, is not elderly but was recently hospitalized, or has a compromised immune system because of a chronic condition.
Cano Health workers who believe they have been exposed to COVID-19 patients are also offered preemptive treatments.
Patients can choose to be diagnosed through a face-to-face phone app such as FaceTime or WhatsApp, report to one of Cano Health’s urgent care clinics, or ask for a free home visit.
Cano Health clinics are in most of the major health insurance networks, and chloroquine treatments should be covered by most insurance, Hernandez said.
Hernandez says chloroquine treatments are available to new patients as well as existing patients, following a virtual visit via one of the smart phone apps. In the near future, Cano Health staff members plan to be at several COVID-19 testing sites to help register patients for examinations.
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