Chinese Doctors at Coronavirus Hub Say Evidence on Chloroquine Is Inconclusive

WSJ
One doctor sees promise for Kaletra—an antiretroviral drug for HIV—even though a recent study concluded it didn’t work

Dr. Zhang Dingyu, left, spoke Thursday in Wuhan about his hospital’s experience with hundreds of coronavirus cases. PHOTO: QIANWEI ZHANG/THE WALL STREET JOURNAL

Dr. Zhang Dingyu, left, spoke Thursday in Wuhan about his hospital’s experience with hundreds of coronavirus cases. PHOTO: QIANWEI ZHANG/THE WALL STREET JOURNAL

Chinese doctors who have for months treated patients on the front lines of China’s fight against the new coronavirus offered a sobering assessment of the potential treatments, saying they hadn’t seen clear evidence that drugs such as chloroquine were effective.

One doctor, however, said he saw some promise for Kaletra—an antiretroviral drug for HIV.

In hospital interviews arranged Thursday by government authorities in Wuhan, the central Chinese city of 11 million where the new coronavirus crisis erupted late last year, doctors called for further research into the use of chloroquine, an anti-malarial drug.

The doctors also cautioned that some recovered patients had tested positive again, while expressing concern about asymptomatic cases, dozens of which have been disclosed in recent days across China.

The doctors’ assessments came one day after Chinese authorities eased their lockdown of Wuhan, and as the U.S. braces in the coming days for what is expected to be the worst of its surge in infections.

Chloroquine has been the subject of fierce debate within the U.S. administration. President Trump has at times touted it as a remedy and in recent days he has advised even those without symptoms to take the drug. That has come in defiance of advice from public health experts and some of his own medical advisors.

White House trade advisor Peter Navarro has cited a study from Wuhan, among other evidence, to argue for the federal government to distribute its stockpile of one form of the drug—hydroxychloroquine—to hard-hit areas of the U.S.

Zhang Dingyu, the head of Wuhan’s Jinyintan Hospital, which has handled hundreds of coronavirus cases since December, said the evidence on chloroquine was so far inconclusive.

“Some patients took it by themselves, and after taking it, there were good and bad” results, Dr. Zhang said Thursday, adding that some patients hadn’t tested negative even seven to 10 days after taking the drug. “There’s no scientific conclusion.”

He expressed concern too about the drug’s recommended dosage. Local health authorities warned in February that an overdose of chloroquine could be fatal.

At the peak of the epidemic in Wuhan, Dr. Zhang said Jinyintan Hospital was treating as many as 500 patients. It still has 123 patients, of which three were in serious condition on Thursday. None were in intensive care, he said.

While Dr. Zhang expressed uncertainty about chloroquine, he said Kaletra —a drug made by U.S. pharmaceutical giant AbbVie Inc. that blocks the enzymes some viruses need to replicate—appeared to have been effective with patients and infected colleagues, even though a recent study concluded it didn’t work.

Desperation and the lack of a proven cure have prompted doctors around the world to experiment with remedies that haven’t yet passed clinical trials.

On Feb. 18, China’s National Health Commission added chloroquine phosphate—one common form of the drug—to a list of officially approved treatments for coronavirus patients, though clinical trials haven’t yet finished.

The U.S. Food and Drug Administration on March 28 authorized the emergency use of chloroquine phosphate and hydroxychloroquine in hospitalized coronavirus patients who weren’t able to participate in a clinical trial. That allowed the government to distribute millions of doses donated by drug companies.

Zhang Junjian, a doctor who ran a field hospital in Wuhan that treated more than 1,700 coronavirus cases, said in a separate group interview on Thursday that 20 to 30 patients had been treated with chloroquine—with the patients’ permission—but it was unclear if the drug was effective.

Given the drug’s unproven effects, “we were extremely careful,” said Dr. Zhang, who is vice president of Wuhan’s Zhongnan hospital, another institution that treated thousands of coronavirus cases. “You can’t see any difference between it and other treatments.”

Dr. Zhang, the Jinyintan Hospital chief, said that several of his patients—and three of his infected colleagues—had taken Kaletra.

“After taking it, the changes in their entire lungs were really dramatic,” he said, adding that none of them needed critical care. “If I had a chance to do things again, I would definitely have patients take this drug within three to five days of getting sick.”

A study published last month in the New England Journal of Medicine, based on a test on severe coronavirus cases at Jinyintan, concluded that Kaletra wasn’t effective. But Jinyintan’s Dr. Zhang said supplementary data in the study suggested it had potential.

Many of the cases at Jinyintan took Kaletra in conjunction with bismuth subcitrate potassium, which had also been effective, he said. Bismuth subcitrate is used in combination with other drugs to treat a common bacterial stomach infection.

Dr. Zhang of Jinyintan also recommended convalescent plasma treatment, which involves transfusing blood plasma from someone who has recovered from the coronavirus into someone who is sick with the virus, in hopes that the donor’s antibodies help the recipient recover.

The FDA says the treatment hasn’t yet been shown to be safe and effective for Covid-19, the disease caused by the coronavirus, but the agency approved its emergency use on a case-by-case basis in March and issued broader recommendations on its use and study on Wednesday.

The Chinese doctors said that 34 of their patients had tested positive again after recovering and being discharged, but they suspected that was because of flawed tests giving false negative results, rather than the patients having been reinfected.

They also both said they didn’t expect a big second wave of infections in China, although they allowed that smaller outbreaks in certain locations were still possible.

Most worrying was a small number of patients—still in hospitals—who had been infected for several weeks, including several for more than 60 days, said Dr. Zhang of Jinyintan. Another focus of concern, he said, was the number of asymptomatic cases and their level of  infectiousness.

“This virus may be with mankind for a long time, so what we need to work on is how to take the next steps,” he said. “We used to pay attention to the flu, AIDS and hand, foot and mouth disease. Now we may need a special ward for this.”

Zhongnan’s Dr. Zhang said his field hospital, in a converted exhibition center, had been closed due to the winddown in the number of cases. But he cautioned that it would not be dismantled for some time—a reflection of lingering concern around how the pandemic will develop in Wuhan in the coming weeks.

WSJ

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