COVID-19: Hydroxychloroquine and Gin (and Tonic)

You have to read all the way to the end for the gin and tonic part and, as always, share away.

If you’ve read some of the other posts, you’ve read my view that hydroxychloroquine isn’t the magic bullet that some might think is coming to save us all. But my strident statement, rightfully so, warrants some scrutiny from all of you. Why do I remain entirely unconvinced that hydroxychloroquine—aka Plaquenil (the brand name)—is the answer to all of our prayers?

And, what of the counterpoint: “What do we have to lose?”


What is hydroxychloroquine?

This is important, so let’s talk about it. Let’s start with hydroxychloroquine itself. What is it? How does it work? Why might it help? To answer that, you need to know something about malaria and Systemic Lupus Erythematosus (Lupus).

Plaquenil (I’m going to stop typing hydroxychloroquine because that word is annoying to type) was originally an anti-malaria drug. Malaria is caused by the protozoa Plasmodium that is transmitted by mosquitos. What’s a protozoa, you might ask? A protozoa is a single-celled organism that can either float around independently or in a parasite. You know the brain eating amoeba Naegleria fowleri that lives in warm water ponds and causes a tragic death in somebody swimming in a lake that we usually hear about once a summer? That’s a protozoa.

Protozoa and bacteria

A main difference between protozoa and bacteria are that protozoa go through different life stages. See, bacteria just divide and then there’s more bacteria. Bacteria are born bacteria and they die bacteria. Protozoans are different—they do a caterpillar/butterfly thing. In the case of malaria, the malaria protozoa Plasmodium is in one stage inside the mosquito (something-sporozoite) when it bites you. Eventually, it gets into your blood cells and turns into trophozoite and starts to eat the blood cells because that’s what protozoans want to do, ultimately: Eat organic matter.

The point is, though, that protozoans go through different life stages and that’s how Plaquenil works on them (Plaquenil targets the malaria bug plasmodium at the trophozoite and gametocyte stage).

So, the first major point: A virus doesn’t have those stages. The way that Plaquenil works on malaria is completely unrelated to anything that the COVID-19 virus does because viruses don’t go through a lifecycle in the way a protozoa does. It would be like trying to melt ice with a potato peeler. It’s just two completely separate processes.

Lysosomes

But that’s not the only thing Plaquenil can do. Plaquenil is also prescribed for SLE (Lupus) and Rheumatoid Arthritis (RA), two autoimmune disorders. In fact, Plaquenil is a main treatment in Lupus and RA. But, Lupus and RA don’t have anything to do with mosquitos and protozoans and plasmodiums, so what’s the connection?

Lupus is an autoimmune disease where the body’s immune system starts accidentally attacking all sorts of different places in the body—joints, liver, kidneys, all over the body. Plaquenil treats this by stopping the action of something called a lysosome—which you have trillions of—inside your body. If you can stop the lysosomes, you can stop some of the lupus damage. Now, here’s the COVID point: If there’s an increase in acid from respiratory failure (think Lactic Acidosis from the movie “A Few Good Men”), the lysosomes release all their enzymes, which breaks down cells.

When somebody is running out of oxygen, acid is building up all over and the lysosomes are releasing their enzymes and destroying the respiratory cells and this is every bit a bad cycle: Cells are dying, more inflammation is occurring, lungs are shutting down, and, in short, we’re in trouble.

Hydroxychloroquine/Plaquenil in theory can maybe stop the lysosomes from releasing their enzymes. We’ve still got an oxygen and an acid problem, true enough, but at least we don’t have friendly fire from the lysosomes. That’s the thinking behind hydroxychloroquine. I want to stress very hard that there are still many other problems generated by COVID-19 in very sick patients that are not treated by hydroxychloroquine (I’m not sure why I started typing that word again).


Will Hydroxychloroquine help curb COVID-19?

So…does it ultimately help save some COVID patients? That’s the million-dollar question. The answer is that nobody knows. On paper, yeah, there’s a reason it might work. That’s true enough. But the human body is never so simple as that. Something that works on paper never works that perfectly in practice.

And this is probably the major point I want you to take away from this whole thing: You have to test the theory and you have to do it under controlled circumstances. You can’t just say, “Well this might work but we’re not sure, but who cares, give it to everybody!” What do you have to lose? A lot, actually.

What do you have to lose? A lot, actually.

Problem #1: Lupus patients can’t get their medication because of the now-increased demand. We know Plaquenil works for Lupus. That’s important because you can’t take medicine away from people you know it will definitely help and give it to people you’re not sure it will help. You may not.

Problem #2: Something called “side effects.” Plaquenil/hydroxychloroquine isn’t entirely a benign drug. It can cause cardiac arrhythmias which is when your heart beats irregularly and sometimes stops beating all together. When your heart stops beating, this oftentimes results in your death.

It can also cause something called aplastic anemia, which is when your body stops making blood cells. You need red blood cells to move oxygen through your body and white blood cells to help fight infection. These are definitely two things you want when fighting a respiratory infection.

I very much hope hydroxychloroquine helps people who are sick. But you don’t just give it to everybody. You have to make sure it’s safe and effective in COVID-19 patients, and you do so through controlled, randomized testing, not just by giving it to everybody who walks in with a positive COVID-19 test or somebody who wants to prevent the disease.

I promised you a blurb about gin and tonic. Here you go:

The action of hydroxychloroquine is quite similar to quinine, which is found in tonic water. British soldiers stationed in India in the 1800s were given tonic water with quinine in it to help fight malaria and found that the bitter tonic water was made quite a bit more palatable when they added their daily ration of gin in it with a lime slice.

And thus, the gin and tonic was invented.

But, better yet, if you want to prevent COVID-19, please stay home and be careful. It’s imperative that we reduce contact with others as we endure this incredibly difficult time.

Stay safe!


The expert family medicine providers at the Des Moines University Clinic are here to help you and your loved ones stay healthy year-round. If you think you or your family have been infected with COVID-19 and live in Polk County, call 2-1-1. If you have an upcoming appointment at the DMU Clinic please call in advance. More information is available on DMU’s coronavirus response website.

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Jonathan Crosbie, D.O.

Dr. Crosbie is an assistant professor in the Departments of Osteopathic Medicine and Family and Internal Medicine at Des Moines University. In addition to his academic responsibilities and providing excellent patient care in the Family Medicine Clinic he is an avid activist for preventative medicine and living a healthy lifestyle. In his spare time he enjoys motorcycling, woodworking, movies and sports, and spending time with his family.

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