It started with a Google Doc.
On March 13, cryptocurrency investor James Todaro and New York City lawyer Gregory Rigano tweeted out a link to a paper they’d put on the file-sharing service. In it, the men described a drug they’d been following, chloroquine, that in early trials in China and France appeared to show promise as a COVID-19 treatment. Long used as a treatment for malaria, the drug is cheap and plentiful and available to combat the pandemic immediately. Not only has it been deemed “effective in treating COVID-19,” they wrote, but it “also has strong potential as a prophylactic (preventative) measure against coronavirus.” The pandemic, they suggested, could be snuffed out in one stroke—if the authorities would just take action. The paper ended with a call for readers to disseminate it and translate it into other languages.
At a time when public anxiety about the pandemic was snowballing, the paper offered a rare ray of hope. As its authors had urged, the paper was quickly disseminated over the internet. On March 16, Elon Musk tweeted a link to the Google Doc, writing: “Maybe worth considering chloroquine for C19.” On March 18, right-wing websites Breitbart and The Blaze picked up the story. On March 19, Rigano went on Fox News and told Tucker Carlson that a chloroquine study had shown “a 100% cure rate against coronavirus.”
From there it was a short leap to the biggest bullhorn of all. That same day Donald Trump declared at a press conference that chloroquine was a possible “game changer” and that the FDA had approved it. “We’re going to be able to make that drug available almost immediately,” he promised. On Saturday, Trump continued to beat the drum, tweeting that chloroquine had “a real chance to be one of the biggest game changers in the history of medicine.”
At a press conference on Monday, he continued to gush over the drug and related a tale about a patient for whom it had a Lazarus-like effect. “They had given him the drug just a little while before, but he thought it was over. His family thought he was going to die. A number of hours later, he woke up, felt good.… He’s in good shape. And he’s very happy for this particular drug that we got approved in record-setting time. There’s never been anything even close to it.” (Earlier that day Fox News had run a story about Rio Giardinieri, a Florida man who credited his recovery from COVID-19 to a variant of chloroquine.)
Actual medical experts were dismayed by Trump’s boosterism. Stephen Latham, director of Yale’s Interdisciplinary Center for Bioethics, labeled the president’s remarks “careless and unhelpful.” With clinical testing of chloroquine barely underway, Latham said, “it’s too early to have its use promoted.”
“Trump said it’s a great drug because we know it’s safe,” said Gail A. Van Norman, an M.D. at the University of Washington who has studied the adoption of investigational drugs. “We know nothing of the kind. Claiming that it’s safe for a use for which it hasn’t been tested is a lie.”
Indeed, chloroquine is notably toxic. Though it has long been used as a treatment for rheumatoid arthritis and lupus as well as malaria, it poses a risk for irreversible eye and heart damage and can potentially cause congenital birth defects. It can be fatal in doses as low as 2 grams per day—just 1 gram more than the dose being tested for COVID-19. One woman in Wuhan took 1.8 grams of the drug she ordered online and developed a malignant cardiac arrhythmia, ending up in the intensive care unit. In Nigeria two patients have been hospitalized after poisoning themselves with it. On Monday a Phoenix-area man died and his wife was in critical condition after they ingested a form of chloroquine used for cleaning fish tanks.
Nor is there yet compelling evidence that chloroquine even works for COVID-19. Todaro and Rigano’s Google Doc mischaracterized the significance of the studies done to date, and Rigano’s claim to Tucker Carlson about its “100% cure rate” was simply false. The human trial he was referring to was a tiny preliminary study in which only 20 patients received chloroquine—far too minuscule a sample for conclusions to be drawn. “It’s amazing to me that I’m seeing articles on the internet saying that chloroquine is a cure for coronavirus. No way has that been shown,” said Van Norman.
What’s more, it turned out that Rigano also mischaracterized his own qualifications. Though he describes himself as “an advisor to the Stanford University School of Medicine,” a Stanford spokesperson told Wired, “Gregory Rigano is not an advisor with Stanford School of Medicine and no one at Stanford was involved in the study.” Stanford Health Care put up a notice on its website declaring that Rigano’s Google Doc was “not legitimate.”
Those who would spread misinformation benefit from the fact that the public has long been poorly informed about how medicine and science work. Movies like Lorenzo’s Oil create the impression that drugs that show initial promise are quite likely to be efficacious, and suggest that the public can effect positive change by lobbying for their use. But the reality is that most prospective drugs don’t hold up under investigation. According to Van Norman, of the drugs deemed promising enough to be tested on animals, 88% wind up getting discarded. Of those that are approved for follow-up testing in humans, another 90% ultimately fail.
Meanwhile, encouraging the general public to stockpile chloroquine has led to near-immediate shortfalls for those who really need it. “We’re getting calls every few minutes, literally, from patients who are trying to stay on the drug and finding it in short supply,” Dr. Michael Lockshin, of the Hospital for Special Surgery in Manhattan, told the New York Times. One sufferer wrote on Twitter: “lupus patients like myself need help. Pharmacies are out of stock of plaquenil. I personally called dozens of pharmacies in NYC and had friends calling in Boston. This is endangering lives.”
Chloroquine isn’t the only drug to become scarce after being touted in the media. When Thai doctors reported success in treating COVID-19 with a combination of the HIV drugs lopinavir and ritonavir, supplies of both quickly became scarce. “I have HIV patients who take lopinavir/ritonavir, and because of one case report, there was a run on the medications and the pharmacies had to scramble to find a source for my patients,” said NYU Langone internist John Emy. As it happened, a follow-up study showed that the drug combination offered no therapeutic benefit.
The public is hungry for information about the pandemic upending their lives, and especially eager to click on stories that promise hope. But when unwarranted optimism leads to dangerous behavior, the media has an extra responsibility to vet what is published. It isn’t only right-wing outlets that have failed at this; on the same day that Trump first touted chloroquine, medical contributor David Agus told Norah O’Donnell on CBS Evening News that the drug was “hope personified” and urged viewers who had come down with COVID-19 to talk to their doctors about using it.
If large numbers of patients did this, and even a small percentage of physicians complied, the result would likely be negative repercussions without any corresponding benefits. “There are scarce-resource issues here, and there are false-sense-of-security issues,” said Yale’s Latham.
As the pandemic grinds on, other potential cures are sure to come to the fore. Few will likely result in useful therapies. To keep things in perspective, bear in mind that researchers have been studying respiratory viral infections for over a century without finding any drugs nearly as effective as antibiotics are for bacteria. That’s because from a biochemical perspective, fighting viruses is a fundamentally difficult challenge. “A bacteria is a completely foreign organism,” said Adolfo García-Sastre, director of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai. “Viruses are made of components very similar to those of our own cells.” After all these years without finding a drug that can help respiratory viral infections, it would be an incredible stroke of luck if one were discovered in the nick of time to avert disaster.
That’s not to say that chloroquine shouldn’t be aggressively tested. On Sunday, New York governor Andrew Cuomo announced that the state had acquired 750,000 doses for use in trials. Patients are already receiving the drug in a clinical setting, including David Lat, the founder of the legal blog Above the Law, who is receiving it at NYU Langone Hospital as he recovers on a ventilator under sedation. The time to publicly promote a drug’s virtues, however, is after it has been thoroughly tested. And that takes time.
Until then, no one should be encouraging physicians to prescribe medicines without demonstrated efficacy. “They shouldn’t be doing it,” said Van Norman. “We need to educate doctors and the public that this is not a good thing to do.”
This article originally ran in Vanity Fair on March 24, 2020.