Coronavirus patients who were treated with the drugs hydroxychloroquine and azithromycin experienced heart abnormalities, adding further evidence to the suggestion the medications come with unknown risks.
Eighty-four patients with COVID-19 were treated at a centre in New York, according to a peer-reviewed correspondence published in Nature Medicine. The majority of the patients were male, with an average age of 63 years old.
The anti-malarial drug hydroxychloroquine and azithromycin, an antibiotic used to treat many infections caused by bacteria, have been widely touted as a treatment to reduce the symptoms of patients diagnosed with COVID-19.
However, both drugs have been independently shown to increase the risk of various types of cardiac rhythm abnormalities, such as QTc-interval prolongation. This is the time it takes for a heart to recharge between beats.
When the QTc interval is prolonged, a patient can be at risk of arrhythmia—a disorder of the heart that affects the rate or rhythm at which the heart beats—and sudden cardiac death.
After the patients were administered the drugs in the New York facility, the authors followed up with an electrocardiogram which revealed cardiac rhythm problems in most people.
The QTc was severely prolonged in 11 percent of the patients, which put them at high risk of arrhythmia and sudden cardiac death. Four patients in the group died from multiple organ failure, without evidence of arrhythmia and without severe QTc prolongation.
The researchers found that most patients with COVID-19 who were treated with hydroxychloroquine and azithromycin experienced QTc prolongation.
However, the authors of the correspondence noted that this may have been exacerbated by pre-existing conditions. They may have also experienced more severe symptoms of the new coronavirus, making them more critically ill than other patients.
The authors concluded that the QTc in patients with COVID-19 who are treated with hydroxychloroquine and azithromycin should be monitored constantly.
One of the key problems is that less is known about the side effects of the medications on critically ill patients.
Trials of hydroxychloroquine are taking place in hospitals across the world, but there is limited evidence to suggest it is effective at treating the virus. One small study in France found the drug had no clinical benefit when combined with azithromycin.
Another small study published by the Journal of Zhejiang University in China showed that patients who took hydroxychloroquine did not fight off COVID-19 more often than those who did not get the medicine. Thirty patients were involved in the research, which was randomized.
Concerns have also been raised about potential side effects of the drug, which in some cases can lead to heart problems and cardiac death. In one trial in France, treatment had to be stopped in one patient after the drug became a "major risk" to their cardiac health.
In an interview with the French daily newspaper Nice-Matin, Professor Émile Ferrari, the head of the cardiology department at the Pasteur hospital in Nice, said the side effects had already been identified, with some patients having to stop treatment because of the risk posed.
Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19
- CDC recommends wearing a cloth face covering in public where social distancing measures are difficult to maintain.
- A simple cloth face covering can help slow the spread of the virus by those infected and by those who do not exhibit symptoms.
- Cloth face coverings can be fashioned from household items. Guides are offered by the CDC.
- Cloth face coverings should be washed regularly. A washing machine will suffice.
- Practice safe removal of face coverings by not touching eyes, nose, and mouth, and wash hands immediately after removing the covering.
- Clean hands frequently with soap and water, or alcohol-based hand rub.
- Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
- Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
- Avoid touching your hands, nose and mouth. Do not spit in public.
- Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.
- Avoid close contact with others if you have any symptoms.
- Stay at home if you feel unwell, even with mild symptoms such as headache and runny nose, to avoid potential spread of the disease to medical facilities and other people.
- If you develop serious symptoms (fever, cough, difficulty breathing) seek medical care early and contact local health authorities in advance.
- Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease.
- Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.
- Healthy individuals only need to wear a mask if taking care of a sick person.
- Wear a mask if you are coughing or sneezing.
- Masks are effective when used in combination with frequent hand cleaning.
- Do not touch the mask while wearing it. Clean hands if you touch the mask.
- Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of the mask.
- Do not reuse single-use masks.
- Regularly washing bare hands is more effective against catching COVID-19 than wearing rubber gloves.
- The COVID-19 virus can still be picked up on rubber gloves and transmitted by touching your face.