The President and the Leprechaun

Malarial drugs as hope for COVID-19 treatment have been much in the news of late, mostly because President Trump has touted chloroquine and hydroxychloroquine multiple times.

“I’m a smart guy,” he said. “I feel good about it. And we’re going to see. You’re going to see soon enough.”

He has also suggested drug cocktails such as hydroxychloroquine and antibiotics could be a cure.

Dr. Anthony Fauci, the immunologist who is Director of the National Institute of Allergy and Infectious Diseases (NIAID) and a member of the White House Coronavirus Task Force, pushed back by explaining that such a treatment had not had medical studies or clinical trials.

In fact, the idea of it was the product of a different kind of viral spread—social media and anecdotal evidence that the drugs were used in other countries, such as China and France, to fight the infection.

The rumors of the benefit of malarial drugs have caused shortages in some areas, which prevents those who must take it (such as lupus patients) from being able to refill their prescriptions. Meanwhile, Trump said in a press conference, “If you wanted, you can have a prescription. You get a prescription. You know the expression, what the hell do you have to lose?”

Yesterday, in Nigeria, two people who had self-medicated with chloroquine were hospitalized for overdose.

Yesterday, Trump tweeted: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains – Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents)…..be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov.”

A 2007 article in the British Journal of Pharmacology says, “For most of the last century drugs such as quinine, chloroquine and mefloquine (Lariam) have provided a safe, cheap and effective method of controlling malaria. […] However, there are a growing number of clinical reports that show these drugs may also have neurological side effects, including paranoia, anxiety and depression. Emerging experimental evidence supports the hypothesis that these compounds adversely affect transmission at both neuromuscular junctions and synapses.”

The US military used mefloquine heavily for more than two decades, prescribing it 50,000 times in 2013 alone. It was implicated in everything from balance problems to depression, and in a small number of cases, murder and suicide.

Military Times said that “67 percent of [a study’s] participants reported more than one adverse side effect, such as nightmares and hallucinations, and 6 percent needed medical treatment after taking the drug. […] A 2004 Veterans Affairs Department memo urged doctors to refrain from prescribing mefloquine, citing individual cases of hallucinations, paranoia, suicidal thoughts, psychoses and more.” In some cases, the drug’s effects lasted for years and coincided with symptoms of PTSD.

The Army started using mefloquine three years after I had gotten out. But my civilian doctor, and my active-duty friend’s military doctor, prescribed it to us in 1995, when we were going on a backpacking trip of Vietnam during rapprochement.

It made us feel crummy—”odd,” we said—and gave me bizarre dreams and thoughts of hopping off a balcony. As I remember, I stopped taking it before the five-week trip was done.

Later, I wrote, “Before we left [the States for] our trip, I was jogging after dark and came up behind a man with a guitar case walking in the road. We were a mile out of town, and it was sleeting. He was 6 feet tall, but I knew he was a leprechaun and was afraid to look at his face. Thinking on it, I’m sure it was the mefloquine. Why would a leprechaun have a mullet?”

It was a joke but true, which could be said for our current situation, where nonprofessionals give expert advice.

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