Bolsonaro promotes a questioned drug for COVID-19

Bolsonaro promotes a questioned drug for COVID-19

© Provided by the Associated Press
An evangelical pastor prays for the President of Brazil, Jair Bolsonaro, who tested positive on COVID-19, outside the Palacio de Alvorada, the president’s official residence, in Brasilia, Brazil, on Tuesday, July 7, 2020. (AP Photo / Eraldo Peres)

RÍO DE JANEIRO (AP) – After months defending an antimalarial drug as a treatment for the new coronavirus, Brazilian President Jair Bolsonaro has become a live test case before millions of people, sharing videos in which he swallows hydroxychloroquine pills and urges others to do the same. The effectiveness of the drug for this virus has not yet been proven.

A women

© Provided by the Associated Press
A women’s rights activist holds a poster in Portuguese with the message “Genocide 60,000 deaths. Bolsonaro out,” during a protest against the government’s management of the coronavirus pandemic and police brutality against blacks, before the National Congress in Brasilia, Brazil, on Thursday, July 2, 2020. (AP Photo / Eraldo Peres)

Bolsonaro said this week that he had tested positive for the virus, but was already feeling better thanks to hydroxychloroquine. Hours later, he shared a video of himself taking what he described as his third dose.

“I trust hydroxychloroquine,” he said, smiling. “And you?”.

On Wednesday he again proclaimed the benefits of the drug on Facebook and claimed that his political enemies wanted it to fail.

Chloroquine and hydroxychloroquine have been shown to be ineffective against COVID-19, and are sometimes fatal due to their side effects on the heart, from studies in Britain and the United States, as well as from the World Health Organization. . Several studies were canceled ahead of schedule due to the detrimental effects.

United States President Donald Trump has touted hydroxychloroquine, a treatment for COVID-19, but chloroquine – a more toxic version of the drug, produced in Brazil – has been defended with even more enthusiasm by Bolsonaro, who claims that the virus is largely unavoidable and is not a serious medical problem.

“It has become the advertisement man to cure COVID with hydroxychloroquine,” said Paulo Calmon, professor of political science at the University of Brasilia. “Chloroquine is part of the denialist political strategy, with the aim of convincing voters that the effects of the pandemic can be easily controlled.”

Trump first mentioned hydroxychloroquine on March 19 during a briefing on the pandemic. Two days later, and a month after the first confirmed case of the virus in Brazil, Bolsonaro presented one of his few major initiatives to combat the pandemic. He announced that he had instructed the Brazilian Army to double the production of chloroquine.

The army produced more than 2 million pills – 18 times the country’s production in a normal year – despite the Brazilian association of intensive care medicine recommending that it not be prescribed, a piece of advice followed by most doctors.

The White House said on May 31 that it had donated 2 million hydroxychloroquine pills to Brazil. Two weeks later, the United States Food and Drug Administration (FDA) revoked an authorization for emergency use, citing harmful side effects and noting that its effectiveness was unlikely.

The Brazilian audit court on June 18 called for an investigation into alleged cost overruns on local chloroquine production, which it described as unreasonable given the drug’s ineffectiveness, and pointed to the FDA decision. Meanwhile, three states ran out of sedatives and other medications used in intensive care, according to a report released in late June by the Brazilian council of state health secretariats.

Former Defense Minister Aldo Rebelo told the Associated Press that he was concerned that the Army would be held unfairly responsible for its involvement in the production of a drug that most experts consider ineffective against the coronavirus.

“All they did was follow a legal order and make the pills,” said Rebelo. “The problem is the Ministry of Health and the decision made by the president.”

The acting health minister, an Army general with no health experience before April, supported chloroquine as a COVID-treatment 19 days after taking office in May. His predecessor, doctor and health consultant, preferred to give up doing the same.

As the death toll continued to rise – almost 68,000 by Wednesday, the second highest in the world – the Ministry of Health distributed millions of chloroquine pills in the vast Brazilian territory. The pills have reached small cities with little or no infrastructure to manage the pandemic, and even remote indigenous territory.

“They are trying to use the indigenous people as guinea pigs to test chloroquine, to use the indigenous people to promote chloroquine as Bolsonaro has done in his video broadcasts, as an advertiser man for chloroquine,” said Kretã Kaingang, coordinator of the organization. indigenous APIB, in statements by telephone from the capital of Brazil, Brasilia.

In the country’s largest city, Sao Paulo, three doctors caring for COVID-19 patients at separate hospitals told AP that patients used to order chloroquine, often citing Bolsonaro. In the past few weeks, those questions had become less frequent after scientific doubts about their effectiveness appeared, according to two doctors.

All three said they were concerned that Bolsonaro’s promotion would spark a new wave of desperate patients and family members asking for chloroquine.

“I tell them that I do not prescribe it because there is no study that shows that it improves patients, that there are significant risks with the indiscriminate use of this drug,” said Dr. Natalia Magacho, an attending physician at Hospital das Clinicas. “Some even get angry at first. But all prescriptions are the responsibility of the doctor, and since the risk outweighs the benefits, I don’t prescribe it. ”

Most doctors oppose protocols on the use of chloroquine or hydroxychloroquine, but some continue to believe in the treatment and have pressured local authorities to allow its use, said João Gabbardo, former number two of the Brazilian minister. of health.

“This issue has been raised in a very divisive, politicized way,” said Gabbardo, who is now executive coordinator of the Sao Paulo contingency center for COVID-19. “We are moving away from the conversation of science, of scientific evidence, towards a conversation of political positions.”

Bolsonaro’s supporters and advisers have amplified his message. Eduardo Bolsonaro, son of the president and federal legislator, said that his father will beat the disease because he is taking the antimalarial drug.

“Chloroquine treatment is quite effective at the beginning of the disease (and should be available to any Brazilian who needs it),” said a member of parliament on Twitter, without distinguishing between the two classes of medication.

Margareth Dalholm, a clinical researcher and renowned professor of respiratory medicine at the Oswaldo Cruz Foundation, which is state funded, said she had no objection to Bolsonaro and his doctor agreeing to hydroxychloroquine treatment. The problem, she said, is disseminating information to an impressionable public who will believe, if the president recovers, that it is due to a medication that can be dangerous.

Dalcomo cares for patients and contracted COVID-19. Before recovering, some friends asked him if he would authorize the administration of chloroquine or hydroxychloroquine if at any given time he was unable to give his consent.

“Above my dead body, dear ones,” he said. “I told them, if I am in a coma, intubated, none of you is authorized to give me chloroquine. I would never authorize its use with me. And I haven’t used it on my dozens of patients. ”


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