Florida Doctors Cautiously Using Hydroxychloroquine to Fight Coronavirus

Governor Ron DeSantis recently arranged for a million doses of hydroxychloroquine to come to Florida as a treatment for COVID-19 patients. President Trump has repeatedly recommended the medication to treat coronavirus, despite warnings from his own health officials that there’s no scientific data to support its use.

Plaquenil is the brand name for hydroxychloroquine. It is an FDA-approved treatment for lupus and malaria. Hospitals across the state are using the medicine for their sickest coronavirus patients, despite some potentially severe side effects.

On the Florida Roundup, hosts Tom Hudson and Melissa Ross spoke with Dr. Marlow Hernandez, Chief Executive Officer at Cano Health in Miami and Dave Lacknauth, Director of Pharmacy Services at Broward Health about fighting a dangerous virus with a controversial medication.

Here’s an excerpt from the conversation. Melissa Ross: Dr. Hernandez, are you seeing success with Plaquenil at your facilities at Cano Health? Are you using it?

DR. MARLOW HERNANDEZ: Yes, we are using it across our 45 facilities in the state. We have over 60,000 patients, and we are using it selectively for those who do not have contraindications, for those who have high-risk symptoms. 

For those who seem to be going into that inflammatory stage of the disease, science now pretty definitively tells us that you've got a viral phase that can last for about a week, maybe more, but that quickly fades. Then what is really causing a lot of the morbidity and mortality is that inflammatory phase of the disease, which follows the peak and viral counts. And that inflammation can build up in your lungs, can build up throughout your body. And if we have a medicine that can lower that inflammation going amuck, we can improve outcomes. 

So, hydroxychloroquine is not a panacea, but we've used it against immune system-derived overreactions for decades. It's safe for most patients. And as long as it is an individualized treatment decision within a clinical setting, I'm very supportive of using it because it's one of the tools, an important one, no doubt, that we must use until everything is ultimately discovered. 

But we're in the midst of this great and terrible pandemic, and we cannot be in a position where we possibly have some type of treatment and withhold it from our patients. 

Ross:  What about concerns about this drug, doctor? The CDC has removed it from its guidelines. It does have serious side effects to vision, to the function of the heart. How can you be sure you're not, even if it is helping patients in the short run, perhaps causing them more longterm problems with their health? 

HERNANDEZ: Sure, and that's why it should never be self-administered. It should not be used as a “preventative drug” different from if you were exposed, and you're a very high-risk patient, and there may be a role for prophylaxis. Then and only there, but never in the case of self-administration without consulting a doctor.

So now I know there's a lot of opinions out there and fortunately, the introduction of politics into the mix. This is a medical issue, not a political one. But unfortunately, just because this is an unprecedented and historic event affecting so many people throughout the world, it's inevitable that there is the introduction of non-medical type of nature. Like, for example, when I hear somebody saying there are no studies to support its use. That is just simply not correct.

Tom Hudson: Are doctors at your health care system prescribing this drug for COVID-19 patients? 

DAVE LACKNAUTH: We are as a health care team. We have assembled a group of infectious disease physicians, intensivists, pulmonologists, and our chief medical leadership that we meet three times a week. 

And this medication is a medication where we, after looking at a lot of data, are using it. Its role in therapy is really kind of where we've been on the back and forth. And right now, we are trying to get this initiated earlier on with our patient treatment once we get a confirmed positive case. Because we think the effects of decreasing viral load will have a bigger impact if we can get this medication on earlier. But of course, on the clinically appropriate patients.

Hudson: Tell us what those clinically appropriate conditions are. What are the conditions for the patient, for the primary care physician or the emergency room doctor in this case? What do they have to agree on for you to fulfill a prescription for hydroxychloroquine?

LACKNAUTH: The big thing we're looking at, the big risk point is the possible cardiac complications. So, in our health care system, we are looking at cardiac monitoring of a patient prior to initiating therapy and making sure the rhythms on that patient are appropriate and that we decrease risk when we do apply the medication. 

Hudson:  And how do you do that? 

LACKNAUTH: In the hospitals we have methods to monitor the heart rhythm through EKG. We also have cardiologists who are also on our teams who have reviewed as well and given our physician team's guidance on the appropriate use of medications based on those rhythm rate readings. 

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