Unlike The President, My Father Needs Hydroxychloroquine

Monday, June 1, 2020

Four months ago, my father began experiencing debilitating joint pain, which first appeared with a progressively sharp throbbing in his left wrist, that was uncomfortable enough for him to notice but not enough to notify others about it.

As weeks continued, the pain progressed in severity and then radiated out to include the base of his hand, his knuckles, and his forearm.

Relatedly, the skin of his hand took on a sunburnt red hue, accompanied by swelling that morphed his fingers into sausages, and a pain that now lingered throughout the night.

Despite this, he continued to work as an Uber driver in the bustling metropolis of San Francisco.

One day he noticed a sharp pain in his right wrist, and in the following weeks, the process had begun to repeat itself: pain, redness, and swelling.

The swelling of his left hand continued to progress; he noticed he couldn't grasp objects such as his phone, a door handle, and, most notably, a steering wheel.

As soon as he could no longer work, he notified me, who has become his caretaker in recent years, and I immediately contacted his primary care physician--this was three months ago.

His physician was puzzled, concerned, yet appropriately cautious, given my father's many underlying health conditions.

He found my father’s clinical presentation to be strange but advised my father to undergo blood tests and x-ray imaging, and prescribed a medication that could be rubbed directly on to the afflictions: diclofenac, a non-steroidal anti-inflammatory drug (NSAID). He also wanted my father to come back for a follow-up visit in a month.

During that month, my father's condition did not improve. He rigorously applied the diclofenac on to his joints every few hours, which provided transient relief.

Unfortunately, the lingering pain throughout the night had now disrupted his sleep, and he soon began to feel a sharp throbbing in his left ankle--a harbinger of a process he had become familiar with.

We waited anxiously and impatiently for his results. Notably, his deteriorating condition was a reflection of the broader country at the time.

A little over three months ago, the COVID-19 pandemic had entered the United States (though some reports say it may have been much earlier). What first began as a cluster of cases in New York quickly swelled into an outbreak.

From there, we saw something not too dissimilar to the radiating inflammation in my father's body, with new clusters and new epidemics spreading throughout the United States only to be followed by widespread pain.

A disjointed response by our federal administration has led to a country fractured on how to approach this situation.

Many have been searching far and wide for a panacea, some of which have gotten more attention than others. Perhaps to shift focus away from the inadequacy of his administration's response, the president spent the first few weeks of the pandemic touting a drug known as hydroxychloroquine.

His championing of the drug was most likely based on a small study that showed some benefit of the drug for the treatment of COVID-19. Still, even the study authors noted: “Data from our trial do not provide evidence to support the use of hydroxychloroquine in this population, particularly considering the increased adverse events.”

Despite this, the president's championing of the drug as a “game-changer” resulted in mass hoarding, shortages, and even someone dying due to a self-medicated overdose.

Subsequent studies have found contrary evidence to the efficacy of the drug for the treatment of COVID-19, and public health officials for weeks have repeatedly advised against doing such given the dangers of its repeated and unmonitored use.

Despite that, the president continues to tout the drug; some have opined he does so because of a financial incentive, while others have thought it is because the president is desperate (evidenced by him inquiring about the use of injecting household cleaners as a possible therapeutic).

And, to the shock of many, he recently acknowledged he is currently taking the drug as a prophylactic and continually disregards all evidence pointing against the action of doing such.

My father's results came back, indicating my father had developed rheumatoid arthritis, an inflammatory and progressive disease involving the joints of the body that can be attributed to an overactive immune system.

We were referred to a rheumatologist, a physician who specializes in the treatment of ailments affecting the joints – among many other things – which provided us a glimmer of hope.

She reassured us that this was a manageable condition, and recommended my father be started on Plaquenil. Unfamiliar with this medication, I searched online only to discover that this was the brand name of none other than hydroxychloroquine.

Curious as to why she opted for this drug, she stated that this was our best option because it could treat his joint pain while not lead to a broad dampening of his immune system – unlike other medications for rheumatoid arthritis.

Such dampening can be deleterious during a pandemic, particularly to people like my father, who already faces grave danger from a COVID-19 infection due to underlying health conditions (e.g., diabetes).

Sensing my hesitation, she put it more succinctly: “Your father needs hydroxychloroquine.”

Immediately, I began to research more about the use of this now infamous medication. It works primarily by interfering with the body's immune cells’ communication, which has been turned haywire by the underlying disease process in rheumatoid arthritis, thus modulating their propensity to attack one's body.

It is also a first-line treatment for systemic lupus erythematosus, an autoimmune disease that can severely impair a person's physical and mental functioning, and elicits a different mechanism to combat malaria, which affects hundreds of millions of people each year.

Evidently, my father is a microcosm of many other patients who need hydroxychloroquine. Will these patients be able to obtain a medication they desperately need if the current trend continues?

When I see the president promoting its unfounded use as a preventative for COVID-19, I sincerely worry that will not be the case.

The American Society of Health-System Pharmacists (ASHP) has reported that there is already a shortage of hydroxychloroquine.

Pharmacies have been advised by the ASHP to cautiously allocate how much of the medication they can provide to patients.

Thus, increased and unnecessary shortages of this medication mean increased and unnecessary suffering to patients who need it most.

Over the past two weeks, my father has seen the swelling in his joints decrease, and the associated pain has subsided dramatically as a direct result of him taking hydroxychloroquine.

Each week is an increment towards him being able to steer his wheel but only if he remains able to access his medication.

As of this writing, he is still unable to work (more so now because of the pandemic), but needless to say, his condition has improved. I wish I could say the same about the country.