'It's a nightmare.' How Brazilian scientists became ensnared in chloroquine politics

By Lindzi Wessel Jun. 22, 2020 , 5:30 PM

Now that several big trials have shown disappointing results, hope has faded that chloroquine or hydroxychloroquine might be miracle drugs against COVID-19. But for one group of researchers in Brazil, the story is far from over.

In April, a team led by Marcus Lacerda, director of the Heitor Vieira Dourado Tropical Medicine Foundation in Manaus, Brazil, published a study showing chloroquine can increase mortality in COVID-19 patients. Since then, they have been accused of poisoning their patients with a high dose of chloroquine just to give the drug—praised by U.S. President Donald Trump and his Brazilian counterpart Jair Bolsonaro—a bad name. Social media attacks, defamatory articles, death threats, and even a legal inquiry into the group’s work have left Lacerda and his team stressed and exhausted.

Other scientists have watched the public spectacle with dismay. But some agree that about half of the patients in the trial received such a high dose that severe side effects, or even deaths, were not unexpected. Lacerda’s trial was one of several using doses that were “dangerous and definitely too high,” says Peter Kremsner of the University of Tübingen in Germany, who is using far lower doses in two trials of hydroxychloroquine. Others say Lacerda and his colleagues took a calculated risk at a time when the optimal dose for SARS-CoV-2, the virus that causes COVID-19, was still under debate. “It’s clearer now that you wouldn’t have gone for that dose,” says Nicholas White, a veteran malaria researcher at Mahidol University in Bangkok who helped design the Recovery trial in the United Kingdom, which included a hydroxychloroquine arm. “But at that time, I think it was a legitimate choice.”

‘Left-wing medical activists’
Lacerda started the trial in late March, at a time when coronavirus cases in Manaus were growing explosively and scientists had promising results from chloroquine and hydroxycholoroquine in test tube studies and small, nonrandomized clinical studies. (Lacerda chose chloroquine because it’s widely available as a malaria treatment in Brazil.) The plan was to recruit 440 patients and give half of them 600 milligrams (mg) of chloroquine twice a day over a 10-day period—a total of 12 grams. The other half received 900 mg for 1 day followed by 450 mg for 4 days, a total of 2.7 grams.

More:
https://www.sciencemag.org/news/2020/06/it-s-nightmare-how-brazilian-scientists-became-ensnared-chloroquine-politics