President of Family Health University College, Dr Enyonam Yao Kwawukume, has written an article espousing the potential benefits for the adoption of hydroxychloroquine to manage COVID-19 in Ghana.
In the largely technical write up, published below, Dr Kwawukume stated that if hydroxychloroquine is administered early, it gets to the blood stream before the coronavirus and could inhibit the entry of the virus into the cell and also delay viral replication outside the cell.
“Hydroxychloroquine could also reduce or stop the devastating cytokine storm. Hydroxychloroquine should be given with Zinc and Azithromycin. Hydroxychloroquine would serve as transporter of zinc into the cells and azithromycin would prevent secondary infections,” he writes.
Prophylactic Hydroxychloroquine in the Management of Covid-19
The realization of coronavirus in Ghana since 12th March 2020 has placed enormous stress on Ghana and the world at large. Many treatment standards have been suggested and followed, but the argument continues showing the versatile nature of the corona virus.
Our medical students, hospital staff, and friends, continue asking many questions but the answers keep on changing because new findings about the virus are emerging every time. I was lecturing our medical students recently and it dawned on me to compare 3 diseases which immensely affect the immune system and have given clue to the management of Covid-19. These are Preeclampsia/eclampsia, Sickle cell disease, and Ovarian Hyperstimulation Syndrome (OHSS); Cytokines storm is a common denominator in the above 3 diseases.
Cytokines and Preeclampsia
In preeclampsia, there is an imbalance of antiangiogenic and angiogenic factors leading to increase in production of sFLT-1(soluble fms-like tyrosine kinase-1) and reduction in the bioavailability of VEGF (vascular endothelial growth factor) and PLGF (Placental Growth Factor). sFLT-1 is able to form a heterodimer with cell surface VEGF receptors and it therefore acts as a competitive inhibitor by simply binding vascular endothelial growth factor A (VEGFA) and placental growth factor (PLGF).
This results in an imbalance of the factors, therefore causing generalized endothelial dysfunction; and in severe forms of Preeclampsia these factors could cause cytokine storm, damaging the body tissues and organs leading to accumulation of fluid and immune cells, which eventually block off the respiration pathway resulting in death. This could be prevented if action is taken early by delivery of the feto-placental unit. Similarly, Covid-19 could be prevented before a cytokine storm with overt symptoms, and this could be achieved by vaccine or prophylactic administration of medications.
Cytokines and Ovarian hyperstimulation syndrome (OHSS)
The main factor underlying ovarian hyperstimulation is increased capillary permeability, leading to fluid shift from intravascular space to the third space compartment that is aided by Vascular Endothelial Growth Factor (VEGF), which stimulates cell permeability, cell proliferation and angiogenesis. Once the complication of OHSS starts, there is no particular drug which can effectively stop it, but these same drugs can prevent the disease if administered early just as how hydroxychloroquine can prevent Covid-19 more effectively than curing the disease.
Cytokines and Sickle cell disease in Pregnancy
Cytokines and Sickle cell disease in Pregnancy with superimposed preeclampsia also has similar actions of cytokine storm especially during repeated bone pain crisis, which could lead to marrow embolism and death.
All these 3 diseases are linked to the immune system and invariably affect the respiratory system, and they can all be prevented just as Covid-19. Our suggestion is to have a high index of suspicion for Preeclampsia, OHSS, SSD and now Covid-19 and treat these diseases early, then the results would be far better than leaving them to develop the overt disease before attempting to treat it.
If Hydroxychloroquine is administered early, it gets to the blood stream before the virus and the drug could inhibit the entry of the virus into the cell and also delay viral replication outside the cell. Hydroxychloroquine could also reduce or stop the devastating cytokine storm. Hydroxychloroquine should be given with Zinc and Azithromycin. Hydroxychloroquine would serve as transporter of zinc into the cells and azithromycin would prevent secondary infections.
In our childhood days, and that of many people above the age of 35 years, we have used chloroquine for the treatment of malaria. The most feared effect of chloroquine was the generalized bodily itching which though devastating we endured it and were cured of the malarial parasite. Sickle cell disease patients were taking chloroquine once a week including some individuals who were scared of taking chloroquine if they had malaria. There are numerous researches on Hydroxychloroquine use to treat diseases such as rheumatoid arthritis and other autoimmune diseases with good results, and so Hydroxychloroquine and Chloroquine are well known and old drugs in Ghana and Africa. Let us look at its efficacy dispassionately again, and this time, taking Covid-19 into consideration.
If we should use hydroxychloroquine then let us seriously administer it mainly as a Prophylactic Drug as well as in the management of Covid 19. The old adage that ‘Prevention is better that cure’ really applies here, so let us remember and reduce or eliminate Covid-19 from our environment.
By Enyonam Yao Kwawukume.
Dr Kwawukume is President of Family Health University College, Ghana’s Premier Private Medical School. He is also Professor of Obstetrics and Gynaecology with Special interest in High Risk Pregnancy, Women’s Health (IVF) and GynaePathology.