•Nigeria’s defiance of WHO warning alarms experts
By Chioma Obinna
Nigerian health professionals have raised concerns over the use of hydroxychloroquine and chloroquine for the treatment of COVID-19 patients in the country following the decision of the World Health Organisation, WHO, to halt the trial of the drugs for coronavirus treatment.
Although the professionals, who include toxicologists, pharmacists, dieticians and molecular laboratory scientists, are divided over the National Agency for Food and Drug Administration and Control, NAFDAC, decision to go ahead with the trial, some of them fear that many of the patients may die of heart disease, especially from the use of hydroxychloroquine.
WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, had, on Monday, announced the halting of the hydroxychloroquine trial following an observational study published in a medical journal, The Lancet, described how seriously ill COVID-19 patients who were treated with hydroxychloroquine and chloroquine are more likely to die.
Since then, the decision has stoked controversy across the world including Nigeria.
According to the Director-General of NAFDAC, Dr Christianah Adeyeye, Nigeria will continue with hydroxychloroquine clinical trial on COVID-19 patients despite the WHO warning.
But in separate chats with Sunday Vanguard, some Nigerian health professionals say the risk involved outweighs the benefit, hence the need to suspend the trial to save lives.
In her submission, an associate professor of toxicology and the Head of the Department, Department of Pharmacology and Toxicology, Madonna University, Prof. Zelinjo Igweze, who noted that hydroxychloroquine was not known in Nigeria as much as chloroquine sulphate, lamented that with a risk of ventricular arrhythmias and abnormal heartbeats that can lead to death, there was no need continuing with the clinical trial in Nigeria for COVID-19 as the risk of the drug outweighs the benefit.
“Every drug has inherent side effects or adverse effect. For hydroxychloroquine, it causes what we call ventricular arrhythmia”, Igweze said.
“It is a technical thing but what happens is that your heart starts beating fast and a heart that is beating very fast out of rhythm, for instance, if a heart beats 80 times a minute, it might be beating 300 times a minute and it is an inefficient heart and, when it continues like that, the person dies.
“Ventricular arrhythmia is a very grievous condition and no doctor wants to handle it. It can kill and hydroxychloroquine has that side effect.
“Again, when it comes to side effects and adverse effects, predisposition to it varies”.
The professor, who regretted that Nigeria as a country does not know where to put her hands, said knowing that hydroxychloroquine has notoriety for causing ventricular arrhythmia, wondered what Nigeria wants to achieve with the planned clinical trial.
She said although the NAFDAC DG claimed that there is genetic difference between the black man and the Caucasian and that real black people were not involved in the solidarity trial, warned against increase in heart disease.
“The Director-General of NAFDAC said that hydroxychloroquine has been postulated but not completely defined but it prevents SARS Cor.2 which is the virus that causes COVID-19 from entering the cell, that if it does not enter your cell therefore, it does not take over your body mechanism and begins to instruct it with this small virus”, she told Sunday Vanguard
“But again, they are saying that people who have co-morbidities like those who have cardiovascular disease like hypertension whose condition of the heart is already going to arrhythmia.
“Now you give hydroxychloroquine to the person suffering arrhythmia. That will kill the person and that is why WHO stopped the trial”.
According to her, in clinical trials, people are not selected outside the actual morbidities which may include people with co-morbidities in the randomised way that are part of the people the COVID would have affected.
Stating that the risk could be managed, she warned that on a scale of one to 10, only two persons out of 10 will survive.
“Hydroxychloroqjuine does not kill the virus but it prevents it. There is something we call a receptor concept”, Igweze said.
“There is this AC2 receptor on most of the lung cells through which the virus enters into the body.
“Some drugs might be able to block that receptor and prevent the virus from gaining access and that is basically what they say hydroxychloroquine does.
“A receptor is like a keyhole but hydroxychloroquine blocks the keyhole but nobody has proven it.
“The problem with Nigeria is that we always want to do what the rest of the world is doing but it does not work that way; even if it is a promising drug, it is not worth the trouble.
“I don’t know who will be their volunteers for this trial. There has to be a tangible data that shows that the drug is doing what they are hoping it will do.
“Let them be also mindful that they have to stop it when they are seeing dangerous signs. They should not continue to save lives”.
Corroborating her views, a virologist at the Infectious Diseases & Clinical Immunology Unit, Department of Medicine, Lagos University Teaching Hospital, LUTH, Dr. Iorhen Akase, warned against indiscriminate use of anti-malarial as doing so can damage some organs of the body, particularly the heart.
Akase, who noted that COVID-19 is a viral infection and can worsen malaria, told Sunday Vanguard that chloroquine has side effects on the heart, amount of liquids in the body, the eyes and the lungs, and more dangerous for people that have been using high dosage for a long period.
But another expert, an associate professor of pharmacology, Dept. of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Dr Ayodele Yemitan, differed, noting that the genetics of different races are also important in making the decision concerning the trial and use of hydroxychloroquine.
Yemitan said based on the African gene and the explanation of NAFDAC, Nigerians may react differently to the drug.
“There is something we call pharmacy genetics. Pharmacogenetics means that the gene which some people have can influence how they respond to a particular drug”, he said.
“The information that I think WHO is relying on is based on what we have in the Caucasian which is the large population of Europe, North America. That is what they are relying on largely.
“Did they get information from clinical trials from other homogenous population like India because they have a particular type of gene-like what you have in Asians?
“Africans have their own gene. The Caucasians have their own gene. We may not have the same effect in all these populations.
“COVID-19 is a pandemic which people don’t understand so much about for now. So whatever information you have about a particular drug and whatever clinical trial that you are doing and that drug is working for you, you are bound to hold on to it for now until everything is clear to everybody.”
He argued that most Nigerians that are up to 40s and above would not have been alive today if not for chloroquine.
“Ordinarily, I don’t want us to demonise chloroquine. It has been with us for a long time and kept many of us alive but the best thing is to review the dosage to guard against what is causing heart problem like WHO claimed.
“Chloroquine is an effective drug in the treatment of malaria. It was jettisoned not because it was toxic but because the plasmodium parasite was becoming resistance to chloroquine due to the fact that people were using it for self-medication”.
On his part, a renowned pharmacist, Okotie Jonah, who is also the General-Secretary of Association of Community Pharmacists, ACPN, Lagos State Branch, stated that as much as the country doesn’t have to reinvent the wheel, it was in the country’s interest to have their own trials.
“It is a known fact that most of the victims managed in the isolation centres claimed to have received chloroquine (CQ) or hydroxychloroquine (HCQ) amongst other things like Vitamin C, especially for those who reported early.
“And Nigeria has recorded not less than 70 per cent recovery rate if not more. Most deaths reported late to hospital and probably had co-morbidities.
“The question then is, what is responsible for our high recovery rate? Is hydroxychloroquine doing something with our genes against the virus or purely our genetic and environmental make-up?”
The pharmacist added that the rate of recovery could also be a difference in how Nigerians respond to the drugs and these reasons cannot be determined until a clinical trial is concluded.
Expressing worry over the WHO report, he stated that chloroquine is supposed to be safe even for use in pregnancy.
On his part, a dietician at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile-Ife and National President, Nigerian Union of Allied Health Professionals, NUAHP, Dr Obinna Ogbonna, cautioned against the use of chloroquine to treat COVID-19, saying the stand of WHO was valid.
“If the drugs were very effective and efficacious, it would have been generally accepted and that is the beauty of scientific research until a more general and effective drug with fewer side effects is found. WHO’s stand is valid”, Ogbonna said.
Also speaking, molecular diagnostics expert/ laboratory scientist, Dr Casmir Ifeanyi, who noted that more data would be required for WHO and nations to take a position on the continued use of hydroxychloroquine, lamented that Nigeria was still operating in shallow waters after it had treated over 2,000 COVID-19 patients and discharged.
According to him, it is worrisome that the details of what the country used in treating the patients were yet to be available or any information on the remedy yet to be published in any medical journals.
“That is not the way communities advance in the scientific world”, he said.
“In Nigeria, a governor has come out to say chloroquine should be used in the management of COVID-19 patients in his state based on his personal experience.
“The truth is that as of today, every drug that has been used to manage COVID-19 patients also has its fair share of negative outcomes and that will not make us jettison the use of those drugs.”
“NAFDAC should continue with the trial. There is no reason to stop; before now, we had used it in our malaria treatment programme.
“The only reason we discontinued the use of chloroquine for management of malaria cases in Nigeria was not because of the adverse effect, but because of resistance.”