Health, Medicine, Nursing Essay: Critical Appraisal Policy Brief: Is Hydroxychloroquine the Long-Awaited Cure for Covid-19?

Critical Appraisal Policy Brief: Is Hydroxychloroquine the Long-Awaited Cure for Covid-19?
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Critical Appraisal Policy Brief: Is Hydroxychloroquine the Long-Awaited Cure for Covid-19?
Executive Summary
The current COVID-19 global pandemic calls for action because a cure or vaccine is yet to be developed. In identifying solutions to the current problem, it is important to establish the potential risks and benefits before decisions can be made. This policy brief provides an evaluation of current evidence on the efficacy of Hydroxychloroquine (HCQ) in treating COVID-19. The results of this critical appraisal will be used to determine whether support for legislation mandating the use of HCQ in COVID-19 treatment is necessary. Six current studies are analyzed and their results are shared. The results indicate that although HCQ has the potential to treat COVID-19, the potential side effects are serious and cannot be ignored. Therefore, support for legislation in favor of HCQ as a treatment for COVID-19 should not be given.
In late 2019, COVID-19 emerged in China as a novel disease and spread to other parts of the world. It was soon announced a global pandemic by the World Health Organization (WHO) in early 2020. By April 2020, the number of infection was over two million, and more than two thousand people had died as a result, globally (de Novales, et al., 2020). The number of new infections and deaths arising from COVID-19 continues to rise despite the guidelines and measures that have been recommended by WHO. No cure or vaccine has yet been established and approved for managing COVID-19. In the absence of a vaccine or a cure, the use of Hydroxychloroquine (HCQ) in treating COVID-19 has been proposed. This emerging use of HCQ is based on the therapeutic experiences derived from HCQ in addressing two other coronavirus diseases, namely the Middle East respiratory syndrome and severe acute respiratory syndrome (Tang, et al., 2020). There, however, lacks adequate clinical evidence to support the use of HCQ as an effective treatment for COVID-19. But since COVID-19 and these two other diseases are caused by the coronaviruses, exploring whether drugs that treat other coronavirus diseases can treat COVID-19 is a viable idea. The purpose of this paper is to critically appraise existing evidence on the use of HCQ in the treatment of COVID-19. Then, based on the result of the critical appraisal, the paper will make a recommendation on whether legislation that approves the use of HCQ in treating COVID-19 is necessary. The emerging use of HCQ in treating COVID-19 has become a controversial issue because the drug has originally been used in managing malaria. Also, in the absence of clinical evidence, caution is being taken given the drug’s potential to prolong the QT interval (van den Broek, Mohlmann, Abeln, van Dijk, & van de Garde, 2020). However, having legislation in place that supports the use of HCQ to treat COVID-19, if effective, is the best approach to reducing mortality from the disease. Hospitals and healthcare providers will be protected and the public will also gain confidence with the drug.
Approaches
Several studies have been conducted to establish the efficacy of HCQ in the treatment of COVID-19. For instance, Horby, et al. (2020) investigated the effect of HCQ on COVID-19 patients. The study, based in the United Kingdom (UK), was conducted in 176 hospitals, and patients were either suspected or confirmed via laboratory testing to have COVID-19. A multicenter, randomized controlled trial was conducted where patients were either allocated to the plain usual standard of care (SOC) or a combination of usual SOC and HCQ or one other treatment. The staff and participants involved in the study were not blinded to the treatment allocation. 1561 patients received to HCQ treatment while 3155 patients received the usual SOC. Patients with known prolonged electrocardiograph QTc interval were excluded from the study. Outcomes were measured after 28 days of online follow-up and the primary outcome measure was mortality. Collected data were analyzed statistically using the log-rank statistic and Kaplan-Meier test.
Tang, et al. (2020) also conducted a study to explore the efficacy of using HCQ to treat COVID-19 adult patients. A multi-center, randomized, open-label trial was conducted in 16 COVID-19 treatment centers in China. Stratified random sampling was used to assign eligible patients, who were then randomly assigned to the treatment and control group in a 1:1 ratio. The treatment group received a combination of HCQ and the current SOC for COVID-19 while the control group received just the SOC. Participants in the study were not blinded to treatment allocation. Patients who had been confirmed with COVID-19, aged 18 years and above, and had no existing medical condition that risked their participation were included in the study after willingly providing consent. 150 patients were randomized, and half of them were assigned to the treatment group. Log-rank test, Kaplan-Meier test, and O’Brien-Fleming cumulative spending function were used in the statistical analysis of the data.
In another study, de Novales, et al. (2020) examined the effect of HCQ on the survival of COVID-19 patients. The study was conducted in a hospital in Madrid, Spain. An observational cohort study was applied. Two groups of patients with similar characteristics were included in the study. In total, 166 patients participated in the study and each group of patients received other potential treatments for COVID-19. 123 patients received HCQ treatment in addition to other treatments and the remaining 43 did not, either due to HCQ shortage or potential adverse reaction from the drug. Patient data were obtained from electronic medical records. Data were analyzed using the Chi-square test, t-test, Kruskal Wallis test, one-way ANOVA, log-rank test, and the Kaplan Meier test.
Ramireddy, et al. (2020) also investigated the impact of using HCQ in COVID-19 treatment, with a special focus on how HCQ affects QT interval prolongation. The study was performed at a hospital in Los Angeles, United States. The researchers did not...