The dangerous disconnect between Trump’s rhetoric and the reality for potential coronavirus treatments

This dynamic has played out over the past few weeks, and was on full display again during the White House briefing on Tuesday. Trump said the drugs might be a “total game-changer” and implied that good news from clinical trials was just days away, only to be corrected by the nation’s top infectious disease expert, who steered clear of glowing superlatives and said the research will take months, “at very best.”

Trump went even further on Tuesday, falsely suggesting that the drugs have already been proven safe. “Very powerful drug, but it’s been out there for a long time,” he said at the daily White House coronavirus briefing. “So, it’s tested in the sense that you know it doesn’t kill you.”

Doctors say he’s wrong, and that comments like these could have deadly consequences.

“As the dose of chloroquine goes up, it goes from being safe and effective to highly toxic, quickly,” said Dr. Christopher Plowe, a renowned malaria expert at the Duke Global Health Institute. “It’s very easy to overdose on chloroquine. You get above the ceiling of safety pretty quickly. There are some very serious risks here. There’s quite a bit to lose, including your life.”

Experts like Plowe who study these drugs, and doctors who are prescribing them, agree with the public health officials that clinical trials will tell whether Trump’s optimism is well-placed.

Testing is underway, including a large study in New York, the epicenter of the US outbreak with more than 75,000 cases, the most of any state in the country. New York public health authorities have obtained at least 1 million doses of hydroxychloroquine, which will be used for a large-scale clinical trial, an official at the New York State Department of Health told CNN.

Optimism versus science

Regardless, within 48 hours, Trump sprang into action and began touting the study and the drugs, and has done so at least a dozen times in two weeks, according to a CNN analysis.

Senior Trump administration officials and public health experts followed suit, partially walking back Trump’s comments with their own tempered takes, often from the very same podium.

When a journalist asked Dr. Anthony Fauci, the nation’s top infectious disease expert, if these medicines could prevent Covid-19, Fauci gave a crystal-clear response: “The answer is no.”

Dr. Deborah Birx, the response coordinator for the White House’s coronavirus task force, said, “We’re trying to figure out how many anecdotal reports equal real scientific breakthrough,” when asked about the drugs.

The FDA Commissioner, Dr. Stephen Hahn, said a “large, pragmatic clinical trial” is still needed to “actually gather that information and answer the question that needs to be answered,” as to whether the drugs are effective and safe to use during the worsening coronavirus pandemic.

The report said more research is needed to corroborate the French study. If those early results are accurate, “this would be the first time chloroquine or hydroxychloroquine was found to be effective for the clinical management of a viral infection,” the report said, because previous clinical trials determined that the drugs had no impact on other viruses like influenza and HIV.

Balancing benefits and risks

Senior public health officials like Fauci and Hahn have said Trump wants to strike an optimistic tone to keep hope alive among Americans who are worried about their health and their paycheck. But there are risks, both to public health and in the presidential campaign unfolding in the background, in over-promising when it comes to things like drug treatments during an epidemic.

“Medical history has so many examples of treatments that people had good experiences with, and people got better, and they had great confidence in the treatment, and years later when a randomized trial was done, it turned out no better than placebo,” said Plowe, the Duke expert.

Even with that uncertainty, some doctors on the frontlines say there aren’t many other options.

“The FDA made a difficult decision, but they were right,” Colyer told CNN. “We won’t have all the hard data we want for months. But at this point, this is one of the most promising treatments out there. We need to understand all these drugs better, but we’re in a unique situation.”

Regardless of Trump’s glowing rhetoric about the medicines, Colyer said the FDA “made a finding after reviewing all the literature” that is available, even though the research is limited.

“They’ve seen the plusses and the minuses and made a professional decision,” he added.