COVID-19: NJ Gov. Murphy, cease your prohibition of physician prescriptions.

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COVID-19: Governors, do your job. Let physicians do theirs.
By Craig M. Wax, DO and Parvez Dara, MD, FACP, MBA

 | April 12, 2020 PhysicianOutlook.com

Based on the current circumstances of an extremely contagious deadly COVID19 virus that is creating chaos in our state and the world, governors’, pharmacy boards' and medical boards' orders to restrict physicians from writing prescriptions to treat their patients with Hydroxychloroquine (HCQ) is contrary to the best practices of medical care. The sanctity of the patient-physician relationship requires personalized individual management and care which must lie in the knowledge and wisdom between those two entities and not artificially imposed by others.

Government orders of restriction to use HCQ prevents patients’ access to a potential life-saving medicine, especially when administered in the early phase of the disease. These mandates may risk the lives of many New Jersey residents.

Timely access to these medications may mean the difference between life or death for patients facing the battle of their lives.  It is time to encourage our nation's pharmaceutical industry to increase the supply of these drugs to benefit the residents of our country and citizens of the world.

Early treatment appears to be crucial for keeping patients out of the hospital and off ventilators. Delaying treatment results in the opposite, more sick patients ending up in overburdened facilities. 

HCQ is thought to prevent the virus from gaining access to the human cell and in doing so it significantly reduces severity of infection. Additionally, in those patients who already have infection in their system, HCQ may block access to the cellular structure called Endoplasmic Reticulum where it replicates. Stopping such replication would reduce the viral load and hence allow the human immune system to fight off the infection. Without this drug, many valuable human lives could be cut short. 

A growing list of state governors, including those of Arizona, Nevada, New Jersey, Michigan, and Texas have formulated mechanisms of restrictions to the use of hydroxychloroquine. At least one governor, when witnessing the burgeoning loss of life has wisely and quickly reversed course. If restriction is to prevent hoarding of the medication, then perhaps using the Texas model of limiting the drug dosing for 10 days (20 pills) might be more appropriate. It prevents harm to our vulnerable, sick and infirmed patients. 

HCQ has many decades of history as used in the care of patients with malaria and rheumatoid arthritis. Knowing its very low toxicity and it poses very little if any threat to the patient, clinicians in New York, Kansas and elsewhere are reportedly preventing deaths and ARDS/ventilator dependent long ICU stays. Waiting for placebo-controlled trials is not a wartime battlefield strategy, given the urgency of treatment.

As physicians it is our duty to treat patients with the best available therapy and available evidence to circumvent disease at its earliest phase, so as to prevent the loss of life and any future morbidity. It is with that wisdom and acquired knowledge that we respectfully ask states to reconsider this restrictive mandate.

That these drugs may be effective against COVID-19 has been shown in some laboratory experiments. And now evidence is mounting that these drugs are working to decrease viral load in patients. Decreased viral loads means patients not only avoid the hospital but are less infectious to others.(1) There is growing evidence that early administration even in mild cases of COVID-19 prevents progression to worse disease, likely attenuating the need for ventilators and ICU beds and improves symptoms. (5) This will decrease the burden on the healthcare system and upon the doctors and nurses that bear the ultimate responsibility of the patient’s care. 

The information available from across the world suggests that the prudent course of action is not to put hurdles in the path of patient care by restricting  most valuable medications that can protect a human life. In fact, India is officially recommending health care professionals and family members of sick patients prophylactically take HCQ. (6) The New York Times reports of a recent study: “Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug.” 

NJ and other states must reverse restrictions given the influence of such overwhelming evidence to the contrary. They must reconsider harmful decisions that can potentially cause a significant loss of life in their states. Each patient care decision is unique to an individual and their own personal situation and value system. Patients and their physicians must carefully weigh the risks and benefits of every potential intervention. The confidential patient-physician relationship must be held sacrosanct for this purpose. It is paramount that physicians have autonomy to make decisions that put patients first. NJ Governor Murphy, medical practice must be left to physicians.  Repeal your dangerous and damaging prohibition.