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The rise and fall of Trump’s obsession with hydroxychloroquine

Forty days of promotion, hype — and eventual retreat

Claims about hydroxychloroquine to treat covid-19 have gained traction despite a lack of scientific evidence. How did this happen? (Video: The Washington Post)

It was about 40 days ago when the idea of using anti-malarial medications to treat covid-19, the disease caused by the new coronavirus, first gained traction on social media. It took only a few days for President Trump to embrace the idea that chloroquine or hydryroxychloroquine might be game-changers in treatment of the deadly disease and only a few days more before Trump was actively hyping the medications.

As evidence mounted that the medications bore significant risks — including evidence coming from the government agencies Trump oversees — the president was much slower to respond. On Thursday evening, he insisted that “we’ve had a lot of very good results and we had some results that perhaps aren’t so good” in assessment of the use of the medications. Less than 24 hours later, though, a nail in the coffin for the medications came, as the Food and Drug Administration offered a public warning against their use.

Here’s how Trump’s focus on the medication rose and fell over the past 40 days.

March 16: Tesla CEO Elon Musk tweets a link to a March 13 paper suggesting that the anti-malarial drug chloroquine might be effective at treating covid-19.

A few hours earlier, the drug gets its first mention on Fox Business Network, with Fox contributor Marc Siegel, a doctor.

“In terms of treatments, remdesivir” — an anti-viral — “looks very promising. I will tell you something you don’t know: the South Koreans have tried chloroquine, that’s for malaria,” Siegel says. “Hydroxychloroquine is something we use for arthritis. Those look very promising."

That evening, Gregory Rigano, one of the authors of the paper Musk linked, appears on Laura Ingraham’s Fox News show. He says that hydroxychloroquine can “just get rid of [the virus] completely."

Rigano, though, is an attorney, not a doctor. He'd written the paper with the help of James Todaro, an ophthalmologist and tech investor. It was identified as having been written “in consultation with Stanford University School of Medicine” — but Stanford publicly denied any link. The document linked by Musk was later removed from Google Docs for violating the company's terms of service.

Mid-March: Trump speaks with Oracle chairman Larry Ellison, who in February hosted a major fundraising event for the president in California. Ellison suggests that the government establish a system (based on Oracle’s database tools) to track the use of chloroquine and hydroxychloroquine as possible treatments for covid-19, the disease caused by the new coronavirus.

Others raise the idea in the same period, including Mehmet Oz (Dr. Oz), a regular on Fox News who the New York Times reports had contacted Trump advisers.

March 17: A French doctor named Didier Raoult is part of a group of researchers who publish a paper suggesting that a combination of hydroxychloroquine and the anti-bacterial medication azithromycin (which is often sold under the brand name Z-Pak) could be effective against the disease. The study later draws significant scrutiny, including from the journal where it was published.

Anthony S. Fauci, a leading member of the White House coronavirus task force, appears on Ingraham’s Fox News program that evening.

“We have to be careful, Laura, that we don't assume something works based on an anecdotal report that's not controlled,” he said. “And I refer specifically to hydroxychloroquine. There's a lot of buzz out there on the Internet, on the social media about that. We need to look at it in a scientific way."

March 18: Rigano appears on Tucker Carlson’s Fox News show. Ingraham touts the Raoult study.

March 19: Trump for the first time mentions the drugs during a daily briefing on the pandemic.

“Nothing will stand in our way as we pursue any avenue to find what best works against this horrible virus,” he said. “Now, a drug called chloroquine — and some people would add to it 'hydroxy-.' Hydroxychloroquine. So chloroquine or hydroxychloroquine. … It is known as a malaria drug, and it's been around for a long time and it's very powerful. But the nice part is, it's been around for a long time, so we know that if it — if things don't go as planned, it's not going to kill anybody."

A few hours later, speaking to the nation's governors on a conference call, he again promotes the drugs.

March 21: Trump promotes the unproven combination of hydroxychloroquine and azithromycin on Twitter. It could be “one of the biggest game changers in the history of medicine,” he speculates.

Later that day, he retweets this tweet. He also retweets a tech investor's citation of the Raoult study. By the end of March 21, Fox News and Fox Business have mentioned chloroquine or hydroxychloroquine 176 times.

March 23. Trump retweets Fox News contributor Andy McCarthy's promotion of a Wall Street Journal opinion essay urging the use of the drugs. Trump again brings them up during the daily coronavirus briefing.

“At my direction, the federal government is working to help obtain large quantities of chloroquine,” he said. “And you can look from any standpoint tomorrow, in New York — we think tomorrow pretty early — the hydroxychloroquine and the Z-Pak, I think as a combination, probably, is looking very, very good."

He told an anecdotal story of success.

“You probably saw a couple of articles today came out where a gentleman — they thought he was not going to make it. He said goodbye to his family,” Trump said. “They had given him the drug just a little while before, but he thought it was over. His family thought he was going to die. And a number of hours later, he woke up, felt good. Then he woke up again, and he felt really good. And he's in good shape."

That evening, some grim news. A couple in Arizona ingested a substance called chloroquine phosphate, a medication for fish, under the mistaken assumption it would protect them from the coronavirus. One person died, the other was hospitalized.

March 27: Asked about the drug, Trump explicitly rejects Fauci’s view.

“Hydroxychloroquine is — is a very powerful drug for certain things, and it's a very successful drug,” Trump says. “There's reason to believe that it could be successful here. Now, the reason I disagree with you — and I think Tony [Fauci] would disagree with me — but the reason I disagree with you is that we have a pandemic. We have people dying now."

A website for employees of the CIA addressed the idea of using hydroxychloroquine to treat covid-19.

“At this point, the drug is not recommended to be used by patients except by medical professionals prescribing it as part of ongoing investigational studies. There are potentially significant side effects, including sudden cardiac death, associated with hydroxychloroquine and its individual use in patients need to be carefully selected and monitored by a health care professional,” the website read. Then, a warning in bold: “Please do not obtain this medication on your own.

March 28: The FDA provides emergency-use authorization for hydroxychloroquine and chloroquine to treat covid-19.

March 29: Speaking during a briefing in the Rose Garden, Trump says that the hydroxychloroquine and Z-Pak combination is being tested with patients in New York. He thanks the FDA for approving its use.

March 30: During an interview with “Fox and Friends,” he again discusses the medications.

“We have a lot of things happening right now,” Trump says. “As you know the hydroxychloroquine, which is a malaria drug and also an arthritis drug, but it's primarily a malaria drug, very powerful drug. And we're going to — we're going to know within days. We're testing that as an example, Brian, which is going to be very exciting if something positive comes of it. But that's being tested very strongly in New York. We have 1,100 people on that drug together with Z-Pak and the Z-Pak, you know what that is."

The hosts of the show do know what it is. “Fox and Friends” is one of the shows to mention the drugs the most over the past month. By the end of March, chloroquine and hydroxychloroquine had been mentioned on Fox News and Fox Business more than 500 times.

That afternoon, Trump again discusses the medications during the briefing. After HHS Secretary Alex Azar announced that the government had obtained 31 million tablets from two drug companies, Trump adds that another company planned to donate 6 million doses to hospitals in the United States.

March 31: During the daily briefing, Trump mentions the study underway in New York.

“The good news is we haven't heard anything bad,” he says. “In other words, there have been no catastrophic events. But we haven't. It's a little bit too soon to talk about it. It would be a total game changer, John, if that happened. If that happened, it would be a game changer."

He suggests that medical staff are taking the medication as a prophylactic, which he says is “a theory going around."

Asked by a reporter, Fauci again insists that controlled trials are needed to gauge the efficacy of the medications.

April 1: A study of the drug in Sweden is ended after “serious side effects” from chloroquine are reported.

April 3: Reading from his prepared remarks, Trump talks about ongoing studies.

“We continue to study the effectiveness of hydroxychloroquine and other therapies, and the treatment and prevention of the virus,” he says. “And we will keep the American people fully informed on our findings."

Looking up and speaking off the cuff, he continues, “Hydroxychloroquine — I don't know, it's looking like it's having some good results. I hope that — that would be a phenomenal thing."

“We've ordered it in the case that it works,” he adds. “And it's — it could have some pretty big impacts. And we'll see what happens."

The Post later reports that Trump had a visitor at the White House that same day: Laura Ingraham, who visited with two doctors to promote the use of the drug.

April 4: The day’s daily briefing falls in the middle of two retweets from Trump, in which allies hype the purported success of hydroxychloroquine. During the briefing, he announces that the national strategic stockpile now includes 29 million doses of the medication.

“The hydroxychloroquine is a — I hope it's going to be a very important answer,” he says. “We're having some very good things happening with it, and we're going to be distributing it through the Strategic National Stockpile."

“I hope they use the hydroxychloroquine,” he adds later, “and they can also do it with Z-Pak, subject to your doctor's approval, and all of that. But I hope they use it because I'll tell you what: What do you have to lose? In some cases, they're in bad shape. What do you have to lose?"

During the briefing, Trump also tells reporters that he’d pressed Indian Prime Minister Narenda Modi to release doses of the medication that the United States had ordered. Two days later, he added a threat to that request: “If he doesn’t allow it to come out, that would be okay, but, of course, there may be retaliation."

“Hydroxychloroquine — try it, if you'd like,” Trump says at one point during the briefing. He then adds a note of warning: “The other thing: If you have a heart condition, I understand. Probably you stay away from the Z-Pak."

April 5: More of the same.

“There are signs that it works on this,” Trump says, without specifying the origin of those signs. “Some very strong signs. And, in the meantime, it's been around a long time. It also works very powerfully on lupus. Lupus."

Lupus patients have repeatedly expressed concern about shortages of the drug due to Trump's advocacy and stockpiling of it.

“So there are some very strong, powerful signs, and we'll have to see. Because again, it's being tested now,” Trump says, one day after telling people to try it.

“If it does work,” he adds later, “it would be a shame if we didn't do it early. But we have some very good signs. So that's hydroxychloroquine and azithromycin. And, again, you have to go through your medical people, get the approval. But I've seen things that I sort of like. So what do I know? I'm not a doctor. I'm not a doctor. But I have common sense. The FDA feels good about it."

Asked why he keeps promoting the medication, Trump gets defensive.

“I want them to try it,” he says. “And it may work, and it may not work. But if it doesn't work, it's nothing lost by doing it. Nothing."

April 6: Trump congratulates a Democratic state legislator from Michigan who attributed her recovery from covid-19 to taking chloroquine at Trump’s suggestion.

April 7: During the briefing, Trump is asked if side effects are being tracked.

“The side effects are the least of it. You have people dying all over the place,” he replies. “And generally, the side effects are really with the Z-Pak having to do with the heart. The Z-Pak — that's the antibiotic. Not with the hydroxychloroquine."

He again touts the story of the Michigan lawmaker.

That night, he’s a caller on Sean Hannity’s Fox News show. He emphasizes a theory that had spread on social media.

“They're finding that people that — like in the malaria countries, that it doesn't seem that those countries have been hit, because the people take it,” he said. “You have countries that have massive malaria problems and they take the hydroxychloroquine, and they don't seem to be having the problem with the — the virus that all other countries are having."

“Malaria-endemic countries in all WHO regions have reported cases of COVID-19,” the website of the World Health Organization notes.

By the end of the day on April 7, Fox News and Fox Business have mentioned chloroquine and hydroxychloroquine nearly 1,000 times.

April 8 to 10: Over the next three days, Trump offers the same update on the number of doses of hydroxychloroquine the government has available and reports that the government is distributing doses to cities in the United States.

Trump retweets a call for French President Emmanuel Macron to expand use of the drug.

April 11: A small study of chloroquine in Brazil is halted due to concerns about side effects.

“Our study raises enough red flags to stop the use of such [high] dosage … worldwide in order to avoid more unnecessary deaths,” the researchers explain.

April 13: Trump promotes hydroxychloroquine during the daily briefing.

“Just recently, a friend of mine told me he got better because of the use of that — that drug,” Trump says. “So, who knows? And you combine it with Z-Pak, you combine it with Zinc — depending on your doctor's recommendation. And it's having some very good results, I'll tell you."

“I think if anybody recommended it other than me,” he adds, “it would be used all over the place, to be honest with you. I think the fact that I recommended it, I probably set it back a lot. But it's a lot of good things that are happening with it. A lot of good tests."

April 16: The family of a woman in New York who died of a heart attack blames her doctor for prescribing hydroxychloroquine and azithromycin. She hadn’t tested positive for the virus but was exhibiting covid-like symptoms.

April 18: Trump retweets a conservative writer who claimed that the president’s “bold gamble on hydroxychloroquine (HC) appears to be paying off."

By now, though, he's not mentioning the medicine much, including during his briefings where his daily updates on the number of doses in the stockpile have ended. Fox News and Fox Business, which had mentioned the two drugs more than 1,300 times in the preceding month, only mention them about a dozen times on April 17 and 18 — and fewer than 10 combined on April 19 and 20.

April 21: Guidelines published by the National Institutes of Health recommend against the hydroxychloroquine/azithromycin combination “because of the potential for toxicities.” The NIH offers no recommendation about use of hydroxychloroquine alone.

Later that day, damning results from a study conducted by the Department of Veterans Affairs suggest that those treated with hydroxychloroquine or hydroxychloroquine and azithromycin didn't see marked improvement from use of the drugs. The rate of death was higher in groups treated with the drugs than among those who didn't receive the treatment.

During the briefing, Trump is asked about the study.

“I don't know of the report,” he says. “Obviously, there have been some very good reports and perhaps this one is not a good report. But we'll be looking at it."

He also says he’ll look at the NIH finding. That evening, with no shortage of irony, Ingraham criticizes the media for promoting a study that wasn’t controlled.

April 22: Rick Bright, the former director of the Biomedical Advanced Research and Development Authority, alleges that he was demoted because he objected to the administration’s promotion of chloroquine and hydroxychloroquine.

“I rightly resisted efforts to provide an unproven drug on demand to the American public,” he wrote in a statement.

“Well, I've never heard of him,” Trump says of Bright at the daily briefing. “If the guy says he was pushed out of a job, maybe he was, maybe he wasn't. I — you'd have to hear the other side. I don't know who he is."

The FDA’s March 28 emergency use authorization letter was sent to Bright “in response to [Bright’s] request that the Food and Drug Administration (FDA) issue an Emergency Use Authorization (EUA) for emergency use of oral formulations of chloroquine phosphate and hydroxychloroquine sulfate.”

April 23: Trump is asked during the briefing why he’s stopped promoting the drugs.

“I haven’t at all. I haven’t at all. What are you say — we’ll see what happens,” Trump replies. “We’ve had a lot of very good results and we had some results that perhaps aren’t so good. I don’t know. I just read about one, but I also read many times good. So I haven’t at all. And it’s a — it’s a great — for malaria, for lupus, for other things. And we’ll see what it is."

April 24: The FDA formally warns against taking the medicines Trump has promoted due to “serious heart rhythm problems."

“We will continue to investigate risks associated with the use of hydroxychloroquine and chloroquine for COVID-19 and communicate publicly when we have more information,” the FDA release states.

By the end of the day on April 22, the most recent day for which data are available, Fox News and Fox Business had mentioned those two drugs 1,375 times.