Nevada doctors are questioning Gov. Steve Sisolak's (D.) restriction on the prescription of antimalarial drugs the Food and Drug Administration approved as a potential coronavirus treatment on Sunday.
On Sunday, the FDA granted emergency approval for the use of chloroquine and hydroxychloroquine to treat patients suffering from the pandemic. The move came five days after Sisolak announced Nevada will prohibit doctors from prescribing and dispensing the drugs to coronavirus patients unless they are in an emergency room.
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Two hospital physicians told the Washington Free Beacon such a restriction could overwhelm health care facilities and limit the ability of doctors to treat patients. If residents discover they can only access potentially life-saving medicines in emergency rooms, already crowded hospitals could be pushed to the brink, according to Dr. Brian Callister, governor of the Nevada Chapter of the American College of Physicians.
"We’re very concerned that while we’re trying to keep patients home, a ban like this is going to drive patients to seek care in ERs and overwhelm the system," Callister said. "We are being asked to ignore our clinical judgment."
Callister said flexibility is key to treating a novel virus, specifically because "this is all new." Rather than prescribing potential treatments that can be administered in home quarantines, coronavirus patients could instead end up filling hospital beds—and exposing more people to the disease as they get there.
States across the nation took action in the face of similar issues with the supply of antimalarials. An Ohio state board worked to keep the drugs available to treat COVID-19, making prescriptions only available to patients who had tested positive for coronavirus. A state board in Idaho said the drugs should only be prescribed for FDA-approved uses, and Texas adopted a similar rule late last week. The FDA's new recommendation could allow those states to adapt more easily than Nevada and its restrictive policy.
President Donald Trump touted the antimalarial drugs, specifically hydroxychloroquine, as a "game-changer" at a recent coronavirus press conference. While hydroxychloroquine is typically used for treatment of diseases like rheumatoid arthritis and lupus, a limited scientific study out of France suggested the drug was effective in treating coronavirus.
Sisolak expressed skepticism about whether the drugs are effective after input from the state pharmaceutical board. The order says the drugs have not yet been demonstrated as a safe or effective treatment course for the deadly disease and could create a shortage for patients who use the drugs to treat other illnesses.
"The Nevada State Board of Pharmacy has determined that an emergency exists due to the hoarding and stockpiling of chloroquine and hydroxychloriquine during the COVID-19 pandemic, and the resulting shortage of supplies of these drugs for legitimate medical purposes," the order says.
Board general counsel Brett Kandt, which recommended the ban to the governor, told the Free Beacon the regulation can be "repealed to the extent this is deemed necessary" if the drugs show further promise.
Movses Kazanchyan, a hospital physician in Nevada, raised concerns about the regulation hindering the ability of doctors to deal with a large number of cases. He told the Free Beacon that while the governor’s ban is "coming from a good place," the regulation may be overly preemptive. Kazanchyan said the treatment regimen for treating coronavirus is still unclear for physicians, let alone politicians.
"Everybody all across the U.S. is still trying to figure out what the right protocol is," he said. "We don’t have the definitive data."
Sisolak, who did not return request for comment, has attempted to alleviate concerns about the new order hampering the response to the deadly virus. On Wednesday he said the order does allow doctors in hospitals and emergency rooms to prescribe the drugs to infected patients.
"This regulation DOES NOT prohibit prescription of these drugs for inpatient treatment," he said on Twitter. "In other words, if a doctor in a hospital or emergency room setting wants to prescribe these drugs to treat a patient diagnosed with COVID-19, he or she is still free to do so."
While the viability of the drugs is still in question, two physicians argued in a Wall Street Journal op-ed that international studies have shown the use of hydroxychloroquine is "appearing to make a difference."
"It isn’t a silver bullet, but if deployed quickly and strategically the drug could potentially help bend the pandemic’s ‘hockey stick’ curve," the pair said.
Other medical experts, however, are advocating for caution before using the drugs and are urging individuals not to self-medicate. A study from a Chinese scientific journal found no significant improvement in patients after the use of antimalarials. Lupus patients also raised alarms about potential drug shortages brought on by coronavirus-shopping. Callister said the Nevada ban could spark a different kind of panic for residents and physicians.
"Panic and fear really have no place in preparing to deal with a crisis like this," Callister said. "We also have to be smart in how we plan and prepare and execute."
Nevada's emergency ban is scheduled to remain in effect until July 22.