Abstract
In the March issue of Microbial Drug Resistance, Hache and colleagues present an Opinion article elaborating on their experience on the use of hydroxychloroquine and azithromycin against infections due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First of all, an opinion article is the sole responsibility of the authors as they are expressing their own opinion on the topic.
However, this controversy on potential treatments against coronavirus disease 2019 (COVID-19) highlights an important issue that scientists encounter in periods of dire need. Pandemics such as the current one always create a need for designated scapegoats and miracle saviors that promise rapid and easy cures. This was also the case during the HIV pandemic in 1980s and has very much been a part of human nature. We, as scientists, need to rise above and beyond these understandable human emotional responses and advance studies based exclusively on hypothesis-driven research and supporting positive and negative evidence to provide effective therapies and relief to patients.
Despite the huge toll on human life, the COVID-19 pandemic is an excellent example of how human scientific advances can help contain a disease. In less than a year, effective vaccines were tested and validated for human use. The success story of RNA-based vaccines is a perfect example of what long-term investment in basic science research can achieve for human health. But as with every microbial pandemic, the infecting agent can evolve. There is a growing worry that some new variants of SARS-CoV-2 might escape our current vaccines. And although we might adapt our vaccination strategy based on the circulating variants like we already do every year for the influenza vaccine, we need to expand our therapeutic strategy and, in particular, pursue our efforts in developing efficient antivirals against SARS-CoV-2.
To the eyes of the public, the rapid deployment and success of vaccines against SARS-Cov-2 have masked the worldwide efforts to find effective antivirals against the virus and therapies that can dampen the symptoms and deleterious consequences of the virus on our immune system and body. There have been some successes in the latter with the use of oxygen therapy, corticosteroids, and monoclonal antibodies to reduce the severity of the disease.
In contrast, despite numerous efforts, the quest to find effective antivirals has failed for the most part. The use of hydroxychloroquine with or without azithromycin was put forward based very early on using data from in vitro studies as a potential antiviral strategy against SARS-Cov-2. 1 Unfortunately, it did not live up to its initial promise, as it was the case for many other potential antiviral therapies. 2 Most importantly, every potential treatment should also weigh the health risk–benefit. In all the cases so far, with the exception of remdesivir, approved by the FDA for hospitalized patients, none has made the cut and none has been recommended by health agencies. In their opinion article, the authors argue that despite a modest benefit, the risk can be managed if physicians are properly informed on the limitations and risks associated with the use hydroxychloroquine and azithromycin. Although we do not endorse the authors' opinion, that does not mean that we should not continue the scientific discussion about potential benefits of different treatments. For example, despite the lack of efficacy in reducing disease severity, could this treatment help in reducing the rate of transmission by reducing viral load and burden, and thus the potential of transmission, in particular with the emergence of the new and more transmissible variants?
Hence, we have decided to publish this opinion article with the goal of continuing to foster a rational and passionless scientific discussion around all potential strategies to control this pandemic, without necessarily endorsing every single statement and opinion of the authors.