Covid -19 challenges: Chloroquine treatment’s risk to G6PD conditions
By Felix Foday Sesay, PV Special Contributor, USA
Cell: 571-455-04285
felixfoday@yahoo.com
Recent revelations from U.S. President Donald Trump that he is taking the anti-malarial drug deoxy chloroquine, as a preventative treatment against COVID-19. Receiving this news reminded me of certain concerns that have been expressed regarding the use of anti-malarial drugs on patients with G6PD deficiency. Notwithstanding warnings about their efficacy and side effects, it is clear that anti-malarial drugs are being prescribed and used to treat COVID-19. For individuals with a genetic condition known as G6PD (Glucose 6 Phosphate Dehydrogenase), the use of anti-malarial medication like Chloroquine for example have adverse effects and can be harmful to their health.
It is concerning that deoxy chloroquine is being promoted to treat COVID by many health professionals and members of the administration without mentioning people that should not take the medication. The pandemic has people desperate and scared of getting the disease and they will do anything to prevent that from happening. There are people who have G6PD that may seek out this form of treatment without knowing all of the facts. This prompted me to write an article on 12/30/2018, titled: “G6PD, Anti-Malaria Regimen, Who Should Be Screened?”. It was published online by the Patriotic Vanguard (www.thepatrioticvanguard.com) with the intent of alerting the public and medical care providers about the unintended dangers of administering standard anti–malarial medicines to G6PD deficient individuals. In these overly trying times for overwhelmed medical professionals trying to save the lives of legions of people coming to emergency wards, this could create more problems than they solve.
Meet G6PD
Glucose 6-Phosphate Dehydrogenase (G6PD) Deficiency is a genetic condition that cannot be cured and can pose risks for carriers when they eat certain foods (Soy sauce, fava beans) take certain drugs or yet still are exposed to certain stressors. Although it is underreported, research indicates that G6PD affects about 200,000 persons in the United States alone. This hereditary condition affects all races but is most common to people of African, and or Mediterranean descent. It is also prevalent in areas where malaria is an endemic disease and can pose great problems, especially when it comes to malaria treatments. The G6PD deficiency affects mostly biological males but women could also be born with the disease. The condition causes red blood cells to break in response to certain foods like fava beans, soy sauce, and anti-malarial drugs like chloroquine.
Primary doctors
In the past couple of months, videos from around the world have been showing how hospitals, especially in the epicenters of the pandemic are grappling with the horrors of combating COVID-19. Persons fitting into the category of G6PD deficiency should be concerned at this juncture because their primary doctors may not even be aware of their conditions. And without a history, which comes in handy in crucial times as these, the treatment they need if they test positive for COVID-19 will not be available, thereby, jeopardizing the lives of these patients.
Fears arise that should these G6PD cases test positive for COVID-19 and are admitted into a hospital, there is every likelihood that they are going to be given the anti-malarial drug like chloroquine, which seems to work for some people but may not work for them. For G6PD-deficient patients given chloroquine, a common reaction is that two days after taking the medication, their oral temperature will scandalously elevate and their condition will take a turn for the worse. The G6PD deficiency symptoms include fatigue, rapid heart rate (especially when in stress), shortness of breath, enlarged spleen, pallor, dark urine, and yellow skin color (Jaundice).
To avoid this scenario, it is advisable for Primary Care Doctors to screen patients who may fit into the category of G6PD Deficiency: African Americans, Africans, and people of Mediterranean descent. All Primary Care Doctors with patients who fit into any of these categories must call them in for a lab test for diagnosis. A stitch in time saves nine. If this is done, it helps the patient throughout his or her life and more importantly, helps reduce the burden on doctors in the emergency care units fighting to save patients infected with the corona virus.
Patient responsibility
Since COVID-19 is now a pandemic, it is important for people to note that they can help themselves fair better against the disease by knowing if they have the G6PD condition ahead of an emergency. People who are biologically born a black male, are of Mediterranean descent, or have traveled internationally within the last four weeks (and may have been exposed to malaria) must get lab tests done to determine whether they are G6PD deficient. Patients with confirmed G6PD deficiency make their Medical Providers aware of that prior to receiving anti-malaria medication like Chloroquine, Quinine sulfate, along with doxycycline, Cotem, Dapsone, Primaquine and probably more, are harmful to their health. They must take other anti-malaria regimen like Mefloquine and Clindamycin. These medications worked perfectly for me when I became very ill at Inova Alexandria Hospital, Virginia in 2008. I was placed on anti-malaria regimen of Quinine sulfate along with doxycycline after diagnosed with malaria. Thanks to the Internal Medicine doctor on call, Dr. Imindra Rana who quickly ordered a lab test and diagnosed me with a full blown G6PD deficiency and promptly stopped his anti-malaria regimen. He then placed me on Mefloquine and Clindamycin. The swift and aggressive response of Dr Imindra Rana on that case, saved my life as I was experiencing a life-threatening acute intravascular hemolysis due to the complication of G6PD and anti-malaria regimen.
Verma Marie Anan
Verma Marie Anan, a student at the University of Ghana, Legon, (my alma mater), was not so lucky. Her G6PD deficiency was not known or detected prior to and during her anti-malarial treatment in Ghana. She died unfortunately, from G6PD complications.
Dr Imindra Rana
Affirmative action
There is a silver lining in the gloomy sky though. Awareness is mounting world-wide on G6PD deficiency. If we all play our part, G6PD deficient persons (said to be roughly 200 thousand in the USA alone) should not die or suffer from the complication of G6PD deficiency, when seeking malaria treatment in hospitals. It is my fervent hope that the World Health Organization (WHO) will make G6PD screening available to all affected persons seeking malaria treatment in heavily malaria-infected countries. This action will consequently help save many lives from lack of knowledge on their G6PD deficient status.
As Peters & Van Noorden (2009) put it: when severe G6PD deficiency complicates malaria infections, treatment with Primaquine or Dapsone can lead to life threatening acute intravascular hemolysis followed by anemia and acute renal failure. However, an antidote to unscreened G6PD deficient individuals seeking malaria treatment, in my opinion, is to provide awareness for medical providers, and flood hospitals with G6PD receptive anti-malaria drugs like mefloquine and clindamycin (more so when these drugs are cost effective) —the drugs that Dr Rana used to alleviate my condition.
Furthermore, after this pandemic subsides, inexpensive tests should be made available in countries where malaria is endemic to reliably determine its heterozygous form.
Conclusion
In 2017, malaria deaths worldwide reached 430 thousand. Though there are no available data on malaria deaths due to G6PD complication, the world health organization (WHO) estimates the prevalence of G6PD in Ghana to be 15-26 % (Adu, Simpong, Takyi &Ephraim 2016). This is telling. The West African belt collectively have a high incidence of malaria infection. If COVID-19 pandemic does not upstage the plan, some 6.5 billion US dollars will be spent on combating malaria in this year alone. Maybe —just maybe— the WHO will revisit budgetary allocation and set aside enough from the chunk of money usually set aside on preventive medicine, to now include lab tests to help diagnose G6PD deficient cases. Until then, stay safe and healthy.
The author, Felix Foday Sesay, resides in the USA and holds a Master’s degree in Public Health from American Public University (USA)
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