Every month, Rajan Rustagi orders hydroxychloroquine tablets on the online medical store, Pharmeasy. They are for his mother, who is in her 80s and has severe rheumatoid arthritis. She needs two doses of 200 milligrammes every day. She has been on the medicine for 25 years.
But now, Pharmeasy says they have run out of stock. Rustogi, who lives in Ghaziabad’s Vaishali area, checked at two or three local pharmacies. They had no supplies either.
“I have enough for two to four days,” said Rustagi. “I asked my doctor if there is an alternative. But he said there is no alternative, just get it when it becomes available on the market. I’m trying my best.”
Drug in demand
With the coronavirus spreading across the globe, hydroxychloroquine, an anti-malarial drug developed during the Second World War, is suddenly in high demand.
Back in mid-February, researchers in China suggested it had shown “anti-viral capabilities against the novel coronavirus” and could be a possible cure. Soon afterwards, there was growing chatter that the drug could be used as preventive medication for healthcare workers, many of whom were treating infected patients without basic protective gear.
United States President Donald Trump has repeatedly endorsed the drug. In a tweet on March 21, he called the combination of hydroxychloroquine and azithromycin one of the “biggest game changers in the history of medicine”. Since then, he has arm-twisted India into lifting its ban on the export of hydroxychloroquine and sending supplies to the United States.
There is scant evidence so far that the drug can work either as prevention or as cure and doctors have warned against relying on it. A doctor in Assam complained of “problems” soon after taking the drug. He died a week later of a heart attack.
Still, several countries have already started allowing the drug for Covid-19 treatment. On March 22, the Indian Council of Medical Research recommended that healthcare workers and Covid-19 caregivers take hydroxychloroquine as preventive medication, although it also said the drug should be used with caution. It also features on India’s list of anti-viral treatments.
On March 26, the health ministry issued a notification saying the “Central Government is satisfied that the drug ‘Hydroxychloroquine’ is essential to meet the requirements of emergency arising due to pandemic COVID-19 and in the public interest, it is necessary and expedient to regulate and restrict the sale and distribution of the drug ‘Hydroxychloroquine’”.
In order to prevent the “misuse” of the medicine, the Centre declared, it would be treated as a Schedule H1 drug under the Drugs and Cosmetics Rules, 1945. Drugs in this category are labelled “dangerous” and cannot be bought without a prescription. Pharmacists are required to keep records of who buys it.
Trump’s endorsement is believed to have caused a “worldwide run” on the drug. In India, supplies to regular pharmacists have been choked off. Scroll.in spoke to four pharmacies spread across Kolkata, Kochi and Jaipur. All except Dr B Lal Pharmacy in Jaipur said they had run out of hydroxychloroquine.
Mahesh Yadav, who works at the Health Good Pharmacy in Jaipur, said, “Ever since Trump and Modi made the announcement, we have stopped getting stocks.”
Bablu Sahaw, who works at the Frank Ross Pharmacy in Kolkata, reckons they ran out of supplies about 20 days ago. “Our stockist told us the he does not have the goods,” said Sahaw.
Needed for auto-immune diseases
But while the uses of hydroxychloroquine’s for Covid-19 are still being debated, it has been established practice for years to prescribe the drug for patients with auto-immune diseases such as lupus, rheumatoid arthritis and Sjogren’s syndrome. These are diseases where the body’s immune system starts attacking its own healthy tissue and organs.
Anti-malarial medicines like hydroxychloroquine help control lupus, an incurable autoimmune disease, in several ways, says this note by the John Hopkins Lupus Centre, “modulating the immune system without predisposing you to infection”. It tackles muscle and joint pain, rashes, fatigue, fever as well as more serious symptoms – pericarditis, or inflammation of the lining of the heart, and pleuritis, of inflammation of the lining of the lungs. Lupus patients who are prescribed hydroxychloroquine live longer than those who are not, according to studies.
It is also a “disease modifying” drug for rheumatoid arthritis, reducing pain and swelling, preventing joint damage and long-term disability.
‘Lupus has damaged my spine’
Many who relied on the medicine are now left in the lurch. “I have lupus with transverse myelitis,” said Priya Bhargava, who was diagnosed with the disease at the age of 19 and went on to win Miss India Wheelchair 2015. Transverse myelitis is an inflammation of both sides of a section of the spinal cord. “Lupus has damaged my spine. My skin is also involved. I have sun sensitivity.”
Bhargava, who lives in Noida, takes a hydroxychloroquine tablet every night and as of April 8, she had six left. “Generally, I go to take medicines just a day or two before it gets finished. But this time I tried earlier as I was hearing about its unavailability,” she said.
Bharagava has taken the medicine for about 12 years, on and off, and never faced shortages before. Till recently, she got supplies from a defence medical store. “That has been shut down for a month and we will have to buy medicines from the civil medical stores,” said Bhargava. But they had no luck there: “The pharmacist told us that ‘there is no HCQS and there will be no availability in the near future’.”
Rushing to the chemist’s
For Nithin K David, an industrial designer who lives in South Delhi’s Defence Colony, the alarm bells rang early. He rushed to the chemist’s he heard the China had started using hydroxychloroquine, about a week before Trump’s tweet. The medicine is vital for his 62-year-old mother, who has lupus. “I am paranoid so I bought enough for two months,” said David.
His mother, who was diagnosed with lupus about a year ago, took two tablets a day. By a stroke of luck, David said, the doctor recently halved her dosage. “So now I have stocks for four months,” he said.
But he worries about getting supplies later. The local drug store had assured him that they would not run out but he later saw a board in the shop window saying they had no stocks of the medicine left.
His mother has severe joint pain. “Her whole body is affected and all her small joints are swollen,” said David. She takes about 15 medicines in all, including steroids. “Even a small change in her dosage affects her,” he explained.