Accounting for its population density and size, California has done relatively well in fending off the novel coronavirus disease, thanks to the commitment of the people of the state to stay home and take precautions. But California’s success is due, in no small part, to local and state health care authorities working together in response, and to the leadership of Gov. Gavin Newsom. Newsom’s 83% approval rating for his COVID 19 response even outstrips the 79% approval rating of Gov. Andrew Cuomo of New York.
On Thursday, Gov. Newsom signed an executive order aimed at limiting administrative pain and cutting red tape while a statewide stay-at-home order is in effect. The governor’s order extends the expiration of drivers licenses by 60 days, allows businesses to meet the state’s environmental quality regulations through electronic filing, and suspends California’s 10-cent mandatory charge for paper or plastic bags provided by grocery stores since many local health departments have banned customers from bringing their own bags for fear of the spread of the coronavirus.
In the meantime, another crisis has been brewing in the State of California and nationwide: the crisis of maintenance care. As regular medical appointments are canceled, “non-emergency” procedures are paused, and medications are stockpiled, care for patients with underlying conditions - ironically the population most susceptible to severe illness and death from COVID 19 - is suffering. For almost a month, chronic patients living with lupus and rheumatoid arthritis in the state have been feeling the brunt of a hydroxychloroquine (HCQ, brand name Plaquenil) shortage. Some patients have been entirely unable to receive this critical maintenance treatment despite having a prescription for it, while others have been forced to put themselves at risk to visit a pharmacy every fortnight for refills. The usual refill period for hydroxychloroquine for lupus patients is 90 days.
What’s more, the shortage is largely a manufactured crisis resulting from prescriber abuse, hoarding, and hospital stockpiling after the drug was touted early as an effective treatment for COVID 19, without any clinical evidence that it is one. The panic and stockpiling was a widespread reaction that went beyond the borders of California and the United States. For a time, India, the largest manufacturer of hydroxychloroquine, banned its export based on the same rumors.
In the past week, evidence has emerged that for a large segment of the COVID 19 population, HCQ may in fact be more harmful than helpful due to its side effects of cardiotoxicity and the surprisingly large portion of coronavirus patients who have developed (we hope temporary) heart conditions. The National Institutes of Health and the Food and Drug Administration have both cautioned against the use of HCQ to treat COVID 19 patients outside of clinical trials and strictly monitored hospital settings in recent days.
Let’s be clear: panic, not the pandemic, is the cause of the hydroxychloroquine shortage.
That is why we have urged Gov. Newsom to sign an executive order prohibiting HCQ stockpiling and hoarding, and directing pharmacies to fill HCQ prescriptions for chronic patients as long as supplies are available. Putting maintenance care for chronic conditions is not just pitting one group of patients against another, it is also shortsighted, as the removal of maintenance care makes it more likely that managed chronic conditions will deteriorate into severe and acute conditions requiring ER visits and hospitalizations, increasing the stress on the health care system and putting lives in jeopardy.
We reiterate our call for Gov. Newsom to act swiftly to protect access to care and treatment for everyone, especially those with chronic illnesses.