When it comes to the coronavirus, the ultraconservative wing of the state legislature is of two minds, springing from its rejection of science and embrace of anecdotal evidence that fits a world view that the government is out to get us.
On one hand, members attending a joint committee hearing today at the state Capitol believe the state is being overly rigid in its efforts to keep people healthy, asking: Why can’t the state reduce the social distancing rules to 4 feet instead of 6 (Sen. Kim Hammer, R-Benton)? Why is the state scaring people by overstating the number of COVID-19 deaths (Rep. Robin Lundstrum, R-Springdale)? Where does the state get off asking a pastor if there is singing in a church (Sen. Jason Rapert, R-Conway)?
On the other hand, these same legislators believe the state is keeping away from its people the silver bullet that will save many lives: hydroxychloroquine.
Rapert and other legislators at the joint committees of Insurance and Commerce harped on what they see as obstinacy regarding the miracle of hydroxychloroquine. Hammer said he knew two people who attributed their recovery to hydroxychloroquine, and that evidence was good enough for him. Rapert insists there are pharmacists refusing to fill prescriptions for hydroxychloroquine because of a guideline from the Department of Health. He told Dr. Jennifer Dillaha, the state epidemiologist called to testify before the committee, that Health Secretary Dr. Jose Romero “needs to get his house in order” and hinted that people may sue over the guidance someday.
State Pharmacy Board Director John Vinson, Arkansas Medical Board Amy Embry and medical board lawyer Kevin O’Dwyer were called to address the hydroxychloroquine issue. Embry and O’Dwyer said no doctors have complained of having their hands tied over the antimalarial treatment. Vinson said it is possible some pharmacists have misunderstood the directive and the board has been meeting with pharmacists across the state to clarify it.
Here is the guidance:
On June 15, 2020 the Food and Drug Administration (FDA) revoked the Emergency Use Authorization (EUA) for the use of chloroquine (CQ) and hydroxychloroquine (HCQ) to treat COVID-19 after concluding it was “no longer reasonable to believe that oral formulations of HCQ and CQ may be effective in treating COVID-19, nor is it reasonable to believe that the known and potential benefits of these products outweigh their known and potential risks”. The latter included serious cardiac adverse events. Based on this information, the Arkansas Department of Health (ADH) updated its guidance related to HCQ and CQ indicating that their use for treatment of COVID-19 should be avoided in both outpatient and hospitalized settings.
CQ and HCQ can continue to be administered, prescribed, and dispensed for FDA approved medical conditions under supervision of a patient’s healthcare provider. Unapproved use (i.e. “off label use”) of these medications is left to the discretion of individual clinicians and their patients. However, the ADH wants clinicians to be aware that coadministration of HCQ or CQ with remdesivir, an FDA EUA approved medication for treatment of COVID-19, is not recommended based on data showing an antagonistic effect of these medications on the antiviral activity of remdesivir.
Lundstrum said Governor Hutchinson was “not truthful” about the death toll and questioned why the hospitalization numbers include people whose viral infection wasn’t detected until after they were hospitalized.
Rapert complained about the behavior of contract tracers, whose job it is to contact people who’ve been exposed to the virus, saying he believes some of them are acting “way outside the bounds” of confidentiality and appropriateness. He said a Fort Smith pastor had told him that a caller was “trying to lay blame on the church” for the number of church members who’d been infected, and asked (according to Rapert), ” ‘Have you been educated on the dangers of singing in church?’ ” Incredulous, he asked Dillaha if she were aware “this is a line of questioning.”
Yes, Dillaha explained. There is a concern about singing because of the virus is aerosolized that way.
“That’s breaking news to me,” Rapert exclaimed. When was that decided, he asked. Dillaha explained to the senator that it had been known and addressed in guidances for many months. Well, he huffed, what about all those screaming rioters in the streets? What have you done about them?
He also complained that contact tracers were identifying themselves as being with the Health Department instead of the companies who hired them under contract, and suggested some of them could be criminals.
Dillaha dutifully answered other questions. Yes, hospitals include COVID-19 positive cases in their numbers because of the protocol for treating infected patients (which requires them to be kept in special rooms and treated with extra caution, an extra burden on hospitals). No, the health department has not banned hydroxychloroquine and does not tell physicians how to prescribe drugs. Yes, sometimes a whole classroom may be asked to quarantine even if the spread is one person to two, because that’s an average.
A stable of dead horses flogged today.