Death blamed on hydroxychloroquine despite lack of evidence

NBC News' Heidi Przybyla has reported that a 65-year-old woman in Queens NY has died from assumed complications taking hydroxychloroquine and azithromycin to treat COVID-19 symptoms. However, like the similar story of a husband and wife poisoned by the ingestion of fish tank cleaner in late March, the story must be viewed with caution and requires closer inspection.

The claim is that a woman was prescribed the drug cocktail of hydroxychloroquine, and azithromycin with neither a doctor's visit, nor a COVID-19 diagnosis, and then died. The supposition, without speaking to doctors, or viewing a death certificate, is that these drugs killed her. But with only one source, and that a spokesperson for the family, and in light of the absence of medical information, this is not a believable claim.

Przybyla's report states, “A New York woman with coronavirus symptoms died last week after being prescribed a drug cocktail with known cardiac side effects, and family members say she was not tested for COVID-19 or for heart problems before receiving the medication.” The report is sourced from the patient’s brother-in-law, Lee Levitt, and the woman is referred to only by her first name, Ligia, at the request of her children.

“NBC News made two attempts to reach Ligia’s doctor for comment," admitted Przybyla, the NBC News correspondent who also perpetuated a sensationalized tweet storm of the Arizona couple who ingested fish tank cleaner. "A man who answered the office phone and identified himself as the doctor then said there’d been a misunderstanding and offered to take a message.”

The decision was made to run the story without any further investigation or verification. Przybyla also admits, “Levitt acknowledged that the family does not know that the drug caused Ligia’s death. The family has not received a death certificate.”

The NBC report also states that, “Ligia received the drug after speaking by phone with her doctor... She was never evaluated in person and received no heart screening or warning about the potential side effects." This is as reported by Levitt.

Przybyla quotes the brother-in-law saying, “It was handed over like a bag of cookies.” Two photos were provided of the medication bottles, one for Hydroxychloroquine, 200MG, and one for Azithromycin, 250MG, both dated 4/4/2020. The pharmacy is listed as Roosevelt Pharmacy in Jackson Heights, NY and both prescriptions are written in Spanish.

With scanty evidence as to the mortal effects of these drugs, and no backup of Levitt's assertions, Pryzbyla takes some drastic liberties.

“The family’s experience suggests that at least some physicians," she writes, "are prescribing hydroxychloroquine and azithromycin—drugs President Donald Trump has promoted to treat the coronavirus—outside of hospital settings, underscoring why major medical organizations including the American Heart Association have issued warnings about the drug’s potential to trigger heart arrhythmia in some patients.”

Michael Ackerman, a cardiologist of the Mayo Clinic spoke with NBC News and said Ligia’s story “showed the concerns were real” regarding prescribing the drugs without pre-screening for cardiac health conditions.

Ackerman stated, “We knew that there would be either unawareness of, disregard to, or disrespect for the drug-induced cardiac effects" and went on to say that "well-intended efforts to treat COVID-19 could in fact cause the patient’s sudden death.” Again, this is a doctor who had no interaction with the family of the deceased.

The daughter of Lee Levitt's coworker Lynn Donawald also apparently had an issue with the drugs. Donawald told NBC that her daughter was prescribed the medication through telemed. Telemed is an option promoted by the CDC as an effective, safe and primary option for seeking initial medical support, given that it reduces physical contact and adheres to new social distancing norms. Donawald said that her daughter's doctor did not ask questions about underlying health conditions, despite her history of myocarditis, an inflammation of the heart muscle, and that her daughter did not divulge this information.

Donawald was speaking with Levitt over the phone discussing the situation when he dramatically told her not to let her daughter take the medication, relaying the story of the death of his sister-in-law. Levitt told NBC News, “If nobody is willing to stand up and say ‘This drug killed my loved one,’ then others will assuredly die as Ligia did,” Levitt said. “It's basically a game of Russian roulette; we don't know who can tolerate the drug and who can't.” There is as yet no confirmation as to Ligia's cause of death.

Donawald told NBC News that the drug is being “administered outside the hospital setting” demanding, “Not once did they ask if my daughter had heart conditions or any underlying ailments. They were just focused on the fact that she was positive for COVID-19.” Przybyla stated that Donawald’s daughter declined to identify the doctor who prescribed her the medication.

Neither Ligia's doctor nor Donewald's daughter's doctor were spoken to before this reporting was published. Neither pharmacy was contacted. Instead, these are anecdotal assertions made by the brother-in-law of the deceased, who then told his coworker to not let her daughter take the medication to treat her confirmed case of COVID-19.

According to the American Medical Association’s Boards of pharmacy COVID-19 prescribing guidelines, updated as of April 11th, 2020, both New York and New Jersey require a positive COVID-19 test to be provided prior to a prescription for hydroxychloroquine or chloroquine being written, except in cases of hospitalization, otherwise the pharmacy is to consider the prescription invalid.

In this case, assertions are being made as the efficacy of a drug cocktail that, based on NBC's report, was improperly prescribed. If anything, that is an indictment of a doctor and a pharmacy, and not a treatment method that is currently being researched along with so many others.

The AMA guidelines refer to the American Associate of Poison Control Centers on hydroxychloroquine side-effects. The guideline states the medication have well-known side effects and, “If it is being used in the context of treating the coronavirus, the short duration of therapy will likely avoid many of those.” Concerns surrounding cardiac health conditions focus on the congenital heart condition G6PD or QT syndrome.

The guideline states, “It should be used with extreme caution in people with prolonged QT syndrome or who are on medications for heart rhythm problems as the addition of chloroquine/hydroxychloroquine can increase the risk for fatal dysrhythmia.”

Adverse effects for the general population, however, are listed as, “[N]ausea, vomiting and/or diarrhea. They may also experience headache and dizziness. Irritability, tremor and even changes in mood have been reported.” Another risk factor is listed as, “Hydroxychloroquine may interfere with drugs used for the treatment of diabetes and produce a drop in blood sugar causing symptoms.” The guidelines from the American Heart Association, cited by NBC News, provides similar guidelines, generalizing to “[P]eople with existing cardiovascular disease.”

The NBC News report states that Ligia was diabetic with high blood pressure but no known history of heart disease. Donawald’s 32-year-old daughter had a known heart condition she did not appear to have informed the telemed doctor of per the story. Without verification from the prescribing physicians, it is unclear as to what was and was not asked, but it seems unlikely a basic history of common health concerns would have been overlooked.

While Przybyla devotes much space to criticizing President Trump and Fox News regarding chloroquine/hydroxychloroquine and Azithromycin (commonly known as a Z-pack), key details required to verify and understand the stories presented are lacking.

As with the prior NBC News report of the Arizona couple, this verification is far more relevant than the opinions of the individuals said to be involved. Pryzbyla should get her facts straight before running a story with such bold declarations on the dangers of medication. A global survey of doctors reported this as the most effective option in combatting COVID-19.

There are legitimate concerns about abuses in prescribing hydroxychloroquine that are addressed in a joint statement by the American Medical Association, American Pharmacists Association and American Society of Health-System Pharmacists. If physicians are prescribing this medication over the phone without proper testing and pharmacies are filling the prescriptions in opposition to state guidelines, this should be exposed.

Fear of the virus should not override good medical practices in keeping patients safe. In the same way, reporting on speculation and anecdotes without proper verification to create fear of potentially life-saving medications, especially for political purposes, is just as dangerous. We must continue holding journalists responsible for this behavior.