Could Donald Trump’s COVID-19 Treatment Accidentally Kill Him?

Photo by Charles Deluvio on Unsplash

As the COVID-19 pandemic began shutting down the United States, early reports suggested an old drug used to treat malaria — hydroxychloroquine — had promising results. But the excitement surrounding hydroxychloroquine faded when further tests seemed to disprove its “miracle drug” status. A couple months later, the drug retook the spotlight after news surfaced that President Donald Trump began taking the medication to protect him from COVID-19. It’s reasonable to wonder: “If it’s a good idea for the president of the United States, is it a good idea for me?”

The arguments for and against hydroxychloroquine’s value in battling COVID-19 are heated, and I don’t know enough to take sides. However, I do know something about hydroxychloroquine’s side effects that’s unrelated to COVID-19 but has killed plenty of people. Since none of the mainstream conversations about the drug are mentioning it, I figured I should warn people. Maybe it’ll save a few lives. Maybe it’ll even save the President’s.

If you look carefully at discussions of hydroxychloroquine, you’ll see vague references to a possible side effect described as “heart problems.” You might think it’s referring to heart disease, which millions of people live with every day. Connecting “heart problems” with “heart disease” makes hydroxychloroquine seem less scary because heart disease can be improved through diet and exercise. Unfortunately, eating less bacon and spending more time on the elliptical won’t solve the heart problems caused by hydroxychloroquine. Instead, hydroxychloroquine causes problems with the heart’s electrical system.

Yes, your heart has an electrical system. It’s the part of your anatomy responsible for making your heart beat, which, as you might already know, is very important. The beating of your heart pumps blood to the rest of your body, giving all your organs the life-sustaining nutrients they need to do everything that allows you to exist. Naturally, that means you don’t want anything screwing with the heart’s electrical system.

Enter hydroxychloroquine. Hydroxychloroquine, that “safe” drug everyone keeps talking about in relation to COVID-19, messes with the heart’s electrical system. Some people’s hearts can handle the change. But some people’s hearts can’t. The problem is, if you’re one of the people with a heart that can’t handle hydroxychloroquine, you probably have no idea, and that’s why it would kill you. If you’re interested in avoiding that fate, keep reading.

Some quick background

In case you haven’t already heard about hydroxychloroquine or why it’s being talked about in relation to the current coronavirus pandemic, there are three things you should know:

  1. Hydroxychloroquine was developed in the 1950s. It’s a derivative of chloroquine, a 1930s drug used to treat malaria. Hydroxychloroquine is known as the “safe version” because it’s better tolerated and has fewer side effects.
  2. I have no idea whether or not hydroxychloroquine is an effective treatment or preventative measure for COVID-19. I’m not here to argue one way or the other, nor am I choosing sides. Instead, what I want to tell you doesn’t have a “side.” As long as you’re human and don’t want to die, the information I’m going to share will be applicable.
  3. It’s worth noting that, as a treatment for COVID-19, hydroxychloroquine is being used in conjunction with the antibiotic azithromycin. Keep this in mind. We’ll come back to it.

A ticking time bomb

In the time it takes you to read this article, your heart will beat roughly 600 times. That’s 600 critical deliveries of fresh, oxygenated blood to all your organs including your eyes so they can keep reading, your brain so it can process what you’re reading, and your stomach so it can digest the fresh batch of quarantine cookies you just baked. Your heart’s electrical system is what makes all that magic happen.

All day every day, like clockwork, the cells comprising your heart’s internal pacemaker fill with electricity. Then they release that electricity by zapping your heart, which causes the muscle to contract and pump blood.

The brief time it takes for your heart’s electrical system to finish zapping the heart and then refill with electricity so it’s ready to zap again is called the QT interval. Don’t worry about why it’s called that. Just know that the QT interval measures time (in fractions of a second) related to how long it takes a heart to recharge itself — technically “repolarize” — in preparation for another heartbeat.

A “normal” QT interval is less than 440. Again, don’t worry whether that’s 440 milliseconds or parsecs or gummy bears. Just know that you want your QT interval to be below 440. A QT interval lower than 440 means your heart completely resets itself and has a decent gap of time in which nothing is happening prior to the next heartbeat.

That brief pause between each and every heartbeat might seem unimportant, but nothing could be further from the truth. The tiny pauses taken by your heart’s electrical system between every heartbeat are critical to your survival because they give your heart the ability to rapidly accelerate.

Yes, our heartbeats can rapidly accelerate. If you’ve ever been scared or startled, you probably already knew that. But I’m guessing you never thought about the mechanism for how it happens and why it’s important.

The physiological details are complex, but the gist is basically this: some external stimulus tells your brain that the body needs more energy ASAP; the brain sends a signal down to the heart’s electrical system telling it that the body needs more blood; and the electrical system starts discharging energy faster. Simple enough, right? That’s why the gap between heart repolarization is so important. With a sufficient gap between heart repolarizations, the heart is ready to beat again at a moment’s notice.

But what happens when the heart needs to speed up and the electrical system hasn’t had time to reset itself?

Scared to death

Hydroxychloroquine, the COVID-19 treatment being touted as “safe,” has an unusual side effect. For complex reasons that aren’t relevant to our purposes here, hydroxychloroquine extends the time the heart needs to reset itself. This is known as prolonging the QT interval.

Hopefully you already see the problem. But, in case you don’t, a prolonged QT interval means the heart has less of a gap between repolarizations. Under normal circumstances, this isn’t a big deal. But what happens if your heart needs to rapidly speed up? For example, what if you get startled awake by a bad dream? What if you dive into a cold pool? What if you’re riding a roller coaster? What if someone jumps out from behind a corner and yells “BOO!” because they think it would be a funny joke?

I’ll tell you what happens. You might die.

I know this because all those things have nearly killed me. I have a disease called Long QT Syndrome. My heart naturally resets itself a fraction of a second slower than most people’s. Because of that, I can be startled to death at any moment. It could even happen before you’re able to finish reading this article.

A disease you’ve never heard of

Long QT Syndrome — LQTS — is an incurable, sudden arrhythmic death syndrome. It’s primarily a genetic disease that causes exactly what the name implies. That means my QT interval, which you already learned is the time it takes for the heart to reset itself, is naturally longer than a normal QT interval. While 440 is considered the top-end of “safe,” my QT interval hovers between 480 and 490. If you’re wondering how much worse that is than normal, I’m in the top 99th percentile of QT intervals. And while being in the top 99th percentile is usually a good thing, in this case, it’s deadly.

For people with LQTS, our hearts don’t have the large gaps between repolarizations that normal hearts have. As a result, our hearts have less time to prepare for new heartbeats. Under normal circumstances, that’s not a problem. But, if something requires our hearts to suddenly beat faster — like a car slamming on its breaks in front of us on the highway — our hearts might try to beat again before they’re ready.

When a heart tries to beat before it’s repolarized, it can cause an irregular heartbeat — an arrhythmia — with a fancy french name called Torsades de Pointes (TdP, or Torsades).

During Torsades, the bottom chambers of the heart are trying to contract before the top chambers. This leaves the heart quivering and unable to pump blood through the body. It leads to seizures, fainting, and, ultimately, death.

Chances are you’ve never heard of Long QT Syndrome. There’s three main reasons. First, its discovery is relatively recent. Second, it’s relatively rare (though researchers are beginning to realize it’s more common than they’d initially thought). And third, it usually kills its victims without them ever knowing they had it, so their deaths get attributed to something else.

Most people who have LQTS have no idea

My disease — Long QT Syndrome — is incurable and genetic. I was born with it.

It killed my father, but he never knew he had it.

It killed my grandfather, too, but he never knew he had it, either.

Are you starting to see a pattern here? LQTS has been killing people in my family for generations. Everyone seemed too young to be dying, but the disease hadn’t been discovered yet, so doctors just assumed all the people in my family were dying from heart attacks. They were wrong.

By some miracle, I found out I had Long QT Syndrome before it killed me. If you’d like the full, terrifying story, you can watch my TED talk about it. But this article isn’t about me. It’s about you.

As I’ve mentioned, the vast majority of people who have LQTS don’t know they have it. That’s because, when they’re not dying, they look and act just like everyone else, so there’s no reason for anyone to suspect they’re sick. It also means thousands, or hundreds of thousands, or possibly millions of people in the world have Long QT Syndrome but don’t know it. Many of them will be killed by it, and nobody will ever know.

That, alone, is a big deal, but it’s not the point of this article. This article is about hydroxychloroquine and how hydroxychloroquine makes LQTS more deadly.

A large portion of the millions of undiagnosed LQTS cases probably have manifestations of the disease that make their risk for sudden death relatively low. However, when you give those same people a QT-prolonging drug like hydroxychloroquine, you dramatically increase their likelihood of a fatal arrhythmia.

Medicines can prolong QT intervals, too

I realize most people have enough to worry about during the pandemic. The last thing they need is me adding to their anxiety by telling them they might have a secret disease that could kill them at any second. So let me add some additional context.

Even if 5 million people have undiagnosed LQTS — which is, from what doctors currently know about the disease, the upper bound of potential patients — it represents less than one-tenth of one percent of the world’s population. That means you’re unlikely to have it.

Similarly, Donald Trump is unlikely to have the genetic version of Long QT Syndrome simply because it usually kills people well before they can reach their 70s.

However, here’s the part that should concern you. Long QT Syndrome doesn’t have to be inherited like mine. It can be caused by medicine. We call this Acquired LQTS, and the risks to your health are the same.

Can hydroxychloroquine cause acquired LQTS? In some patients, it already has. Plus, it’s not the only QT-prolonging drug. Here’s a list of 250 common drugs that prolong QT intervals. When you give hydroxychloroquine to people already taking those, it exacerbates the problem.

On the list, you’ll notice everything from Benadryl to Zofran to cocaine. Mind you, I’m not here to judge people’s vices. I’m just here to let you know that you should be careful how your vices interact with hydroxychloroquine.

Also, if you looked closely at that list, you should have noticed another familiar drug: azithromycin. That’s the same azithromycin I referenced way back at the beginning of the article by writing:

“It’s worth noting that, as a treatment for COVID-19, hydroxychloroquine is being used in conjunction with the antibiotic azithromycin. Keep this in mind. We’ll come back to it.”

In other words, in addition to prescribing the QT-prolonging hydroxychloroquine, doctors are simultaneously prescribing another QT-prolonging medication. According to White House reports, President Trump has taken both medications together, too. One possible side effect of this potentially fatal cocktail is being described as a “risk of heart problems.” While that’s technically accurate, knowing what you know now, doesn’t the phrase “risk of heart problems” seem like a bit of an understatement? Does he know? Do other people taking the same combination of drugs know?

To solve this issue, I propose we replace the phrase “risk of heart problems” with “risk of sudden death.” This way, when describing the allegedly mild side effects of hydroxychloroquine, everyone clearly understands what could happen.

On the plus side, contracting a mild case of sudden death is a surefire way to avoid contracting coronavirus.

I teach entrepreneurship at Duke. Software Engineer. PhD in English. I write about the mistakes entrepreneurs make since I’ve made plenty. More @ aarondinin.com

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