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by Sharon Rondeau

(Mar. 28, 2020) — On Tuesday, March 24, the governors of Michigan and Nevada signed respective executive orders prohibiting physicians from prescribing hydroxychloroquine and chloroquine to patients for the treatment of the novel coronavirus, or COVID-19, outside of a hospital.

Both Governor Steve Sisolak (D-NV) and Gov. Gretchen Whitmer (D-MI) acted upon recommendations from their respective public health entities.  In his order, Sisolak reiterated a request from the Nevada State Board of Pharmacy to reserve the prescribing of hydroxychloroquine and chloroquine for “legitimate medical purposes” only.

The Michigan Department of Licensing and Regulatory Affairs wrote that it “received multiple allegations of Michigan physicians inappropriately prescribing hydroxychloroquine or chloroquine to themselves, family, friends, and/or coworkers without a legitimate medical purpose.”

“Michigan pharmacists may see an increased volume of prescriptions for hydroxychloroquine and chloroquine and should take special care to evaluate the prescriptions’ legitimacy,” the letter continues. “Pursuant to Michigan Administrative Code, R 338.490(2), a pharmacist shall not fill a prescription if the pharmacist believes the prescription will be used for other than legitimate medical purposes or if the prescription could cause harm to a patient.”

According to the Federal Drug Administration (FDA) as to “off-label” usage of a medication:

From the FDA perspective, once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient.

You may be asking yourself why your healthcare provider would want to prescribe a drug to treat a disease or medical condition that the drug is not approved for. One reason is that there might not be an approved drug to treat your disease or medical condition. Another is that you may have tried all approved treatments without seeing any benefits. In situations like these, you and your healthcare provider may talk about using an approved drug for an unapproved use to treat your disease or medical condition.

Additionally, the FDA advises patients, “If you and your healthcare provider decide to use an approved drug for an unapproved use to treat your disease or medical condition, remember that FDA has not determined that the drug is safe and effective for the unapproved use.”

A March 26, 2020 editorial in the New England Journal of Medicine by NIAID Director Dr. Anthony S. Fauci, CDC Director Dr. Robert R. Redfield, and NIAID Deputy Director for Clinical Research and Special Projects H. Clifford Lane, M.D.:

A robust research effort is currently under way to develop a vaccine against Covid-19.10 We anticipate that the first candidates will enter phase 1 trials by early spring. Therapy currently consists of supportive care while a variety of investigational approaches are being explored.11 Among these are the antiviral medication lopinavir–ritonavir, interferon-1β, the RNA polymerase inhibitor remdesivir, chloroquine, and a variety of traditional Chinese medicine products.11 Once available, intravenous hyperimmune globulin from recovered persons and monoclonal antibodies may be attractive candidates to study in early intervention. Critical to moving the field forward, even in the context of an outbreak, is ensuring that investigational products are evaluated in scientifically and ethically sound studies.12

After serving multiple terms on the Clark County Commission, including as its chairman, Sisolak was elected governor on November 6, 2018 and sworn into office in January 2019.  He was preceded by Republican Brian Sandoval, a Republican and former federal judge.

“Today, I signed an emergency regulation limiting the prescription & issuance of two drugs that have unproven results with treating COVID-19,” Sisolak tweeted on March 24. “While these drugs serve necessary medical purposes, this regulation protects the Nevadans who need them and prevents unnecessary hoarding.”

In an information release for clinicians “last reviewed” on March 21, 2020, the Centers for Disease Control (CDC) states, in part:

There are no US Food and Drug Administration (FDA)-approved drugs specifically for the treatment of patients with COVID-19. At present clinical management includes infection prevention and control measures and supportive care, including supplementary oxygen and mechanical ventilatory support when indicated. An array of drugs approved for other indications as well as several investigational drugs are being studied in several hundred clinical trials that are underway across the globe. The purpose of this document is to provide information on two of the approved drugs (chloroquine and hydroxychloroquine) and one of the investigational agents (remdesivir) currently in use in the United States…

Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19. In the United States, several clinical trials of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection are planned or will be enrolling soon.  More information on trials can be found at:  https://clinicaltrials.gov/external icon.

According to the National Institutes for Health (NIH), COVID-19 was originally termed “SARS-CoV-2.”

In its March 23 letter to Sisolak requesting the executive order, the Nevada State Board of Pharmacy wrote that hydroxychloroquine and chloroquine, which are FDA-approved for malaria and other conditions, are currently being studied for their effectiveness in treating COVID-19.  It claimed that “an emergency exists due to the hoarding and stockpiling of chloroquine and hydroxychloroquine during the COVID-19 pandemic” which has created a “shortage of supplies of these drugs for legitimate medical purposes.”

On the same day, the Associated Press reported Sisolak’s executive order but retracted the story the following day without explanation.  “In a story March 24, 2020, about coronavirus in Nevada, the Associated Press erroneously reported that Gov. Steve Sisolak signed an emergency order barring the use of anti-malaria drugs to treat people with coronavirus,” the AP wrote on March 25 under the title, “Correction: Virus Outbreak-Nevada Story.”

Any text from the original article appears to have been excised.

However, a March 24, 2020 AP article appearing in The Washington Times reads:

LAS VEGAS — Nevada’s governor has signed an emergency order barring the use of anti-malaria drugs for someone who has the coronavirus.

Democratic Gov. Steve Sisolak’s order Tuesday restricting chloroquine and hydroxychloroquine comes after President Donald Trump touted the medication as a treatment for the virus.

Trump last week falsely stated that the Food and Drug Administration had just approved the use of chloroquine to treat patients infected with coronavirus. After the FDA’s chief said the drug still needs to be tested for that use, Trump overstated the drug’s potential benefits in containing the virus.

The AP appears to have been referring to the March 19 White House Coronavirus Task Force press briefing; other media outlets echoed the AP’s finding.  Trump’s full remarks on that day begin at approximately the 9:00 mark here, during which he said that the FDA had approved certain drugs for coronavirus as “compassionate use,” a claim the FDA has affirmed.

In addition to the AP, Bloomberg reported on March 24, “The Food and Drug Administration has been told by President Donald Trump to see if it can expand the use of a decades-old malaria drug as an experimental treatment for coronavirus patients.”

Dr. Mehmet Oz, a frequent guest of late on the Fox News Channel, has reported positive results in the use of chloroquine, hydroxychloroquine and azithromycin obtained by a French physician, Didier Raoult, M.D, PhD, while cautioning that the regimen Raoult described continues to undergo study and that readers should not “take these medications without the guidance of a doctor.” (emphasis Dr. Oz’s)

At a Fox News “virtual townhall” on the U.S. response to the coronavirus pandemic conducted on March 24, Vice President Mike Pence said that “the FDA [Food and Drug Administration] is approving off-label use for the [anti-malarial drug] hydroxychloroquine right now” and “doctors can now prescribe chloroquine for that off-label purpose of dealing with the symptoms of coronavirus.”

“We are making that clear across the country,” Pence added.

An FDA-sanctioned study of hydroxychloroquine’s efficacy for coronavirus based in Minnesota is seeking more volunteers, ABC News reported Wednesday.

While doctors have agreed that clinical trials need to be completed on the drug or drug combinations, some are reporting very favorable results after prescribing them to patients with coronavirus.  A Monroe, NY physician, Dr. Vladimir Zelenko, who interviewed with President Trump’s attorney, Rudy Giuliani, and other outlets recently claimed that “he had kept more than 500 symptomatic patients out of the hospital” by prescribing a combination of azithromycin, hydroxychloroquine and zinc sulfate for patients complaining of “shortness of breath of any age, and those over 60 years old or who are immunocompromised and exhibiting milder symptoms.”

On March 25, Las-Vegas-based KTNV reported that Sisolak said of his new order, “This emergency regulation protects Nevadans who needs these drugs for legitimate medical purposes. At this point in time, there is no known cure for COVID-19 and we must not withhold these drugs from those who need them.”

The paper additionally reported that “Dr. Ishan Azzam, the chief medical officer for the state Division of Public and Behavioral Health,” remarked on the occasion, “This emergency regulation is a strong step in protecting patients. While studies are underway [sic] on the usefulness of these drugs in treating COVID-19, we must deal with facts, not fiction.  Preserving these drugs for those who need it is the right decision.”

Appointed in May 2018, Azzam’s first name is spelled “Ihsan,” and his official title is stated as “Chief Medical Officer” for the State of Nevada Department of Health and Human Services, Division of Public and Behavioral Health.  The press release announcing his appointment states of his experience:

Dr. Azzam earned his medical degree from the University of Cluj-Napoca, School of Medicine in Romania in 1982 and completed his OBGYN residency in 1986. He holds the National Centers for Disease Control and Prevention (CDC) Graduate Certificate in Public Health from the University of Washington, Seattle School of Public Health and Community Medicine, and the CDC Applied Chronic Disease Epidemiology Certificate from Penn State College of Medicine. Dr. Azzam completed his MPH in 2002 and his Ph.D. in 2010 at the University of Nevada, Reno (UNR). He is a scholar of the Great Basin Public Health Leadership Institute, and has been the recipient of several awards including the 2011 National Charles C. Shepard Science Award. Dr. Azzam has also been an instructor at University of Nevada, Las Vegas and the University of Nevada, Reno graduate schools since 1997.

On September 11, 2018, the AP, via The Washington Times, reported:

Nevada’s top doctor isn’t licensed to practice medicine in the United States.

Ihsan Azzam testified in Las Vegas on Tuesday that he has a master’s degree and worked for several years in environmental public health and epidemiology before being named chief state medical officer last May.

Azzam says he practiced for several years as an obstetrics and gynecology physician in Africa before moving to the United States in the 1990s.

However, the AP added, “That qualifies Azzam for the job under Nevada state law.”

On March 22, New York Gov. Andrew Cuomo announced that on March 24, the following Tuesday, “The federal government cleared the way for New York to experiment with the malaria and lupus drug hydroxychloroquine and the antibiotic Zithromax (generic name azithromycin) as a treatment for COVID-19,” as paraphrased by NBC-New York.

The following day, NBC News reported that hydroxychloroquine, also known as Plaquenil, was becoming difficult to obtain for patients already taking it for lupus.  “Clinical tests are only just beginning, and infectious disease experts say it’s too soon to reach a conclusion,” NBC reported on March 23.  “Still, the publicity surrounding hydroxychloroquine, which began well before Trump’s remarks, has fueled shortages across the country.”

On March 24, Cuomo issued Executive Order #202.10 titled, “Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency” containing, among other items, the directive:

No pharmacist shall dispense hydroxychloroquine or chloroquine except when written as prescribed for an FDA-approved indication; or as part of a state approved clinical trial related to COVID-19 for a patient who has tested positive for COVID-19, with such test result documented as part of the prescription. No other experimental or prophylactic use shall be permitted, and any permitted prescription is limited to one fourteen day prescription with no refills.

On Friday The Post & Email contacted Sisolak’s public information officer at the email address appearing in his tweet.  We wrote:

Hello, I have read conflicting reports about Governor Sisolak’s March 24 executive order regarding the prescription of hydroxychloroquine and chloroquine for COVID-19 patients. Of course, I also read the actual order, which appears to say that a physician cannot prescribe either of those drugs for a COVID- 9 patient even if he or she believes it is the very best course of treatment available.

Does that not infringe on a Nevadan’s right, constitutional or otherwise, to make an informed decision about his or her health in consultation with his physician? Does the directive contemplate that untreated COVID-19 patients might worsen and require hospitalization, further taxing the public health system and endangering more lives?

If the pilot study being conducted now in New York City should prove positive for the treatment of COVID-19, would the governor consider modifying his directive?

Thank you very much.

Sharon Rondeau, Editor
The Post & Email

Shortly afterward we received a response from Meghin Delaney, which reads:

Hi there,
The State Board of Pharmacy also issued information about the regulation: https://nvhealthresponse.nv.gov/wp-content/uploads/2020/03/03.25-Board-of-Pharmacy-release.pdf
Here’s a relevant part of what they wrote: The provisions of this emergency regulation do not apply to a chart order for an inpatient in a hospital or other institutional setting. Hospital patients are receiving and will continue to receive chloroquine and hydroxychloroquine for treatment of COVID-19.

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  1. SARS-Cov-2 is the name of the Virus. The disease that it causes is named Covid-19. See the term “Ionophore”. Am Ionophore is a substance that is able to transport an Ion across a cell barrier., an ion carrier. Zinc is an ion and hydroxychloroquine is a zinc Ionophore. It carries zinc into the cells that would normally not be able to get in. Zinc was shown to inhibit coronavirus replication in cell over ten years ago. https://www.reserchgate.net/publication/47794995_Zn_Inhibits_Coronavirus_and_Arterivirus_RNA_Polymerase_Activity_In_Vitro_and_Zinc_Ionophores_Block_the_Replicatio_of_These_Viruses_in_Cell_Culture/

  2. Sharon, this article is the most comprehensible, well written one on this issue. Thank you so very much! I have known for well over a month that the powers that be in NJ medicine have discouraged the use of Hydroxychloroquine. It’s sad because families cannot be with their loved ones in the hospitals to advise them and make the best decisions regarding its use. I’ve even known of someone who administered it ONCE to a patient, not repeated dosages for 5 days which is most effective. That person eventually was put on a respirator and died needlessly. Even a “nurse friend” of mine touted the party line when she said, “we don’t want to spread false hope regarding Plaquenil.” Imagine. Hypocrattic oath? or Hypocritical oath.

    1. Thank you for your comment. It is an older article now, but it was interesting that governors took it upon themselves to mandate what a doctor could or could not prescribe to a patient. Michigan Gov. Gretchen Whitmer reversed herself not long afterward and requested a large supply of the drug for a clinical trial. Nevada Gov. Sisolak was sued for his decision. https://www.thegatewaypundit.com/2020/04/people-dying-believe-money-nevada-doctors-sue-democrat-governor-hydroxychloroquine-ban-video/?ff_source=Email&ff_medium=the-gateway-pundit&ff_campaign=dailyam&ff_content=daily

      Even here in Connecticut, the use of it has been discouraged publicly by a medical doctor advising the governor, although the governor did not issue an executive order similar to those of Nevada, New York and Michigan.

  3. These Governors should be beaten in the head with a ball peen hammer. Many people have already died because they’ve been denied a life saving drug due to these Governor’s Trump Derangement Syndrome!

    1. The Post & Email never advocates violence against anyone but understands the sentiment behind the comment. Other governors or state agencies, including in Texas, have done the same, as it turns out.

  4. Great article Sharon!! I hope you keep the pressure up on these governors they are traitors. There is no shortage of Chloroquine/Hydroxychloroquine and the ailments they are citing (Lupus and Arthritis) are not fatal if the drug is not taken. They should be allowing those who have existing prescriptions precedence in fulfillment and for them to acquire a 3 month supply up front they should not be taking the option away. This drug is most effective as a prophylactic and early onset and it is criminal that they are overburdening the healthcare system with requirements that those who can be ameliorated by these drugs be committed to a hospital care or it’s equivalent. The NJ governor is another traitor who has precluded this drug from being prescribed outside of a hospital setting.

  5. Americans ought to rise up and feed the FDA and these three governors to the buzzards.
    The FDA repeatedly makes the insane assertion that there is no “real” evidence of the value of Chloroquine in treating the virus. However there is a massive amount of “real” evidence — the methodological madmen just don’t accept the clear truth. Incredibly, it is now far safer to walk down a street in Wuhan, China than any city in America. In turn, by applying China’s methods, South Korea has been able to keep viral deaths below two hundred people. These seeming miraculous things are because both nations have simply used Chloroquine to slay the plague. If the FDA would do like the medical authorities in South Korea (a U.S. style democracy) there would be no quarantines, and practically no deaths from the virus in America and our economy would not be in the tank. The president wanted to drain the swamp in Washington, but he is regretfully taking advice from some of the worst swamp rats in the city. Double-blind studies are not the only way to obtain “real” and worthwhile evidence. So far the FDA has needlessly killed thousands stonewalling the use of Chloroquine because there has not been time to produce evidence by the only way they will recognize or accept evidence. They don’t realize their epistemology is blown to . . . Any authority with spiderwebs in his brains that causes him to support the FDA in its methodological madness should be fed to the buzzards with them. There is plenty of Chloroquine to treat everyone that needs treating, just like in China and South Korea. It has been used for the better part of a century in millions upon millions of prescriptions. Next to aspirin, it is one of the most used drugs in history. But according to our FDA the dangers in its use for treating this virus are still too unknown to risk — despite its stellar performance in China and South Korea. In turn, no on can even suggest that Korea has twisted its statistics. The FDA is absolutely insane.

  6. The portion of this story relating to Michigan is inaccurate. There is no ban on prescribing chloroquine or hydroxychloroquine to COVID-19 patients

  7. Time for the President to use that DPA card to invoke the usage of Hydroxychloroquine in Michigan and Nevada. The press has been yelling for him to use it, so, USE IT HERE.

  8. best comment and logic so far: The purpose of economic shutdown is to flatten the curve. Translation: Slow spread of virus so hospitals and clinics are not over whelmed with sick patients.
    The reason for off label use of chloroquine is the same. Reduce severity of symptoms so patients do not have to be hospitalized.
    By restricting chloroquine to patients already in a hospital, these Democrat governors are making matters worse.
    Side note, Governor Sislak’s reason of preventing hoarding is unreasonable and untrue. These are prescription only drugs, not toilet paper. Private citizens and Doctors can not hoard them. Only licensed pharmacies can stockpile the drugs.

  9. The Administrative State is bloated, unreliable and corrupt! The Administrative States kills to stay in power! It’s time to end the Administrative State!

  10. democrats trying to rack up the body count on purpose. amazing to watch how evil and how they kowtow to the chicoms and how they would do anything to get more power and use that power for their chicom masters.

  11. As a physician, may I tell everyone the FDA does not tell physicians how to practice medicine. Everyday thousands of prescriptions are written for off label uses that the FDA has not approved but have been shown effective through either controlled studies or even through anecdotal evidence. This is still the land of the free at least for now.

  12. I live in Michigan. And if my Doctor decides to prescribe me a med, HIPPA laws prevent the pharmacist from reporting anything. HIPPA is a FEDERAL law and there is a lot of existing case law that my lawyer can use to personally sue Gov Whitmer and the state of Michigan in federal court.

  13. Lefty-Liberal Gov. Gretchen Whitmer must have stocks in funeral and cemetery businesses. WTF?

    Millennials voted her in when they went to vote in record numbers because recreational weed was on the ballot.

  14. Nevada and Michigan are both blue-ish swing states. It is becoming increasingly clear that these drugs are quite helpful against COVID-19 even if they fall short of a magic bullet. I think these governors are going to end up helping Trump and hurting themselves and Democrats.

  15. The sole purpose of “flattening the curve” with quarantining is not to destroy the virus but to not inundate the unprepared and over loaded hospitals. These ridiculous governors are doing just the opposite.
    Doctors should be allowed to issue the drugs to STOP going to a hospital.

  16. Sad how badly Democrats.want to use this virus in another fruitless attempt to hurt Trump. To the point of withholding a proven cure! It’s staggering. And the media help them perpetrate this deadly fraud.

  17. The real title should be, “It doesn’t matter what you do President Trump we will do whatever it takes to stop you.” -American Democrats