Djibouti has more than 1,800 COVID-19 cases, making it the African country with the highest number of cases per 100,000 people. But more than 1,000 of those cases have already recovered and only nine people have died from the disease. The head of Djibouti’s main COVID-19 response center says systematically giving COVID-19 patients the anti-malarial drug chloroquine is the main reason for the country's low death rate. But even scientists who see evidence of the efficacy of chloroquine caution on their use.
Ever since Djibouti discovered its first case of coronavirus in late March, the World Health Organization and the government has rolled out an aggressive program to test and trace those who have come in contact with COVID-19 patients. The approach has led to Djibouti recording 77 cases per 100,000 people, the highest in Africa.
But a death rate of only 0.5 percent, health officials in the country say, is at least in part due to the use of the antibiotic azithromycin, used for the treatment of bacterial infections, and chloroquine, an anti-malarial drug known to reduce fever and inflammation.
Morocco, where 194 people have died and the number of coronavirus cases is at more than 7,100, has also followed that method and recorded a death rate of just 2.7 percent, lower than the global average of 7 percent.
U.S. President Donald Trump was criticized this week after he said he had been taking the antimalarial drug hydroxychloroquine, despite warnings it might be unsafe.
Despite some observational optimism, scientists say it is still too early to attribute low death rates to antimalarial drugs. Sultan Ayoub Meo, a professor in clinical physiology at the King Saud University in Saudi Arabia, told VOA via a messaging app that since December there had been nearly 300 peer reviewed articles published on chloroquine and hydroxychloroquine. The articles are based on the findings of just five clinical trials, four of which came out in favor of using antimalarial drugs to fight the coronavirus.
“Although the literature is supporting, I must say being a physician, being a scientist, that these entire studies, their sample size is not sufficient to reach a proper conclusion. I think the science community must have to conduct large sample size clinical trials globally,” he said.
Ayoub Meo said that while many people living in Southeast Asia and Africa were already using antimalarial drugs, the true extent of their side effects when used to treat the coronavirus is unknown. He added that such drugs can cause so-called "conduction disorders" that disrupt the electrical system that makes the heart beat and controls its rhythm, especially for people above the age of 55.
Ahmed Zouiten, World Health Organization representative for the Djibouti country office, told VOA via a messaging app that while the WHO has no scientific evidence to support the use of antimalarial drugs to treat COVID-19, observationally their use alongside antibiotics does seem to be working in Djibouti’s case.
“So for us, the treatment with chloroquine and all that, we until today do not have evidence that it is something that is functional," he said. "We see that we have very good outcomes of that treatment today in Djibouti but WHO cannot just work on observation, WHO works on evidence.”
Pushed on whether Djibouti’s decision to treat everyone with antibiotics and antimalarial drugs was working, Zouiten said the strategy did seem to be have a positive impact.
“The treatment itself does seem to be working, because people when they are put on treatment they do not develop much symptoms," he said. "Although I said earlier we do not work with observation, the indicators are talking. Very low mortality and very low number of symptomatic [cases].”
Another reason for Djibouti’s apparent success, Zoutien said, is that the government has “a very, very aggressive testing strategy” and an even more aggressive approach to contact tracing. Before patients can leave the hospital, they need to test negative two times within 48 hours.
Dr. Maad Nasser Mohammed, a specialist in tropical infections who is responsible for Djibouti’s main COVID-19 response center at the Arta Regional Hospital 40 kilometers from the capital city, confirmed the Djiboutian approach of treating all positive cases with antibiotics and anti-malarial drugs.
He said most patients suffered from loss of taste, a cough and a fever but did not experience the type of breathing problems that has come to typify more serious bouts of the coronavirus seen elsewhere in the world. Offering one explanation, he said “chloroquine anti-malarial drugs act positively on the virus.”
“That’s what we think, though nothing has confirmed it,” he said.