After President Trump and entrepreneur Elon Musk began endorsing the medications chloroquine and hydroxychloroquine as promising treatments for COVID-19, online inquiries about how to buy those two drugs surged by more than 1,000 percent, according to a study published this week in JAMA Internal Medicine.

Those searches stayed elevated even after the news media reported that an Arizona man had died after self-medicating with chloroquine phosphate, which is used to treat aquarium fish. He and his wife believed taking the product would help protect them from COVID-19.

This study’s findings underscore the very real dangers posed by the spread of misinformation about COVID-19, particularly when hyped by well-known people.

Musk’s and Trump’s endorsements of chloroquine (used to prevent malaria) and hydroxychloroquine (approved for the treatment of lupus and rheumatoid arthritis) for COVID-19 are especially troubling, says Michael Liu, the study’s lead author and a graduate student at the University of Oxford, in a statement released with the study.

“First, these treatments have inconclusive clinical efficacy,” Liu points out. “Second, these drugs have potentially fatal side effects. Third, chloroquine-containing products such as aquarium cleaner are commercially available to the public without a medical prescription.”

How the study was done

For the study, Liu and his colleagues used Google Trends, which aggregates Google searches, to find searches originating from the United States related to chloroquine and hydroxychloroquine between Feb. 1 and March 29. Those dates include periods of roughly two weeks before and after Musk’s comment on Twitter that it was “maybe worth considering chloroquine for C19” (March 16) and before Trump’s initial touting of both chloroquine and hydroxychloroquine (March 19). (“The nice part is,” said Trump, “it’s been around for a long time, so we know that if it — if things don’t go as planned, it’s not going to kill anybody.”)

The researchers looked for all Google searches that mentioned either drug in combination with the words “buy, “order,” “Amazon,” “eBay” or “Walmart.” (The last three words represent the top three e-commerce companies in the U.S.)

“We specifically wanted to know if people were looking to buy these drugs, instead of just looking to learn more about them,” explains John Ayers, one of the study’s co-authors and a computational epidemiologist at the University of California San Diego, in a released statement.

An analysis of all that data found that searches for purchasing chloroquine jumped 442 percent higher and those for hydroxychloroquine shot up 1,389 percent higher after the public endorsements of the drugs by Musk and Trump.

The first spike in searches coincided with Musk’s March 16 tweet. The second — and biggest spike — occurred right after Trump’s March 19 endorsement.

In absolute numbers, the researchers estimate there were about 93,000 more searches than expected for chloroquine and 96,000 more searches than expected for hydroxychloroquine in the 14 days following the two high-profile endorsements.

“This could be evidence that thousands of Americans were interested in purchasing these drugs,” says Mark Dredze, another co-author of the study and a professor of computer science at Johns Hopkins University, in a released statement.

“As someone who has been studying health misinformation for years, we usually think misinformation spreads from unreliable health sources, online trolls, and bots. It’s rare to have health misinformation coming from such high-profile figures,” he adds.

Wait for the evidence

Public figures should refrain from making claims about possible treatments for COVID-19 that are not evidence-based, the researchers stress.

“In times of public health crises, therapies not supported by adequate evidence — such as would lead to US Food and Drug Administration approval — should not be touted by public figures,” they write in their paper. “Endorsements can lead to unsupervised use of the products with dangerous consequences to the people who take them, and hoarding of these medications can results in shortages for those who require them for legitimate health reasons.”

At a press conference last week, Trump inexplicably — and bizarrely — speculated that injecting disinfectant might serve as a COVID-19 treatment. Health officials around the world, along with the makers of disinfectants, immediately put out statements to warn the public that it is unsafe to inject — or ingest — disinfectants.

Also last week, the U.S. Food and Drug Administration (FDA) cautioned against using chloroquine or hydroxychloroquine to treat COVID-19 outside of a hospital setting or a clinical trial. The drugs had been found to cause abnormal heart rhythms or dangerously rapid heart rhythms in some COVID-19 patients, the agency said.

FMI: You’ll find the study on the JAMA Internal Medicine website.