U.S. coronavirus cases topped 500,000 on Friday, according to a Reuters tally, although there are signs that Americans staying home was helping to curb new infections. Nearly 2,108 people lost their lives in US due to COVID-19 in last 24 hours.

Coronavirus Outbreak: US records its highest daily death toll

Until last year, leading countries were happy to call China the workshop of the world. Also read: Coronavirus replaced by racism, xenophobia and hate against foreigners in China Not anymore, the over dependence on China has cost them dearly.

Until last year, leading countries were happy to call China the workshop of the world. Also read: Coronavirus replaced by racism, xenophobia and hate against foreigners in China Not anymore, the over dependence on China has cost them dearly. China has been the world's largest exporter of goods since 2009 but this might change now in the times of "social distancing". Also read: France to extend the lockdown as Thailand begins mobile testing Maybe, the time has come to launch a campaign of "economic distancing" from China. Two countries are ready to do just that, the United States and Japan. Both countries are badly hit by the coronavirus. They are learning their lessons and taking steps to bring their businesses back home. Japan is taking the lead. On Tuesday, the country unveiled its largest-ever economic stimulus package. It's worth a whopping $990 billion. This "world-class" relief package has a unique allocation. Japan wants to keep its businesses safe. So, it is ready to pay them to shift their factories out of China. A little more than $2 billion has been set aside for this. This fund will be used to pay businesses who want to move back to Japan. Another $215 million will be made available to those who want to move to other countries. This has caught Beijing off guard. China's foreign ministry was asked about Japan's moves yesterday. What about the United States? The exodus of American companies had already begun. Thanks to US President Donald Trump, his "America First" agenda had forced companies to rethink their supply chains. The trade war forced some to ditch China. Last year, more than 50 American companies had reportedly escaped from China. Now, they could leave at a much faster rate. A report by consulting firm Kearney claims companies are rethinking their approach. Now, they would want to diversify their sourcing and supply. A fragile system that broke instantaneously, when China shutdown its entire country. Now, half of the earth's humanity is under a lockdown. That's more than three billion people. Companies that could not get their suppliers earlier, now can't sell because the stores need to remain shut. The losses are mounting and the coronavirus outbreak is a black swan moment for the world. It is forcing countries, even businesses to rethink their approach. Japan and the United States might have just shown them the way. Which country is the next global export hub? A group of five countries, known as the "mighty five" -- could benefit from withdrawals from China. India is one of them. It can offer manpower at the same scale as China. The trade war benefited some emerging markets. They will be fighting for new contracts after the global lockdown lifts. Vietnam is one of them. Before the coronavirus crisis, it was exporting around 5,000 products to the United States. Thailand, Malaysia and Indonesia could gain too, again due to, low labour and raw material costs.

As coronavirus grips China, Japan & US take lead to pull out companies

At the time when global fuel demand has plunged, Saudi & Russia oil deal came down under threat. The US pressure underlines record oil cut.

Saudi & Russia oil deal under threat, US pressure underlines record oil cut

Donald Trump is blaming the WHO for the evolving crisis in the United States. While the health body needs to be held accountable, is the U.S. President trying to evade responsibility for his faults? WION's Palki Sharma brings you the story.

Gravitas: Trump takes on the WHO | Wuhan Coronavirus

A record single-day death toll of 779 taking the total count to 6000 and counting. Nearly 1,50,000 active cases. This is the tally for New York alone. The United States' most populous city.

A record single-day death toll of 779 taking the total count to 6000 and counting. Nearly 1,50,000 active cases. This is the tally for New York alone. The United States' most populous city. Also read: Coronavirus replaced by racism, xenophobia and hate against foreigners in China The world's financial capital and now global coronavirus epicentre. New york's COVID-19 numbers have surpassed that of Spain's. Also read: COVID-19: New York reports new one-day record death toll as governor Cuomo says hospitalizations have fallen To make the matters worse, authorities have flagged the possibility of under-counting. The situation is a grim reminder of 9/11. New York Governor, Andrew Cuomo said: "I mean, I went through a 9/11 I thought in my lifetime, I wouldn't have to see anything like that again." The city's hospitals are inundated. Patients are now being treated at churches. There has been a fall in the hospitalisation, experts say that the curve may also be flattening but authorities are wary of striking a note too optimistic. "Be careful of counting our chickens before they hatch. We haven't seen cases yet. We are in the midst of this. Don't start doing a retrospective like it's over because that's the attitude we have to avoid," added Cuomo. New Yorkers know its not over, in fact, far from it. Alix Monteleone, a 28-year-old, experiential account supervisor, said: "This is very real. And we're seeing so much chaos manifest outside of our home that we can't imagine how bad it is inside. You know, we stopped counting how many bodies came out." The number of cases in the United States has crossed 4,35,000 and the death toll is nearing 15,000. The US has been the hardest hit by the pandemic. President Donald Trump's weapon of choice is denial. He says social distancing is working, Trump said: "What we've accomplished, if every American continues to strictly adhere to social distancing guidelines, we can defeat the invisible enemy and save countless lives that we can do it much more quickly." The reality is thousands of Americans are flouting social distancing norms and the reality is a shortage of test kits, so much so that, frontline workers are being denied tests. That is, unless, they show severe symptoms Fixating over hydroxychloroquine. The reality is also apathy at the highest level. According to the US Media, the White House was warned about a possible pandemic as early as November 2019. The president sat on this putting millions of lives at risk and months later. President Donald Trump said: "So you're talking about 2.2 million deaths, 2.2 million people from this. And so if we could hold that down, as we're saying, to 100,000, it's a horrible number, maybe even less, but to 100,000. So we have between 100 and 200,000. We altogether have done a very good job." The good news is that the latest estimates show fewer projected deaths in the country. Americans are cheering each other up in tough times like these, empathy and solidarity is helping them cope with the crisis.

Trump wobbles as New York becomes coronavirus epicentre

The US has been hit the hardest in terms of the figures reported. WION correspondent form New York tells you how the country is dealing with the crisis. Watch report.

Coronavirus Pandemic: US highest daily death toll for 2nd day in a row

US President Donald Trump had threatened to retaliate, if India didn't resume the export of Hydroxychloroquine. Is Trump's bluster an attempt to cover up his mistakes? WION's Palki tells you why the US President is not in a position to dictate terms.

Trump's threat to India: Why the US President can't dictate terms? | Gravitas

A sizeable chunk of the 29 million doses of hydroxychloroquine bought by the US to combat the coronavirus pandemic is from India, President Donald Trump has said as he acknowledged that Prime Minister Narendra Modi was "great" when he sought his help to allow the sale of the anti-malaria drug to treat the growing number of COVID-19 patients in America.

Trump and Prime Minister Modi spoke over the phone last week. During the call, Trump requested Modi to lift the hold on the American order of hydroxychloroquine, of which India is the major producer.

Hydroxychloroquine has been identified by the US Food and Drug Administration as a possible treatment for the COVID-19 and it is being tested on more than 1,500 coronavirus patients in New York.

Anticipating that it will work, given initial positive results, Trump has bought more than 29 million doses of hydroxychloroquine for the potential treatment of COVID-19 patients.

"I bought millions of doses (of hydroxychloroquine). More than 29 million. I spoke to Prime Minister Modi, a lot of it (hydroxychloroquine) comes out of India. I asked him if he would release it? He was Great. He was really good," Trump told Sean Hannity of the Fox News on Monday night.

"You know they put a stop because they wanted it for India,"&nbsp;Trump said responding to a question on the usage of hydroxychloroquine.

India on Tuesday allowed the export of hydroxychloroquine to the US, which has emerged as the global hotspot of COVID-19.

By Tuesday night, nearly four lakh Americans tested positive for the novel coronavirus and the fatalities was more than 12,850. During the interview, Trump described hydroxychloroquine as a powerful malaria drug. The drug is being tested on hundreds of coronavirus patients in New York.

"But there are a lot of good things coming from that,"&nbsp;Trump said.

"Lot of people are looking at it and saying, you know I don't hear bad stories, I hear good stories. And I don't hear anything where it is causing death,"&nbsp;said the US President.

Hydroxychloroquine, an old and inexpensive drug used to treat malaria, is seen as a viable therapeutic solution by President Trump to coronavirus.

Last week Trump said he has sought help from Prime Minister Modi to allow the sale of hydroxychloroquine tablets ordered by the US to treat the growing number of coronavirus patients in his country, hours after India banned the export of the anti-malarial drug.

India has received similar requests from several other countries including its immediate neighbours Sri Lanka and Nepal. India has said that it is reviewing its export ban order.

Notably, India's decision to ban the exports of hydroxychloroquine is driven by its desire to take stock of the domestic requirements and ensure that the country has enough of the drug.

"I would be surprised if he would, you know, because India does very well with the United States," Trump told reporters during a press briefing at the White House on Monday.

Trump and Modi enjoy a personal friendship as reflected in the president joining the prime minister at the "Howdy, Modi!" event in Houston last September.

This February, Trump made a rare India-specific solo trip to Ahmedabad and New Delhi.

India on Monday agreed to lift the ban on export of hydroxychloroquine to the US. Three Gujarat-based companies would export these tablets to the US, Chief Minister Vijay Rupani said on Tuesday.

India manufactures 70 per cent of the world's supply of hydroxychloroquine, according to Indian Pharmaceutical Alliance (IPA) secretary-general Sudarshan Jain.

The country has a production capacity of 40 tonnes of hydroxychloroquine (HCQ) every month, implying 20 crore tablets of 200 mg each. And since the drug is also used to auto-immune diseases like rheumatoid arthritis and lupus, manufacturers have good production capacities that can also be ramped up.&nbsp;

A sizeable chunk of the 29 million doses of hydroxychloroquine bought by the US to combat the coronavirus pandemic is from India, President Donald Trump has said as he acknowledged that Prime Minister Narendra Modi was "great" when he sought his help to allow the sale of the anti-malaria drug to treat the growing number of COVID-19 patients in America.

A sizeable chunk of the 29 million doses of hydroxychloroquine bought by the US to combat the coronavirus pandemic is from India, President Donald Trump has said as he acknowledged that Prime Minister Narendra Modi was "great" when he sought his help to allow the sale of the anti-malaria drug to treat the growing number of COVID-19 patients in America. Trump and Prime Minister Modi spoke over the phone last week. During the call, Trump requested Modi to lift the hold on the American order of hydroxychloroquine, of which India is the major producer. Hydroxychloroquine has been identified by the US Food and Drug Administration as a possible treatment for the COVID-19 and it is being tested on more than 1,500 coronavirus patients in New York. Anticipating that it will work, given initial positive results, Trump has bought more than 29 million doses of hydroxychloroquine for the potential treatment of COVID-19 patients. "I bought millions of doses (of hydroxychloroquine). More than 29 million. I spoke to Prime Minister Modi, a lot of it (hydroxychloroquine) comes out of India. I asked him if he would release it? He was Great. He was really good," Trump told Sean Hannity of the Fox News on Monday night. "You know they put a stop because they wanted it for India," Trump said responding to a question on the usage of hydroxychloroquine. India on Tuesday allowed the export of hydroxychloroquine to the US, which has emerged as the global hotspot of COVID-19. By Tuesday night, nearly four lakh Americans tested positive for the novel coronavirus and the fatalities was more than 12,850. During the interview, Trump described hydroxychloroquine as a powerful malaria drug. The drug is being tested on hundreds of coronavirus patients in New York. "But there are a lot of good things coming from that," Trump said. "Lot of people are looking at it and saying, you know I don't hear bad stories, I hear good stories. And I don't hear anything where it is causing death," said the US President. Hydroxychloroquine, an old and inexpensive drug used to treat malaria, is seen as a viable therapeutic solution by President Trump to coronavirus. Last week Trump said he has sought help from Prime Minister Modi to allow the sale of hydroxychloroquine tablets ordered by the US to treat the growing number of coronavirus patients in his country, hours after India banned the export of the anti-malarial drug. India has received similar requests from several other countries including its immediate neighbours Sri Lanka and Nepal. India has said that it is reviewing its export ban order. Notably, India's decision to ban the exports of hydroxychloroquine is driven by its desire to take stock of the domestic requirements and ensure that the country has enough of the drug. "I would be surprised if he would, you know, because India does very well with the United States," Trump told reporters during a press briefing at the White House on Monday. Trump and Modi enjoy a personal friendship as reflected in the president joining the prime minister at the "Howdy, Modi!" event in Houston last September. This February, Trump made a rare India-specific solo trip to Ahmedabad and New Delhi. India on Monday agreed to lift the ban on export of hydroxychloroquine to the US. Three Gujarat-based companies would export these tablets to the US, Chief Minister Vijay Rupani said on Tuesday. India manufactures 70 per cent of the world's supply of hydroxychloroquine, according to Indian Pharmaceutical Alliance (IPA) secretary-general Sudarshan Jain. The country has a production capacity of 40 tonnes of hydroxychloroquine (HCQ) every month, implying 20 crore tablets of 200 mg each. And since the drug is also used to auto-immune diseases like rheumatoid arthritis and lupus, manufacturers have good production capacities that can also be ramped up.

US bought over 29 million hydroxychloroquine doses from India: Trump

Nearly 2,000 people infected with the new coronavirus have died in the United States in the last 24 hours, according to a tally by Johns Hopkins University as of 8:30 pm Tuesday (0030 GMT Wednesday). WION spoke to Dr. Anil Kaul about the nature of COVID-19 and its complex diagnosis.

WION speaks to Dr. Anil Kaul about nature of COVID-19 and its diagnosis

As hospitals in the United States deal with coronavirus crisis the fear of infection, drug shortages and strict rules imposed in visitors are now leading more and more women in the United States to consider home births. Watch report:

Coronavirus Pandemic: Women in United States struggle with home births

Data emerging from some states suggest that African Americans are bearing the brunt of the pandemic in the US. Experts say blacks are disproportionately impacted by underlying health conditions linked to poverty, face discrimination in medical care, and are more likely to work jobs that require them to leave their home.

Coronavirus Pandemic: African-Americans worst hit in United States

Nearly 2,000 people infected with the new coronavirus have died in the United States in the last 24 hours, according to a tally by Johns Hopkins University as of 8:30 pm Tuesday (0030 GMT Wednesday).

Coronavirus Pandemic: US records highest daily COVID-19 death toll

The US President Donald Trump threatened on Tuesday (April 7) to cut US funding to the World Health Organization (WHO), accusing it of bias toward China, where the authorities lifted a two-and-a-half month travel ban on Wuhan, the city that spawned the global coronavirus pandemic.

Donald Trump accuses WHO of bias toward China, threatens to halt funding

Coronavirus is no longer the "Wuhan virus" for the United States, as the country has reached a truce with China. It is being said that the superpowers saw a tactical interest in making peace with each other in the vitriolic feud over the COVID-19 pandemic that has been ravaging the world.

US President Donald Trump dropped the provocative term "Chinese virus" and did not, for the first time, criticise&nbsp;Beijing's response on March 26. It is said this happened after a phone call with his Chinese counterpart Xi Jinping.

Even US Secretary of State Mike Pompeo has been talking of cooperation.

"We know that this is a global pandemic, and this is the time for every country to work together to resolve that," Pompeo told reporters Tuesday when asked about China.

Talking of their feud, Trump said the coronavirus could very effectively be also called the Chinese virus because it broke out in China's Wuhan city.

Beijing then infuriated the United States last month when a foreign ministry spokesman spread a conspiracy theory that US troops brought the virus to Wuhan.

<a href="https://www.wionews.com/world/donald-trump-accuses-who-of-bias-toward-china-threatened-to-put-hold-on-us-funding-291237">Also read |&nbsp;Donald Trump accuses WHO of bias toward China, threatened to ‘put hold on’ US funding</a>

China's ambassador to Washington, however, struck a highly different tone in an op-ed in The New York Times in which he spoke of his affection for Americans and promised China would do "whatever it can to support the United States."

China has been, across the world, held responsible for passing on the virus to the world. But whatever the faults in China's response, many observers saw Trump's blaming of Beijing as a political ploy as he faces criticism for not acting sooner to stop COVID-19, which has killed more than 12,000 people in the United States.

Political reasons aside, with medical supplies in dangerously short supply, Trump also needs China, which produces half of the imported masks in the United States.

To this end, an expert opined: "Washington certainly does not want to alienate Beijing to the point that it bans the sale of medical equipment to the United States," doubting if the newfound tone would improve the rest of the relationship, which was already tense before the pandemic.

From China's standpoint, when Beijing is seeking to cast itself around the world as a pandemic benefactor, the friction with the US will hardly reap any benefits. Its top priority, at &nbsp;this moment, would be to revive global demand for its exports.

China also sees a "historic strategic opportunity" to expand its power as Trump has weakened US alliances, experts say.

All's well that ends well? Or not!?

<a href="https://www.wionews.com/world/china-reports-no-new-coronavirus-deaths-for-first-time-291187">Also read |&nbsp;China reports no new coronavirus deaths for first time</a>

Coronavirus is no longer the "Wuhan virus" for the United States, as the country has reached a truce with China. It is being said that the superpowers saw a tactical interest in making peace with each other in the vitriolic feud over the COVID-19 pandemic that has been ravaging the world.

Coronavirus is no longer the "Wuhan virus" for the United States, as the country has reached a truce with China. It is being said that the superpowers saw a tactical interest in making peace with each other in the vitriolic feud over the COVID-19 pandemic that has been ravaging the world. US President Donald Trump dropped the provocative term "Chinese virus" and did not, for the first time, criticise Beijing's response on March 26. It is said this happened after a phone call with his Chinese counterpart Xi Jinping. Even US Secretary of State Mike Pompeo has been talking of cooperation. "We know that this is a global pandemic, and this is the time for every country to work together to resolve that," Pompeo told reporters Tuesday when asked about China. Talking of their feud, Trump said the coronavirus could very effectively be also called the Chinese virus because it broke out in China's Wuhan city. Beijing then infuriated the United States last month when a foreign ministry spokesman spread a conspiracy theory that US troops brought the virus to Wuhan. Also read | Donald Trump accuses WHO of bias toward China, threatened to ‘put hold on’ US funding China's ambassador to Washington, however, struck a highly different tone in an op-ed in The New York Times in which he spoke of his affection for Americans and promised China would do "whatever it can to support the United States." China has been, across the world, held responsible for passing on the virus to the world. But whatever the faults in China's response, many observers saw Trump's blaming of Beijing as a political ploy as he faces criticism for not acting sooner to stop COVID-19, which has killed more than 12,000 people in the United States. Political reasons aside, with medical supplies in dangerously short supply, Trump also needs China, which produces half of the imported masks in the United States. To this end, an expert opined: "Washington certainly does not want to alienate Beijing to the point that it bans the sale of medical equipment to the United States," doubting if the newfound tone would improve the rest of the relationship, which was already tense before the pandemic. From China's standpoint, when Beijing is seeking to cast itself around the world as a pandemic benefactor, the friction with the US will hardly reap any benefits. Its top priority, at this moment, would be to revive global demand for its exports. China also sees a "historic strategic opportunity" to expand its power as Trump has weakened US alliances, experts say. All's well that ends well? Or not!? Also read | China reports no new coronavirus deaths for first time

All's well that ends well? US and China have reached a 'truce'

In this segment of WION, let's take a look on how equip is healthcare systems in world's most affected COVID-19 nations.

How equip is healthcare systems in world's most affected COVID-19 nations

The US has the most number of coronavirus cases. The Pentagon has ordered 100,000 body bags. The US has also procured ventilators from a Russian firm under Trump's sanctions list.

Wuhan Coronavirus: US government orders 100,000 body bags | Gravitas

Watch today in WION Fineprint: United States of America has entered the toughest week as it witnesses consecutive rise in Coronavirus (COVID-19) positive cases.

Fineprint: US enters toughest week of COVID-19, consecutive rise in positive cases

In mid-March, President Donald Trump personally pressed federal health officials to make malaria drugs available to treat the novel coronavirus, though they had been untested for COVID-19, two sources told Reuters. Shortly afterward, the federal government published highly unusual guidance informing doctors they had the option to prescribe the drugs, with key dosing information based on unattributed anecdotes rather than peer-reviewed science.

While Trump, in a series of tweets and press comments, had made his opinions on the drugs, chloroquine and hydroxychloroquine, well known, the nature of his behind-the-scenes intervention has not been previously reported. The guidance, published by the Centers for Disease Control and Prevention, has received scant notice outside medical circles.

The episode reveals how the president’s efforts could change the nature of drug oversight, a field long governed by strict rules of science and testing. Rarely, if ever, has a U.S. president lobbied regulators and health officials to focus their efforts on specific unproven drugs.

“The president is short-circuiting the process with his gut feelings,” said Jeffrey Flier, a former dean of Harvard Medical School. “We are in an emergency and we need to rely on our government to ensure that all these potential therapies are tested in the most effective and objective way.”

In a statement to Reuters, the White House said the president had not launched a “pressure campaign” but was taking appropriate action.

“The President’s top priority is the health and safety of the American people which is why he has brought together the federal government and private sector, including doctors, scientists, and medical researchers, for an unprecedented collaboration to expedite vaccine development,” said the statement, which did not address Reuters questions about the CDC guidance.

Administration supporters say the CDC document, highlighting options, makes sense at a time of medical calamity with no proven treatment. And, they note, chloroquine and hydroxychloroquine have been prescribed for years with known risks. Any potential risk to coronavirus patients, some argue, is worth taking given the health crisis.

“In a perfect situation you would never do this,” said a public health specialist who recently left government. “But if you know what the safety downside is, and the patient is ready to try it, it's worth a try.”

It has long been known that in certain patients, and with prolonged use, hydroxychloroquine and chloroquine can cause an interrupted heartbeat or a cardiac arrhythmia, the medical literature shows. A new research paper says these “may pose particular risk to critically ill persons.”

'NOT HAPPY’

In a series of conversations last month, President Trump personally instructed top officials at the Centers for Disease Control, the Food and Drug Administration and the National Institutes of Health to focus on the two drugs as potential therapies, said two sources familiar with the president’s efforts.

In seeking a medical breakthrough to the global crisis, Trump had contacted Dr. Stephen Hahn, the FDA administrator, and other top health officials, questioning whether they were moving rapidly enough to make the drugs more widely available, one source said. “He was not happy because of the bureaucracy.”

Trump did not raise his voice or express anger, but did emphasize the “urgency” of fast-tracking access to the drugs, the other source said. A cascade of federal action soon followed to make the drugs more available, including the federal government’s grant of emergency authorization to supply them nationwide.

An NIH spokeswoman said the agency was “not the source of the content” of the CDC-compiled document. The CDC said it presented the guidance to doctors at the request of a coronavirus task force, which urged prompt action.

An FDA spokesperson declined to discuss any push by the president or address the CDC-issued guidance. The agency, in a statement to Reuters, said it acted appropriately when, later in March, it issued an emergency order allowing the drugs to be prescribed and distributed.

“It was determined, based on the scientific evidence available, that it is reasonable to believe that the specific drugs may be effective in treating COVID-19, and that, given there are no adequate, approved, or available alternative treatments, the known and potential benefits to treat this serious or life-threatening virus outweigh the known and potential risks,” the FDA statement said.

The first official action came March 21, at the height of the president’s efforts, when the CDC prepared a document, Information for Clinicians on Treatment Options for COVID-19 Patients, that included a section on the antimalarial drugs.

The document describes possible prescription information for coronavirus patients, while at the same time proposing hydroxychloroquine and chloroquine as an option in coronavirus treatment. It was the first time the federal government’s disease control agency had officially floated the idea.

“Although optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown,” the document says, “some U.S. clinicians have reported anecdotally” about different hydroxychloroquine doses.

The document does not name the clinicians, say whether their treatment was successful or explain the paper’s sourcing.

Dr. Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University, says she was surprised to read the document guidance, after Reuters pointed it out to her. “Geez!” she said. “No references, no nothing! Why would CDC be publishing anecdotes? That doesn’t make sense. This is very unusual.”

Flier, the former Harvard dean, agreed. “It’s kind of offering these drugs up and suggesting that doctors might prescribe them when it’s obviously not established whether or not they are effective or harmful,” he said.

The CDC declined to detail the interactions of its director, Dr. Robert Redfield, with President Trump. In a statement, the agency said the guidance was prepared at the request of the coronavirus task force and doctors who “requested CDC review the literature, compose, and post the information as quickly as possible.”

“The agency did,” the statement said.

The CDC would not disclose the identities of the authors who prepared the document, nor detail its sourcing. The document said it was reviewed by the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases.

‘BIGGEST GAME CHANGER’

Trump’s push for action came after Fox News on March 16 reported on a small French study highlighting the effectiveness of one of the drugs, hydroxychloroquine. Fox News interviewed a lawyer it said was involved, Gregory Rigano, who said “we have strong reason to believe that a preventative dose of hydroxychloroquine is going to prevent the virus from attaching to the body and just get rid of it completely.”

Rigano, appearing on Fox News again two days later, said the president “has the authority to authorize the use of hydroxychloroquine against coronavirus immediately.”

Rigano did not respond to an emailed request for comment from Reuters.

On March 19, Trump vowed to make the drugs more widely available. “It’s shown very encouraging – very, very encouraging early results,” he said at a press conference. “And we’re going to be able to make that drug available almost immediately. And that’s where the FDA has been so great. They – they’ve gone through the approval process; it’s been approved. And they did it – they took it down from many, many months to immediate.”

In fact, the drug had not gone through an FDA review process by then. At the same press conference, FDA administrator Hahn said regulators were taking “a closer look.”

“That’s a drug that the president has directed us to take a closer look at, as to whether an expanded-use approach to that could be done to actually see if that benefits patients,” Hahn said.

In a press release that day, the FDA emphasized it was merely investigating whether the drugs “can be used to treat patients with mild-to-moderate COVID-19 to potentially reduce the duration of symptoms.” Studies were underway, the FDA added, “to determine the efficacy in using chloroquine to treat COVID-19.”

While the FDA approves drugs for the U.S. market and oversees the testing, the CDC is the key agency coordinating the response to infectious diseases and providing information about them. At that point, the CDC had not singled out the drugs.

Two days later, on March 21, the president personally pushed the health officials. The president also tweeted that the drugs should be “put in use immediately.” Trump, citing the study, promised that the drugs demonstrated “a real chance to be one of the biggest game changers in the history of medicine.”

That’s when the CDC posted its newer guidance to doctors, appearing to give the stamp of approval on using hydroxychloroquine and chloroquine directly for COVID-19 patients. While the document doesn’t recommend the drugs be used, it cites them as a possible option.

Meanwhile, the agency heads began publicly shifting their stance. After initially expressing caution, the FDA’s Hahn on March 23 told Fox News host Tucker Carlson that preliminary data showed the drugs might indeed help treat the disease.

Now, millions of hydroxychloroquine and chloroquine pills are on their way to the public, donated by drugmakers, including Novartis’ Sandoz, Bayer and Teva Pharmaceutical Industries Ltd. The FDA issued an emergency authorization on March 28 allowing them to be prescribed and distributed from the Strategic National Stockpile.

NEW QUESTIONS

A paper in Annals of Internal Medicine, the premier internal medicine journal, this week warned of the dangers of touting the drugs, given the unproven evidence and their potential shortage for other uses, such as treatment for patients with lupus.

In a statement to Reuters, the paper’s authors, Drs. Jinoos Yazdany and Alfred H.J. Kim, on one hand called the CDC document “direct and factual, if its purpose is to outline what we do know.”

But they also expressed concern that the guidance may “leave the reader free to interpret this information depending on their bias. We do think a document like this should more clearly state what this means for health care providers.”

Noting the president’s tweets in their report, the authors urged the medical community and the U.S. government to send “clear messages” that include a proper interpretation of available data “to counteract misinformation, including misleading statements or articles with ‘clickbait’ material.”

In mid-March, President Donald Trump personally pressed federal health officials to make malaria drugs available to treat the novel coronavirus, though they had been untested for COVID-19, two sources told Reuters.

In mid-March, President Donald Trump personally pressed federal health officials to make malaria drugs available to treat the novel coronavirus, though they had been untested for COVID-19, two sources told Reuters. Shortly afterward, the federal government published highly unusual guidance informing doctors they had the option to prescribe the drugs, with key dosing information based on unattributed anecdotes rather than peer-reviewed science. While Trump, in a series of tweets and press comments, had made his opinions on the drugs, chloroquine and hydroxychloroquine, well known, the nature of his behind-the-scenes intervention has not been previously reported. The guidance, published by the Centers for Disease Control and Prevention, has received scant notice outside medical circles. The episode reveals how the president’s efforts could change the nature of drug oversight, a field long governed by strict rules of science and testing. Rarely, if ever, has a U.S. president lobbied regulators and health officials to focus their efforts on specific unproven drugs. “The president is short-circuiting the process with his gut feelings,” said Jeffrey Flier, a former dean of Harvard Medical School. “We are in an emergency and we need to rely on our government to ensure that all these potential therapies are tested in the most effective and objective way.” In a statement to Reuters, the White House said the president had not launched a “pressure campaign” but was taking appropriate action. “The President’s top priority is the health and safety of the American people which is why he has brought together the federal government and private sector, including doctors, scientists, and medical researchers, for an unprecedented collaboration to expedite vaccine development,” said the statement, which did not address Reuters questions about the CDC guidance. Administration supporters say the CDC document, highlighting options, makes sense at a time of medical calamity with no proven treatment. And, they note, chloroquine and hydroxychloroquine have been prescribed for years with known risks. Any potential risk to coronavirus patients, some argue, is worth taking given the health crisis. “In a perfect situation you would never do this,” said a public health specialist who recently left government. “But if you know what the safety downside is, and the patient is ready to try it, it's worth a try.” It has long been known that in certain patients, and with prolonged use, hydroxychloroquine and chloroquine can cause an interrupted heartbeat or a cardiac arrhythmia, the medical literature shows. A new research paper says these “may pose particular risk to critically ill persons.” 'NOT HAPPY’ In a series of conversations last month, President Trump personally instructed top officials at the Centers for Disease Control, the Food and Drug Administration and the National Institutes of Health to focus on the two drugs as potential therapies, said two sources familiar with the president’s efforts. In seeking a medical breakthrough to the global crisis, Trump had contacted Dr. Stephen Hahn, the FDA administrator, and other top health officials, questioning whether they were moving rapidly enough to make the drugs more widely available, one source said. “He was not happy because of the bureaucracy.” Trump did not raise his voice or express anger, but did emphasize the “urgency” of fast-tracking access to the drugs, the other source said. A cascade of federal action soon followed to make the drugs more available, including the federal government’s grant of emergency authorization to supply them nationwide. An NIH spokeswoman said the agency was “not the source of the content” of the CDC-compiled document. The CDC said it presented the guidance to doctors at the request of a coronavirus task force, which urged prompt action. An FDA spokesperson declined to discuss any push by the president or address the CDC-issued guidance. The agency, in a statement to Reuters, said it acted appropriately when, later in March, it issued an emergency order allowing the drugs to be prescribed and distributed. “It was determined, based on the scientific evidence available, that it is reasonable to believe that the specific drugs may be effective in treating COVID-19, and that, given there are no adequate, approved, or available alternative treatments, the known and potential benefits to treat this serious or life-threatening virus outweigh the known and potential risks,” the FDA statement said. The first official action came March 21, at the height of the president’s efforts, when the CDC prepared a document, Information for Clinicians on Treatment Options for COVID-19 Patients, that included a section on the antimalarial drugs. The document describes possible prescription information for coronavirus patients, while at the same time proposing hydroxychloroquine and chloroquine as an option in coronavirus treatment. It was the first time the federal government’s disease control agency had officially floated the idea. “Although optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown,” the document says, “some U.S. clinicians have reported anecdotally” about different hydroxychloroquine doses. The document does not name the clinicians, say whether their treatment was successful or explain the paper’s sourcing. Dr. Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University, says she was surprised to read the document guidance, after Reuters pointed it out to her. “Geez!” she said. “No references, no nothing! Why would CDC be publishing anecdotes? That doesn’t make sense. This is very unusual.” Flier, the former Harvard dean, agreed. “It’s kind of offering these drugs up and suggesting that doctors might prescribe them when it’s obviously not established whether or not they are effective or harmful,” he said. The CDC declined to detail the interactions of its director, Dr. Robert Redfield, with President Trump. In a statement, the agency said the guidance was prepared at the request of the coronavirus task force and doctors who “requested CDC review the literature, compose, and post the information as quickly as possible.” “The agency did,” the statement said. The CDC would not disclose the identities of the authors who prepared the document, nor detail its sourcing. The document said it was reviewed by the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. ‘BIGGEST GAME CHANGER’ Trump’s push for action came after Fox News on March 16 reported on a small French study highlighting the effectiveness of one of the drugs, hydroxychloroquine. Fox News interviewed a lawyer it said was involved, Gregory Rigano, who said “we have strong reason to believe that a preventative dose of hydroxychloroquine is going to prevent the virus from attaching to the body and just get rid of it completely.” Rigano, appearing on Fox News again two days later, said the president “has the authority to authorize the use of hydroxychloroquine against coronavirus immediately.” Rigano did not respond to an emailed request for comment from Reuters. On March 19, Trump vowed to make the drugs more widely available. “It’s shown very encouraging – very, very encouraging early results,” he said at a press conference. “And we’re going to be able to make that drug available almost immediately. And that’s where the FDA has been so great. They – they’ve gone through the approval process; it’s been approved. And they did it – they took it down from many, many months to immediate.” In fact, the drug had not gone through an FDA review process by then. At the same press conference, FDA administrator Hahn said regulators were taking “a closer look.” “That’s a drug that the president has directed us to take a closer look at, as to whether an expanded-use approach to that could be done to actually see if that benefits patients,” Hahn said. In a press release that day, the FDA emphasized it was merely investigating whether the drugs “can be used to treat patients with mild-to-moderate COVID-19 to potentially reduce the duration of symptoms.” Studies were underway, the FDA added, “to determine the efficacy in using chloroquine to treat COVID-19.” While the FDA approves drugs for the U.S. market and oversees the testing, the CDC is the key agency coordinating the response to infectious diseases and providing information about them. At that point, the CDC had not singled out the drugs. Two days later, on March 21, the president personally pushed the health officials. The president also tweeted that the drugs should be “put in use immediately.” Trump, citing the study, promised that the drugs demonstrated “a real chance to be one of the biggest game changers in the history of medicine.” That’s when the CDC posted its newer guidance to doctors, appearing to give the stamp of approval on using hydroxychloroquine and chloroquine directly for COVID-19 patients. While the document doesn’t recommend the drugs be used, it cites them as a possible option. Meanwhile, the agency heads began publicly shifting their stance. After initially expressing caution, the FDA’s Hahn on March 23 told Fox News host Tucker Carlson that preliminary data showed the drugs might indeed help treat the disease. Now, millions of hydroxychloroquine and chloroquine pills are on their way to the public, donated by drugmakers, including Novartis’ Sandoz, Bayer and Teva Pharmaceutical Industries Ltd. The FDA issued an emergency authorization on March 28 allowing them to be prescribed and distributed from the Strategic National Stockpile. NEW QUESTIONS A paper in Annals of Internal Medicine, the premier internal medicine journal, this week warned of the dangers of touting the drugs, given the unproven evidence and their potential shortage for other uses, such as treatment for patients with lupus. In a statement to Reuters, the paper’s authors, Drs. Jinoos Yazdany and Alfred H.J. Kim, on one hand called the CDC document “direct and factual, if its purpose is to outline what we do know.” But they also expressed concern that the guidance may “leave the reader free to interpret this information depending on their bias. We do think a document like this should more clearly state what this means for health care providers.” Noting the president’s tweets in their report, the authors urged the medical community and the U.S. government to send “clear messages” that include a proper interpretation of available data “to counteract misinformation, including misleading statements or articles with ‘clickbait’ material.”

Pressed by Trump, US pushed unproven coronavirus treatment guidance

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