At the center of a daily tit-for-tat between President Donald Trump and leading infectious disease specialist Dr. Anthony Fauci, debating the advisability of using the anti-malarial drug hydroxychloroquine to treat COVID-19, is Dr. Robin Armstrong, who is treating elderly patients with it in a Texas City nursing home.
Armstrong is a Texas City-born hospitalist at HCA Houston Healthcare Mainland, a graduate of La Marque High School and the University of Texas Medical Branch and former president of the Galveston County Medical Society. He also is a leading Texas Republican, member of the Galveston Pachyderm Club, delegate at the 2016 Republican National Convention that nominated Donald J. Trump and national party committeeman for Texas.
Armstrong argues there’s no connection between his standing in the Republican Party and his decision to use the drug on elderly, infected patients.
“It amazes me that someone would make that leap, would think I’m using this drug just because the president wants me to, because I’m a Republican,” Armstrong told The Daily News. “I have always kept my medical practice separate from my political life.”
On Sunday, 39 COVID-19-infected patients under Armstrong’s care at The Resort at Texas City nursing home completed a five-day regimen of hydroxychloroquine, a drug approved by the FDA for treatment of rheumatoid arthritis, malaria and lupus, but not the coronavirus.
“After Sunday, none of them will be on it anymore,” Armstrong said. “We’re just happy the patients are better.”
Armstrong based that observation on how the 39 nursing home residents appear, on no evidence of increased shortness of breath and that no one started on it had been hospitalized, he said.
“That’s a positive result,” he said.
Armstrong said he didn’t inform patients’ relatives before using the drug, as the U.S. Centers for Disease Control and Prevention recommends before physicians use any drugs not approved by the FDA for treatment of COVID-19.
He has used hydroxychloroquine in a hospital setting before and would have used it even if Trump wasn’t promoting its use enthusiastically in daily Tweets and at press conferences, he said.
Trump announced last week he had secured 29 million doses of the drug for the national stockpile.
On April 10, the Fort Worth Star-Telegram published an endorsement of the president’s leadership of the COVID-19 emergency response, written by Armstrong.
“Most encouragingly of all, the most promising treatments yet proposed for COVID-19 — off-label uses of a variety of already FDA-approved drugs with known risk factors — are being sped to the front lines thanks to the personal intervention of the president,” Armstrong wrote.
“This administration’s comprehensive and innovative strategy for combating the coronavirus is enormously encouraging to me as a physician,” he wrote. “But it’s also encouraging to me as a Republican National Committeeman and a proud member of the Black Voices for Trump coalition.
“To me, the president’s aggressive response to this invisible enemy is the most compelling proof yet that he’s the right person to lead our nation,” he wrote.
‘I KNOW THESE PEOPLE’
The Galveston County Health District announced April 3 that 83 employees and residents of The Resort at Texas City, 1720 N. Logan St., had tested positive for COVID-19.
Two days later, Armstrong began treating 27 residents with hydroxychloroquine, made available to him with the help of Lt Gov. Dan Patrick, he said.
Twelve additional patients were added to the five-day treatment regimen — hydroxychloroquine with azithromycin or Z-Pac and a zinc supplement — over the next few days.
All patients completed the five-day treatment on Sunday. Armstrong and his team will continue to monitor them — all were symptomatic for COVID-19 before receiving the medication — and will share what they observe, he said.
“This is not an experiment, not a clinical trial,” he said, pointing to use of the drug in India and to studies from China and France that have indicated the drug has been effective at slowing the virus’ invasion of cells.
Fauci and others have dismissed the French study as too small and only anecdotal. Clinical trials are in progress with approval of the CDC in the United States. Scientists have criticized Trump’s promotion of using the drug, arguing there’s no proof of its safety or effectiveness.
Since Armstrong’s use of hydroxychloroquine has become national news, some medical experts have argued that not informing relatives or formally obtaining informed consent, a requirement in a clinical study, should be expected among a vulnerable patient population such as the already ill nursing home residents.
Informed consent — or the right to receive information and ask questions about treatment to make well-considered decisions about care — is fundamental to ethics and law, according to the American Medical Association.
Armstrong has said that some of the patients he is treating were given the medication without that kind of beforehand discussion, either with them or their families, and that it wasn’t necessary because hydroxychloroquine has been in use for a long time, since the 1950s, and is widely used by physicians for off-label purposes on conditions for which it has not been approved.
The federal government approved the use of hydroxychloroquine on an emergency basis in some COVID-19 cases, but in the past week, following the president’s repeated message that it should be widely used, the CDC has withheld guidance for physicians on how often and widely it should be used, only saying that it does not recommend widespread use of any drug not yet tested in clinical trials.
Armstrong agrees with both Fauci and the president, he said.
“Yes, there has not been a large randomized clinical trial done,” he said. “But for someone to say it should not be used for that reason, it sounds like somebody not actively engaged in patient care.”
The people he has been treating are people he knows, whose families he knows, Armstrong said.
“It makes me angry that people think I would experiment on people I know,” he said. “I’m practicing medicine in my hometown at the hospital where I was born. I know these people.”