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Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith March 28, 2020, 11:00 AM ET This is an official CDC HEALTH ADVISORY Severe Illness Associated with Using Non-Pharmaceutical Chloroquine Phosphate to Prevent and Treat Coronavirus Disease 2019 (COVID-19) Summary Chloroquine phosphate, when used without a prescription and supervision of a healthcare provider, can cause serious health consequences, including death. Clinicians and public health officials should discourage the public from misusing non-pharmaceutical chloroquine phosphate (a chemical used in home aquariums). Clinicians should advise patients and the public that chloroquine, and the related compound should be used only under the supervision of a healthcare provider as prescribed medications. Background The Centers for Disease Control and Prevention (CDC) has become aware of two individuals who ingested non-pharmaceutical chloroquine phosphate, a chemical for aquarium use that is commercially available for purchase at stores and through internet websites. One of the individuals died shortly after arrival to the hospital. The second individual was critically ill with severe gastrointestinal and cardiac conduction abnormalities. Upon recovery, the surviving individual reported to the media that they ingested the product to prevent infection with SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19), after seeing information on the medical use of chloroquine on television. The product in their possession was in powder form inside a 2.2-lb. container and labeled “for Ornamental Fish Use Only”. CDC is also aware of unconfirmed media reports that these commercially available aquarium-use chemicals may be out of stock due to potential increased demand by the public. Public Health Brief Richard O. Johnson, M.D., MPH Nichole Williamson Public Health Officer HHS Director Office: [PHONE REDACTED], Ext 249 Office: [PHONE REDACTED] e-mail: [EMAIL REDACTED] 24/7/365 Emergency Contact Numbers Dr. Johnson’s cell: (760) 914-0496 Dispatch: [PHONE REDACTED], Ext 330 ---PAGE BREAK--- Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith At this time, there are no routinely available pharmaceutical products that are FDA-approved for the prevention or treatment of COVID-19. Pharmaceutical chloroquine phosphate and sulfate are approved by the US Food and Drug Administration (FDA) to treat specific medical conditions, such as malaria, lupus, and rheumatoid arthritis. Currently, these medications are being studied and evaluated as treatment for COVID-19; however, their efficacy to either prevent or treat this infection are unknown. In overdose situations or when used inappropriately, these medications can lead to severe toxicity, including cardiac disturbances such as prolonged QT, severe hypokalemia, cardiovascular collapse, seizures, coma, and death. Inappropriate uses include taking commercially available non-pharmaceutical preparations, taking chloroquine phosphate or sulfate without a prescription, and taking additional doses not recommended by a healthcare provider. Chloroquine phosphate has a narrow therapeutic index—it can be toxic at levels not much higher than those used for treatment—which raises the risk of inadvertent overdose. Recommendations for the Public 1. Do not ingest aquarium use products or any other chemicals that contain chloroquine phosphate. These chemicals are not intended for human consumption and can lead to serious health consequences, including death. 2. Medications like chloroquine phosphate and sulfate should be taken only when prescribed by and under the supervision of your healthcare provider and always according to the instructions provided. 3. Seek immediate medical attention if you are experiencing any unexpected after taking chloroquine or by contacting your healthcare provider or your poison center (1-[PHONE REDACTED]). For More Information • CDC coronavirus website • U.S. Government coronavirus website • FDA Letter to Stakeholders information/fda-letter-stakeholders-do-not-use-chloroquine-phosphate-intended-fish- treatment-covid-19-humans) • Banner Health (Phoenix, AZ) press release • Dailymed for medical prescribing information • American College of Medical Toxicology for poisoning information • Association of American Poison Control Centers