American politicians and doctors are debating whether to use the drug hydroxychloroquine against the new coronavirus. The drug has been used to treat some COVID-19 patients in the United States. But doctors ordering its use have no idea whether it is working.

The medicine is among several drugs they experiment with on those infected. The patients differ in severity of sickness, age, sex, pre-existing health condition and other ways. As a result, it is unclear what treatment has helped those who improve or if they would have improved without any treatment at all.

The drug has been around for many years and is a popular treatment for the diseases malaria and lupus.

‘What do you have to lose?'

American President Trump is expressing great support for hydroxychloroquine in treating COVID-19. He has said publicly that he might give the drug a try, although tests have shown that he is not infected with the new coronavirus.

On Sunday, during his daily coronavirus press conference, he suggested all infected people should try it. "What do you have to lose?" he asked.

The answer could be your life, in rare cases. Hydroxychloroquine can have severe side effects, including deadly heart problems. It can also cause vision loss, skin wounds, thinking problems, and mental-emotional changes, including hallucinations and paranoia.

Not all members of the Trump administration's COVID-19 crisis team agree with the president's judgement on the medicine. The country's leading infectious disease expert, Dr. Anthony Fauci, supports a more restrained approach to use of the drug while scientists carry out studies on the drug in connection with COVID-19.

How is it being used?

Hydroxychloroquine can help control the body's natural defense, called the immune system. It has been used since the 1940s to prevent and treat malaria, and to treat rheumatoid arthritis and lupus. It is sold in generic form and under the brand name Plaquenil in the United States. The U.S. Food and Drug Administration approve its use for malaria, lupus and rheumatoid arthritis only. But doctors can order it for patients with other diseases, now including COVID-19.

What's the evidence?

There are a few small and very early studies on treating COVID-19 patients with hydroxychloroquine. The studies have shown conflicting results. One lab study suggested it damaged the virus' ability to enter cells. Another report on 11 people found it did not improve the speed at which patients cleared the virus or recovered from the disease. A report from China claimed the drug helped more than 100 patients at 10 hospitals, but the study was not carried out with usual scientific controls.

Other researchers in China reported that cough, pneumonia and fever seemed to improve sooner among 31 patients given hydroxychloroquine compared to 31 others who did not get the drug. However, the two groups did not share severity of symptoms. Four people developed severe sickness and all were in the group that did not get the drug. These results were posted online. They did not appear in a traditional scientific publication nor were they officially examined by other researchers.

Finally, a small study from France that Trump noted as evidence of the drug's effectiveness is now in question. The head of the publication in which it appeared has put out an expressed concern about the study's methods.

Larger studies using accepted scientific methods are underway now.

The sharp rise of hydroxychloroquine in the U.S.

The United States has quickly become the center of the new coronavirus spread. More than 380,000 people in the United States have been infected, and more than 12,000 have died from COVID-19. The federal government estimates that as many as 240,000 people in the country may die from the disease before the outbreak is over.

Facing those numbers, and lacking any known effective treatments, doctors said they began using hydroxychloroquine on patients who are worsening. Some said they were pressured by patients to use the drug.

Patients admitted to American hospitals are generally much sicker than cases of patients cited in the few studies done. This situation has made it difficult for doctors to judge whether the drugs are making a difference.

Doctors who spoke to Reuters said they treat coronavirus patients with the medicine for a very limited time. They said the risks are relatively low from only a few days of use and the medicine costs little and is generally available.

"I have seen hundreds of patients with severe COVID and most of these people are on hydroxychloroquine," Dr. Mangala Narasimhan, a director of critical care at Northwell Health, a 23-hospital system in New York, said in an email. "In my opinion, although it is very early, I do not see a dramatic improvement...."

Dr. Daniel McQuillen is an infectious disease specialist at Lahey Hospital & Medical Center in Burlington, Massachusetts. He said he has ordered hydroxychloroquine treatment for about 30 COVID-19 patients so far because the drug has shown "a little bit of antiviral activity." But he has not seen "marked improvement for patients."

I'm Ashley Thompson. And I'm John Russell.

Caty Weaver adapted this story from the Associated Press and Reuters news agency reports. Hai Do was the editor.

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vision -n. the ability to see: sight or eyesight

hallucination -n. something (such as an image, a sound, or a smell) that seems real but does not really exist and that is usually caused by mental illness or the effect of a drug

paranoia -n. a serious mental illness that causes you to falsely believe that other people are trying to harm you

approach -n. a way of dealing with something: a way of doing or thinking about something

generic -adj. not sold or made under a particular brand name

cough -n. an expulsion of air through your throat with a short, loud noise often because you are sick

pneumonia -n. a serious disease that affects the lungs and makes it difficult to breathe

fever -n. a body temperature that is higher than normal

dramatic -adj. striking in appearance or effect