First they came for the vitamins, then they came for the face masks and the hand sanitiser. And then they came for the chloroquine.

Ever since the coronavirus was discovered, more and more customers have been coming to the Iskandar Muda Pharmacy in Medan, Indonesia, looking for ways to keep themselves and their loved ones safe.

In the past two days, customers have been arriving in droves in search of chloroquine, a drug that derives from quinine and is usually used to treat malaria.

“At first we were confused about why people wanted it, then we saw that [President Joko “Jokowi” Widodo] had announced that it was a possible treatment for Covid-19,” explained pharmacist Maria. “It all made sense.”

On March 23, Indonesia’s president announced the country had ordered 3 million chloroquine tablets. Chloroquine comes from the cinchona tree which grows widely across Indonesia. “There is neither a cure nor an antiviral to Covid-19, but in drawing from the experiences of countries, chloroquine can be used to help patients recover from disease,” Widodo said. He added that the tablets would be distributed to patients through hospitals.

There is no chloroquine at the Iskandar Muda Pharmacy, even though Maria reported up to 50 customers a day trying to source the drug. But increasingly grim statistics are helping to drive the demand regardless.

As of Wednesday, Indonesia had reported 790 infections, 58 deaths and 31 recoveries. However, studies this week suggested the true numbers could be far worse. The London-based Centre for Mathematical Modelling of Infectious Diseases estimated as few as 2 per cent of Indonesia’s infections had been reported. That would bring the true number to as many as 34,300, more than Iran. Other modellers have projected a worst-case scenario of 5 million cases in the capital, Jakarta, by the end of April.

Indonesia’s geography may make matters worse. Its health care system is highly decentralised, given that it is a sprawling archipelago of more than 17,000 islands with 260 million people, and is already under strain with a shortage of staff, beds and protective equipment.

PRAISED BY TRUMP

Widodo is not alone in his praise of chloroquine. US President Donald Trump has also been regularly touting it on social media and in press briefings, despite any comprehensive evidence that it is effective against coronavirus.

In fact, a study by the Journal of Zhejiang University in China found chloroquine and a similar drug hydroxychloroquine had little effect on the coronavirus. In its study of 30 patients with the coronavirus, 15 were given hydroxychloroquine and 15 received conventional treatment like oxygen and bed rest. Of the 15 given the drug 13 shed the virus within a week. Of the 15 given the standard treatment, 14 recovered within a week, while one patient remained infected.

While a study on such a small scale can’t be considered definitive either way, even White House insiders are sceptical of the two drugs’ benefits in treating the coronavirus. Coronavirus task force member Anthony Fauci said any evidence so far was only “anecdotal”.

Even so, trials of the drugs have started in New York and public health experts in France are considering using them for extremely ill patients. Eight hundred people are taking part in trials as part of a wider initiative across Europe involving 3,200 patients.

Meanwhile, as potential demand surges across the globe, India banned exports of hydroxychloroquine on March 25 with immediate effect.

MORE HARM THAN GOOD

The problem with chloroquine’s sudden rise to fame is that while it remains unclear if it can help those with coronavirus, it could actually cause more harm than good if people buy the drug and self-medicate. There have been reports of poisonings in Nigeria and the United States, where one man in Arizona died on March 24 after ingesting chloroquine phosphate, which is also used to clean aquariums and fish tanks.

The side effects of chloroquine include problems with heart rhythm, dangerously low blood pressure and damage to the body’s muscles and nerves.

For Dr Corona Rintawan, an emergency medicine doctor who is now the head of a task force in Indonesia run by Muhamadiyyah (the second largest non-governmental Muslim organisation in the country), self medication with chloroquine is almost a bigger worry than the virus itself.

“I am worried [about people poisoning themselves] and I think most other doctors are too,” he said. “I think the government must have regulations about chloroquine buying and implement them. As long as there are online shops selling chloroquine, people will be able to order it freely.”

A number of sellers of the drug have popped up online in the past few days, making regulations a challenge. It is also difficult to stop people from trying to source chloroquine through any means possible, given the psychological toll the virus is taking on people around the world, according to Irna Minauli, a psychologist based in Medan.

“If we look at the vicarious learning model theory, people learn by what they see other people doing. So if they get information about a drug that can help them and see or hear of people trying to buy it, they will do the same,” she said.

DISINFORMATION

This information, or disinformation, about chloroquine has spread rapidly on Indonesian social media according to Santi Indra Astuti, a lecturer in the Faculty of Communication Science at the Islamic University of Bandung (UNISBA) and the Head of the Research Department of Mafindo, an online fact checking civil society organisation.

“Right now, we’ve found that hoaxes regarding coronavirus are spreading massively,” she said. “In terms of quantity, it is overwhelming. We have collected data regarding Covid-19 hoaxes since January and recent data shows that the number has risen to 201 in eight weeks.”

Mafindo has volunteer fact checkers in 18 cities across Indonesia who have been data mapping Covid-19 hoaxes and compiling an online resource to debunk them.

Astuti said chloroquine disinformation had become a new issue in recent days. “We found that the information about chloroquine has been spreading, most of it through WhatsApp. It became our concern that doctors or whoever was quoted in the messages have not yet been proven as reliable sources. The discourse regarding chloroquine itself is still ongoing, so we are collecting information about that and publishing it so that people know what’s going on. Overall, our fact checkers reported that hoaxes regarding alternative medicine, herbs or medicine have been rising this past week.”

When asked how Indonesia’s health authorities can best ensure that Widodo’s latest comments don’t set off a chain of illicit chloroquine purchases, Corona said that they need to, “Put out statements that people should not buy it through the media.”

This was echoed by Astuti, who said Mafindo had “received a call for collaboration from local governments and administration, as well as related institutions such as health units, religious groups and professional associations to share information and fact check strategies”.

“As the situation in Indonesia gets worse, we need to combat it online,” she added.