Deaths from COVID-19 continue to rise across the globe. New York City continues to be in the mist of an unprecedented public health crisis. The prime minister of the United Kingdom, diagnosed weeks ago with COVID-19, was recently released from intensive-care hospitalization. Despite these incontrovertible realities, some individuals online remain invested in convincing you the disease caused by SARS-CoV-2 is an overblown media invention. One such person is Eric Nepute, a chiropractor described on YouTube as a "real doctor telling it like it is."
A 20-minute screed live-streamed by Nepute is memorialized on that platform (confusingly attributed to "Frank Hahnel" in many cases). The video, at least one version of which had been viewed 1.3 million times, makes several unsupported, contradictory, or dangerously misinformed arguments about a) the media's misrepresenting the severity of the pandemic; and b) the efficacy of Schweppes tonic water in preventing or treating COVID-19. Here we analyze the claims, misrepresentations, and pseudoscientific assertions that make this video potently dangerous in the time of a global pandemic.
Who is Eric Nepute?
Despite being described as a "real doctor" on YouTube, Nepute is not an MD or DO — the two degrees that allow one to be recognized as a medical doctor in the U.S. He holds a Doctorate of Chiropractic degree from Logan University and is accredited by the state of Missouri where he runs his own clinic. It is unclear how this training makes him an expert in epidemiology, virology, or the science of pandemics. "I’m a physician," he stated at one point in the video.
Should I 'Go Get Some Schweppes Tonic Water'?
Nepute spends a perplexing amount of time in the livestream advocating Schweppes tonic water for the prevention of the COVID-19 coronavirus disease. These claims are problematic for several reasons, but perhaps the most obvious is Nepute’s interchangeable use of quinine, the chemical, with Schweppes tonic water, the mixer.
The Food and Drug Administration (FDA) limits quinine content in tonic water to no more than 83 parts per million. Put another way, this is approximately 83 milligrams of quinine per one liter of tonic water. For comparison, the amount of quinine approved as a treatment for simple cases of malaria is "648 mg every 8 hours for 7 days." To get a sense of how little quinine is in tonic water compared to the amount required for medical use, think of it this way: You would need to drink more than 12 liters of Schweppes tonic water every eight hours to maintain those therapeutic levels of quinine (usually provided in pill form) from tonic water. Despite this reality, Nepute frequently conflates the two:
Tonic water has a ton of quinine in it. ... If you know someone who's got flu like symptoms, if they've got symptoms of COVID-19, the cold, the flu, whatever, go and get some … quinine and/or Schweppes Tonic Water
Regardless of any alleged efficacy against COVID-19, in other words, the amount of quinine in tonic water is medically negligible.
Are Quinine, Chloroquine, and Hydroxychloroquine Interchangeable Treatments?
To bolster his argument in support of tonic water, Nepute falsely equates quinine (all 83 milligrams per liter of it) with the drugs hydroxychloroquine and chloroquine — two antimalarials promoted aggressively by U.S. President Donald Trump and others. In support of that argument, Nepute cited a local news article about a Los Angeles doctor who claims he has been treating patients at his private practice with a combination of hydroxychloroquine and zinc successfully.
"When people get on this protocol, typically within 12 to 24 hours, they're literally walking out of the hospitals," he stated in the video. This claim, based on the testimony of a doctor/CEO who benefits financially from people visiting his clinic and provided without any data about the condition of the patients treated, is at best anecdotal and more likely than not scientifically useless.
At several points, Nepute broadly implied that chloroquine, hydroxychloroquine, and quinine work in "similar-ish" ways and are therefore interchangeable. The "similar-ish" mechanism shared by these three chemicals, according to Nepute, is their alleged ability to make "the cell wall more permeable so that it helps get toxins out of the cell and helps get nutrients in." Suggestions of the interchangeability of these three chemicals are misleading and falsely imply the same level of risk associated with each treatment.
Quinine is a naturally occurring chemical derived from quinoline, an alkaloid found in the bark of cinchona trees. Two synthetically produced drugs, chloroquine and hydroxychloroquine, are based structurally on quinoline as well — they belong to a group of chemicals called 4-aminoquinolines. As antimalarials, these drugs have a similar mechanism of action: Their structure allows them to block the ability of the malaria-causing parasite to digest the chemical hemoglobin found in blood without poisoning itself.
As antiviral treatments, however, things are far less clear cut. Researchers have long observed that some quinoline drugs appear to act against some kinds of viruses, including coronaviruses, but the mechanism for these actions is poorly understood, and almost all of the research in support of the notion comes from cell culture studies that may have limited relevance in demonstrating efficacy in humans. Most research suggests that these chemicals' antiviral properties stem from an ability to alter intracellular pH levels in a way that blocks viruses from replicating. The proposed "toxin" mechanism in no way describes the reason for the potential antiviral properties of quinoline drugs.
Zinc, too, could play a role in limiting viral replication, but the evidence here is conflicting as well. Research suggests that zinc may be able to inhibit the spread of some viral infections, but the question remains unsettled. A 2010 study using cell cultures published in PLOS One found evidence that increasing intracellular zinc concentrations "can efficiently impair the replication of a variety of RNA viruses" including coronaviruses. According to the Cochrane Database of Systematic Reviews, "trials conducted in high-income countries since 1984 investigating the role of zinc for the common cold symptoms have had mixed results." The idea behind mixing zinc with quinoline-style treatments stems, as suggested by Nepute, from laboratory studies that suggest the former aids in the cellular absorption of the latter. It remains unclear if this mechanism would have a clinical relevance in the human body, however.
In sum, quinine, chloroquine, and hydroxychloroquine may or may not have some kind of action against COVID-19 due to vaguely understood antiviral properties, but the “mechanisms” described by Nepute are either flat out wrong or overstate the scientific certainty behind their use. From a big-picture perspective, unless you are planning on drinking around 25 liters of Schweppes tonic water a day, any claim that equates tonic water with any of these three treatments is meaningless.
Will 'Getting Healthy' Prevent COVID-19?
Nepute asserts that an adequate defense against COVID-19 is healthy living, adding that "we're going to get through this in the next couple of weeks" — an assertion that bears scant semblance to any scientific reality:
You know what? Here's the truth. The truth is this. Get healthy and now's the time to do it. Most of you guys are on lockdown for the next two weeks to four weeks. It's time instead of getting fat, let's get fit. Let's eat right. Let's exercise, let's move. Let's take our supplements. Let's get some C, some zinc, some vitamin D. Let's get some elderberries, some astragalus. Let's get some quinine. Let's get a good probiotic and let's eat good, clean, healthy foods. Not the crap in the middle of the aisles, this process, but go get some vegetables, eat a little bit of fruit, eat some clean meat, some grass fed beef.
Not only does such a line of thinking downplay the severity of the disease, it falsely suggests that people with healthy immune function have nothing to worry about with regard to it. This is simply not true — a significant subgroup of COVID-19 deaths or complications occur in young, healthy people with no known risk factors, as reported in Vox:
“A lot of young patients without comorbidities are getting very sick, and we wish we knew who was going to deteriorate,” Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital and a professor of medicine at Harvard, told reporters last week. “We do know it happens precipitously. One day they’re okay, the next day they require intubation. [It’s] one of scariest parts of this disease.”
Is the Media 'Lying' to You?
Nepute’s video jumps between the problematic medical advice discussed above and anti-media conspiracy theories — oftentimes mid-sentence. In his video Nepute asserted that, "You guys are being lied to, propagated to us by the false news fake narratives that are out there. People are trying to get us all riled up and in a panic." To make this argument, Nepute claimed that the media and/or the government overcounts COVID-19 deaths. To do this, Nepute cherry-picked two news reports that, he seems to believe, prove the media's duplicity.
The first report concerned the death of an extremely preterm baby in Louisiana born after the infant’s mother, severely ill with COVID-19, was placed on a respirator. Speaking to NBC News, William Clark, a coroner for the East Baton Rouge Parish in which this event occurred, explained why this death is counted as a COVID-19 death despite the baby testing negative for the disease:
“We all agree that this would be considered a COVID-19 related death because of the positive nature of the mother in this scenario,” he said. “Had she not been COVID-19 positive, had not required ventilatory support, had not had shortness of breath and the hypoxia that's associated with the virus, likely she would have not gone into preterm labor and there would have been a different outcome.”
This explanation evidently incensed Nepute, who used this single incident as evidence that COVID-19 death counts, in general, are incorrect. The second story cherry-picked by Nepute stems from the death of a 7-month-old Connecticut baby described by Gov. Ned Lamont as "probably the youngest person to ever die of COVID." Though the baby had tested positive for COVID-19, the official cause of death has not yet been determined, leading Nepute to accuse Lamont and the media of scaremongering or narrative-pushing.
In reality, the uncertain nature of this death and its reporting in the press stem from two different standards of evidence. "The Department of Public Health tally of COVID-19 deaths includes all people who test positive for the virus just before or after their death," Connecticut State Epidemiologist Matthew Cartter explained on April 10. "That’s different from saying COVID-19 caused someone’s death." An autopsy is currently being performed to determine the cause of death.
Regardless, armchair speculation about fraudulent COVID-19 deaths counts miss, catastrophically, the bigger picture of the pandemic. That picture is one of unprecedented mortality — regardless of classification — in so-called COVID-19 hot spots like New York City. On April 10, The New York Times presented monthly data on all deaths in New York City, finding there to be twice as many overall in March 2020 compared to previous years, for example:
Should You Go to Hospitals To Find Out 'What Is Really Going On'?
In one of the most aggressively flawed bits of advice proffered in the video, Nepute implored his viewers to go "to hospitals right now," suggesting a need to expose the actual truth behind the pandemic. "I mean independent people should be going and ask to volunteer at hospitals and see how crazy it is," Nepute told his viewers. "Journalists should be going inside of the emergency rooms in the ICU to find out what the hell is really going on in there."
Do not do this. Such a move would expose you to potentially contagious individuals, directly expose front-line healthcare workers to more risk than they already have, and place an undue burden on a medical system already unprepared for this pandemic. Several qualified individuals, it also bears mentioning, have already done valuable work documenting the pandemic.
Jeff Rhode, a staff photographer at a hospital in Teaneck, New Jersey, has been documenting the response to COVID-19 there almost daily since the pandemic began. His reporting is vivid and can be viewed without endangering anyone’s health here. You can also view videos leaked to the media from ER doctors fighting COVID-19, such as this one published by The New York Times. The account of a Chicago doctor who volunteered to be the person in charge of the dangerous job of placing respirators into patients with severe and often fatal COVID-19 cases also provides harrowing details into what "is really going on" inside these hospitals.
The Bottom Line
Nepute’s video is a case study in the abuse of anecdotal information. From a single news report about a handful of cases at one clinic in Los Angeles, Nepute concluded that chloroquine and zinc "crushes" COVID-19. From two news reports about young children’s deaths being classified, with some controversy, as COVID-19 related, Nepute has concluded that the news media is trying to cause a COVID-19 panic with the ultimate goal of pushing a new vaccine on the American populace.
On top of the limited evidence to support his wild claims, Nepute went further by making a series of scientifically impossible claims about the relationship between antimalarials and Schweppes tonic water. Nepute used (anecdotal) evidence about chloroquine and hydroxychloroquine as if it were evidence for the efficacy of tonic water. This is dangerous on its own, given the fact that quinine and those two drugs each come with different risks, but it is also self-evidently absurd given the dearth of quinine in tonic water.
For valid information and hard data from actual medical doctors with expertise in virology, immunology, or pandemic responses, we recommend the COVID-19 information portals at the World Health Organization, the Centers for Disease Control and Prevention, or Johns Hopkins University.