Editor-In-Chief Salim R. Rezaie, MD debates Senior Board member William Sullivan, DO, JD, on the use of Ivermectin in treating COVID-19.
Just Say No to Ivermectin for COVID-19
Throughout the COVID-19 pandemic, numerous therapeutic agents have been repurposed and applied empirically and within clinical trials. Prophylactic medications for COVID-19 could have a huge benefit, but studies to date haven’t panned out. Initially many therapeutic medications were used late in illness, and one of the criticisms of these negative studies was that the drugs were applied too late in the disease and therefore didn’t have any potential for benefit.
There were also numerous studies showing associations of benefit, but subsequent randomized clinical trials have failed to prove effectiveness in reducing mortality (i.e. remdesivir, hydroxychloroquine, lopinavir/ritonavir, colchicine, convalescent plasma and single monoclonal antibodies).
Now we have Ivermectin. Ivermectin is an anti-parasitic medication that has been the focus of speculation as an anti-viral and anti-inflammatory medication against SARS-CoV-2 and COVID-19.
We could go through all the issues of every single trial on Ivermectin, but I think some important messages from the trials would be more prudent. The story starts with in vitro evidence showing that Ivermectin could potentially reduce viral replication and therefore help kill SARS-CoV-2. You know what else kills anything living in a Petri dish? Bleach! What works in vitro, does not always pan out in vivo.
The Cochrane review (published July 2021) stated in their conclusion, “We found no evidence to support the use of Ivermectin for treating or preventing COVID-19 infection, but the evidence base is limited.”
All the trials thus far discuss the efficacy of Ivermectin in the treatment of COVID-19 at various time points in illness, but very little is mentioned about safety. Due to its massive global use in low- and middle-income countries, the knowledge base establishing a high margin of safety and low rate of adverse effects is nearly unparalleled. However, the doses used are prophylactic doses. A single dose of subtherapeutic Ivermectin most likely dose not exert a beneficial effect nor cause any severe adverse effects. The doses needed to reach IC50 (Concentration resulting in 50% inhibition) at a pulmonary level are much higher than what a single dose would achieve.
It would take doses 10 times higher than the approved single dose amount to achieve any type of potential therapeutic effect. What happens when you take supratherapeutic doses of Ivermectin? You get an increase in toxicity as is evidenced by the increase in calls seen by the National Poison Data System (NPDS).
Finally, disinformation has been a real issue throughout the pandemic. We are seeing more and more trials on Ivermectin retracted due to falsified data. Just to name a few here:
- Kory P et al. clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19. J Intensive Care Med 2021. PMID: 33317385 [Link is HERE]
- Elgazzar A et al. Efficacy and Safety of Ivermectin for Treatment and Prophylaxis of COVID-19 Pandemic. Research Square 2020. [Link is HERE]
- Samaha AA et al. Effects of a Single Dose of Ivermectin on Viral and clinical Outcomes in Asymptomatic SARS-CoV-2 Infected Subjects: A Pilot Clinical Trial in Lebanon. Viruses 2021. PMID: 34073401 [Link is HERE]
The definition of insanity is doing the same thing over and over again and expecting different results. We have seen the adoption of therapeutics too early during this pandemic, including Ivermectin, with many of them not panning out with subsequent high quality randomized clinical trials.
Long Live Horse Paste!
With masks, Salim suggested that we don’t allow “perfect to be the enemy of good.” If we try to apply that same reasoning to Ivermectin use, the narrative shifts. Ivermectin advocates are uniformly ostracized as abject right-wing idiots who enjoy eating horse dewormer and chugging swimming pool cleaner. Those comparisons are about as dumb as saying that people who drink water are ingesting a nuclear reactor coolant, but hey – I already warned you about the evils of social media.
So deep is anti-Ivermectin sentiment that I was personally chastised by a moderator on a national medical message board for being too “political” when I dared to just mention the “I-word.”
Ivermectin is extremely effective as an anti-parasitic and its discovery resulted in the award of a Nobel Prize. Since then, multiple studies show that ivermectin is also highly effective in stopping viral replication of SARS-CoV-2. See, e.g. https://www.nature.com/articles/s42003-020-01577-x, https://pubs.rsc.org/en/content/articlelanding/2021/cp/d1cp02967c. This study showed that Ivermectin had the highest binding affinity to SARS-CoV-2 proteins of any drug studied. Pay no attention to these studies, though. Remember that Ivermectin is horse paste and it’s too political.
Salim mentions in vitro versus in vivo results. Many studies outside petri dishes show the dramatic effect Ivermectin has on improving COVID outcomes. Scientists just need to read them.
One study by Tanikoa showed that morbidity and mortality from COVID-19 was 700% TO 800% higher in African countries where onchoceriasis was non-endemic compared to countries where it was endemic. The biggest difference between the two groups? Countries with lower mortality rates were using large amounts of Ivermectin to treat onchoceriasis.
In Peru, excess deaths during the COVID-19 pandemic decreased by 93% upon widespread distribution of Ivermectin in 14 states. Lima restricted Ivermectin use and its death rate during that same time frame decreased by only 25%.
Deaths in the 14 low excess death states increased by 1,300% within 30 days after the newly elected Peruvian president imposed a national restriction on Ivermectin use.
An observational study in India showed that counties using ivermectin had COVID-19 rates drop by up to 97% while counties that did not use Ivermectin had 700+% increases in COVID-19 cases. This study was “debunked” by the web site … wait for it … PolitiFact.
The Indian Bar Association filed a notice of contempt against WHO physicians that suggested Ivermectin was ineffective as a COVID treatment. Those statements reportedly undermined an India Supreme Court opinion stating the opposite. The WHO physician’s assertions could reportedly constitute a criminal act with a maximum punishment of death under Indian law. Side note – attention ABEM and FSMB: Still think punishing COVID “misinformation” is a good idea?
If you want to learn about multiple other Ivermectin studies showing a combined 87% improvement in COVID outcomes with early Ivermectin treatment, go to https://c19ivermectin.com/. However, you should probably just ignore all that research, too. It’s horse dewormer, people.
Why aren’t we performing further investigations on Ivermectin use in the US? Who knows? Luckily, we almost have a new miracle drug called molnupiravir that costs $700 per treatment course, has worse treatment outcomes than Ivermectin and can reportedly cause mutations of genetic material in mammalian cells, predisposing to cancer and birth defects.
I’m sure the medical establishment will ignore these issues as well. The federal government already purchased more than $1 billion worth of molnpiravir and has options to purchase an additional $2 billion more.
I’m glad Salim mentioned remdesivir because continued use of that medication helps prove that some prescribers care more about social media reports than they care about science. Early in the pandemic, the WHO concluded that remdesivir was ineffective as a treatment against COVID.
Many doctors ignored this study and continued prescribing remdesivir. Strange how there weren’t news articles calling remdesivir “Ebola treatment” and how scientists weren’t banned from social media for merely mentioning the drug’s name. How many people suffered liver or kidney damage and how many billions of dollars were wasted when medical providers prescribed a medication known to be ineffective?
It is appalling when, in treating a virus that the entire world has studied for nearly two years, the standard of care for early treatment amounts to “go home and come back if you get worse.” I predict that when patients suffer an adverse COVID outcome, “loss of chance” lawsuits will increasingly be filed against providers who refuse to prescribe potentially life-saving medications and against pharmacists who refuse to dispense those medications.
Studies show that Ivermectin is an effective treatment for COVID-19. If you’re still questioning whether to prescribe a “horse dewormer” as a potential COVID treatment, try to find a news report about a horse dying from COVID.