Carlos Chaccour is an assistant professor of tropical medicine at Instituto de Salud Global de Barcelona. (Courtesy of Carlos Chaccour) Posted on 09/21/2020 7:35:46 AM PDT by SeekAndFind
For three nights in April, Heather Coutts listened through the door as her husband lay awake in bed, gasping for air. He told her later he’d strained to remember the details of his life insurance policy — had he signed all the documents? — in case he didn’t make it. Coutts cared for him from a distance, while minding their 11-year-old and 1-year-old.
After two weeks of belabored breathing, extreme fatigue and a trip to the emergency room, her husband started to feel better. But Coutts felt like she’d been hit by a truck. She had a sore throat and a fever.
Hoping to avoid the hell her husband had just endured, Coutts called her close friend Alexis Lieberman, a Philadelphia pediatrician, to ask if there was anything else she should be doing. Lieberman and Coutts are like family — they met years ago volunteering at a camp for kids with queer parents and have stayed friends ever since. So when Lieberman suggested that Coutts try ivermectin, a cheap, safe drug designed to treat parasites that had almost no known side effects, Coutts trusted her.
“We kind of thought, well, there’s no negatives to taking this,” said Coutts. “It’s not going to have any really bad side effects. If it could help, why not?”
Within 24 hours, her fever was gone. After two days, Coutts felt completely herself again.
In the early days of the pandemic, Lieberman was convinced that the best way to temper the impact of the novel coronavirus would be to find an inexpensive, generic drug that would mitigate the virus’s symptoms and keep people out of the hospital. None of the big medical associations, like the American Association of Pediatrics or the American Medical Association, were recommending therapies yet, so Lieberman looked in the various Facebook groups full of doctors she belonged to.
“There were people just trying things,” she recalled. “Especially ICU doctors and hospitalists. That’s it, just trying things.”
Lieberman kept a running list of all the drugs her fellow physicians posted, researched each one, and eliminated those whose potential side effects were too risky. Among the remaining possibilities was ivermectin.
Developed in the 1980s by Merck and approved by the Food and Drug Administration in tablet form to treat worms and as a topical cream to treat head lice, ivermectin is off-patent, widely available and inexpensive, and has few known side effects when taken at appropriate doses. It was originally developed to treat parasites in animals, and is still used for heartworm. It’s been shown to be somewhat effective in treating other viruses, like dengue and yellow fever.
Lieberman’s interest was piqued in April, when she saw the results of a study published by a group of Australian researchers showing that ivermectin slowed the replication of the novel coronavirus in mammal cells. The scientists infected the cells with SARS-Cov-2 in a test tube, added ivermectin, and found that within 24 hours, the amount of viral RNA had been reduced by 93%. By 48 hours, essentially all viral material was eradicated.
The results, while promising, fell short of a miracle cure: The concentration of ivermectin used on the cells was way too high to be safe or even feasible in the human body. Still, at lower doses, the researchers indicated that ivermectin had the potential to inhibit the replication of the virus in the body.
The drug could also work differently in humans than in isolated cells because ivermectin modulates the way the body responds to inflammation and infection, according to Carlos Chaccour, an assistant professor of tropical medicine at Instituto de Salud Global de Barcelona. Chaccour has devoted more than a decade of his career to studying ivermectin. He said the in vitro study alone was not enough to start treating people en mass with ivermectin. Yet it showed enough promise to merit further research.Carlos Chaccour is an assistant professor of tropical medicine at Instituto de Salud Global de Barcelona. (Courtesy of Carlos Chaccour)
“This is a safe drug for a non-treatable disease, so test it, by all means,” he said. “And if it doesn’t work, then put it to bed. And if it works, then jackpot.”
Emboldened by the potential of the in vitro study and her success with Coutts, Lieberman started prescribing ivermectin to other patients, with anecdotal success. Still, she knew better than to extrapolate any conclusions from a few individual instances, and wondered whether there were any clinical studies she could draw data from.
She started posting about ivermectin in one of her doctors’ Facebook groups — one for physicians who are also moms. Expecting to be met with the same sense of experimentation she saw in earlier months, the response she got was jarring.
“When I try to talk to doctors about ivermectin, it feels like someone has poisoned them against it before I even say my first word,” Lieberman said. “The level of response is: You’re suggesting eye of newt. Why don’t we try some mugwort? Why don’t we try some fairy dust?”
Lieberman was surprised. It’s common for doctors to treat patients using off-label drugs with a safe track record, especially in the context of a public health emergency for a disease with no known treatment. In the World Health Organization’s COVID-19 guidance on the practice, known as compassionate use, it notes that “the decision to offer a patient an unproven or experimental treatment is between the doctor and the patient but must comply with national law.”
As she watched the trajectory of the antimalarial hydroxychloroquine rise and subsequently fall in the public eye, it dawned on Lieberman that some of the hostility she faced must be because the medical community was traumatized by its unbridled use. President Donald Trump hailed the drug as a potential “game changer” during the peak of the pandemic without any scientific evidence to back that up, sparking a frenzy of self-medication. An Arizona couple ingested the chloroquine tablets for a fish tank, which killed one of them; a run on the drug left lupus patients at a loss for the daily treatment they depend on.
Lieberman said some people expressed fear the same thing would happen if another cheap, accessible drug were promoted before there was substantial evidence for its success.
Three thousand miles away, deep in the Peruvian rainforest, that was already happening.
In Latin America, ivermectin is a common treatment for parasitic worms; it’s inexpensive and available over the counter. Its ubiquity there meant that the release of the in vitro study from Australia caused quite a stir among health officials, who were drawn to the potential promise of a drug in such wide circulation. Chaccour also attributed what he described as an over-reliance on the study to its somewhat misleading title, “The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro”. Ivermectin is FDA-approved, but not for COVID-19.
In Peru, the need for such a treatment was mounting. Cases began to soar in April, with the number of official COVID-19 deaths there likely a dramatic undercount. By the beginning of May, COVID-19 was spreading among thousands of Indigenous residents of Peru’s Loreto region in the Amazon jungle. Many of the communities there lack road access, and flights were grounded due to travel restrictions, making supplies in already remote areas hard to obtain. Hospitals quickly ran out of bed space and oxygen. Official case counts were unreliable due to lack of testing, but local infectious disease experts estimated that 60% of people in Loreto’s most populous city, Iquitos, could have been infected. The positivity rate there is over 30%.
Meanwhile, it appeared new research to support ivermectin was emerging. Shortly after the Australian study came out, a Chicago-based company called Surgisphere released several papers based on data pulled from a massive pool of COVID-19 patients at 1,200 hospitals around the world. The data became known for demonstrating evidence against hydroxychloroquine, but researchers also drew from the data to explore the impact of ivermectin. Their “pre-prints” — non-peer-reviewed studies — showed the drug had significant promise: Patients who received ivermectin had a 65% reduction in the need for mechanical ventilation and an 83% reduction in overall death rate.
The combination of the Surgisphere study and the in vitro Australian research was enough for Peru’s health ministries to recommend ivermectin in their national COVID-19 treatment protocol. Bolivia did the same.
Just a few weeks after the preprints were released, it was revealed that the entire Surgisphere data set had likely been fabricated. The Lancet and the New England Journal of Medicine both retracted the studies they had published based on the data. The ivermectin pre-prints were also retracted.
Brief currency though it had, the evidence backing ivermectin was quickly adopted by elected officials.
“There is a ghost of this pre-print driving policy decisions all through Latin America,” Chaccour said.
In Loreto, the province’s leader had joined forces with a group of evangelical volunteers to offer free ivermectin injections to thousands of residents. Local reports noted there was a run on pharmacies, draining their supply of ivermectin. Some began using the veterinary formulation of the drug, instead of the one designed for humans. At the beginning of June, the country’s health minister proclaimed there was “no time to wait for scientific evidence,” and President Martín Vizcarra announced the country had acquired 500,000 doses of ivermectin for distribution.
Ultimately the Peruvian government issued a warning against using the veterinary formula, but Chaccour said it is now encouraging hospitals and pharmacies to formulate their own ivermectin, a process that is normally highly regulated.
It’s difficult to know if the treatment did, in fact, work, because of a lack of follow-up care or data tracking. Doctors reported that some who received the mass injections developed racing heartbeats and anxiety; others got infections at the injection site.
Overall, the rate of new cases in the region did begin to slow by early June. But with such widespread consumption, it’s difficult to isolate ivermectin as having a causal effect. Cases have risen again in Peru; it has the fifth highest COVID-19 case count of any country in the world, with its steepest increase in case counts during the month of August.
Beyond the potential for side effects and lack of oversight, Chaccour worries about a false sense of security that widespread use of an unproven drug could offer.
“How about moral risk — people feeling `protected’ because they got their shot?” he said. He also noted that because parasites modulate the body’s immune response, massive deworming of a population where the prevalence of parasites is naturally high could affect the way an entire population responds to COVID-19 or other viruses.
On June 22, the Pan-American Health Organization, a regional subset of the World Health Organization, issued a statement saying that ivermectin should not be used to treat COVID-19, and that it would not be included in its international Solidarity Trials, which included the antiviral drug remdesivir and hydroxychloroquine. The FDA also issued a warning not to self-medicate with ivermectin.
Ping. Related to Hydroxychloroquine
Because it’s cheap and they don’t give Dr Fauci any kickbacks.
There is a cure , STOP TESTING
I’ve heard of it, I give it to my dogs once a month.
Anybody with animals (horses, cows, and dogs) knows about it. My dogs take it for heartworm.
Ping
RE: I’ve heard of it, I give it to my dogs once a month.
The dosage your dog takes is NOT the dosage doctors give. Also, Ivermectin is given in conjunction with a cocktail ( a triple therapy ), as in Hydroxychloroquine, ZINC ( once again ) being one of them.
It’s a one word answer and it’s in the headline.
And not a one of them has gotten Covid-19!......................
Yep, follow the money...
RE: It’s a one word answer and it’s in the headline.
Let me guess — CHEAP?
Here is what I got out of this. She watched her husband struggle for 2 weeks. When she got it she calls a dr friend. WTH. She let him struggle for 2 weeks because he was not important enough?
Those of us with horses have heard of it...
I have been giving it to my doggies for over 30 years for heartworm.
No side effects at all.
There are a number of recent articles on Ivermectin in this Twitter feed:
https://twitter.com/Covid19Crusher
The answers in the question. It’s too cheap. Remember hydroxychloroquine.
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