You made a blanket statement Ivermectin it is not used for prevention, but Ivermectin is used for prevention. Why lie?
No, HCQ is not consumed daily by a high percentage of Africans. It is not used as a preventative, but sometimes is used (often in conjunction with artemisinin) as a cure (although it is not very effective, as P. falciparum is chloroquine-resistant in nearly all of sub-Saharan Africa, with HCQ even less effective than plain chloroquin).
In fact, because chloroquine (and its relatives) have been so much more out of use for so many years, chloroquine-sensitive strains are now beginning to emerge:
https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2298-y
That said, chloroquine, being cheap, and given there have been over 230 million cases of malaria in sub-Saharan Africa per year of late, no doubt millions did take chloroquine to treat malaria. Consider though, that is out of a total population of 1.1 billion and only for a limited course of treatment. It is hardly as if everyone in Africa is popping HCQ (or chloroquine, or more expensive related drugs) every day.
Even if you just assume (!) that every single case was treated, that would only constitute about 20% of the total population, and only for about two weeks per case. On average, a little over 9 million would be in treatment at one time, slightly less than 1% of the total population. Even if every single one was taking HCQ (which they were not), how could this make a significant impact? (Granted, there will be seasonal variations in number of cases at one time, but for the purposes of easy discussion...)
Artemisinin is also widely used to treat malaria in Africa, and that stuff really rocks. It works amazingly fast, but does not wipe out all the nasty little baddies, so another drug (or drugs) should be administered as well. Sometimes it’s chloroquin, sometimes mefloquine, sometimes doxy, sometimes Fansidar, sometimes good old quinine, sometimes newer more expensive drugs — depending on availability, what the patient can afford (which usually is not much, hence chloroquine) and the strain. (And sometimes people just take the arty until feeling better, then get a recurrence later — lots of self-diagnosis and self-medication in the poorest countries of our world — and possibly contributing to the sad emergence of artemisinin-resistant strains.)
So, if malaria treatment does make a difference, which treatment is it? The chloroquine? Or could it be the artemisinin? It has been looked at as a possible treatment for Covid, too:
https://www.frontiersin.org/articles/10.3389/fphar.2021.649532/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605811/
It appears to me HCQ use is not the answer. Certainly not the whole answer! I don’t think artemisinin is, either.
As for ivermectin, it is *not used for Covid prevention in Africa*. Nor is it is used for prevention of round worm infestations, as so many here seem to believe, although it is widely used as a cure. For round worms in the intestinal tract, only a single dose is usually given, so that would hardly affect differences in Covid rates.
There is a WHO programme (APOC) which distributes ivermectin for prevention of river blindness in a number of African countries, and some here have made much of the lower rates of Covid infection and death in those countries, and some rather rough preliminary statiatical studies have looked at that.
African countries (”APOC countries”) participating in the WHO ivermectin programme to prevent river blindness have a 28% lower Covid fatality rate (but only 8% lower infection rate) than those African countries which do not, according to those studies (not peer reviewed and further research is certainly needed):
https://pubmed.ncbi.nlm.nih.gov/33795896/
https://www.medrxiv.org/content/10.1101/2021.03.26.21254377v1
Before anyone gets too excited about this, though, the ivermectin is only distributed to high-risk villages, not to everyone in these countries! Furthermore, South Africa (non-APOC) is an outlier in several ways (climate, higher level of development, higher median age, higher Covid infection rate than neighboring non-APOC countries, etc). And, as daniel1212 pointed out, significantly higher obesity rate. Take South Africa out of the mix, and I suspect the difference would be much less significant.
There *may* be something to the ivermectin use in APOC countries contributing to lower Covid death rates, but it needs looking at more closely on a village-by-village basis. Do the APOC villages have significantly lower rates than similar non-APOC villages? If yes, maybe over next in does have an effect, provided the villages and villagers are very similar in other ways (obesity rate, age distribution, level of activity, diet, etc).
One study noted their figures had been adjusted for developmental level. Well, they may have got it backwards there. Perhaps in less developed countries, where people spend little to no time inside climate-controlled buildings, riding elevators, etc, there is naturally less spread of Covid. They shop at open-air markets, live in dwellings without HVAC, etc. Sunlight and fresh air may really make a difference.
On the other hand, perhaps they got it right, as there is likely less accurate Covid surveillance in less developed countries. Or maybe it’s a wash. We really don’t know.
Meanwhile, here in the States, we have monoclonal antibodies, which really do work. I am so grateful I live here and will have access to MAB should I get Covid again. In the beginning, before we had MAB and better treatment, I may have considered ivermectin or HCQ as better than nothing. Now that we understand Covid better, have MAB and better treatment, I’ll just go with the MAB, thank you.
I don’t think those who are using ivermectin or HCQ are wrong. If taken early enough, these people may have a less severe bout of Covid than they otherwise would have. There simply is not enough solid research, to my mind, to justify taking it myself. MAB is a sure thing and available, so I will go with that, personally. What others choose to do is their business, not mine.
Back to Africa, I would not be surprised if it turns out to be a sort of synergistic combination of factors such as climate, naturally more robust immune systems (given greater disease burden), less time spent in closed climate-controlled public buildings, more sunshine and fresh air, lower obesity rate, much lower median age, and so on. Perhaps ivermectin and/or chloroquine do a bit, but I have some doubts about how much it could be. Whatever it is, good for Africa. They have way more than their fair share of nasty diseases.