Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka

Introduction: While multiple vaccines are undergoing clinical trial across the globe, we yearn for an FDA approved drug to protect us from the devastating pandemic for the time being. This study aims to determine the effectiveness of Ivermectin when administered as pre-exposure prophylaxis for COVID-19.

Method: An observational study, with 118 healthcare providers who were enrolled purposively, was conducted in a tertiary hospital in Dhaka from May 2020 to August 2020. The subjects were divided into experimental and control groups; and the experimental group received an oral monthly dose of Ivermectin 12mg for 4 months. Both groups were exposed to COVID-19 positive patients admitted in the hospital during the course of study. The symptomatic subjects were evaluated by physical examination, COVID-19 RT-PCR and/or HRCT of chest. Differences between the variables were determined using the Chi-square test and the level of statistical significance was reached when p<0.05.

Result: 73.3% (44 out of 60) subjects in control group were positive for COVID-19, whereas only 6.9% (4 out of 58) of the experimental group were diagnosed with COVID-19 (p-value < 0.05).

Conclusion: Ivermectin, an FDA-approved, safe, cheapand widely available drug, should be subjected to large-scale trials all over the world to ascertain its effectiveness as pre-exposure prophylaxis for COVID-19

Drs. Paul Marik and Pierre Kory recommend Ivermectin for pre-exposure prophylaxis. See EVMS COVID-19 MANAGEMENT PROTOCOL: An overview of the MATH+ and I-MASK+ Protocols. Here is the relevant section:

Prophylaxis

While there is no “Level 1 evidence” that this “cocktail” will prevent/mitigate against COVID-19 we believe there is significant evidence supporting the efficacy of the individual agents included in the prophylactic protocol. This protocol MUST be part of an overall strategy which includes common sense public health measures, i.e. masks, social distancing, and avoidance of large groups of people. Furthermore, it should be noted that there is emerging evidence suggesting that IVERMECTIN may be highly effective in the prevention and treatment of COVID-19. It is important to emphasize that ALL of the medications included in our prophylactic regimen are inexpensive, safe, and widely available.

Vitamin D3 1000–3000 IU/day. Note RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. [1-22] Vitamin D insufficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly, those of color, obese and those living > 45o latitude. [7-22]
Vitamin C 500 mg BID (twice daily) and Quercetin 250 mg daily. [23-34] It is likely that vitamin C and quercetin have synergistic prophylactic benefit. [35] It should be noted that in vitro studies have demonstrated that quercetin and other flavonoids interfere with thyroid hormone synthesis at multiple steps in the synthetic pathway. [36-39] The use of quercetin has rarely been associated with hypothyroidism. The clinical impact of this association may be limited to those individuals with pre-existent thyroid disease or those with sub-clinical thyroidism.[40] In women high consumption of soya was associated with elevated TSH concentrations.[41] The effect on thyroid function may be dose dependent, hence for chronic prophylactic use we suggest that the lowest dose be taken. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored. It should also be noted quercetin may have important drug-drug interactions; the most important drug-drug interaction is with cyclosporin and tacrolimus. [42] In patients taking these drugs it is best to avoid quercetin; if quercetin is taken cyclosporin and tacrolimus levels must be closely monitored.
Melatonin (slow release): Begin with 0.3 mg and increase as tolerated to 2 mg at night. [43-50]
Ivermectin for postexposure prophylaxis (see ClinTrials.gov NCT04422561). 0.2 mg/kg (12 mg) immediately then repeat day 3.
Ivermectin for pre-exposure prophylaxis (in HCW) and for prophylaxis in high-risk individuals (> 60 years with co-morbidities, morbid obesity, long term care facilities, etc). 0.15–0.2 mg/kg Day 1, Day 3 and then weekly for 10 weeks, followed by biweekly dosing. [5,61-64] (also see ClinTrials.gov NCT04425850). See dosing Table below. NB. Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions - Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs.
Optional: Famotidine 20–40 mg/day [55–61]. Low level evidence suggests that famotidine may reduce disease severity and mortality. However, the findings of some studies are contradictory. While it was postulated that famotidine inhibits the SARS- CoV-2 papain-like protease (PLpro) as well as the main protease (3CLpro) this mechanism has been disputed.[58] Furthermore, a single study suggested that users of PPI’s had a significantly increased odds for reporting a positive COVID-19 test when compared with those not taking PPIs, while individuals taking histamine-2 receptor antagonists were not at elevated risk.[62] This data suggest that famotidine may be the drug of choice when acid suppressive therapy is required.
Optional/Experimental: Interferon-α nasal spray for health care workers [54]

Ivermectin dosing (by body weight): 150-200 ug/kg or fixed dose of 12 mg (≤ 80kg) or 18 mg (≥ 80kg).[65] Depending on the manufacturer ivermectin is supplied as 3mg, 6 mg or 12 mg tablets.

Body Weight (kg)	Dose (mg)
50 - 64.9	12
65 - 79.9	15
80 - 94.9	18
95 - 109.9	21
≥110	24

I've heard from several doctors who've been having a lot of success using Ivermectin for patients seriously ill with COVID-19, but I haven't seen anything before about its use as a prophylaxis

The same mechanisms that Ivermectin uses to treat serious, active cases of COVID -19 is at work in the very early stages of the infection. The drug wipes out the virus before it has a chance to replicate to a level where the virus is to reach a level in the body that creates a symptomatic infection.

That Ivermectin regulated peak infection level can range across the spectrum from the case of virtually nil where the Ivermectin simply prevents any measurable replication of the initial infection's viral load to the worst case scenario where the 6.9% of the prophylaxis cohort developed COVID -19 symptoms. It is reasonable to assume that those 6.9% who eventually developed symptoms had significantly moderated degree of severity and a significantly shortened recovery and reduced permanent damage and/or long term effects.

The same can be said for the various ZPack treatment regimes.

FWIW, the effectiveness of Ivermectin prophylaxis is, in the nominal sense, about as good as that of the best of the competing vaccines and actually better than the second best of the competing vaccines. In practice, Ivermectin may be a better option than a vaccine as it appears the vaccines effectiveness either works or it does not, whereas the Intermectin prophylaxis has the benefit of being course of therapy for treating and moderating COVID -19 infections of those who do develop symptoms.

Additionally, If the secondary components of the various drug cocktails (ie - zinc, antibiotics,anti inflammatory and anti coagualnts )are administered to the Ivermectin prophylaxis group there is a very early seamless transition to the best available therapeutic options.

If we are truly in the unprecedented public health crisis we are being told, the best course of action would be to mobilize the proven HCQ and Ivermectin prophylaxis regimens to as many as possible with a priority towards those in high risk groups as an interim measure until the vaccines are fully available as they can be prescribed and distributed for immediate implementation .

Personally, I would opt for Ivermectin or HCQ prophylaxis as a preference to any of the vaccines currently available

Yeah, who needs these side effects:

tiredness
loss of energy
stomach pain
loss of appetite
nausea
vomiting
diarrhea
dizziness
itchiness
joint pain and swelling
swollen and tender lymph nodes
itching
rash
fever
eye problems
Pain in your neck and back
Serious eye problems. Symptoms can include: redness
bleeding
swelling
pain
loss of vision
Shortness of breath
Inability to control urination
Inability to control bowel movements
Trouble standing or walking
Confusion
Extreme tiredness
Extreme drowsiness
Seizures
Coma
Low blood pressure, especially when you get up after sitting or lying down. Symptoms can include:
lightheadedness
dizziness
fainting
Severe skin reactions. Symptoms can include:
severe rash
redness
blistering skin
peeling skin
Liver damage. Symptoms can include:
tiredness
nausea
vomiting
loss of appetite
pain on the right side of your stomach
dark urine
yellowing of your skin or the whites of your eyes

Oh. Wait. Those are the side effects of Ivermectin!

Undoubtedly that is dose-dependent and has a lot to do with one’s health status. Besides, lawyers will require that every possible side effect be listed to protect the manufacturer.

As for prophylaxis, not being a medical professional, I don’t think that I really need it. What is best for people like me, IMHO, is to keep one’s immune system in the best condition possible - which requires good sleep habits and plenty of immune-boosting vitamins and minerals. Losing excess weight apparently helps with Coronavirus, as does taking care of one’s blood sugar (and the latter 2 are certainly good for many other reasons).

I do NOT trust the vaccine - not yet. I will reconsider after a few million other people act as guinea pigs, plus some number of months have gone by to assess what, if any, long term effects present themselves.

The truth is that any medication (or medical procedure) is going to have negatives attached to it - that life, and both the medical profession and we as patients have to be aware that there are always trade-offs.

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