Ivermectin may not be the ‘silver bullet’ antiviral against Covid-19 (link to original Medrxiv report included)

‘A team of researchers based in Peru and the US recently examined the role of the anti-parasitic drug ivermectin in treating COVID-19. The team has released their findings on the medRxiv preprint server... (link below).

Study details

‘The researchers included 12 qualitative and five quantitative studies, mostly preprints. These studies originated from all over the world, two being from the U.S., two from Spain, two from South America, one each from Iraq and Iran, and four from Bangladesh.

‘Altogether, there were around 7,400 participants, with a mean age of 47.5 years. About 60% were male. The treatment protocols for all included studies comprised ivermectin either alone or in combination with another anti-inflammatory, antibiotic or blood-thinning drug like azithromycin, hydroxychloroquine, dexamethasone, enoxaparin, aspirin or dicloxacillin...

‘Ivermectin was not significantly associated with a lower mortality or higher recovery of patients in this meta-analysis. However, the majority of studies were preprints, allowing for later changes in the data on which these conclusions are based.’

Read here (Medical News, Feb 1, 2021)

• Outcomes of Ivermectin in the treatment of COVID-19: A systematic review and meta-analysis

Read original study here (Medrxiv, Jan 27, 2021) 

FLCCC Alliance issues open letter to UK researchers planning a new trial to test ivermectin for use in Covid-19

‘The Front Line COVID-19 Critical Care Alliance (FLCCC) has issued an open letter to researchers  in England at the University of Oxford who are planning to conduct a double-blind, Randomized Controlled Trial (RCT) of ivermectin for use in COVID-19.  The letter states, “Our manuscript, which reviewed both epidemiologic data and the existing clinical trials evidence base, concluded that ivermectin should be the standard of care in COVID-19.”

• ‘A meta-analysis of existing data of ivermectin as a therapeutic finds large, statistically significant reductions in time to clinical recovery, length of hospitalization, and death.
• ‘The Declaration of Helsinki – Ethical Principles for Medical Research involving Human Subjects” states that “when combining medical research with medical care, patients can only be studied...if the physician has good reason to believe that participation in the research study will not adversely affect the health of the patients who serve as research subjects.”

Read here (Newswire, Jan 25, 2021)

Download FLCCC Aliiance PDF here

‘Major breakthrough’ | Large study shows effectiveness of colchicine to treat Covid-19

‘A large study launched last March by the Montreal Heart Institute allows a “major breakthrough” in the treatment of COVID-19. Its results show that the anti-inflammatory drug colchicine is effective in treating the disease and preventing its complications. It is the first oral medicine proven to be effective in treating patients before they are admitted to hospital. “We have just provided the planet with hope, exclaims the D.r Jean-Claude Tardif, principal investigator of the COLCORONA study and director of the research center of the Montreal Heart Institute (ICM). We finally have a first treatment that can help patients with COVID before their hospitalization to prevent hospitalizations, prevent intubations and prevent death. ”

‘In 4,159 patients proven to be diagnosed with COVID-19 using a PCR test, colchicine resulted in a 25% decrease in hospitalizations, a 50% decrease in the use of ventilation and a decrease in deaths by 44%. “It’s a major breakthrough,” says Dr Tradif. Colchicine works to prevent the “major inflammatory storm” that affects the lungs and can send patients to hospital.’

Read here (The Canadian, Jan 23, 2021)

The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe Covid-19: A pilot, double-blind, placebo-controlled, randomized clinical trial

Added value of this study: ‘This pilot, randomized, placebo-controlled, double blind trial failed to show a reduction in the proportion of PCR-positive patients seven days after ivermectin treatment; yet it shows a reduction in the self-reported anosmia/hyposmia and a (non-statistically significant) tendency to lower viral loads and lower IgG titers which presumably reflect milder disease.’

Implications of all the available evidence: ‘The positive signal found in this pilot together with emerging evidence from animal models and other clinical trials warrants the conduction of larger trials using ivermectin for the early treatment of COVID-19.’

Read here (EClinicalMedicine, The Lancet, Jan 19, 2021)

Afriforum may take battle over Ivermectin to court

‘Afriforum insists that investigations regarding studies that have already been conducted globally on the use of Ivermectin be carried out as soon as possible to confirm if this drug can be used effectively in the prevention and treatment of the coronavirus. “A large range of studies in various countries show that Ivermectin can possibly be effective in the treatment of the virus,” Barend Uys, Afriforum’s head of research said.

‘According to him, it was irrational to approve the use of a vaccine that had been developed within months while at the same time banning the use of a drug that had been proven safe and been in use for four decades. “Farmers have been using Ivermectin as a livestock product for many years and it is immediately available in their medicine cabinets,” said Uys.’

Read here (IOL, Jan 16, 2021)

'Miracle' drug ivermectin unproven against Covid, scientists warn

‘Scientists have warned against taking an anti-parasite drug as a treatment for Covid-19 despite headlines that have touted it as a cure. Facebook posts and articles endorsing ivermectin have proliferated in Brazil, France, South Africa and South Korea as governments around the world scramble to roll out vaccination programmes.

‘But health agencies say that there is not enough evidence to promote the drug as a remedy for coronavirus -- and that research into the question has often been unsound. Ivermectin has long been used to treat parasites such as head lice and has been widely distributed in sub-Saharan Africa since the 1990s to treat river blindness.’

Read here (France 24/AFP, Jan 15, 2021)

Association of American Physicians and Surgeons (AAPS) applauds NIH revised stance on Ivermectin for Covid-19

‘The National Institutes (NIH) has issued a new statement on the use of the anti-parasitic drug ivermectin for the treatment of COVID-19. Previously, it recommended against this treatment, but now states that its Panel “has determined that there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19.”

‘The Association of American Physicians and Surgeons (AAPS) notes that there are now 49 ivermectin studies summarized on c19study.com, 100 percent of which show favorable results. In contrast, there are very few studies of the antibody cocktails now being used under an Emergency Use Authorization.

‘NIH concludes from its current analysis that “results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide further guidance on the role of ivermectin in the treatment of COVID-19.” The NIH may be responding to requests related to the testimony strongly favoring ivermectin in a Dec 8 Senate hearing before the Committee on Homeland Security and Governmental Affairs.’

Read here (Globe Newswire, Jan 15, 2021)

Ivermectin is now a therapeutic option for doctors & prescribers

‘One week after Dr. Paul Marik and Dr. Pierre Kory – founding members of the Front Line Covid-19 Critical Care Alliance (FLCCC) – along with Dr. Andrew Hill, researcher and consultant to the World Health Organization (WHO), presented their data before the NIH Treatment Guidelines Panel, the NIH has upgraded their recommen­da­tion and now considers Ivermectin an option for use in COVID-19.

‘Their recommendation has now been upgraded to the same level as those for widely used monoclonal antibodies & convalescent plasma, which is a “neither for nor against” recommen­da­tion. The significance of this change is that the NIH has decided to no longer recommend against the use of ivermectin in the treatment of COVID-19 by the nation’s health care providers. A consequence of this change is that ivermectin has now been made a clear therapeutic option for patients.’

Read here and press release here (FLCCC Alliance, Jan 15, 2021)

Prevalence and risk factors for delirium in critically ill patients with Covid-19: A multicentre cohort study

‘In this large, international cohort study of more than 2000 patients with severe COVID-19, acute brain dysfunction (coma or delirium) was more common and more prolonged than observed in other studies of patients with acute respiratory failure without COVID-19. Patients with COVID-19 also received treatment with sedatives for a prolonged duration: two-thirds of patients were given benzodiazepines and propofol for a median of 7 days. 

‘As a result of the COVID-19 pandemic, many ICUs were operating in resource-constrained environments, and despite demonstrated efficacy in previous studies, evidenced-based strategies, such as light sedation techniques, spontaneous awakening and breathing trials, avoiding benzodiazepines, early mobility, and family visitation, all occurred on fewer than 1 in every 3 days among patients with severe COVID-19. We found that risk of delirium among patients with severe COVID-19 was lower when benzodiazepine sedative infusions were avoided and family was present, whereas greater severity of illness and greater respiratory support was associated with a higher risk of delirium.’

Read here (The Lancet, Jan 8, 2021)

UK scientists trial drug to prevent infection that leads to Covid

‘British scientists are trialling a new drug that could prevent someone who has been exposed to coronavirus from going on to develop the disease Covid-19, which experts say could save many lives.

‘The antibody therapy would confer instant immunity against the disease and could be given as an emergency treatment to hospital inpatients and care home residents to help contain outbreaks. People living in households where someone has caught Covid could be injected with the drug to ensure they do not become infected too. It could also be given to university students, among whom the virus has spread rapidly because they live, study and socialise together.’

Read here (The Guardian, Dec 25, 2020)

From control rooms to testing, several strategies helped Uttar Pradesh contain pandemic

‘Several factors distinguish the handling of the pandemic in the state but I aim to discuss a few in this article. Of the many innovative steps taken there are three clear winners. 

‘First is the setting up of Team 11 — a group of 11 senior government officials tasked with managing different aspects like surveillance and contact tracing, testing and treatment, sanitisation, containment, enforcement, doorstep delivery, issues of migrants, communication strategy, etc — in March itself...

‘The second winner is the Integrated Covid Command and Control Centre (ICCC) set up in every district. This is the nerve centre of pandemic management in the district, sending testing teams to different areas as per plan, ensuring surveillance and contact tracing, sending positive patients to different Covid hospitals or placing them under home isolation...

‘The third winner is the integrated data management portal (upcovid19tracks.in). It provides us with the ability to crunch and analyse data on a daily basis... 

‘Let me also discuss two strategic interventions, out of many, which we have taken. 

‘The first is the widespread use of the drug, ivermectin, not just for treatment of cases but also as a prophylactic. The state government provides free medicines to all patients in home isolation or in government COVID-19 facilities, which have more than 1.5 lakh beds. We have used the combination of ivermectin and doxycyclin to successfully treat over three lakh home-isolated patients with mild symptoms so far. This combination has also been used by the hospitals across the state for admitted COVID-19 patients. But what is more interesting is the state’s successful use of ivermectin as a prophylactic.

‘The second strategic intervention is the targeted testing of selected groups. We started doing this in June with residents of urban slums, workers at nursing homes, pharmacy shops, bus and auto drivers, shopkeepers, security guards in malls, hospitals, etc.’  

Read here (Indian Express, Dec 17, 2021) 

These drugs might prevent severe Covid

‘Even with vaccines on the way, treatments are needed to prevent the disease from getting worse—and to be ready for COVID-25, COVID-37, and so on...

‘In an interview with Scientific American, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, described the desired characteristics of early COVID treatments. “My overwhelming preference is for direct-acting antiviral agents that can be administered orally” and that suppress the virus completely within a week or less, he said. “That, to me, is the highest priority.” 

‘Scientists have begun on differing paths to search for these drugs... One of the current leading contenders for treating mild COVID is an antiviral pill that was previously developed for influenza. At first called EIDD-2801, the drug was found to protect mice from severe lung disease caused by two other coronaviruses—SARS-CoV and MERS-CoV... 

‘Repurposing existing drugs can also yield some surprises by finding ones that are not logical candidates to work against COVID-19. Fluvoxamine, a pill used for treating anxiety disorders, shows some promise in treating early COVID...’

Read here (Scientific American, Dec 14, 2020) 

Ivermectin and Covid 19: Dr John Campbell

Dr John Campbell examines the evidence on ivermectin and suggests that health authorities the world over study its efficacy as a prophylactic and treatment for Covid-19; they should consider including it in the treatment regime if it is found to be effective. 

View here (Youtube, Dec 12, 2020)

Research finds 5 genes linked to severest form of Covid-19

‘A study found five key genes central to many severe cases of COVID-19 and pointed to some existing drugs that could be repurposed to treat those at risk of getting critically ill from the disease...

‘Five key genes are linked with the severest form of COVID-19, scientists said on Friday, in research that also pointed to several existing drugs that could be repurposed to treat people who risk getting critically ill with the pandemic disease.

‘Researchers who studied the DNA of 2,700 COVID-19 patients in 208 intensive care units across the United Kingdom found that five genes involving in two molecular processes – antiviral immunity and lung inflammation – were central to many severe cases.’

Read here (Aljazeera, Dec 11, 2020)

‘This was a gift to us’: Ivermectin effective for Covid-19 prophylaxis, treatment

‘Numerous studies have provided evidence supporting the use of ivermectin to prevent and treat COVID-19, according to the Frontline COVID-19 Critical Care Alliance. Paul Marik, MD, FCCM, FCCP, founder of the alliance and a professor and chief of the division of pulmonary and critical care medicine at Eastern Virginia Medical School, said that ivermectin “is a safe drug that is exceedingly cheap.”

‘He added that “what is truly remarkable — this was a gift to us — ivermectin has high activity against COVID-19.” In a press conference, researchers said that ivermectin is an FDA-approved anti-parasitic drug that has been available for approximately 40 years and previously earned researchers a Nobel Prize.’

Read here (Healio, Dec 8, 2020)

FLCCC Alliance: Review of the emerging evidence demonstrating the efficacy of Ivermectin in the prophylaxis and treatment of COVID-19

Read PDF here (FLCCC Alliance, Dec 7, 2020) 

Anti-inflammatory therapy for Covid-19 infection: The case for colchicine [also used for gout]

‘Given the large body of data demonstrating colchicine’s inhibitory effects on neutrophil activity, cytokine generation and the inflammation/thrombosis interface, together with an overall lack of evidence for systemic immunosuppression, there is a rationale to study colchicine as a potential treatment for COVID-19. Given that colchicine is generally well tolerated, simple to take and inexpensive, demonstration of colchicine as a useful agent in COVID-19 would potentially spare patients morbidity and mortality, help to conserve valuable clinical resources (hospital floor and ICU beds, ventilators, etc), and dramatically reduce the cost of COVID-19 care. Colchicine might be of particular use in resource-poor rural and developing world settings, both of which have been increasingly affected by COVID-19. However, unless and until evidence is obtained from adequately designed and randomised placebo-controlled trials, this hypothesis must remain speculative.

‘The optimal dose of colchicine for daily use, even in well-established conditions such as gout, is unknown. Many but not all patients tolerate up to 1.2 mg daily in divided doses; whether lower doses such as 0.5 mg or less daily can be equally effective is unknown. The largest colchicine study for COVID-19 (ColCorona) is testing a dose of 0.5 mg daily based on prior cardiology trials. The duration of colchicine therapy for SARS-COV2 infection would also need to be determined. Most studies to date test a treatment duration of 2–4 weeks, concordant with the acute course of the infection; whether a shorter or longer treatment would be optimal is unknown. Finally, the timing of colchicine initiation is uncertain, with some studies beginning treatment in the outpatient setting, and others in the early inpatient setting. Given the recent track record of failure of treatment of severe COVID-19 treatment with anti-IL-6 biologics such as tocilizumab (a much more potent but also more specific immunosuppressive agent), it is likely that the severe inpatient setting is not the optimal condition under which to assess colchicine efficacy.’

Read here (BMJ, Dec 8, 2020)

WHO advises against remdesivir for COVID-19 treatment

‘The anti-viral drug remdesivir should not be used to treat COVID-19 patients no matter how severe their illness as it has "no important effect" on survival chances, the World Health Organization said on Friday (Nov 20).

‘Scratching one of the few treatments that had shown some initial promise in severe patients, a WHO Guideline Development Group (GDG) of international experts said there was "no evidence based on currently available data that it does improve patient-important outcomes".’

Read here (Channel News Asia, Nov 20, 2020) 

Back to intensive care, where I notice one major change

‘When I first reported from a Covid intensive care unit in April, I was left haunted by what I'd seen. All but one patient had been on a ventilator, in a medically induced coma. It was eerily quiet, just the rhythmical sound of machines pumping air into lungs.

‘The medical teams were at a loss to know how best to treat a savage condition which was ravaging victims' lungs and other organs. Lives hung in the balance, often for weeks on end. In early April, two out of three ventilated patients did not survive.

‘Today, in this intensive care unit (ICU) at the Royal Victoria Infirmary, Newcastle upon Tyne, only one of the five patients is on a ventilator. The others are sitting up, engaging with the nurses, reading or watching TV.’

Read here (BBC, Oct 27, 2020)

US Covid-19 cases are skyrocketing, but deaths are flat—so far. These 5 charts explain why

 ‘In just the last two weeks, the global daily tally for new COVID-19 cases has jumped more than 30%, according to TIME’s coronavirus tracker, which compiles data from Johns Hopkins University. The steep upward trend is driven by viral waves in Europe and the United States that started in August and mid-September, respectively. On Oct. 23, the daily case count in the U.S. reached a new record high, suggesting that this wave will be worse than the one that swept the country over the summer.

‘But despite this rapid uptick in cases, the daily death count in the U.S. is not yet rising at the same rate, and remains at lower levels than in April. At face value, a lower case-to-fatality rate suggests that fewer people who test positive for the virus are dying from it. But the virus hasn’t necessarily become less lethal; it isn’t mutating quickly enough for that to be the case.

‘What’s happening now is not a result of how the virus treats humans, but rather how humans are treating the virus—that is, how we test for it, how we avoid it and how we combat it. The following five charts explain how human-driven factors are, at least for the moment, keeping deaths from spiking as high as they did early in the pandemic, even as cases rise dramatically...’

Read here (Time, Oct 26, 2020)

‘No longer groping in the dark’: NCID doctors share how Covid-19 is being treated in Singapore

‘So far, 28 people have died of COVID-19 in Singapore - one of the lowest mortality rates in the world. In the US, where there have been about 8 million cases, more than 200,000 people have died. As of Saturday (Oct 17), 37 COVID-19 patients remain hospitalised in Singapore, with none in intensive care. More than 99 per cent of those infected have been discharged, while there are 41 in community care facilities.

‘But it wasn't always like this. Three National Centre for Infectious Diseases (NCID) consultants told CNA how treatment of the novel coronavirus has evolved here and how NCID has kept the number of critical cases low.’

Read here (Channel News Asia, Oct 18, 2020)