[nudephil (OP)]

Stephen asks us about a possible COVID-19 treatment:

Are you aware of Professor Thomas Borody in Australia? Borody claims ivermectin has been proven to be highly effective in killing COVID-19 in vitro, and he suggests combining it with doxycycline and zinc to maximise its efficacy.

Why are we not hearing anything about ivermectin?

Could it possibly be due to how ivermectin is not under any patent to any of the big pharma companies, and therefore they cannot make an excessive profit from it?

Any info?

[Bored chemist]

Could it possibly be due to how ivermectin is not under any patent to any of the big pharma companies, and therefore they cannot make an excessive profit from it?

No.
Because, if that was how the decision was made, they wouldn't be using aspirin or paracetamol.

[alancalverd]

Ivermectin is available on prescription in the UK and over the counter in the USA  as an antiparasitic, so you shouldn't have much problem getting hold of the maximum tolerable dose if you want to try it. The reason it isn't being routinely prescribed to treat COVID is that the in vivo trials are at an early stage. There's little point in exposing critically sick people to a fairly aggressive drug if it doesn't actually do the job, and the sequelae of COVID infection are so variable (from no symptoms to death) that clinical trials are extraordinarily difficult.

You can quickly and completely zap the COVID virus in vitro with alcohol, but whilst neat vodka will sterilise your hands, the quantity needed to destroy any virus inside your body will pickle your brain first.

Just like Ebola and HIV, the best treatment for COVID is not to catch it, and since the only vector outside China seems to be human beings, it's a lot easier to prevent than to treat. But that requires a competent government, so it's not going to happen for another 4 years in the UK and may never happen in the USA.

If you can emigrate to New Zealand, don't hesitate.

[Bored chemist]

Why are we not hearing anything about ivermectin?

"The doses used in cell culture would require 10,000 times larger doses in humans based on this data, which does not look promising as an effective treatment for COVID-19"..
"Such high doses of ivermectin are not covered by the current human-use approvals of the drug and could be dangerous, as the likely antiviral mechanism of action is the suppression of a host cellular process"
From https://en.wikipedia.org/wiki/Ivermectin
That's a polite way of saying it won't work.
Like Alan says, alcohol kills covid, but it would kill the patient first

[set fair]

Could it possibly be due to how ivermectin is not under any patent to any of the big pharma companies, and therefore they cannot make an excessive profit from it?

Wouldn't surprise me.

Here's an interview with Thomas Barody he's the doctor who found the cure for peptic ulcers.
https://www.triplem.com.au/shows/night-shift-with-luke-bona/catch-up/666c6146-c3c4-4d22-9fa8-ac15013993f1?fbclid=IwAR11wBzTuEMDos_14nZUacSDkt0GDNSnZaAaaexNucizv-7mHGz2S8q64JQ

[alancalverd]

"Big pharma" makes plenty of money - indeed most of its profits - from proprietary formulations and presentations of non-patentable molecules like aspirin and penicillin.

Given the worldwide incidence of COVID, with a guaranteed market of 300,000,000 doses in the USA alone (you can count on 10% antivaxer/trumpist/antibigpharma idiots not taking it) , anyone who can produce anything that works, will make a fortune without patent protection by just selling it in a useable tablet form.   

The last thing any pharma company wants is to see its primary market for cancer and heart disease medications disappear under a cloud of easily preventable COVID complications.

[jj_]

I've been following COVID-19 stats on more than ten cities where ivermectin has been widespread by the local governments, resulting in astounding mortality reduction. The reduction starts within two weeks or less.
Scientists have been trying to downplay the results explaining them as a kind of herd immunity, but the cases keep happening, just people stop dying.

[alancalverd]

Citation needed, please!

Genetic herd immunity does not occur until the vulnerable have all died, and is unlikely to appear quickly in the case of COVID as those most likely to die are also those least likely to reproduce, so the next generation is just as vulnerable. Acquired herd immunity requires at least 80% vaccination or low-level infection, and AFAIK there is no proven vaccine and generally less than 20% infection worldwide.

What is required to illustrate the effectiveness of a treatment is the time evolution of infections (difficult unless you have 100% testing at 100% accuracy) and excess deaths (easy and unequivocal). In a short period (less than 10 years) we would expect deaths to peak rapidly and decline as the over-70's die off, regardless of the effectiveness of treatment.

The more important figures long-term are the number of hospitalisations and chronic disabling sequelae, and the overall functional depression caused by endemic low-level infection. The military are well aware of this, which is why sublethal weapons are so important: a dead body reduces the enemy's fighting capability by one, but a disabled soldier permanently reduces the enemy's economic capability. Sadly,

the cases keep happening, just people stop dying.

is exactly that.

[jj_]

Itajaí, a Brazilian city with a 220.000 population started a campaign with ivermectin (07/07/20)

It is a voluntary campaign; not everyone has received the treatment. Up until 07/30/20, 135,000 received at least one dose.

The improvements are evident.
On 07/07 there were 62 patients from Itajai in the ICU, on 08/26 there were only 29
Source: itajai.sc.gov.br

I created a dashboard to monitor changes in cases, deaths, positivity rate, and symptom prevalence. There is an evident improvement on every single aspect.

[alancalverd]

On 07/07 there were 62 patients from Itajai in the ICU, on 08/26 there were only 29

The other 33 presumably having recovered or died, and sufficient public health measures having been imposed and observed that the number of new infections has decreased and/or earlier low-level intervention has reduced the likelihood of progression to ICU and/or the most vulnerable died first.

The big problem is that in the absence of a matched control group, you cannot assign an effect to any particular cause. Taking part in a controlled experiment even improves outcomes for the control group!
 

[jj_]

OK, how could you explain this:
By 08/07/20
- 75% of the population of Itajaí received ivermectin
- Since the beginning of the campaign (07/07/20), 60 people have died
- 49 out of 60 deceased (82%) DID NOT receive ivermectin
The chance of dying from COVID was reduced by 13 fold in those who received ivermectin.

[set fair]

45 divided by 11 =13

[Bored chemist]

OK, how could you explain this:
By 08/07/20
- 75% of the population of Itajaí received ivermectin
- Since the beginning of the campaign (07/07/20), 60 people have died
- 49 out of 60 deceased (82%) DID NOT receive ivermectin
The chance of dying from COVID was reduced by 13 fold in those who received ivermectin.

It is both easy to explain, and impossible to explain, for the same reason.
We do not have enough data.

So I can explain it by saying "maybe the young people were more likely to get the drug- because they could be bothered to go + get it"
In that case survivors- who are more likely to be young, are also more likely to have taken the drug.

(The same argument probably applies to cannabis.)

Obviously, that explanation is just a plausible guess.
We can't know what the real reason is- because we don't have access to enough data.
And, if you do have, you shouldn't be posting it here without patients' consent.

[alancalverd]

The average length of stay in hospital to death from COVID is around 4 weeks. Now let's interpret the data we have been given in Reply#10:

The ivermectin campaign ran for 4 weeks

Therefore the majority of those who died in that period did not receive ivermectin before being admitted to ICU

Which suggests that those who did, died anyway.

Medical statistics is a minefield at the best of times, but when you are dealing with a disease that has a variable incidence, a significant asymptomatic incubation period, wide ranging and poorly defined symptoms, causes death indirectly by unpredictable immune response, and is not always reported as cause of death, your minefield is embedded in a foggy swamp. The political and economic impact of COVID doesn't help. 

[jj_]

It seems that today is your lucky day

Open your browser and seach for: ClinicalTrials.gov Identifier: NCT04422561

Prophylactic Ivermectin in COVID-19 Contacts

Outcome: Development of Symptoms

Contacts who will receive prophylactic ivermectin  15/203   7.4%   
Contacts who will be only observed without prophylaxis 59/101  58.4%

[alancalverd]

Thanks for the reference.

The recruitment criterion "family contact" is decidedly nonspecific, and it is not clear whether a group of 300 is large enough to provide a statistically valid sample of all the possible interpretations of that criterion. A second cousin in Australia who is recovering from a mild fever, is a very different "family contact" from the sweating, coughing, spitting, gasping person who shares your bed. 

It's not obvious what the 7.4 and 58.4% actually means, unless it indicates that they didn't really analyse the active participants - a very odd thing to omit. One possible explanation is that, being an open-label trial, the control group were 7.9 times as likely to report  "Fever ,Cough, Sore Throat, Myalgia,Diarrhea, Shortness of Breath" in the period than those who knew they were being treated.

 "White coat effect" - deference to authority - is a known phenomenon particularly prevalent in Eastern cultures (see https://en.wikipedia.org/wiki/Korean_Air_Cargo_Flight_8509 for an infamous example) which is the reason that  blinded placebo-controlled studies are preferred over open-label or passive control studies. If you are giving people a tablet, there is no excuse for an open-label study: the manufacturer can make indistinguishable placebos*. 

The objective, definitive test, development of COVID by swab, was relegated to a secondary outcome and has not been reported.

Reading further down the report, nobody died in either group (not entirely surprising as the cutoff age was 70)  but 5.4% of those on ivermectin reported adverse effects compared with none in the control group.

So we know that
(a) telling people that they are on a trial drug reduces the likelihood of their reporting the symptoms it is intended to suppress
(b) telling people that they are not on a trial drug increases the likelihood of their reporting those symptoms and
(c) ivermectin makes you sick

(a) and (b) are well known, and the reason this trial was a waste of time. (c) is probably written on the packet anyway.

and we do not know if it actually works.

Beware of swimming in the swamp!

*Late edit! In this case they could have tested for White Coat Effect by labelling the pills, say, 40,60, 80 and stamping 100 on the placebo. My guess is that the "super-strength placebo" would have cured everything and guaranteed a good harvest.