Bad medicine

Ivermectin cannot be used to cure COVID-19 – so where did we get the idea that it can?

Why do so many people still want to be treated with a medicine that’s only effective against the coronavirus in a dose that would kill a human being several times over?

Wesley Davis (Emergency Nurse Practitioner: DNP, ENP-C, FNP-C, AGACNP-BC) says Crook County Medical Services District (CCMSD) is seeing an alarming increase in the number of patients asking to be prescribed ivermectin.

Though these patients are often angry when their request is denied, he says, they usually feel much less so after he explains how the myth of the miracle cure came to be.

Science in Motion

As with all branches of science, new medical knowledge starts with a single piece of research and evolves along a strict, pre-defined route until it becomes an accepted finding.

Ordinarily, the public doesn’t see much of this process of rigorous verification. By the time we find out about a new discovery, it has been critiqued and double checked by other experts in the same field, who will aim to replicate the results and review the research thoroughly.

But these are not ordinary times, and COVID-19 research is not ordinary research. Each breakthrough has an immediate impact on the lives and lifestyles of every person on the planet.

And so, for

the first time in living memory, the public is following the science every step of the way.

Unfortunately, most of us have never had reason to think about the practical side of scientific research and are unaware of the steps between study and publication.

That’s where misunderstandings can come in, which is exactly what happened with ivermectin.

In this case, says Davis, the problems began in “pre-print,” which is a concept unfamiliar to most of us who don’t work within a scientific field.

“That means it has not yet been peer reviewed for rigor or to make sure there’s a valid scientific process that’s been followed,” Davis says.

If, for example, a group of doctors within CCMSD found a certain medication was working well on their patients, performed a small study to verify that observation and then decided to publish their findings for the rest of the scientific community, the first draft would be considered “pre-print.”

It hasn’t been checked by other scientists, but at this early stage it’s already available for public viewing.

“Anybody can pull that up and read it and, if you don’t have a background in interpreting research, you don’t know that it has not been peer reviewed and you may take it as being the state of science – that everything written in that paper is true and accurate,” Davis says.

Trouble Along the Way

So how did pre-print cause the ivermectin controversy?

“The initial studies out of Egypt, where they used ivermectin extensively, touted very good benefits. Among the people who were given ivermectin over there, they basically reported no deaths,” he says.

“That went out on a pre-print server and the news and media got a hold of it and widely published it. Enthusiasm travels very quickly.”

Exactly one month later, in July, 2020, “The Egyptian government found out that this entire manuscript was fictitious. A lot of it was made up, there were a lot of deaths that were not reported.”

A single author reported the information and later admitted he lied. Journals retracted the study, but this was never widely disseminated in the media, Davis says, which left the public with a strong belief that ivermectin was a valid treatment.

Instances like this can set the global response to COVID-19 back months, Davis says. Unfortunately, it’s not a part of the process that can be skipped over – especially in a situation of such urgency.

After all, when time is of the essence to save as many lives as possible, the priority must be to share potential new information as quickly as you can with as many others as you can.

“In the case of a pandemic, where you have people dying and the pandemic is not putting its brakes on for us, there has to be a mechanism to get this information out and the way to do that is by pre-print servers,” Davis says.

“Peer reviews take months and, by the time it gets reviewed and published, you’ve lost millions of lives.”

Does Ivermectin Work?

The myth of ivermectin as a miracle treatment isn’t just down to the practical process of science. As often happens, an inadvertent lie was built around a kernel of truth.

“There was a study that put the COVID-19 virus basically in a test tube and they added ivermectin to the test tube to see if it affected the replication rate,” he says.

The study found that ivermectin did stop the virus from replicating, but the amount of the drug needed to make that happen was far too high for human consumption.

“The concentration of the drug in that test tube is not possible in humans,” Davis says.

The drug was able to affect how the virus enters human cells, but only at very high doses. To “cure” COVID-19 with ivermectin, a person would need to take several of the larger dosage tubes that are made for treating livestock.

For a human, that dosage would be lethal.

In terms of treating human beings, the study was about as useful in the real world as if it had found that bleach kills the virus. That’s an interesting fact, but not very useful for treating patients, because drinking bleach will kill the human along with the disease.

“It does kill it, but the dosage that would do that is not possible in humans,” Davis says.

Though many of the patients who have asked for ivermectin were angry when he declined to prescribe it, he says most felt differently once he explained this reality.

The company that manufactures ivermectin in the U.S. has released its own statement on the use of the drug. Davis points out that Merck has a vested financial interest in the matter because it stood to make a lot of money if ivermectin had turned out to be an effective cure.

According to Merck, “Our analysis has identified: no scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies, no meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and a concerning lack of safety data in the majority of studies.”

Many state boards have told practitioners they cannot prescribe ivermectin, hydroxychloroquine or other treatments that have not been recommended and are believed to be harmful. Doing so, says Davis, is considered malpractice.

The Evolution of Treatments

At the beginning of the pandemic, says Davis, the information being shared about COVID-19 was not particularly trustworthy because the disease was entirely new and science was starting from scratch. Almost two years into the pandemic, the data is becoming increasingly reliable.

Treatment options have also been changing and improving as our knowledge continues to improve.

“It’s definitely evolving very rapidly. Treatments that we used eight or six months ago with the first round of COVID-19, we’re certainly not seeing those things be as effective now,” he says.

“Whether that’s our patient population or whether that’s due to the Delta variant, it’s kind of hard to say, but there is an evolution and it’s occurring rapidly.”

A good example is the use of ventilators for patients who are struggling to breathe. This has been standard protocol since the beginning of the pandemic but, for a while there, it seemed like most of the patients who were put on ventilators died.

Did that mean ventilation wasn’t working? Actually, no, says Davis – it was a mistake in the timing.

“What we actually know now is that we should have been putting them on ventilators earlier than what we typically do – we shouldn’t be waiting until the last minute,” he says. “Now we’ve started putting people on ventilators quite early in the disease process, the survival rates are much higher.”

What Treatments Do Work?

For those who are interested in keeping up with the science, Davis recommends using the National Institute of Health (NIH.gov) as your primary source.

“They have a coronavirus disease treatment guidance website,” he says. “It’s a very comprehensive repository of current treatment guidelines and talks about what we know that works, what we know that doesn’t work and what’s harmful.”

The site is updated almost daily, Davis says, as new knowledge comes in. That’s why a patient admitted to Crook County Memorial Hospital today could be treated differently to a patient last week.

For those who are looking for ways to be pro-active in treating or preventing COVID-19, Davis says that the best response is, “Anything that people would typically do for the common cold or influenza.”

“If people want to take what they consider immune-boosting supplements, like vitamin C, vitamin D, those things still apply,” he says.

“I don’t know that there’s any evidence out there that shows a clinically significant benefit to people who take it, but it’s certainly not harmful and it’s certainly not contraindicated.”

Be aware, he says, of snake oil salesmen who tout their “remedy” as a cure or prevention. Some are outright fraudulent, while others are simply unproven to be specifically useful against COVID-19.

He uses elderberry as an example: this common supplement is often taken for viral infections and the homeopathic literature suggests it can be beneficial to boost the immune system.

However, he says, “There is no literature that directly links it to COVID-19.” To say something is “scientifically proven” is a very general statement; linking back to the “pre-trial” problem with ivermectin, the quality of the evidence may not be high, or the science may not be directly relevant.

Ultimately, Davis says, simple common sense can help guide you when you see advertisements for COVID-19 cures or preventatives.

“If there was a wonder drug that had been around forever, and it was easy to use to prevent COVID-19 infection, I think we wouldn’t have the deaths we do today,” he says.

“It would be something that everybody would be taking if it was something that was working.”

At this time, says Davis, only two medications are proven to treat COVID-19, “And number one is the vaccine.”

“Here in our hospital, we’ve only had one admission for a vaccinated person who had COVID-19. All the rest of our admissions have been unvaccinated, so that’s a pretty good statistic just for our local community,” he says. “I would guess that over the last two or three months, we’ve had 25-30 COVID-19 admissions.”

The second proven treatment is corticosteroids, which Davis confirms is being given to all COVID-19 patients in the hospital and can be prescribed.