Ivermectin, the anti-parasitic meant for deworming roundworm infections in humans and animals, has been in the news for becoming a much preferred, self-administered and self-prescribed medicine to treat SARS-CoV-2 infections.
Even though not officially approved to treat COVID-19, the medicine is being consumed world over as a way to alleviate COVID-19 symptoms. It is gaining prominence as famous personalities like US-based comedian and podcaster Joe Rogan continue to propagate its use. Rogan, a fierce voice against the COVID-19 vaccine, announced to his followers that he was using ivermectin to treat his COVID-19 symptoms. He, however, still continues to be against the vaccine.
In March 2021, The World Health Organisation said that ivermectin would only be prescribed for COVID-19 treatment to patients who are a part of ongoing clinical trials across the world. The apex health organisation ordered this after the various studies conducted to understand the effect of the drug on reducing the impact of the virus showed inconclusive results.
But this has not stopped US citizens from taking extreme steps to acquire the drug such as flocking departmental stores to purchase dewormers meant for livestock as they contain ivermectin. Following this increase in demand and overuse, the US Food and Drug Administration had to issue an appeal asking people not to trust a medicine that did not have any supporting evidence.
Even Australia is showing an increasing demand for the drug, leading to a surge in the import of the drug into the country.
Ivermectin In India: To Be Given Or Not To Be Given?
Ivermectin was not a part of the clinical guidelines in India in the first wave but became popular during the second wave.
Even though the Ministry of Health and Family Welfare stated that there was insufficient evidence supporting the use of ivermectin against COVID-19, it removed hydroxychloroquine and azithromycin from its treatment protocol and included ivermectin. As these documents are now easily available online, many patients started asking their doctors to prescribe the same to them.
Two doctors from Mumbai and Delhi on condition of anonymity told BOOM that they were forced by their patients to write prescriptions for ivermectin. "During the second wave, when the WHO was saying to stay away from ivermectin, our government was asking it to be given to patients with mild symptoms. I was bombarded with calls as patients kept asking why I was not prescribing them the same," the doctor from Mumbai said.
"When the government removed the medicine from the guidelines, people panicked and asked if they did something wrong by consuming it two months ago. The same patients who badgered me for a prescription were now calling me because they were worried. The government issued no reasons for the inclusion or exclusion of the drug," the doctor from Delhi said.
After the government's directive, Vishvajit Rane, Goa Chief Minister announced on May 10, 2021 that the drug will be provided to all adults in the state as a prophylactic measure. While announcing so, he even issued a disclaimer that the drug does not prevent a COVID-19 infection but does reduce its severity. Uttarakhand's chief secretary Om Prakash followed Goa's footsteps on May 11 and announced that the drug would even be given to children. Uttar Pradesh has been prescribing 200mg of the medicine since August 2020.
However, come June 6, 2021, the newly released COVID-19 Treatment Protocol had no mention of ivermectin. The medicine was only a part of the guidelines for a brief period of three months. The guidelines issued by the Directorate General of Health Services, a part of the MOHFW, removed it but the Indian Council of Medical Research still had ivermectin in its recommendations.
In The US: People Consuming Ivermectin Meant For Livestock
As the FDA and WHO do not promote the use of ivermectin, many doctors are not prescribing the use of the drug. This, however, has led to an increase in the purchase of ivermectin containing dewormer meant for livestock from departmental stores.
An investigation by US-based NBC news showed that people were consuming horse ivermectin as opposed to taking the vaccine. A group of frontline doctors that drove the demand for HCQ are the ones pushing for ivermectin too.
The FDA has issued a set of explainers denoting the difference between ivermectin used in humans and animals. "Animal products are often highly concentrated because they are used for large animals like horses and cows, which weigh a lot more than we do Such high doses can be highly toxic in humans. Moreover, the FDA reviews drugs not just for safety and effectiveness of the active ingredients, but also for the inactive ingredients. Many inactive ingredients found in products for animals aren't evaluated for use in people. Or they are included in much greater quantity than those used in people. In some cases, we don't know how those inactive ingredients will affect how ivermectin is absorbed in the human body," reads the FDA website.
Ivermectin To Treat COVID-19? Existing Research Dodgy
Over the past year, there have been many research papers ascertaining the use of ivermectin but many of them which are systematic reviews of studies with sample sizes have produced inconclusive evidence about the use of ivermectin in reducing mortality or hospitalisation. The use of ivermectin was pushed after Australian researchers found that the anti-parasitic was effective against SARS-CoV-2 in laboratory settings,
Furthermore, researchers such as Gideon MK, an epidemiologist from Australia, have found many ethical concerns in the studies so far. Gideon first highlighted a now retracted paper in July for scientific fraud. The study titled "Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic" was a pre-print from Egypt with 400 participants. Not only was the introduction of the study plagiarised, the study collected faulty data. Close to one-third of the participants were already dead but still shown to be a part of the study.
As the authenticity of this data is questioned due to the repetition of statistics, the researchers also found that most of the hospitalised patients were already admitted to the hospital before the study. After these concerns were raised, the results of many systematic reviews that push for using ivermectin on the basis of this one study are now skewed. Questions are even being raised on whether these studies were actually conducted or are completely fabricated.
Similarly, others have questioned the data from a study in Brazil and in Argentina. In the Brazilian study titled "Early COVID-19 Therapy with Azithromycin Plus Nitazoxanide, Ivermectin or Hydroxychloroquine in Outpatient Settings Significantly Reduced Symptoms Compared to Known Outcomes in Untreated Patients", two entirely different group of patients have been compared to come to the conclusion that Ivermectin helps in reducing severity and mortality by 70-85 per cent. This goes against the basic principles of conducting clinical trials where control and treatment groups need to have similar characteristics.
Furthermore, the data in the study looks generated, Gideon has shown.
In the study from Argentina, Buzzfeed news found that a hospital said to have participated in the study declined having ever done so, and Buenos Aires local health officials denied ever approving such a study. This study published in the Journal of Biomedical Research and Clinical Investigation said that ivermectin prevented 100% of COVID-19 infections.
This Argentinian study's head researcher, Hector Carvallo is not even sharing data with his other collaborators. This was the study recommended to Joe Rogan.
Adding to the concerns around the study, when Buzzfeed asked Carvallo about the sample size being different at many places, he blamed a statistician named Monica Lombardo. Lombardo, however, denied having any affiliation with the study. Carvallo then acknowledged that he had falsely used her name.
Even the journal in question was launched only in 2019.
While papers and researchers from various countries keep promoting the use of ivermectin through fraudulent methods, a trial called Together Trial found that ivermectin has no effect on SARS-CoV-2. Initiated by McMaster University, Canada in partnership with the Pontificia Universidade Católica de Minas Gerais in Brazil and the University of Stellenbosch in South Africa, interim results of the trial showed that ivermectin had no real impact on SARS-CoV-2.