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Letter to the Editor

Letter to the Editor

What about Ivermectin for COVID-19?

doi: 10.1097/01.EEM.0000743268.53422.c7

    Editor:

    I found the article by James Roberts, MD, on COVID-19 a great read. (EMN. 2021;43[2]:12; https://bit.ly/2MMglKB.)

    Why was Ivermectin not mentioned? In a pandemic, we emergency physicians don't have time to wait for validated studies before we try something. The oath we all took, do no harm, fits here.

    In the war named pandemic, our ammo box should be full of whatever may help lessen the severity of infection and possibly save a life. That is, after all, what we do.

    Douglas Nederostek, MD

    Laurinburg, NC

    Dr. Roberts responds: Ivermectin, an FDA-approved anti-parasitic agent, was found to be an inhibitor of SARS-CoV-2 replication in the laboratory. The drug has been minimally studied for a possible benefit in treating COVID-19 infections. Some clinicians support its use, and it has few adverse side effects, but it is not universally recommended.

    The Infectious Diseases Society of America's typical conservative guidelines suggest against ivermectin use outside of a clinical trial in outpatients or hospitalized patients with COVID-19. The guideline states that additional sufficiently designed clinical trials are needed to support recommendations for routine use by clinicians.

    Most of the published studies have incomplete information and significant methodological limitations. Many emergency clinicians would agree with Dr. Nederostek's argument for such a drug, but for ivermectin to be used in the ED, it likely would require support from a variety of hospital resources and an emergency clinician who has a personal interest in moving it forward.

    Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
    • Brian Dillon, MD2:50:31 PM<p>As much as I respect Dr. Roberts and always read his column, it is sad to see him spouting off the party line about ivermectin. Naysayers always quote the initial in vitro Australian study because they used a high dose of ivermectin. That’s how in vitro studies work. They used a high dose of everything they were testing but ivermectin showed the most promise. However, now there are nearly 100 clinical studies done over the past year, all of which are extremely positive for ivermectin with the exception of the one they chose to publish in JAMA and publicize in the New York Times, Wall Street Journal, etc. That study used patients who were not ill enough to be hospitalized, which was the original endpoint. They changed the endpoint mid-study, which is questionable methodology. Even then there was a trend toward the ivermectin group clearing symptoms faster. The ICON study done in Florida published in Chest last October showed mortality dropped from 81 percent to 39 percent. In other words, it cut mortality in half. The authors of that study testified before the Senate Homeland Security committee begging for funding from NIH to do a bigger study. They were denied. Then the video was scrubbed from YouTube. Are you catching on yet? There are five meta-analyses already performed showing a huge decrease in admissions, ventilator use, length of stay, viral clearance, etc. Yet we as emergency physicians continue to ignore this mountain, this avalanche of data. The dose is 0.2 mg/kg. Ivermectin comes in 3 mg tablets in the United States. In an average person, a reasonable dose is 15 mg per day times for five days. Vitamin D is also extremely important in all stages of the infection, from the viral phase to cytokine storm. I have noticed almost all of my COVID patients are vitamin D deficient. This is especially true among the obese, renal patients, and diabetics. I beg the readers to go to YouTube site “Whiteboard Doctor” for a synopsis of all the literature. The five meta-analyses have concluded that the only a one in four trillion probability that the effect seen with ivermectin is by chance alone. Last thought&#58; Mexico City had a huge outbreak of COVID and all hospital beds were full. In December 2020, the health department decided to adopt a test in the tree strategy where they opened 250 COVID testing centers and started all patients on ivermectin right away if positive. The hospital admissions in the COVID group actually dropped below the admit rate of the general population within a couple of weeks. They were already 15 randomized, blinded placebo-controlled trials done worldwide, all showing huge benefit of ivermectin. Other parts of the world will no longer use placebo because the effects of ivermectin are so strong they consider it unethical. Being a frontline medical hero is great. It’s even better if you don’t send the patient home to die unnecessarily. Thank you. </p>