Covid update, August 2021 - Ivermectin Addendum

I was surprised my mention of Ivermectin became such a flash point. Unfortunately, this focus misses the point I intended. Which is the importance of recognizing patients at risk for severe disease and aggressive early intervention. Ivermectin is a small part of that.

EFM treated over 1,000 covid positive patients in our urgent care August alone. Mercy hospital is full. We are treating complex disease in the outpatient setting. We need all the tools that we can get. We believe we should do more than telling the patient to go home and wait until they desaturate less than 90%, and then go to the ED. We are failing our patients if they think the only treatment options are in the hospital. Because at that stage, much of the story is written.

Little viral replication occurs in the later phases of Covid. By the time patients reach the hospital, that phase is largely past. The mortality and morbidity in Covid is provoked by an overwhelming hyper immune inflammatory response. A cytokine storm. In the laboratory, Ivermectin has potent anti-inflammatory properties with profound inhibition of cytokine production. Many studies across many nations suggest it may help. Studies are ongoing to help clarify its role, if any.

At Evergreen, we understand the unsettled science surrounded Ivermectin. We recognize this is off label use of this medication. The patient is fully informed of this. Informed consent is important, and we do not oversell Ivermectin’s benefits.

Ivermectin is inexpensive. With appropriate dosing, its safety in human use is demonstrated by 40 years of use and billions of doses, with mild and rare side effects. The argument against the use of Ivermectin has been based on poison control reports of people using veterinary doses of this drug. Evergreen does not use veterinary doses of Ivermectin. A drug cannot be judged based on its misuse.

There are 2 recent large conflicting meta-analysis studies of Ivermectin. They came to different conclusions about differences in mortality with early treatment using Ivermectin. What they did not disagree about is that Ivermectin was safe when used correctly. The meta-analysis in Clinical Infectious Disease, the study adverse to Ivermectin efficacy in treating Covid, stated “Ivermectin was found to be similar to placebo in safety and tolerability, even at 10 times the highest FDA-approved dose” However, since the drug has not been specifically used to treat Covid, the authors added “well -designed randomly controlled trials with longer treatment and higher doses would be necessary to evaluate safety when treating patients with Covid.”

In the meantime, many patients are telling us that Ivermectin had a positive effect (including medical professionals). In March 2020, EFM had an inpatient census of 40 patients in the hospital. Currently, at the peak of the delta surge, we have about 20. We believe the totality of our early interventions is helping to keep patients out of the hospital.

The CDC has never had a problem blocking a drug that doctors on the front lines think is helpful, even in the heat of battle, if the CDC can’t get that drug to jump over the exact hurdle it sets for it. And that’s wrong. That occurred in 1987 when Dr. Fauci declined to promote Bactrim as PCP Prophylaxis in patients with AIDS costing thousands of patient lives.

When the Medical Association Chairman of the nation of Japan recommended to Japanese Doctors they should prescribe Ivermectin for Covid, he made an interesting statement. “I would like the government to consider treatment at the level of the family doctor.”

I wish our government would do the same.

Tim Powell MD

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