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An alliance of U.S. professors proposes a treatment for coronavirus disease

November 15, 2020

A group of established professors of intensive care, Front Line COVID-19 Critical Care Alliance (FLCCC Alliance), proposes ivermectin, a common pharmaceutical used for treatment of e.g. scabies, for prophylaxis and early outpatient treatment of COVID-19.1 The leader of the group, professor Paul E. Marik, adopted corticosteroids and anticoagulants for COVID-19 in January 2020, over six months before their general adoption.2 Ivermectin is the most recent addition to his treatment protocols.3 

In Latin America, ivermectin has been used in COVID-19 treatments for some time, e.g. in Peru as an official treatment since May 8, 2020.4 According to an epidemiological review, large-scale distribution of ivermectin seems to have abolished excess mortality in people over 60.5 In three Brazilian cities, ivermectin distribution seems to have reduced incidence rate of COVID-19 to approximately half of the rate in comparable cities without distribution.6 Countries such as Haiti which had implemented nation-wide ivermectin programs for other reasons, the pandemic has been practically non-existent, with incidence and mortality rates at about one quarter of the rates in Finland. 

According to a pilot trial, in patients with mild and moderate COVID-19, a high-dose ivermectin (0.6 mg/kg/day) for five days reduced viral load to approximately half in comparison to the controls.7 The treatment group reported slightly more adverse events than the control group. The symptoms were generally mild and transient, including rash, nausea, dizziness, anxiety and mild hypotension. Dosage was not associated with the appearance of the symptoms. The researchers stated that the treatment was well tolerated. 

In an earlier trial in which ivermectin was given to family members of people with COVID-19, seven percent of the treatment group developed symptoms, in contrast to 58 percent in the control group.8 In another trial in which medical personnel treating COVID-19 patients were given ivermectin as a prophylaxis, the incidence of COVID-19 infections was 73 percent lower in the treatment group than in the control group.9 The results indicate a three-fold to seven-fold effect, larger than with any other method. 

A trial published in October about ivermectin and doxycycline combination treatment of inpatients indicated that the treatment significantly reduced the severity of the disease, reduced the number of patients with a persistently positive coronavirus test result, and prevented clinical deterioration.10 Another trial with the same combination achieved a similar result.11 An earlier retrospective study indicated a reduction in mortality in patients with a severe form of the disease.12 Currently, tens of clinical trials are ongoing or planned.13 Taken together, these preliminary results indicate that ivermectin is likely to produce a significant benefit in all phases of COVID-19.

The exact mechanism of action for COVID-19 is currently unknown. A new of mechanism of action has recently been found.14 Vitamin C is known to protect against possible side effects of large doses of ivermectin.15 

Prophylactic treatment for the elderly and high-risk groups can be implemented by prescription-free distribution of ivermectin tablets from pharmacies, in the first phase to people over 70, and later to people over 60, according to availability of the medicine. For people with confirmed infection, an outpatient treatment can be started immediately after a positive test result. The treatment consists of two doses of medication, three days apart. Prophylactic doses can also be given to people exposed to COVID-19 patients, and e.g. tourists arriving to a country. 

The medication is affordable, safe and immediately available. It is usually administered as tablets and does not require a non-standard supply chain. As a broad-spectrum antiviral its efficacy is unaffected by viral mutation. Its adoption will likely reduce need for vaccinations and it may be produced locally. The proposed treatment may enable suppression of the pandemic without a need for financially and societally harmful lockdown strategy. 

Mika Turkia
M.Sc.

Additional information: http://covidcare.fi, https://flccc.net

References

1. Kory P, Meduri GU, Iglesias J, et al. Review of the Emerging Evidence Supporting the Use of Ivermectin in the Prophylaxis and Treatment of COVID-19. OSF Preprints 2020. https://osf.io/wx3zn/

2. Turkia M. FLCCC Alliance MATH+ ascorbic acid and I-MASK+ ivermectin protocols for COVID-19 – a brief review. SSRN Electronic Journal 2020. https://doi.org/10.2139/ssrn.3723854

3. Marik PE, Kory P, Varon J, Iglesias J, Meduri GU. MATH+ protocol for the treatment of SARS-CoV-2 infection: the scientific rationale. Expert Review of Anti-infective Therapy 2020;:1–7. https://covid19criticalcare.com/wp-content/uploads/2020/08/MATH-protocol-for-the-treatment-of-SARS-CoV-2-infection-the-scientific-rationale.pdf

4. TrialSite News. How a Grass Roots Health Movement Led to Acceptance of Ivermectin as a COVID-19 Therapy in Peru. https://www.trialsitenews.com/how-a-grass-roots-health-movement-led-to-acceptance-of-ivermectin-as-a-covid-19-therapy-in-peru/

5. Chamie J. Real-World Evidence: The Case of Peru. Causality between Ivermectin and COVID-19 Infection Fatality Rate. ResearchGate 2020. https://www.researchgate.net/publication/344469305

6. TrialSite News. An Old Drug Tackles New Tricks: Ivermectin Treatment in Three Brazilian Towns. https://www.trialsitenews.com/an-old-drug-tackles-new-tricks-ivermectin-treatment-in-three-brazilian-towns/

7. Krolewiecki A, Lifschitz A, Moragas M, et al. Antiviral Effect of High-Dose Ivermectin in Adults with COVID-19: A Pilot Randomised Controlled, Open Label, Multicentre Trial. SSRN Electronic Journal 2020. https://doi.org/10.2139/ssrn.3714649

8. Waheed S. Prophylactic Ivermectin in COVID-19 Contacts. NCT04422561. ClinicalTrials.gov 2020. https://clinicaltrials.gov/ct2/show/study/NCT04422561

9. Behera P, Patro BK, Singh AK, et al. Role of ivermectin in the prevention of COVID-19 infection among healthcare workers in India: A matched case-control study. medRxiv 2020. https://doi.org/10.1101/2020.10.29.20222661

10. Reaz M. Clinical Trial of Ivermectin Plus Doxycycline for the Treatment of Confirmed Covid-19 Infection. NCT04523831. ClinicalTrials.gov 2020. https://clinicaltrials.gov/ct2/show/results/NCT04523831

11. Hashim HA, Maulood MF, Rasheed AM, Fatak DF, Kabah KK, Abdulamir AS. Controlled randomized clinical trial on using Ivermectin with Doxycycline for treating COVID-19 patients in Baghdad Iraq. medRxiv 2020. https://doi.org/10.1101/2020.10.26.20219345

12. Rajter JC, Sherman MS, Fatteh N, Vogel F, Sacks J, Rajter J-J. Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019. Chest 2020. https://doi.org/10.1016/j.chest.2020.10.009

13. Jans DA, Wagstaff KM. The broad spectrum host-directed agent ivermectin as an antiviral for SARS-CoV-2? Biochemical and Biophysical Research Communications 2020. https://doi.org/10.1016/j.bbrc.2020.10.042

14. Li N, Zhao L, Zhan X. Quantitative proteomics reveals a broad-spectrum antiviral property of ivermectin benefiting for COVID-19 treatment. Journal of Cellular Physiology 2020. https://doi.org/10.1002/jcp.30055

15. Chahrazed M, Hassina K, Soumya B, et al. Beneficial effects of ascorbic acid on ivermectin repeated high-dose therapy in rabbits: biochemical and histopathological investigations. European Journal of Biological Research 2020;11(1):1–13. http://www.journals.tmkarpinski.com/index.php/ejbr/article/view/336