COVID-19 ROUND-UP: Ivermectin, Colchicine, Reopening, and Racism
Updated: Feb 25, 2021
Just yesterday a nurse mentioned how she felt like there was no real new "news" regarding COVID-19 aside from vaccines. So...here are some non-vaccine COVID-related things!
Q: Is anti-parasite medication ivermectin being used to treat COVID-19? A: Not yet. There is a video that recently went around of Dr. Pierre Kory testifying in front of a Senate hearing on early outpatient treatment of COVID-19. He gives a very impassioned testimony about the results of using ivermectin in early treatment of COVID-19. However, most of the studies he points to are in vitro studies or smaller observational studies or anecdotal evidence. For every positive study or report, there is at least one negative one. And the positive studies are not randomized controlled trials - many of them utilize other medications that probably had more effect (like dexamethasone, which is the same drug that did the heavy lifting in the hydroxychloroquine studies).
My biggest issue is that he keeps touting it as a miracle drug. We've heard this song before - hydroxychloroquine did not have the real-world evidence to back its claims (despite the claims of certain politicians and certain Breitbart-paid/organized physician groups whose lead spokesperson went on to storm the Capitol and participate in White supremacy violence) and nor does ivermectin so far. In addition, the in vitro studies utilized HUGE amounts of the drug, far higher than we would normally use in humans (it's usually as an anti-parasite medication - e.g. scabies, certain cases of lice, Strongyloides). You would be much more likely to experience harmful side effects (like seizures) before you gained any benefit from the drug. I'm not saying it shouldn't be studied further (and it is under study), but it should definitely not be sought as a treatment outside of that context yet.
Most importantly, I have to repeat this warning: DO NOT GO TO YOUR VET AND TAKE IVERMECTIN FROM THEM. DO NOT TAKE YOUR PET'S IVERMECTIN OR OTHER MEDS. Medications are dosed differently for animals. More importantly, we saw a run on hydroxychloroquine months ago and it left people that ACTUALLY needed the drug for their autoimmune diseases (in which HCQ is proven to work) without access to a needed medication. Please do not do the same with ivermectin or any other medication. Q: Can my gout medication help me treat COVID-19? A: Again, not any sort of great news here yet. The COLCORONA trial was researching use of colchicine (an anti-inflammatory, used in acute gout flares) in early outpatient treatment. This was a MUCH better-designed randomized controlled trial than the cited studies for ivermectin. Unfortunately, in trying to prevent hospitalizations or deaths, overall the trial could not achieve statistical significance (in one subgroup, hospitalization decrease barely reached that threshold). There is still more data being gathered - the trial wasn't as successful as we would have hoped, but this is how we should be doing it. This is how we learn more about treatment of this virus. I should also say, I wholeheartedly support repurposing inexpensive already-existent drugs for widespread use if there is evidence to back it up (more than developing new expensive medications, if possible). We're getting there. Q: Cases are down! That's great! Time to reopen, right? A: *Sigh*...I don't have a good way to answer this. We don't have a way to explain why cases are going down at the moment - it's too soon to see effects from vaccines. We definitely saw a surge after the holidays, but if cases are going down, I'm grateful. BUT with reopening does come risk. We may go back to work and go out to eat, but we are not ready to go back to pre-pandemic-level behavior. Precautions still need to be taken because vaccines are not yet a substitute for that - for that we need much larger numbers of people to be vaccinated, and for it to take its full effect. As we reopen, I won't be surprised to see cases go back up - that's not because vaccines are ineffective, it's because the exposure risk has gone up. I say this now so that if it happens (I hope it doesn't), it's not entirely unexpected. And I would be remiss if I didn't say that as more and more people get vaccinated, the world WILL be able to open up. I am sincerely looking forward to hugging my parents, sisters, in-laws, and, of course, my wife (who has been living with her in-laws for this year while she's been in fellowship, so we haven't seen much of each other at all). Q: What are all these letters and numbers you're using when you talk about variants? A: So there is not yet a universal system for naming SARS-CoV-2 variants, especially one, in the words of the WHO "that does not reference a geographical location." They are trying to organize it by viral lineage. Most recently the Phylogenetic Assignment of Named Global Outbreak Lineages (PANGOLIN) has formed a system based on what is so far six major lineages (not all are actively circulating or causing infections). It is in this system that we have, in addition to the wild type, variant B.1.1.7 (originally identified in the UK) and B.1.351 (originally identified in South Africa). Why am I not just calling it the UK variant or the South African variant? For the same principle/reason I don't call it the Chinese virus. The racist diatribes of the previous president and too many Republican politicians fanned the flames of anti-Asian racism that has come in waves. There were videos last year of business owners refusing to serve or accommodate Asian Americans because of a mistaken belief that just by being Asian they would be carrying the virus, or that they were more likely to catch and spread COVID-19. Like many misconceptions of physiological differences between races, this belief is based in racism, rather than actual science. No one is blaming British folks for B.1.1.7, and hopefully no one is looking warily at South Africans for B.1.351 (though the word Africa is there, so I cannot promise anything). Why would you blame the Chinese people or other Asian Americans for the wild type virus? Unfortunately, the anti-Asian American sentiment has resurged. There have been multiple incidents in recent weeks of violence against Asian Americans, especially the elderly. I do not pretend to understand what motivates a person to knock over an elderly person of any race, for any reason, but I am here to state that it will not make a difference in COVID-19 spread, nor does it make one any kind of hero.
Below is a paper on the origins of the SARS-CoV-2 virus, discussing the investigation into the idea that it was created in Chinese lab, and refuting that claim. To put it simply, previous viral pandemics came from viruses that evolved naturally, and this is no different. China has little to do with the virus's origin (it's just biology), it is just where it was found first. This is where we actually need to talk about how we are all in this together. As I've said before, this pandemic proves that we as humans cannot afford to be so individualistic. We must consider others and do our part to stop the spread until more people can be vaccinated. Keep wearing your masks and stick to your bubble for now, please be kind to each other, and don't be racist. Links:
Daily Show segment on anti-Asian American hate crimes: https://www.youtube.com/watch?v=L9hJed6P4Hk
Origins of COVID-19: https://www.nature.com/articles/s41586-021-03291-y_reference.pdf