However, most people in rich Western countries like America-where demand for ivermectin, driven by advocates on social media, is so high that some people have resorted to taking the equine version of the drug-do not fit this description. The World Health Organisation also recommends ivermectin in this context. In July 2020 a group of doctors argued in the Journal of the American Medical Association that it was “reasonable to consider presumptive treatment with ivermectin for moderate- to high-risk patients not previously tested or treated for strongyloides”, and said that the risk of infection by the worms in covid-19 patients should be “based on factors such as country of origin and long-term residence”. “It treats parasites (shocker) that kill people when they get steroids that treat covid.” He concluded that “taking strongyloides endemic populations, putting them into a control group with corticosteroids is a death sentence”. “Ivermectin doesn’t treat covid,” Dr Bitterman wrote. This mechanism would explain why most studies conducted in places where strongyloides are rare showed no benefit from taking ivermectin. This would make it look as if ivermectin were preventing deaths caused solely by covid-19, when in fact it was preventing those caused by the parasites or by a combination of the two infections. But patients in control groups would be left at the worms’ mercy. In the groups who received ivermectin during trials, the drug would keep strongyloides in check. Covid-19 might already have weakened their bodies’ defences against the worms treating the coronavirus with corticosteroids would let the parasites run wild. In trials conducted in countries where the parasites are common, many people could have both covid-19 and strongyloides infections. And dexamethasone, a corticosteroid, is now a standard treatment for severe covid-19, because it prevents the immune system from going into overdrive and attacking the body’s own cells.īuilding on observations by David Boulware, a professor of medicine at the University of Minnesota, Dr Bitterman concluded that strongyloides may account for the conflicting results of studies about the effectiveness of ivermectin as a treatment for covid-19. Such “hyper-infection”, which is often fatal, becomes far more likely if a patient is receiving corticosteroids, which both suppress the immune system and appear to make female worms more fertile. However, they only pose a graver threat if their numbers grow out of control. Common in much of Africa, Asia and Latin America, strongyloides can cause, among other things, diarrhoea, fatigue and weight loss. Wading through the papers whose methodologies appeared sound, Dr Bitterman noticed that the studies that looked best for ivermectin tended to cluster in regions with high rates of infections by strongyloides, a parasitic worm. Ivermectin probably does help one subset of covid-19 patients: those who are also infected by the worms it was designed to fight. Could this many studies all be wrong? Recent analysis by Avi Bitterman, a dermatologist in New York, and Scott Alexander, a prominent blogger, suggests that the answer is nuanced. One well-documented website lists and links to 65 different papers on the subject, many of which, on the surface, seem to support this claim. Yet ivermectin’s advocates insist that there is solid science demonstrating the drug’s efficacy.
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