Aug. 31st, 2021

February postings were light. To discuss, go here: https://ecosophia.dreamwidth.org/145097.html?thread=18056905#cmt18056905 (updated Sept. 3)

Eduardo

February 2, 2021 at 8:53 am

The Lancet: Sputnik V COVID-19 vaccine candidate appears safe and effective.

IM DocFebruary 2, 2021 at 9:13 am
I will say I am personally much more comfortable with this approach to a vaccine.
Furthermore, one thing to note. Unlike the AZ Oxford approach which uses just one adenovirus vector, this Sputnik has two different doses each having a completely antigenically different adenovirus vector. There is always the chance the patient may already have immune exposure to one adenovirus and using two at different times mitigates that possibility.
The actual efficacy numbers are far more consistent with other vaccines making me feel better the numbers have not been gamed. And note this editorial is far more “just the facts” than the Pfizer and Moderna ones were in NEJM. It makes the reader feel they are not reading corporate propaganda.
And it appears they bothered to include people in the trial who were elderly and had comorbid conditions.
And these could be easily distributed on our existing ice cream cold chain transport systems.
Again, I would be much more comfortable to recommend this vaccine to my patients. I am just not sure I will have that opportunity.

IM DocFebruary 4, 2021 at 1:36 pm

Internist with boots on the ground.

Our vaccinated cohort so far in my area has been basically nursing home patients and workers, about half the medical staff, and now working through the 75 and up that want it. So not the general population.

I have frankly been stunned by the number of people who become COVID positive with symptoms within a day or two of the first dose. Many HCW and fully 25-30% of the nursing home patients. I do not believe this is related to behavior because these are mostly a captive audience still following protocols in the NH, HCW who are still under directives for PPE, and the 75 and up crowd I know are still taking things very seriously. This was such an issue that they tested all our shot-givers and all were negative.

In other words, we are not vaccinating thirtysomethings who then go out to party. Nor are the shot-giving personnel seem to be infected and giving it to the patients.

Again, this is a very clear pattern. Vaccine is given and within 2 days they are coughing or fevering and are COVID positive.

I want to reiterate – THERE IS NO WAY THAT COVID is BEING GIVEN TO PATIENTS BY THE VACCINE. Simply not possible. I am beginning to become increasingly confident that something is happening with the immune response and a process called viral reactivation. Some viral families like herpes do this for a living. This is known to happen in coronaviruses. Vaccine administration is one of the things that is known to cause this. As we know from the cycle threshold PCR tests, many of us have deactivated viral particles laying around the respiratory tract. Could they be being reactivated by the vaccine and its effect on our immune system? Unknown – but needs to be found out. This phenomenon would be consistent with that happening.

Interestingly, most but not all of these patients have a fairly mild case – some however are really ill. The more concerning thing is proceeding with the 2nd dose on time. Many of these patients in this situation become very very ill after that 2nd dose. I am advising people to wait for a few weeks and to put them all on aspirin to help with blood clots.

If this happens to you – becoming COVID positive after the first dose – please talk to your physician before that 2nd dose. Do not just blindly follow the timing of vaccinations dictated by the Health Dept or Walgreen’s.

Alternate DelegateFebruary 4, 2021 at 8:12 pm
Dear IM Doc, I ran the viral reactivation hypothesis past a geneticist of my acquaintance.
They think viral reactivation is an unlikely explanation in this case. Other vaccines consist of inactivated virus, but these new ones contain large amounts of RNA. The RNA could be causing false positive RT-PCR Covid test results.
Could the clinical symptoms, separate from the positive tests, be consistent with a reaction to the vaccine?

clarky90February 5, 2021 at 2:54 pm

The 1889–1890 flu pandemic, also known as the “Asiatic flu” or “Russian flu”, was a pandemic that killed about 1 million people worldwide, out of a population of about 1.5 billion.

https://en.wikipedia.org/wiki/1889%E2%80%931890_pandemic

I found this comment by “Dagan68” on The Market Ticker……

“I am a medical historian – I know what I am talking about. Go look up CORONAVIRUS OC43 – one of the 4 that circulate yearly as common colds. You can find this information online, far too much to go into here – but genetic sequencing and mutation analysis has made it clear – this virus emerged between 1887-1889. It just so happens that the biggest pandemic in the 19th century – started in 1889-1890. It was called the “Great Russian Flu” but when you read the symptoms – especially the neuro and cardiac ones – it is virtually identical to COVID. This was very likely the birthing of OC43. And like all pandemics, it did not cause what happened in the 1890s but it sure exploded the folly that was already going on. A huge economic panic/depression occurred, the railroads failed, the retailers failed, the anarchists became a major force leading to the assassination of McKinley later that decade, the British Monarchy was completely disrupted. The events of this economic crisis led directly to the establishment of the Federal Reserve. It was a big deal – that occupied the attention of the world.

But WE DO HAVE RECORDED HISTORY OF A CORONAVIRUS PANDEMIC – and I think there is another essential fact that we must begin to recognize. The pandemic of the 1890s came in 4 large waves – each lasting 12-24 months. It was not fully done until 1897 – and even today – elderly people die from this virus. Viruses like COVID tend to behave in a similar fashion as their family members.

These 1890s waves ended as if the virus fell off the cliff. Not unlike what we are seeing now. Then months/years later, like a thief in the night, would re-emerge with a vengeance – without rhyme nor reason.”

IM DocFebruary 5, 2021 at 6:10 pm

I actually attended a lecture earlier this fall about this very subject. It had always been thought that the “Great Russian Flu”, the largest pandemic of the 19th Century was actually influenza. There is no way to confirm with tissue samples. We only know what we know about the Spanish Flu of 1918 because bodies of Eskimos were literally frozen and the viral particles preserved. We know of no Eskimos from the 1890s.

It turns out very creative viral work was done and completed in the past few years. This coronavirus OC43 was found to have likely emerged from cattle right before this pandemic in the 1890s. The symptoms as this writer states are indeed much more consistent with COVID than any flu. Especially problematic for the flu diagnosis are the severe neurologic issues that occurred in the 1890s: fatigue, insomnia, headaches, inattention. Sound familiar? And it lasted for months. Again, sound familiar?

We will never know for certain unless actual tissue is found. However, it is very likely this virus was the 1890s culprit. Furthermore, the coronavirus wave pattern discussed is quite germane to our current situation. Is COVID going to be like SARS-2003 and just completely disappear after the first wave? Or is it going to be more like OC43 and come back even worse after months of complete quiet? And what will our vaccine efforts have done?

The history of that decade was quite tumultuous. Pandemics are often the thing which rips the veil off systemic societal problems. They very rarely are the cause.

The speaker in the lecture that I attended this fall brought up a very fascinating topic about the 1890s that may have everything to do with the OC43 virus. Sir Arthur Conan Doyle was almost assuredly infected with this virus – having severe cough and fever – followed by chronic lifelong headaches and insomnia. He wrote about how ill he was in some of his journals. And the speaker showed several examples where these symptoms were “gifted” to both Sherlock Holmes and Dr. Watson in the canon. I seem to remember a passage where Dr. Watson referred to this illness specifically.

This post contains much of March 2021's comments. Next, there's a long conversation related solely to ivermectin that's potentially worth saving in entirety.. still debating whether or not that's a good idea, but doing so would put IM Doc's comments in the full context. Comments are open here.

Isotope_C14March 20, 2021 at 7:40 am

“AstraZeneca: German team discovers thrombosis trigger DW (David L)”

Is it Heparin? They won’t say in the article. My bet is heparin. (Not the trigger, but the cheap treatment)

Supposed to get AZ on Wed morning. Last weeks vaccinations that were supposed to be done in Berlin were rescheduled for this week. My research group, by Wed will be 100% first dose AZ, with followup doses in June.

Case count is up to almost 100 per 100k in Berlin, Thuringia is still awful at over 200 per, and a lot of other German regions are above 100 per.

For those that think “German efficiency” is a thing, it is just hard-work propaganda. This place is terrible at doing anything besides generating paperwork.

Vaccine rollout has been done in perfectly German style…

IM DocMarch 20, 2021 at 8:46 am
My understanding from other literature – that it is bridging with LOVENOX ( unfractionated heparin) or plain old-fashioned subcutaneous heparin at therapeutic dosing for a few days – then either XARELTO or ELIQUIS for as long as deemed necessary. ( Needless to say, none of these drugs have been approved for this usage).
I have done this a few times, with patients who have any history of blood clotting issues (factor v leiden, etc.) , unexplained deep vein thrombosis or pulmonary emboli who have received ANY of the COVID vaccines. Early on, I had a few people who developed blood clots (so far just DVT thankfully) around the time of their injections. But have also had a few who had atherosclerotic events immediately around their vaccine (very unclear if this is correlative).
This is another reason why I am concerned about the football stadium parking lot approach to these vaccines. There are any number of people who really should be talking to their physicians about potential problems. Of course, that would assume their physician has a clue about what the side effects even are. There are so many who are just on auto-pilot – Vaccinate everybody – and Vaccinate NOW!!!
1. Isotope_C14March 20, 2021 at 9:26 am
  Thank you for your well informed response IM Doc!
  What is your take on the MMR 2 correlation (Titer of mumps) vs. COVID symptom severity?
  https://mbio.asm.org/content/11/6/e02628-20
  ^ this link was found by user name Cojo
  https://asm.org/Press-Releases/2020/November/MMR-Vaccine-Could-Protect-Against-COVID-19
  I’m fascinated by this, and the fact that this is an already established safe vaccine that could be used at least to mitigate symptoms, especially in the case of older folk, that probably didn’t get MMR due to the fact that they were children at a time when the vaccine didn’t exist, and therefore didn’t get it.
  1. IM DocMarch 20, 2021 at 11:32 am
    I have looked into this question. I do not think we have enough data one way or the other to make valid assertions. It is an interesting concept – and very unclear how that mechanism would work – but we just do not know enough. Like many other things in this pandemic, I am certainly hoping someone somewhere is really looking into this in a way that will clarify the answers.
    1. Isotope_C14March 20, 2021 at 3:34 pm
      Thank you for your reply!
      I’m reasonably sure that as there is no financial gain in answering this question, and that the Ferrengi that run the show will make sure we don’t have an answer any time soon.
      I suspect looking at the numbers in Argentina in the next 2-3 months may be informative, since they are deploying this vaccine there – at least according to my co-worker who has a mother and sister there who were both vaccinated with MMR 2 in the last 2 weeks.
      I thought the “Western Democracies” would love to help the global south, but apparently that isn’t the case.
    2. Three SkiesMarch 20, 2021 at 5:05 pm
      IM Doc, Dr. Robert Gallo discussed the Oral Polio vaccine’s possible benefits
      too. https://www.youtube.com/watch?v=rHvV81ZB-fk. The Gallo part starts at 40:00.
      He touches on the politics of the funding of the research.
      1. CuibonoMarch 20, 2021 at 11:25 pm
        Sad that NIH shot Gallos line of investigation down…but we have mRNA so all good
    3. CuibonoMarch 20, 2021 at 11:27 pm
      here is an interesting look into this SORT of question from a broad view:
      https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30742-X/fulltext
2. CarlaMarch 20, 2021 at 9:55 am
  IM Doc — given the recent information (in CNN link above, and elsewhere) about low-dose aspirin apparently being somewhat protective against infection with Covid-19, and also protective against severe disease, do you think it possibly wise for adults to take low-dose aspirin for one or more days before receiving Astra-Zeneca or any other Covid-19 vaccine?
  1. IM DocMarch 20, 2021 at 11:30 am
    I often recommend this – especially patients with known history of any kind of arterial disease. It is NOT going to hurt them in any way – and it may prevent some of these rare but known problems from happening. I view that as a WIN-WIN.

IM DocMarch 20, 2021 at 8:36 am

With regard to the progesterone/COVID link. [https://www.dailymail.co.uk/sciencetech/article-9381227/COVID-19-Injecting-MEN-female-hormone-progesterone-reduce-infection-severity.html]

As an internist, this has been something I have grappled with for about the past 10 years when this phenomenon appeared out of nowhere out of the ether.

I think most people would be absolutely shocked if they knew how many middle aged women were being placed on TESTOSTERONE for very flimsy reasons. The testosterone dosing is often much more than I would dream giving a male patient with documented low testosterone levels.

The testosterone is often given with rather large doses of estrogen and even bigger whopping doses of adrenal hormones. I have never really understood what is the purpose behind this – other than many believe it makes them “feel better”.

Needless to say, this regimen completely negates any effect progesterone would have, not only on COVID but many other things. It also puts these women at extreme risk for many other medical problems – situations which I have seen with my own eyes repeatedly.

And the medical profession looks down the nose on physicians who are using ivermectin for COVID off label while this is going on all around them.

Sometimes, I wonder what is happening to my profession

Robert HahlMarch 20, 2021 at 10:01 am
Twenty years ago it was popular to put post-menopausal women on Prempro, a mixture of estrogen and progesterone, ostensibly to prevent bone loss and heart attack, but really to improve sexual performance (citation: personal communications from my wife). The Nurses’ Health Study spoiled all that, by showing Prempro gives no benefit for heart or bone, and the whole business dried up for American Home Products almost overnight.
Now, it well known that testosterone makes women horny (cite: id). It seems to me that the only mystery here is what doctors claim to be prescribing it for, not why.
1. graysladyMarch 20, 2021 at 10:39 am
  Every woman has natural testosterone–levels vary, and blood tests are not the best method of finding out if you have the correct amount. Testosterone definitely plays a part in overall balance for mental health and it doesn’t have to do with sex drive; it has to do with aggression. When I first started HRT for menopause, many years ago (I only ever used bioidentical estrogen), I became unable to cope with small life disruptions that I would previously have tackled handily. My doctor added a small amount of testosterone to my program and it made all the difference. We agreed that I could chop the tablets in half until I found the right level–an approach I recommend, since a little goes a long way.
  Unfortunately, bad products from big pharma and the resulting studies that frightened doctors away from recommending HRT have left many menopausal women miserable. Anti-depressants are the worst thing that can be prescribed since they, inevitably, don’t work. The mental issues have to do with hormones, not serotonin re-uptake. A certain amount of testosterone is important for women, but getting to the right level is something that needs to be worked out between the woman and her doctor. For some women, it can take years for the body to readjust after menopause, so any program should be monitored annually for correct hormonal balance.
  1. IM DocMarch 20, 2021 at 11:28 am
    I completely understand what you are talking about – and it is a genuine problem. Many post-menopausal women are miserable. And that is my concern about any of these hormone approaches – too little attention is paid to what it is doing to the patient over time and the follow up is often atrocious. In many of our big cities, this is being done in strip mall fly by night kind of clinics. And that leads to tragedy – which is often what I see. And to my point above – the whole issue about the protective effect of progesterone is completely obliterated in these patients – their own native progesterone production could never compete with the often godzilla sized doses of testosterone, DHEA, and estrogen.
    When I give a patient any medication for a non-approved indication, I tend to be very careful.

ambritMarch 24, 2021 at 2:37 pm

This is not a standard ‘flu.’ It has a ‘long covid’ component that has just been seen and not analyzed yet. Why? Because we are just at the beginning of this new malignancy. If ivermectin does constrain the extent of damage the ‘long covid’ component of the disease inflicts, then it is going to be important for future complications, social cohesion, economic productivity, etc etc.
Plain old ivermectin is now in the generic stage of life. I would not be surprised to see Big Pharma try to steal ‘rents’ from the public for a reformulated ivermectin.

Lambert StretherMarch 24, 2021 at 2:40 pm
> I would not be surprised to see Big Pharma try to steal ‘rents’ from the public for a reformulated ivermectin.
Good point. Patented, if possible.
1. BaldandersMarch 24, 2021 at 3:19 pm
  “Merck, known as MSD outside the US and Canada, markets ivermectin as Stromectol for human use to treat onchocerciasis and intestinal strongyloidiasis. In a 4 February press statement Merck noted that its own analysis revealed “No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies,” as well as a lack of “meaningful evidence” for clinical activity or efficacy in patients.
  Merck also cited a “concerning lack of safety data in the majority of studies.” Both EMA and FDA noted that clinical trials are ongoing examining the use of ivermectin for prophylaxis or treatment of COVID-19.”
  Might be difficult to do after those statements..
  https://www.raps.org/news-and-articles/news-articles/2021/3/no-ivermectin-for-covid-says-ema
  1. CuibonoMarch 24, 2021 at 4:49 pm
    yeah, the Merck statement really changed my mind.
  2. pjayMarch 24, 2021 at 5:00 pm
    >“No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies,” as well as a lack of “meaningful evidence” for clinical activity or efficacy in patients.
    So what is “meaningful evidence” here? What do we mean by a “scientific basis”? Are none of the data from the clinical observations by highly qualified medical professionals listed in Lambert’s six articles above “meaningful”? Why not? And are “large randomized clinical trials” the *only* basis for making “scientific” claims here? Or more importantly, the *only* legitimate basis for considering a potentially promising treatment that is at the very least safe (the misleading implications about dosage in this article to the contrary)?
  3. IM DocMarch 24, 2021 at 5:34 pm
    I would let everyone know that Merck is also in the final stages of approval for a brand new oral anti-COVID agent – that will possibly be hitting the market soon – assuming it is approved.
    This downplaying of other drugs like this, especially in your own company’s arsenal, is standard operating procedure in the pharma industry. The difference now is it is being played out for the world and not just the medical community. I have seen this repeatedly done over the years.
    They will do everything they can not to cannibalize the market for their new, expensive upcoming agent – if that includes torpedoing their older drugs – so be it.
    They are all pretty much total slimeballs.
    As far as safety – it has literally been given over the years in multiple billions of doses – and has a vanishingly small side effect and complication profile. Much less problematic than things like remdesevir or even these vaccines. I have not a clue what they are talking about there. I have seen no studies with any kind of safety issues elucidated.
    It has worked amazingly well for my patients. I have had a marked drop off in people being admitted to the hospital. If our government agencies forbid its off-label use for COVID – they are really going to open up an entire can of worms. The common uses of dozens/hundreds of drugs in an off-label manner is staggering. The FDA simply cannot take the risk to forbid JUST ivermectin for off-label use.

[at this point there were a few non-Covid comments on disparate days. Not included here because not relevant.

the following, while not Covid-specific, is of medical-care interest, so I include it here]

fresno danMarch 26, 2021 at 6:17 pm

Whoo Hoo! Finally took possession of my special medicare decoder …uh, code. And the suicide pill in case Putin tries to get ahold of it – OK, there was no suicide pill – I just have to kill myself with whatever implements are handy.
Only one case today. A couple, who worked for Kaiser, had retired. They couldn’t understand why they were paying 148 dollars to medicare Part B when they had Kaiser insurance (the health insurance they had held their whole working careers). Kaiser does apparently have retiree health insurance for some of its “higher end” employees. I doubted that these clients qualified. So I went through the whole process of generating medicare.gov website user names and passwords, and it was as I suspected. Kaiser was no longer insuring them as employees (because they were now retired), and Kaiser was not insuring them as retirees. The pair were insured under a medicare advantage plan, which in this case happened to be a Kaiser medicare advantage health plan. Easy to understand how the clients would think they were still being insured by Kaiser, and that the medicare premium wasn’t actually paying for anything.
This confusion about advantage health plans being medicare is a rather common problem.

floraMarch 26, 2021 at 6:48 pm
Interesting that Kaiser or who ever enrolled them in Advantage plan without their input, instead of letting them decide for themselves whether to enroll in an (so-called) Advantage Plan (so-called) instead of into a traditional Medicare Medigap “Part” plan. The confusion seems by-design to benefit the private insurance companies, imo. (As you know, the $148 dollars is probably the Medicare Part B premium that applies to everyone, usually auto-deducted from the retiree’s SS monthly payout. (so-called Advantage Plans (so-called) don’t eliminate the traditional Medicare Part B requirement.
1. floraMarch 26, 2021 at 6:56 pm
  adding: your clients will have to now wait until next Jan-March to change back to a tradtional Medicare Medigap plan if they so desire.
2. IM DocMarch 26, 2021 at 8:22 pm
  You would simply not believe the huge number of patients that are on “Medicare Advantage Plans” – end up having a stroke, broken hip, etc., and then need to be admitted to a rehab unit for further care.
  EXCEPT – Medicare Advantage Plans – almost universally do not pay for Rehab units – or SNU care. Seriously – not making this up.
  So the hospitals cannot send them home – and I have had any number of patients either get rehab as an inpatient in the hospital – or WAIT until the 1st of the month when they can change back to regular Medicare and go to the rehab unit.
  It is all a big joke – and all a big scam – to skim funds off of people’s Medicare benefits to fund the multimillion dollar executive salaries. When this started to happen about 8-10 years ago was when I knew in my heart the whole system had jumped the shark.
  Seniors – if you are having to be bribed to sit through a presentation with a steak dinner – you are by definition the chump in the transaction – please please do not sign up for these things – they are a complete disaster when bad things really happen to you.

IM DocMarch 29, 2021 at 11:01 am

We hear alot about the Flu of 1918. This is a very bad analog for our current issues for any number of reasons.

There is indeed an analog that we can look back to – the “Russian” or “Asiatic” flu of the 1890s. From its inception – the physicians of the day realized that it was much different than any other influenza – read William Osler’s first textbook of internal medicine in the flu section written in the first decade of the 20th century for an idea on that. And it almost assuredly was not a FLU or influenza at all.

Modern research and genetic/virology studies have shown it almost assuredly was Coronavirus OC43 – that is still floating around with us today.

More than 100 years after the initial pandemic, this organism causes upper respiratory infections in millions/billions every year, and is responsible for the deaths of hundreds/thousands globally each and every year – mostly old and infirm.

The organism had its way with humanity in the 1890s – coming back wave after wave after wave – likely representing variant drift until we as a species and the viruses settled into a new relationship and a new reality.

Humanity did not know what viruses even were then – this illness was blamed on “Miasma”. But they tried everything known to medicine at the time to stop it – social distancing, quarantines, recuperation facilities, even masking (to a much smaller degree than we are now) and NOTHING worked.

But things eventually settled down. But not without the social, political and economic chaos that almost always accompanies pandemics.

I am afraid this is where we are today. Unlike the 1890s, we have the possibility of anti-virals and the possibility of vaccines ( the jury is still out on both – the verdict on the vaccines will be coming in the next few months – again the studies showing case number reduction is what we have – and is worthless – morbidity, hospitalizations and death are what are important – and the data there is completely unclear ).

One thing is for sure – this is going to be an interesting ride the next few years.

I discuss with my patients dozens of times daily – the things we know will help – GET LESS FAT, GET LESS DIABETIC, EXERCISE like a FIEND, VITAMIN D , SUNSHINE and plenty of sleep.

And we as a society – must somehow find ways to begin tried and true public health issues – like vigorous testing and quarantine. We have had a clear fail on this up until now.

Buckle up and be safe everyone.

EdwardMarch 29, 2021 at 6:02 pm

Russia may have developed a terrific Covid vaccine, CoviVac. RT reported on this vaccine recently:

https://www.rt.com/russia/517024-russia-third-vaccine-dead-virus/

…The vaccine is based on the most traditional technology that has been around for a long time and is widely used throughout the world, Aidar Ishmukhametov, the director general of the Chumakov Scientific Center, told RT.

“Globally, almost 100% of vaccines contain either deactivated or live pathogens,” he said, adding that the one developed by his center contains an ‘inactivated’ (dead) coronavirus. This type of vaccine simulates a natural infection process, introducing the immune system to the virus and “teaching” the body to fight the pathogen without the risk of it spreading through the body and causing disease, he explained.

…“Since we are talking about a whole-virion vaccine, the deviations in the genetic sequence – something one is calling different strains or different variants – are insignificant and amount to less than one percent. So… it would be weird to think that a whole-virion vaccine might fail to work against new strains, considering how small the differences are,” he said.

CoviVac received national approval in Russia while still in the second phase of clinical trials. It now has to go through the third phase so the developers can precisely assess its effectiveness, according to Ishmukhametov. However, the first trials have already shown that it has no side effects, he said.

“The most important thing is that at this point we have a vaccine that definitely has no side effects,” he said, adding that, out of 300 volunteers, none reported any symptoms except for occasional soreness around the injection site.

**********

Unfortunately, CoviVac probably won’t be available in the U.S.

IM DocMarch 29, 2021 at 6:36 pm
I would take that vaccine in a flash if it were available here – and I would be encouraging all around me to do so.
I do not have the same feeling about our current options – and have wondered why we are not working on something similar to this.
And you are right – Hell will freeze over before a Russian vaccine is available here. Especially if folks like Rachel Maddow are still allowed on the national airwaves.

IM DocMarch 29, 2021 at 2:34 pm

With regard to the CDC chief almost breaking down in tears.

I am very likely what would be called old school. I embrace that.

I have been rather perturbed all year by the physicians and nurses and health care workers going on the national news and breaking down in tears. That is of course in between production of TikTok videos, many of them done in crowded hospital areas – WITH PATIENTS WAITING FOR CARE WATCHING THE FESTIVITIES.

The very first rule of public health is that fear and panic are the primary enemies. I learned that as a very young physician in the middle of the AIDS crisis – we were allowed to grieve and weep all we wanted in private but to do that in front of patients was unthinkable. It is an age old trait in excellent physicians that is called equanimity. You must be seen as the captain of the ship – no matter how bad things look, patients and their families are looking at you to keep your cool and be strong. The founder of my own specialty, Sir William Osler, penned a very famous graduation speech about this very subject – Aequanmitas – if anyone is interested. I may be forced to send a copy to the CDC after today’s performance.

My now long-deceased Chairman of Medicine must absolutely be doing RPMs in his grave – despite the heroic actions by many, it has been a very poor showing by medicine all year for those to vent for all to see. Thankfully, none of my residency colleagues and certainly none of my years of students have been involved in this display.

Again – I quote the Jedi Master Yoda –

Fear leads to suffering, suffering leads to anger, and anger leads to death.
Fear is the first step on the way to the dark side of the Force.

Riverboat GramblerMarch 29, 2021 at 5:29 pm
Ready good comment, but if I may quibble on behalf on the green puppet: “Fear leads to anger. Anger leads to hate. Hate leads to suffering .”
1. IM DocMarch 29, 2021 at 5:34 pm
  You are correct about the comment –
  I should really learn not to do things on the fly – I am getting too old.

Very nearly this entire post and comments section https://www.nakedcapitalism.com/2021/03/its-time-to-talk-about-ivermectin.html are relevant to the topic at hand and IM DOC's comments are embedded deeply within and are pertinent to much of the article and ensuing conversation. Sorry, this is long - and it gets weirdly and incurably narrow for a while there. Comments are open.

It’s Time To Talk About Ivermectin

Posted on March 30, 2021 by Nick Corbishley

I’d like to start this article with a couple of disclaimers and a caveat. First of all, I am not a medical doctor. This article is not intended as medical advice. It’s a layman’s account of how an extremely cheap, safe and widely available off-patent medicine called ivermectin appears to be saving the lives of countless Covid-19 patients across Latin America and beyond. Yet hardly anybody is talking about it.

Here’s the caveat: The first section of the article, which was completed on Friday, is about Mexico City’s recent deployment of ivermectin in its fight against Covid-19. On Saturday, Mexico’s Ministry of Health jacked up its total excess death count due to Covid (for the whole country) by 60%, from 182,000 to 294,000. However, most of these deaths took place before Mexico City began using ivermectin as part of its its test-and-treat approach to Covid.

Covid-19 vaccines are reaching most emerging and developing economies in only drips and drabs, with a few notable exceptions such as Chile. In many countries, locking down entire cities or regions and paying millions of non-essential workers not to work while front-line doctors and nurses battle to contain the virus is not an option. There simply isn’t enough money available. This has left doctors and health authorities with little choice but to try out cheap, widely available generic medicines. Those drugs include ivermectin, a “well-studied, well tolerated,” (in the words of a 2013 FT article) off-patent anti-parasitical.

The results have been extremely promising, according to almost all of the clinical studies conducted thus far. Many of the studies took place in Latin America where around half of the countries in the region have used or are using ivermectin to some degree or another. A meta analysis of 42 clinical trials, involving approximately 15,000 patients, found that 83% showed improvements with early treatment, 51% improved during late-stage
treatment and there was an 89% prevention of onset rate noted. Yet the studies have received scant attention in more advanced economies — so much so that the vast majority of the people I talk to here in Europe have still not even heard of the medicine.

Bucking the Trend

On December 29th of last year, Mexico’s Institute of Socal Security (IMSS) allowed ivermectin to be prescribed to outpatients with Covid. On the same day the Secretariat of Health of Mexico City and the State of Mexico decided to adopt a protocol in which anyone testing positive at any one of the city’s 250 rapid testing sites would be given ivermectin. As you can see in the graphs below, courtesy of Juan Chamie, a data scientist from EAFIT University in Colombia, based on data provided by Mexico City authorities, the number of hospitalizations due to Covid and excess deaths peaked shortly after the New Year and have been falling sharply ever since. They are now almost back to their prior base line.

Mexico City is the first major global city to adopt what amounts to a test-and-treat approach to covid-19 involving ivermectin. But it was the largely indigenous southern state of Chiapas that led the way last summer. In July 2020, as Mexico was buckling under its first wave of the pandemic, the state decided to distribute ivermectin as a Covid-19 treatment, having already deployed the medicine in its battle against mosquito-borne RNA viruses such as Zika and Chikungunya. Since October Chiapas has consistently occupied the lowest risk level on the federal government’s coronavirus stoplight map.

Thanks to ivermectin’s apparent success in Chiapas, IMSS allowed the medicine to be prescribed nationwide. It also helped launch the pilot program in Mexico City, for which it received a barrage of criticism. An official group of health experts argued that there’s no scientific evidence that the drug is effective, and called for the immediate repeal of its use. To their credit, both the Secretariat and IMSS have stuck to their guns.

Playing With Lives

Of course, there’s no way of definitively proving that the rapid falloff in hospitalizations and deaths, first in Chiapas and then Mexico City, is due to the use of ivermectin. Correlation, as we well know, is not causation. It’s also true that Mexico City authorities have introduced tougher social distancing measures and travel restrictions since December. But similar dramatic drop offs have been witnessed in other regions and countries where ivermectin has been used widely, including across the length and breadth of Peru and Iran as well as parts of Brazil, Paraguay, Bolivia, the Dominican Republic and India.

In Peru, ivermectin was used in eight states during the very early stages of the pandemic (May-July). Its use was then extended to the whole country except Lima, which did not start deploying the drug until months later. For the 24 states with early IVM treatment (and Lima), excess deaths dropped 59% (25%) at +30 days and 75% (25%) at +45 days after day of peak deaths. But in October, after the first wave had been brought under control, the new government in Peru took the inexplicable step of withdrawing a number of medicines, including ivermectin, from its treatment guide for the disease. Within weeks hospitalizations and deaths were soaring once again.

The following graph, taken from a study by Juan Chamie, Jennifer Hibberd of the University of Toronto and David Scheim of the US Public Health Service, shows the sharp rise, fall and resurgence in excess deaths (among the over 60 year-old cohort) in Peru as the virus waxed, waned and waxed again. Between August and December case fatalities dropped sharply in all states but Lima, yet six indices of Google-tracked community mobility rose over the same period, before rising once again. In other words, the treatment appeared to be working even as the country reopened.

In the Brazilian city of Belem authorities began using ivermectin way back in June 2020. Since then the city has managed to escape the massive surge in covid-related deaths that has plagued Brazil since early November, as the graphic below shows. In another study a like-for-like comparison of cities in similar regions of Brazil showed that the cities that began distributing ivermectin in June last year were, by September, registering much lower case counts than those that didn’t.

Imagen

Iran has also seen a sharp fall in covid-related deaths since late November followed by a flattening of the curve. Earlier that month the country, with a similar population to Germany and an urban population density twice as high, succeeded in gaining the technical knowledge to produce ivermectin and began distributing it to hospitals in the country.

Imagen

What is Ivermectin?

First discovered in 1975 and launched onto the market in 1981, ivermectin is a safe, broad-spectrum anthelminthic drug registered for the treatment of a number of neglected tropical diseases (NTDs) including river blindness (onchocerciasis), strongyloidiasis, trichuriasis, ascariasis, and lymphatic filariasis. It is also used widely in veterinary medicine. In recent years it has been discovered to have strong anti-viral properties against RNA viruses such as zika and yellow fever. In its use against river blindness in Africa it is estimated to have prevented 7 million years of disability.

The medicine is not only extremely effective in treating a broad range of illnesses, including RNA viruses; it is also well tolerated. To date, more than 3.7 billion doses have been distributed with an excellent safety profile. Most adverse reactions are mild, transitory and associated with parasite death rather than with the drug itself.

“The reason why this medicine is distributed in Africa not by doctors and nurses but mainly by volunteers is that it is extremely safe,” says Japanese microbiologist Satoshi Omura, who jointly with the Irish parasitologist William C. Campbell, led the team that isolated a strain of Streptomyces avermitilis that produce the anti-parasitical compound avermectin, the active ingredient in ivermectin. Omura and Campbell were awarded the Nobel Prize for Medicine in 2015 for their discovery.

Dr. Omura himself believes there’s already enough evidence of the benefits of ivermectin against Covid-19 for it to be granted approval as a therapeutic. One of its biggest benefits is that it appears to work in the early stages of the disease, he co-writes in an article published earlier this month in the Japanese Journal of Antibiotics:

“Currently, there are no therapeutic agents available for mildly ill patients who are being treated at home (or in self-isolating accommodations) or for moderately ill hospitalized patients. Nothing is as helpless as a disease without a cure.”

Anti-Viral, Anti-Inflammatory, Anti-Long Haul

Another major ivermectin proponent is the Frontline Covid-19 Critical Care Alliance (FLCCC), which has been trying to repurpose medicines already on the market for the treatment of Covid-19. In October it created the I-MASK+ protocol for prevention and early outpatient treatment, which includes ivermectin, vitamin D3, vitamin C, zinc, melatonin and quercetin.

The FLCCC believes that ivermectin is not only “one of the world’s safest, cheapest and most widely available drugs,” it is also the most effective against Covid. “The studies we presented to the NIH revealed high levels of statistical significance showing large magnitude benefit in transmission rates, need for hospitalization and death,” says Dr. Pierre Kory of the FLCCC, who twice gave testimony to the US Congress on Covid-19.

Besides the dozens of clinical studies conducted so far on the efficacy of ivermectin against Covid, the FLCCC also cites “natural experiments” in Peru, Brazil, Paraguay, the Dominican Republic and Mexico where ivermectin was distributed widely, with “large decreases in case counts … soon after distribution began.”

Another recent convert to the cause is Dr Alessandro Santin, a renowned cancer researcher who runs a large laboratory at Yale. Santin believes that ivermectin is a game-changer that could significantly reduce Covid’s toll on human health.

“The bottom line is that ivermectin works. I’ve seen that in my patients as well as treating my own family in Italy,” Santin said, in reference to his father, 88, who recently suffered a serious bout of COVID. “We must find a way to administer it on a large scale.”

In an interview with Italian daily Il Fatto Quotidiano, Santin explains why he believes ivermectin is so effective against Covid:

Its powerful anti-viral properties: “The theory behind the main mechanism of action is that ivermectin attaches itself to Sars-Cov2’s Spike1 protein as well as at various strategic points used by the virus to bind and enter our cells. This is why it can also work against variants, unlike monoclonal antibodies.”
Its anti-inflammatory activity: “Ivermectin has a powerful anti-inflammatory effect similar to that of cortisone. But unlike with cortisone, the effect is not immunosuppressive. Therefore the immune response of both T cells and B cells (producing antibodies) continues to function under ivermectin, acting on the transcription factor NF-KB (which informs our body to produce cytokines and causes a real cytokine storm when hyperactivated by Covid). This is why the drug also works well during the advanced phase of the disease”.
It even seems to help long-haulers: “I have treated and am treating ‘long haulers’, including people who have been sick for a year and who do not breathe well, who have tried out everything to no avail. Within two weeks of starting them on ivermectin… these people have started to live again, with practically no side effects. The virus is an intracellular parasite; only if it enters our cells can it use the cellular machine to replicate. If it can’t get in and hack our immune system, then it stays out on the doormat and gets attacked by our immune system much more easily.”

More Evidence Needed, Say Regulators

Yet despite the growing body of evidence supporting ivermectin’s therapeutic effects against SARS-Cov2, national and supranational health authorities, particularly in more advanced economies, are dragging their feet. The European Medicines Agency (EMA) concluded this week that the available data “do not support its use for COVID-19 outside well-designed clinical trials”. The decision comes just two months after Slovakia and Czechia became the first EU countries to approve the temporary use of ivermectin against Sars COV-2.

In the US Ivermectin is not yet FDA-approved for the treatment of COVID-19, but in January the NIH changed their recommendation for the use of ivermectin in COVID-19 from “against” to “neutral”. This is a major step forward. As a result, doctors are at liberty to prescribe ivermectin for Covid patients.

But most regulators and expert panels insist that definitive proof is still lacking, despite the abundance of real world data, and have called for randomized placebo controlled double blinded studies. But that is time consuming and time is a luxury most doctors and their patients can ill afford right now. As covid continues to rage and patients continue to die, growing numbers of doctors feel that the risk of doing nothing, particularly in the early stages of the illness, significantly outweighs the risk of doing something — especially if that something has already been shown to work across multiple trials and real-world experiments.

“Clinical trials take time, but because of the abundance of overseas data, it may not be necessary to conduct clinical trials in Japan,” says Omura. “Experts have shown the numbers and announced that they are working. Therefore, I would like [the Japanese health authority] to grant it special approval. If you do not use it here, what is the special approval system for? Some people will die if they are waiting for a clinical trial.”

According to a WHO-sponsored review and meta-analysis of 18 clinical studies, the drug could cut the number of deaths from Covid-19 by as much as 75%. Crucially, some of the studies suggest that it is effective not only as a treatment in the early and later stages of the virus but also as a prophylactic. Yet the conclusion of the WHO-sponsored review is that more studies are needed.

Contrast this with the FDA and EMA’s mad rush to approve the anti-viral medicine Remdisivir for use against SARS-CoV-2 last October, despite the medicine’s lackluster performance in clinical studies and unproven safety record. On October 15, results from WHO’s Solidarity trial suggest that remdesivir does not even reduce mortality or the time COVID-19 patients take to recover. Yet a week later the FDA approved the drug for use against SARS-CoV-2 in the US, becoming the first drug to receive that status.

With a five-day course of treatment costing around $2,600 per person, there’s a lot of money to be made for remdesivir’s manufacturer, Gilead. Once remdesivir was approved in the US and the EU, it set off a cascade of approvals across the world, including in countries such as Brazil and Mexico whose public health systems cannot possibly afford to administer it on a large scale. In this case that is a good thing given how ineffective the drug appears to be.

Meanwhile, a Nobel-prize winning medicine that has been used extensively for four decades and costs just a few dollars per course of treatment could prove to be one of our best lines of defense again covid. Time and again it has been shown to work. Yet for the moment most health authorities in advanced economies — and quite a few in less advanced ones (South Africa, the Philippines, Peru…) — do not seem to be interested. In the coming days the World Health Organization is expected to come out with a definitive recommendation for or against ivermectin. If it opts for the latter, the pressure on doctors to stop using it will only increase.

John SimanMarch 30, 2021 at 10:13 am
John Day, M.D., “Treat Your Own COVID” — article in The Automatic Earth:
… Ivermectin has a remarkably broad safety profile, and has been served up about as many times as McDonald’s hamburgers, to man and beast alike, for various forms of worms and parasites. It does cause birth defects in rats, when given at high doses, so don’t use it in pregnancy, please. Like most medicines to treat coronavirus illness, ivermectin does different things against the virus, than it does on regular days. Ivermectin inhibits the transport of the viral RNA into the cell nucleus, where it would be transcribed, manufacturing new viruses. It does other things, like reduce inflammation during cytokine-storm, in the second and third weeks of illness, helping the people who get really badly sick. Ivermectin is effective in prophylaxis, in early illness and also in later, severe illness, and through multiple mechanisms. Ivermectin is what I prescribe since last August.
Ivermectin is now available mail-order from India, and from a reliable source. https://www.medicinesdropshipper.com/antiparasitic-drugs.html#iverlast-12mg-tablet
The preventive, “prophylactic” dose of ivermectin is based upon body weight, and it can be taken weekly, once an initial level inside of the cells is established. Ivermectin leaves the cells very slowly, so it can just be topped-off once per week. There are some slight variations on this, but I’ll describe the one I prescribe. It uses the same body-weight dosing that you will find wherever you look up ivermectin dosing for humans or animals. For every 5 kg, or 11 pounds of body weight, a person takes 1 mg of ivermectin at that dose. For most people I treat, that is 12 to 18 mg of ivermectin per dose. For COVID-19 prophylaxis, this dose is taken Day #1, Day #2 and then every seventh day after that. If you forget, take it when you remember, and get back to the original schedule after that….
https://www.theautomaticearth.com/2021/02/treat-your-own-covid/
Steven J Kunasek IIIMarch 30, 2021 at 10:50 am
I learned about ivermectin’s use for Covid from Chris Martenson at Peak Prosperity at least six months ago. Through him I also became aware of Dr. Pierre Kory and Paul Marik at Frontline Covid-19 Critical Caregiver’s (FLCCC). They were using ivermectin clinically and were having great success. Dr. Tess Lawrie at Evidence-Based Medical Consultancy in Bath, England became aware of ivermectin when she watched Dr. Kory’s testimony at a Senate sub-committee hearing. She and her staff took it upon themselves to do a meta-analysis of ivermectin and found that it was significantly effective for all stages of Covid and as a prophylaxis. At the same time, the World Health Organization hired Dr. Andrew Hill at the University of Liverpool to do a meta-analysis of ivermectin which is now completed. WHO is supposed to be issuing a statement concerning ivermectin shortly.
I visit Naked Capitalism everyday and would notice an occasional article about ivermectin in the Links or Water Cooler. But I was disappointed that no major article on ivermectin was forthcoming. Until today. Nick’s article is excellent. The cat is now out of the bag. Evidence from around the world is showing that ivermectin is safe and effective against Covid-19.
1. Lambert StretherMarch 31, 2021 at 4:38 am
  > Dr. Tess Lawrie
  Lawrie article (not peer-reveiwed) and video interview. Here is Lawrie’s company.
IM DocMarch 30, 2021 at 10:51 am
I believe this post and the comments are perfectly emblematic of unfortunately where my profession is and where my country is. I have to admit, I would have never dreamed this possible just 10 years ago.
I will start by quoting one of my medical professors years ago when I was an intern….You have to imagine it in a very hard Danish accent….”Young man, if research or scientific findings make you angry in any way, you must immediately examine yourself. You are by definition not practicing science or medicine, you are practicing dogma. You must put down your test tubes and go to the nearest closet and in private examine your soul.”
I have thought of this old man often this past year – and the tenor of some of these comments have brought him yet again to mind.
We have created a world where every side has their own facts. Unfortunately, I believe we are all going to find the hard way that science is not going to work like that.
We have done everything possible to politicize medicine and science this year in this country – and look where it has gotten us. People not just here but all over Twitter and our media screaming at one another about things they have no clue about – just because their side says so. It has been a revelation.
I would also like to echo one of the above commenters – decrying the fact that most practicing physicians have just been cut loose to flap in the wind. Trust me – there are many days when I feel just like that. We have not had time for science in this pandemic to give us real answers – but the more unfortunate thing is that our national agencies have not even tried. The minute that these overwhelmingly positive studies were coming in from other countries about Ivermectin – our NIH and other agencies should have immediately been on the ball – working on our own rigorous studies. They have been nowhere. That has led physicians like me to use the drug despite our own credulity in the beginning (Lice pills? You have got to be kidding!) – guess what – it seems to be working to keep people out of the hospital. And it is not nearly as scary as the other option, monoclonal antibodies (MONOCLONAL ANTIBODIES, WTF?) to keep people out of the hospital. And I remind you – the monoclonal antibodies are on an EUA just like the vaccines – and are considered the same status as Ivermectin by the NIH. This is a safety no brainer – and yet my profession and our country seems hell bent on laughing off the 8 dollar a month safe 40 year experience pill for something that is equivalant to a dose of chemotherapy – with really no strong efficacy numbers to balance out the risk. And they are thousands of dollars a dose.
Our nation’s medical leadership has been all over the place this year – wear masks – don’t wear masks. 3 foot social distance – 6 foot social distance. You all know exactly what I am talking about. Instead of leadership, they have often gotten on national TV to fear monger and even cry like yesterday.
Meanwhile, there are thousands of physicians like myself in communities all over this country doing our best to hold it all together for our patients. Not just the COVID patients, the countless others who have lost jobs and livelihoods and lifelong businesses. We are seeing all kinds of vaccine complications – while the media and medical elites are screaming that they are 95% effective and perfectly safe. I am praying every day that the vaccines work – and it was worth the risk – the backlash if not will be unforgiving.
That is where I am today. I will continue to use ivermectin to keep people out of the hospital. It seems to be as effective as any other modality we have right now. I will keep my eyes peeled for studies and evidence about this issue. Antivirals are going to be as critical going forward as vaccines.
And for those questioning why doctors are remaining anonymous ( a trend that was never dreamed of during AIDS) – you really must be dense. Look at the cancel culture in which we live. We as a country need some serious introspection when good faith questioning leads to job loss and career suicide.
To Yves and Lambert – like everyone else – you are not 100% right all the time. The definition of humanity. But you have given thinking people a forum to discuss and learn. For that we should all be eternally grateful. You are doing a great service to our world.
1. antidlcMarch 30, 2021 at 1:01 pm
  “We are seeing all kinds of vaccine complications ”
  Could you be specific? Maybe I missed prior posts of yours.
  Also, just wanted to say “thanks” for your contributions.
  1. Yves SmithMarch 30, 2021 at 8:57 pm
    Reactions by those with autoimmune diseases. Multiple reports from people who are one degree of separation removed from me of a significant worsening of symptoms after getting the Pfizer and Moderna vaccines, and that not abating over time.
    1. SEMarch 31, 2021 at 7:43 am
      Just an anecdote but good to know from someone with an autoimmune condition. I have been worried about this and can’t get any information from doctors or the internet. I figure I have to wait a year until the shit hits the fan (or not) to see what shakes out. So frustrating.
  2. IM DocMarch 30, 2021 at 10:28 pm
    What am I seeing?
    The most fascinating problem that has no obvious explanation is a surprisingly large number of patients that get sick and are COVID positive within hours/days of their first injection. I have heard all kinds of lame excuses why this may be happening – but none of them really ring true for the numbers that are occurring. I would predict this is going to be an interesting story when the full story of COVID comes out in a few years. By the way, they tend to be WAAAAY more sick than a regular COVID patient. No hospitalizations yet.
    I am seeing blood clots in both venous and arterial systems. This is happening mainly to younger people. I have 4 so far – an unexpected DVT, a PE, a very strange problem in a young healthy man having unstable angina with positive enzymes within hours of his first shot, and a young woman who clotted off the main artery to her arm on the injection site leading to a compartment syndrome. None of these patients have died – and all are doing well now. But it was scary when it was happening. No proof the vaccines did it – but the timing is very concerning, especially in the last 2. I would reiterate that the PCPs of the world are flying blind in this regard. We have no guidebook of completed and well-done trials to guide us with what are common problems. We are literally just taking it all in as we go along. I will reiterate – in a decades long career – these things I have just outlined are 3 times as many severe complications as I have seen after giving 10s of thousands of other immunizations. This is the truth.
    A handful of patients with sudden flares of their dormant autoimmune syndromes – one of which is turning into something possibly bad. Multiple patients with COVID negative and severe URI symptoms. And multiple severe issues with lymph nodes almost to the point of being bubos. I have also seen a severe Ramsay Hunt syndrome in an elderly woman and one episode of anaphylaxis.
    That is all I can remember off the top of my head. Maybe these all have nothing to do whatsoever with the vaccines. The timing, however, is very suspicious. And please note – this is a handful of severe problems in probably 1500 to 2000 vaccinated already. The number of people with fever, chills, flu-like illnesses, etc has been very high, just as predicted in the protocols. But the vast majority of patients have no obvious long-term problems. It is my contention that the patients of the world should have had this presented to them correctly – and we would all be better off emotionally. But alas – it is what it is. Younger people seem to be having a much worse time with side effects – now that we are moving into the younger age groups, I fear this is going to become a much more significant issue.
    1. Lambert StretherMarch 31, 2021 at 4:35 am
      > the patients of the world should have had this presented to them correctly – and we would all be better off emotionally.
      It does seem that, at least at the top level of the public health establishment, lying to the public to achieve an acceptable outcome is considered best practice (see Fauci on masks). Those lying must not perceive the practice as maladaptive from a career perspective, so one shudders to think of the state of the institutions through which they rose.*
      * “Everything is like CalPERS.”
    2. Good enoughMarch 31, 2021 at 6:13 pm
      Actually we have precedents for the observation you mention on cases cropping up early from other vaccine trials and we now have DATA from two vaccine studies for this vaccine that document what you are saying.
      JerryDenimMarch 30, 2021 at 1:11 pm
      I adopted a rescue dog from coastal North Carolina in 2012 that had a bad case of heart worms. The universally accepted treatment is a dangerous (and very expensive) two-dose injection of arsenic to the dog’s spine followed by cruelly immobilizing the dog in a tiny crate for six weeks. The shots leave many dogs with permanent paralysis and many more die from blood clots formed by rotting masses of dead heart worms which die off suddenly from the injections. A small town Vet in North Carolina who was very skeptical of the cruel and high-risk injections tipped me off to a University of Georgia study where dogs were successfully cured of heart worms using a standard prophylactic dose of Ivermectin and intermittent Doxycycline. I ran the idea by my very caring, intelligent and open-minded Vet in Manhattan and after reading the study said he was willing to try the alternative treatment. The one-two punch of the Ivermectin and three-cent-a-pill Doxycycline worked like a charm and my dog was heart worm free after six months without being cruelly confined or running the risk of paralysis or sudden death. The vet was amazed and swore he would never recommend the standard heart worm treatment again. I saved myself about $3000 as well, and while the amount was significant to me, that was just icing on the top not the prime motivator for seeking an alternative treatment. However, for many pet owners, that sum could be the difference between seeking treatment and letting a dog slowly succumb to parasites. I researched the dangerous and expensive shot and why it was universally accepted in the United States as the only legitimate cure for heart worms and the answer seemed to be strategically placed board members among prestigious Veterinary Schools and a quite few lavish Marlin Fishing junkets funded by the pharmaceutical company producing the arsenic shot. Yes, veterinary medicine I know, but from what I’ve learned Veterinary medicine and Human medicine operate exactly the same in the US. Never treat anything with a pill that cost pennies if you can use a shot that costs thousands, even if the more expensive treatment paralyses and/or kills the patient – large profits are far more important to the functioning of the system than curing disease or minimizing harm. When it comes to medicine trust no-one receiving payment, do your homework and plan on advocating for yourself at every turn.
      
      BaldandersMarch 30, 2021 at 3:02 pm
      This story is heartwarming, but it’s no proof ivermectin is a good covid treatment.
      It’s amazing how skeptical folks are of Big Pharma’s PR, but how incredulous they are for “heartfelt anecdotes.”
      
      JerryDenimMarch 30, 2021 at 3:42 pm
      Never said my story was proof Ivermectin is a COVID miracle drug. Just a real world example of how Ivermectin has been dismissed as a treatment option by the (Veterinary) medical establishment due to a Capitalist preference for a more expensive, but less desirable treatment. Furthermore this isn’t a ‘heartfelt anecdote’ but a firsthand account. I think the treatment regime I detailed has gained a bit more acceptance for heartworms now, but it was virtually unheard of in 2012 despite published research showing efficaciousness dating back several years. The other parallel of my story is the economics and availability of the preferred medicine of western doctors in highly developed countries frequently mean nothing to those without the financial means to obtain the treatment, and in some countries the drugs simply aren’t available to people, necessitating alternative treatments and experimentation, which most I think most would agree is preferable to dying. I have no dog in this fight ( pardon the pun ) but I do have experience with Ivermectin being sold short as a drug by credentialed medical experts in the pursuit of profits.
      
      Lambert StretherMarch 31, 2021 at 4:32 am
      *** crickets *** in response…
      
      Blue PilgrimMarch 30, 2021 at 6:36 pm
      Reminds me of Doris Cully talking about ivermectin talking about river blindness and allowing time for clearing the parasite from the eye — about 14 minutes into the podcast. Sounds like the mass of dead worms you mention.
      About 3 minutes in Doris Cully relates her background working with ivermectine when it was discovered.
      
      Blue PilgrimMarch 31, 2021 at 12:50 am
      forgot to give link https://www.microbe.tv/twiv/twiv-599/
      
      Jeremy GrimmMarch 30, 2021 at 2:50 pm
      Thank you for this and your other comments. I watch for and greatly value your insights and revelations offered through your view from the trenches of medical practice.
      Before the Corona pandemic I had been growing pessimistic about how Humankind would respond to Global Warming and the impending limits to growth, and about what prospects the future held. After a year of the Corona pandemic observing the incompetence, greed, and cruelty of the US Government, and organizations, agencies, authorities, and disciplines that once held my highest regard, mishandling the pandemic and the ongoing economic disasters it created, my pessimism nears fatalism regarding prospects for the future of Humankind, myself, and my children.
      
      UnfinishedMarch 30, 2021 at 10:53 am
      A recent addition to the FLCCC website is a page “How To Get Ivermectin” offering a list of physicians who will prescribe ivermectin.
      https://covid19criticalcare.com/guide-for-this-website/how-to-get-ivermectin/
      
      CarlaMarch 30, 2021 at 4:34 pm
      Thank you very much for this valuable information.
      
      RMarch 30, 2021 at 11:32 am
      I grew up stock farming in the great Ivermectin boom when every farmer was recommended to drench his cows (forced oral administration) with it against liver flukes and the like.
      Ivermectin, IIRC, is notorious in the organic farming community for producing “plastic cowpats” – cowpats that do not degrade and support insect populations but dry into frisbees. The difference between organic cow manure and intensively farmed is profound.
      So, if you do take it off-label, just be aware your microbome might need some serious restoration of your commensal bacteria and parasites. Low parasite loads are linked with many autoimmune diseases and gut disorders.
      I still think the data on Ivermectin justify proper randomised clinical trials. The examples and counterexamples are just too noisy. Even the argument about effective concentration is not clear: in vitro is not in vivo because compounds exhibit preferences for different tissues (volume of compartmentation), which is why chloroquine reaches effective blood cell concentrations on low regular doses and, after many years, can lead to blindness because of the effects of high retinal concentration.
      
      Lambert StretherMarch 30, 2021 at 3:26 pm
      > I still think the data on Ivermectin justify proper randomised clinical trials.
      They do indeed (though many of the RCTs for HQ seemed almost designed to produce a negative outcome, not being designed to test for prophylaxis).
      However, given the givens, I think the threshold could be — is, obviously, already in many countries — lower than RCT. Zeynep Tufecki writes, of RCTs and masking:
      The effectiveness of some interventions can be shown even without randomized clinical trials. How? First, there must be a physical theory of the mechanism of the intervention. In this case, the theory holds that the disease is spread by virus-laden droplets and aerosols–and that masks dampen the spread of droplets and aerosols that we emit out of our mouths when we breathe, talk, shout, and sing. Second, we must have a way to test and examine that mechanism: in this case, it’s through lab studies, which we definitely do have, finally, at this stage of the pandemic. Third, there should, hopefully, be indirect epidemiological evidence. Do mask-wearing places fare better than non-mask wearing places? As I write in the piece, this issue is thorny because of confounding effects: places where most people wear masks are probably doing many other things as well.
      So far as making public health decisions in a pandemic, I don’t see why the enornous natural experiments listed in the post aren’t enough to go forward on, RCT or no RCT.
      
      Blue PilgrimMarch 30, 2021 at 6:44 pm
      To do it right, studies for all the possible drugs should be funded, and research funding, which is pitifully stingy, should have been ongoing for decades, including genomic research and such into possible vectors for zoonotic diseases, such as bats. This is a constant complaint among researchers (corona virus among deer mice, for one example I heard). We seem to be too preoccupied with finding new ways to blow ourselves up for that however.
      
      John SimanMarch 30, 2021 at 11:55 am
      Reality check from the CDC’s Mortality and Morbidity Weekly Report: “Among 148,494 U.S. adults with COVID-19, a nonlinear relationship was found between body mass index (BMI) and COVID-19 severity, with lowest risks at BMIs near the threshold between healthy weight and overweight in most instances, then increasing with higher BMI. Overweight and obesity were risk factors for invasive mechanical ventilation. Obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years.”
      Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020 | MMWR
      https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e4.htm?s_cid=mm7010e4_w
      
      SynoiaMarch 30, 2021 at 12:39 pm
      AKA: If you are already “ill” (Obese) it take less effort for disease to kill you.
      That’s not a surprise.
      I suspect there is a causal link between Obesity, Air Conditioning and Driving, as both air conditioning and driving appear to eliminate exercise appear to promote obesity (through lack of exercise) and its attendant ills.
      
      HopelbMarch 30, 2021 at 12:32 pm
      I used the site AmericasFrontlineDoctors which takes you to speakwithanMD.com to get my 80 year old father ivermectin. After the consult, they sent him hydroxychloroquione/zinc instead, and they have not responded to any of my emails/texts inquiring if that was done due to possible interactions with my father’s other medications.
      
      floraMarch 30, 2021 at 2:01 pm
      From my reading, and I’m not an MD or biomed person, I believe there are a few ivermectin contraindications – like pregnancy and liver disease – and drug interactions – like Warfarin and coumadin. Don’t take my word. This is one reason it’s so important to talk to your doctor about whether it’s an appropriate med for your medical condition.
      It’s infuriating the US pharma/med/govt nexus is trying to stop your local MD who knows your med history from prescribing ivermectin when appropriate.
      
      Lambert StretherMarch 30, 2021 at 3:16 pm
      > I used the site AmericasFrontlineDoctors which takes you to speakwithanMD.com to get my 80 year old father ivermectin. After the consult, they sent him hydroxychloroquione/zinc instead, and they have not responded to any of my emails/texts inquiring if that was done due to possible interactions with my father’s other medications.
      Well, so much for them! (One of the disadvantages of being an outsider is lack of resources, and one of the dangers is zealotry.)
      
      BaldandersMarch 30, 2021 at 3:17 pm
      So why do you trust “America’s Frontline Doctors” over Big Pharma?
      Or is this organization NOT selling you something?
      As alternative treatments always do, this reeks of “we care, not like horrible Big Pharma!”
      Great bedside manner is the entire foundation of a quack’s practice. A great mild example is Cancer Treatment Centers of America. Expensive, but they support you with alternative treatments! And there survival rates look great! Must work, right?
      They get those rates by not admitting folks with low survival probabilities. It’s much money for a kinder, more pleasant environment. Which feels “healing.”
      “Well, it can’t hurt..”
      Sorry, TANSTAAFL applies. The cost may be low, but there is a cost. Quackery crowds out resources for real treatments.
      
      Lambert StretherMarch 31, 2021 at 4:30 am
      Ignoring the actual evidence in the post entirely. But you do you.
      
      ambritMarch 31, 2021 at 7:14 am
      TANSTAAFL is Libertarian code speak for Neo-liberal Rule #2.
      (Here we go again!)
      Update: Yay! It worked! I have no clue as to why the previous comments were eaten by the Internet Dragons. Oh well. Perhaps the “gods” are trying to teach me something about the quantum nature of reality.
      
      lyman alpha blobMarch 30, 2021 at 12:38 pm
      Since there is now an article dedicated to this subject, here is a related link from an MD who specializes in bioweapons: https://anthraxvaccine.blogspot.com/2021/01/first-country-bans-ivermectin-lifesaver.html
      She first came to my attention after the anthrax mailing scare years ago as a skeptic against the official narrative. I thought of her again when Covid started and I’ve been reluctant to post anything from her here before, since she is once again going against the official narrative. I have no idea how she is regarded within her field, she does get tend to hyperbole a bit in the link above, and I don’t know nearly enough about medicine to evaluate what she says in this and other posts of hers I’ve seen across the interwebs over the last year. That being said, while I’m not a regular follower of her blog, I have checked in over the years when microbes are in the news and she does seem to have a lot of knowledge in her field and comes across as a genuinely decent human being. Also, she is from Maine!
      Her other writings on the coronavirus topic, including what I thought was decent argument debunking a study claiming chloroquine was not only ineffective but dangerous (she said it is dangerous when they drastically overdose people like they did in the study, but not when used in proper dosages) can be found with a quick search for anyone interested. Or you can just read more on her blog linked to above, but the blog may not have the most detailed and scientific arguments compared to other writings.
      I would be genuinely interested in what others with a better understanding of virology/vaccines make of her take.
      
      vwMarch 30, 2021 at 2:14 pm
      Of so many tragedies to come out of the COVID-19 pandemic, one of the saddest to me – and probably the one with the longest-reverberating consequences – has been its wholesale discrediting of our health science institutions.
      Here we are, over a year into this pandemic, and we cannot get a straight answer on whether or not this relatively cheap and safe drug saves human lives from COVID-19 or not. Worse, we can’t even seem to properly investigate it. All questions bring hysterics, or hardly-believable obfuscation, or (informed?) outrage, no matter what authority we turn to. The fallout in my own life from watching all this unfold has been… dramatic.
      I don’t trust what the CDC says. I don’t trust what the WHO says. I don’t trust what the FDA says. I don’t trust Pfizer and the rest of the pharmaceutical companies any farther than I can throw them. I look with suspicion on my own scientist acquaintances, wondering if they are really following the data, or if they are clinging to a chosen worldview that science in America still works, oh god it still works, oh god it hasn’t been completely discredited, no it cannot be, my life work must have meant something, it must still work, it must still work….??
      None of this means that ivermectin works–or for that matter, that it doesn’t work. It means that I have realized, slowly and then all-of-a-sudden, that I cannot know. Nor can any other layperson. We are alone, our economy is collapsing in slow-motion, and our lives are at stake. Or so we think! If we doubt so much, how much more should we really be doubting? I believe, for what it’s worth, that COVID-19 is real and that these experimental vaccines probably won’t kill us. At least… not that many of us.
      But I wonder now, in my darker moments, whether the claim of those who don’t believe such things that refusing the vaccination is a “Darwin’s test – pass it and survive” have grokked something that was beyond me, in my previous worldview. How could it have come to this…? And if I am feeling like this, how must people with less scientific background (I attended a science magnet school) be feeling about it all??
      Will my children be safe from measles, etc in the years to come? I have vaccinated them with the whole slate, and feel fine about that choice, but will the fallout from this debacle mean the end of herd immunity in America, as trust in the ‘health experts’ collapses into dust? How can we get it back, then – at gunpoint? With all that would imply… is it even worth such a high price…?
      NC is doing the Lord’s work in finding the high quality news sources it continually brings forth for our viewing. But – pardon me – this isn’t something that should need to be be argued over in the comments section of a news site. This isn’t something that laypeople should have to suss out, with their own lives on the line. That it has come to this is a shame, and a shame so complete, that every time I really contemplate it I get the shivers. Our government has failed us. It has failed us. Yet we elected it. Oh, the shame…!
      Is it my fate to live the rest of my life ashamed, utterly ashamed, of my own country? There has been no feeling reoccurring more regularly over the course of this past dreadful year, than that one. When, if ever, will the day come where I can live free of that dreadful emotion, attacking me every time now when I catch a glimpse of that flag flapping in the wind…?
      
      IM DocMarch 30, 2021 at 2:49 pm
      I could not have expressed many of my same feelings better. Thank you. And I am a medical professional. You should not feel alone in the chaos. Anyone who has a brain and the ability to reason has felt the same way all year.
      
      Jeremy GrimmMarch 30, 2021 at 2:56 pm
      My feelings echo your despair.
      
      Lambert StretherMarch 30, 2021 at 3:08 pm
      > Is it my fate to live the rest of my life ashamed, utterly ashamed, of my own country? There has been no feeling reoccurring more regularly over the course of this past dreadful year, than that one.
      I have had the same feeling all this year, too.
      
      tennesseewaltzerMarch 30, 2021 at 4:03 pm
      My first comment from a long time reader. This heartfelt comment is exactly what has concerned me throughout this year. I thank you for so eloquently speaking what I consider truth.
      
      CoryPMarch 31, 2021 at 5:21 am
      Here’s another “Amen” from a healthcare person who is feeling dazed and confused by this year and is having a bit of an epistemological crisis — I feel much the same about the organizations you referred to.
      As for the original post, I could hardly believe the vehemence of the reaction against hydroxychloroquine last year, since in my experience it’s not known to be overly dangerous. But I thought, “Ok, well, Trump Derangement Sydrome, Plus, it’s probably bad news to give it to someone really old who’s critically ill and
      has a bunch of electrolyte disturbances etc..”
      Now the pushback against Ivermectin. I have to wonder where it comes from. Who knew there was such widespread simmering emotion about a drug that most wealthy Westerners never encounter in their lifetime!
      I don’t know. I’m probably just internet-poisoned but this whole thing stinks and now my question-everything paranoia directly affects my work life, so now I can’t get away from it. Argh!
      I am so glad I am not having to administer the AZ vaccine yet! I’m supposed to be able to give patients an intelligent recommendation on these things, but I mostly feel like an idiot.
      
      ambritMarch 31, 2021 at 7:23 am
      You have captured the essence of the New American Experience.
      It feels like what someone losing a life long religious conviction must experience.
      Are we going to have a “Lost Generation” like the West did after World War One?

Last of the March 2021 comments.

See also, this post https://www.nakedcapitalism.com/2021/03/a-covid-tragedy-wholesale-discrediting-of-our-health-science-institutions.html

Comments are open.

Kevin Smith MD

March 31, 2021 at 8:18 am

Re: covid immediately after vaccination
1. I just got my appointment for Covid vaccine, and felt like loosening up on the precautions [and I am a doc!] I reined myself in, and reminded myself that the shots will be just one more layer of protection, and are sure not a license to abandon precautions. Knowing patients as I do, I imagine that some folks may loosen up before they get a shot, get infected, then get sick right around the time of the shot.

2. It is possible that some immunizations [not just for Covid] may transiently depress cell-mediated immunity in some individuals, facilitating the emergence of incipient infections [notably viral infections like Covid] and/or the emergence of latent infections [for example, herpes simplex = cold sore; or herpes zoster = shingles.]

The above may also explain why some folks have a nasty case of the flu very shortly after having a flu shot.

SKMMarch 31, 2021 at 12:12 pm
I`m really puzzled by the statement in links :”the most fascinating problem that has no obvious explanation is a surprisingly large number of patients that get sick and are COVID positive within hours/days of their first injection. I have heard all kinds of lame excuses why this may be happening – but none of them really ring true for the numbers that are occurring…”
There is no immune protection for about 12 days after the first shot – just puzzled a doctor seeming not to know this. Protection then builds slowly over the following weeks etc
“Lots of people” coming down with Covid very shortly after the first vaccination, if true (ie if statistically true that is compared with the rest of us) might suggest they caught it at the vaccination centre (see occasional photos of overcrowded centres and under-nose mask wearing)….
just perplexed at the statement…..
1. IM DocMarch 31, 2021 at 2:00 pm
  That was my comment – so I will be happy to explain.
  I have had actually numerous patients sealed up in cars double masked at the vaccine center in the parking lot far away from anyone – with the vaccine attendants in CAPR PPE – get very ill within 24 hours of the vaccine and end up positive for COVID. These are not people “letting their guard down” which is the main excuse for this phenomenon. Furthermore, they are people who have been holed up at home – at no risk for exposure. At least in the time frame that it takes for COVID from exposure to illness. They are certainly not vaccinated fully until 2 whole weeks from the last vaccine.
  But the timing and their exposure make no sense. I can see this happening to a few patients – but this is just happening way way too often.
  This phenomenon of getting ill with COVID within 24 hours of the vaccine has become so common across the country that I am seeing Twitter threads among my colleagues about what is going on. It is happening repeatedly in my practice. Many are noticing this – and many are discussing.
  I had a couple this AM who got their shots on Monday – again in a car with no exposure sticking their arms out the window to a CAPR clad attendant. They have not been out of the house in 6 weeks. Their groceries and mail are left on the doorstep every day. They called yesterday evening – a day after their shots – both very ill – and their rapid tests were positive this AM.
  The leading theory on this that makes any sense at all was alluded to by the other physician above – Kevin Smith MD – some kind of viral reactivation. In other words, patients may have deactivated COVID particles lying around their upper airways or lungs that get activated when the immune system is distracted by the vaccine. The herpes virus family does this type of thing all the time. There is evidence that this could be happening in coronaviruses as well – although not as well worked out. There are other theories that are too abstruse to go into here. NO ONE is suggesting the vaccines are giving them COVID. NO ONE is suggesting that the vaccines should be effective in 8 hours. It is just the fact the timing and access to infection is all wrong – and something else must be going on to explain this scenario. It is much much too common to ignore.
  It is almost like an Agatha Christie locked-door mystery.
  I am a veteran of the AIDS crisis. These kinds of issues in the times when not much was known were common. The insights that came from many of these scenarios back then were critical for learning about the virus and its life cycle. I am certain this will be no different.
  It is imperative that when everyone runs across discussions among physicians on Twitter about these things – restrain yourselves. Do not insert yourselves unless you know what you are talking about. Read and learn and think. This is how we in medicine are going to get to the bottom of this pandemic. People in our time seem to forget the years it took to unravel AIDS; COVID will be no different. And it is still very early.
  1. HarryMarch 31, 2021 at 3:27 pm
    Thank you.
    Very useful
  2. GFMarch 31, 2021 at 3:29 pm
    IM Doc:
    Which vaccines seem to be the worst offenders?
    1. IM DocMarch 31, 2021 at 9:44 pm
      I have experience only with Pfizer and Moderna – and I can see no difference.
  3. drumlin woodchucklesMarch 31, 2021 at 6:50 pm
    Would it make sense for people scheduled for vaccination to marinate their bodies in the appropriate anti-virals so that they are full of anti-viral chemical when getting the vaccine? So that the anti-viral will keep suppressed any dormant coronavids which the vaccine distracts the body from keeping suppressed?
    1. IM DocMarch 31, 2021 at 9:45 pm
      I think that would be a bad idea. Dormant or inactived viral particles are going to engender no immune response – so I think that would not be indicated.

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