Itajai city and Ivermectin

[-] thaw4188 | 2 points | Aug 10 2020 20:48:29

I have no proof but strong doubts about ivermectin as prophylactic.

I do believe it is very effective for early infection (and can rescue even with late infection though not as well).

Hopefully more studies will emerge.

[-] TrumpLyftAlles | 2 points | Aug 11 2020 06:51:31

I have no proof but strong doubts about ivermectin as prophylactic.

What is the basis for your doubt? AFAIK there are no studies reported about ivermectin prophylaxis. Do you have evidence that it fails to protect against covid-19, or a theory about why it wouldn't? Sincere question: if there is evidence of that I really want to see it. If you have a theory, let's hear it.

I do believe it is very effective for early infection

Why do you think it is effective early after infection but not before? Early in the affection, ivermectin helps cure covid-19, but not as the infection is starting? That doesn't make sense to me.

At this point, I take it as known that ivermectin helps clear the virus -- not because of RCTs, unfortunately, but from a fairly enormous pile of "anecdotal" evidence, like lots of MDs saying it cured their patients.

Do you accept that premise?

If it clears the virus when the infection is newly established, why wouldn't ivermectin also be active against the virus when it first arrives in your nasopharynx? AFAIK there are no theories that the virus has to be in your lungs for it to be effective, or that ivermectin is not active in the nasopharynx.

I want my nasopharynx to be as inhospitable to the virus as I can make it, since that is where the virus first takes root and multiples before heading to the lungs. To me it seems obvious that if I have ivermectin circulating in my blood stream, it will do whatever it does to kill the virus, in my nasopharynx, so the virus does NOT take root and does NOT spread further. Prophylaxis.

Does that theory / hope seem plausible to you?

I don't know if you have seen them, but there are lots of reports of lots of MDs taking ivermectin to avoid catching the virus. The reports are that it works. It's just anecdotal, but it's a lot of anecdotes. An example is the original story out of Bangladesh, where they gave ivermectin to the hospital staff and their families. 100% success, the story alleged. No one got the virus. I find the 100% hard to believe -- but nonetheless this adds a bit of weight to the ivermectin prophylaxis side of the question.

I'm probably not a good source about this. I'm arguably overcommitted to ivermectin's success, and that no doubt colors my perception of the anecdotal evidence. For example, I allege that it is known that ivermectin helps clear the virus. That hasn't been proven, though.

Until the research is in, I'm adopting as my null hypothesis that ivermectin is prophylactic and will keep taking it. Why not? It's cheap and ridiculously safe.

There's no prophylactic benefit from assuming ivermectin does NOT protect against the virus, right? :)

Edit: This (excellent!) post is evidence that ivermectin doesn't protect against the virus. I didn't understand the post when I wrote the above.

Edit: No it's not.

[-] thaw4188 | 3 points | Aug 11 2020 12:51:53

My doubts about it being a true prophylactic is based on it not preventing infection in the areas that have experimented with it's use or have previously used ivermectin in the population for parasites, etc.

Wild guess but I think timing is everything with ivermectin, if you take it a week before you are exposed, it is pointless and does nothing because 18 hour half life is not even a day. By two days it's almost doing nothing and by three it's like you never took it.

I believe it has to be active and present when the virus is present.

My guess would be the very day you feel a fever and heartbeat starts racing from infection, if you took ivermectin immediately, the effect would be to radically cut down the infection time and not even a week, just days.

I believe this is because ivermectin allows the body to identify and attack the virus more readily rather than the way covid tends to hide and start hunting for ACE to attach to.

I keep going back to the example of the way they purify water in certain parts of the world using a simple coagulant dropped into a bucket of water, where the coagulant makes all the impurities clump together and sink to the bottom instead of floating and polluting the water.

In a way ivermectin to me works like that, it helps the body clump and attack the virus where it would be able to hide before and quietly replicate otherwise.

Now I took ivermectin far too late, many weeks into illness, but it still did something every time, it was distinct and obvious to me, though eventually the virus slowly worked it's way back because my immune system was far too weak to completely overcome it at that point.

It took three rounds to finally break the virus hold on my body but I believe I would be dead now otherwise without it.

Earlier the better, but too early before sickness is almost pointless IMHO, you'd have to be darn lucky and happen to catch it within 24-48 hours before ivermectin is washed out of your system.

[-] Haitchpeasauce | 1 points | Aug 12 2020 02:02:20

It seems the theme with all medicine is to treat as early as possible. The proposed mechanisms of IVM are many so I am uncertain what is truly at work, but the theory is that coronavirus is silencing multiple anti-viral defences including interferon type 1, which Ivermectin is able to prevent. There are even statements that it has affinity to the spike S protein, so who knows?

I am hearing varying figures of IVM half life, anywhere from a week to a few days, so the weekly or monthly prophylaxis protocol may be insufficient. Your personal account leads to the question of treatment for long haulers, it would be good to find more study in this space.

I remain both positive and sceptical for Ivermectin, but it needs some really good hard proofs before it gets recognised properly. It's already falling into the political trenches which does it no favours.

[-] TrumpLyftAlles | 1 points | Aug 13 2020 00:34:29

it not preventing infection in the areas that have experimented with it's use or have previously used ivermectin in the population for parasites, etc.

Do you just observe this, watching the news or something -- or is there a study you can site. I'm not being combative, just very interested in the answer. Because I have observed the opposite, in a bit of original research I did three months ago, that I should get back to, to see if the hypothesis still holds.

it is pointless and does nothing because 18 hour half life is not even a day. By two days it's almost doing nothing and by three it's like you never took it.

Someone has said that ivermectin accumulates in fat. I don't know about that. I do know that people treated for scabies once had a 90% lower infestation rate two years later. There's something mysterious about ivermectin's action that makes its effects weirdly long lasting.

That said, I'm dosing twice a week because of the 18-hour half-life. A safety study I posted recently said there's no danger of build up in the blood if taken every 4 days.

I believe it has to be active and present when the virus is present.

You take ivermectin, the virus arrives, it's active an present. I guess you're saying that the blood level will be low soon after dosing, so it wouldn't help. I say keep dosing. If the virus has been taking hold for a couple days when you re-dose and ivermectin disposes of it then -- prophylaxis.

I keep going back to the example of the way they purify water in certain parts of the world using a simple coagulant dropped into a bucket of water, where the coagulant makes all the impurities clump together and sink to the bottom instead of floating and polluting the water.

Great analogy. Don't know why you think ivermectin would work like that, though. There is the recent molecular study suggesting that ivermectin may prevent the virus from acquiring the hat that helps it hide from the immune system. Would that fit in with your thinking?

Now I took ivermectin far too late, many weeks into illness, but it still did something every time, it was distinct and obvious to me, though eventually the virus slowly worked it's way back because my immune system was far too weak to completely overcome it at that point.

It took three rounds to finally break the virus hold on my body but I believe I would be dead now otherwise without it.

Thanks for sharing your experience. I'm SO glad you came through! It was looking pretty dark for a while!

Earlier the better, but too early before sickness is almost pointless IMHO, you'd have to be darn lucky and happen to catch it within 24-48 hours before ivermectin is washed out of your system.

They keep saying that the virus has a long incubation period. I don't know what that means -- what's going on with the virus during that period. It's, like, 6 days? That's a big enough window for me to hit the virus with a new dose of ivermectin, with my twice-a-week regimen.

[-] thaw4188 | 2 points | Aug 13 2020 01:53:45

with chemical half-life I cannot imagine it matters where it's stored, blood or fat, the chemical starts to come apart at its bonds

if you are trying to prevent even an hour of sickness I don't think it works that way, I think because covid is so small and so distributed that the body is unaware of it's presence until enough of it builds up, they call that a "plaque"

then the problem is to prevent the body from overreacting, ie. cytokine storm with white blood cells flooding in

so timing is everything, not too soon, not too late

but also, imagine for a moment your idea works and you can prevent even an hour of sickness

that would mean you'll never ever make antibodies

[-] TrumpLyftAlles | 1 points | Aug 13 2020 02:22:28

that would mean you'll never ever make antibodies

Sure I will, after the vaccine comes out.

if you are trying to prevent even an hour of sickness I don't think it works that way, I think because covid is so small and so distributed that the body is unaware of it's presence until enough of it builds up, they call that a "plaque"

Not following. ivermectin in my blood doesn't need to "seek out" or "find" the teeny virus, right? It's not like leukocytes, not that I know anything about those.

so timing is everything, not too soon, not too late

What's the right time? If you catch enough of the virus on Day 1 for it to take root and begin to infect the body, what's the right day to take ivermectin? Let's say you're not symptomatic until Day 7. Which day is good?

Why wouldn't ivermectin be effective between Day 1 and whichever day you think is correct? Surely it would be more effective at the earliest stage?

I'm writing code that will figure out the maximum concentration ivermectin will get up to, in the Italy arm that's dosing 1200mcg/kg for 5 days. So far I have it working to calculate each day's level, based on the half-life. Next is adding it up across the 5 days.

Here is the 1-day result, using the standard 200 dose (I haven't figured out the units yet), which illustrates your point about the rapid decline of the blood concentration. I guess I'm just showing off. I had to do exponentiation! Have done that for decades, had to look up how to do it in C#.

Day 1
  Hour 0:   200.00
  Hour 6:   158.74
  Hour 12:  125.99
  Hour 18:  100.00 &lt;--
Day 2
  Hour 0:    79.37
  Hour 6:    63.00
  Hour 12:   50.00
  Hour 18:   39.69
Day 3
  Hour 0:    31.50
  Hour 6:    25.00
  Hour 12:   19.84
  Hour 18:   15.75
Day 4
  Hour 0:    12.50
  Hour 6:     9.92
  Hour 12:    7.87
  Hour 18:    6.25
Day 5
  Hour 0:     4.96
  Hour 6:     3.94
  Hour 12:    3.13
  Hour 18:    2.48
Day 6
  Hour 0:     1.97
  Hour 6:     1.56
  Hour 12:    1.24
  Hour 18:    0.98
Day 7
  Hour 0:     0.78
  Hour 6:     0.62
  Hour 12:    0.49
  Hour 18:    0.39
Day 8
  Hour 0:     0.31
  Hour 6:     0.25
  Hour 12:    0.20
  Hour 18:    0.16

Got that number down by half at hour 18! :)

[-] thaw4188 | 2 points | Aug 13 2020 03:28:13

that's some amazing data and proves the point

eating with fatty meals might slow digestion rate so it's around slightly longer but it won't change the half-life

and no I don't think ivermectin "seeks out" anything, it basically "floats around" then when it stumbles across the corona virus it prevents the virus from binding to a heterodimer and that's the end of that for that virus

at least I think that's how it works, based on that diagram I keep posting

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261036/figure/Fig2/

without that anti-binding from ivermectin, the virus is free to move about and replicate

that's why I keep comparing it to the water purifying coagulants that sink the heavy pollutants floating in the water to the bottom, leaving the water clean

ivermectin isn't a perfect "attack dog" like say remdesivir but it works and $30 vs $3000, and pill/paste vs hospital IV only

but back to the timing, too soon and there's not enough virus before the ivermectin half-life dissipates the chemical or like me and take it too many weeks late there is WAY too much virus hiding everywhere so even though it can disable a great deal of it, there's too much left and it eventually slowly replicates more (why I needed three rounds)

I've got a feeling the perfect time is the first week with the innate immune system is trying to burn the virus out with a fever, you take ivermectin on those first days, you might never have a second week of sickness which is the really bad week, first week fever is manageable with tylenol

(editing this because I said it backwards, ivermectin actually -prevents- binding of covid19 to heterodimer, not encourages it, that's how it prevents replication)

[-] jpdowlin | 1 points | Aug 10 2020 20:58:43

These results would seem to agree with your "feeling". There is a small sign Itajai is growing slower than expected, but not a strong sign. There is also likely a dose response in Ivermectin. And maybe people are not taking it prophylactically, but only if they get infected.

[-] dunnododo | 1 points | Aug 11 2020 12:30:06

Also don't let misinformation harm your people. Great research put up here. Thx

[-] Capeletti | 2 points | Aug 12 2020 16:11:55

Itajai used homeopathy, canfora tea, ivermectin, hcq and now will start rectal ozone.

Its an example about what not to do during an epidemy.

[-] Haitchpeasauce | 1 points | Aug 13 2020 00:52:25

Yeah I saw the rectal ozone headline too, smh.

[-] PineapplePecanPie | 1 points | Aug 10 2020 22:09:54

The morality rate will tell an important story

[-] jpdowlin | 5 points | Aug 10 2020 22:17:11

In a facebook group, Juan Jose Chamie, wrote this:

Itajaí - Brazil

- 75% of the population of Itajaí received ivermectin (7/7/20)
- Since the beginning of the campaign, 60 people have died
- 49 out of 60 deceased (82%) DID NOT receive it

The chance of dying from COVID was reduced by 13 fold in those who received ivermectin.

Go to 17:30
https://www.facebook.com/PrefeituradeItajai/videos/2739908672958308/?t=1132

[-] jpdowlin | 3 points | Aug 10 2020 22:19:31

This begs the question - why did the 11 people who took ivermectin die?
Is there a dose response and they took too low a dose?
Were there co-morbidities? Did they take it too late in the course of the disease?

[-] propargyl | 3 points | Aug 11 2020 03:42:22

The mechanism of action is not well understood. If it reduces viral load then in some cases the load may be insufficiently reduced to prevent a life-threatening infection. People have said the same about masks because they help but don't always prevent transmission.

The combination ivermectin, zinc, doxycycline are also popular. The background endogenous zinc levels might vary between individuals and diets. Shellfish and crustaceans are high in zinc and this is a coastal region.

'Studies revealed that ivermectin as a broad-spectrum drug with high lipid solubility possesses numerous effects on parasites, [1, 3] nematodes, arthropods, flavivirus, mycobacteria, and mammals through a variety of mechanisms. In addition to having antiparasitic and antiviral effects, this drug also causes immunomodulation in the host. Studies have shown its effect on inhibiting the proliferation of cancer cells, as well as regulating glucose and cholesterol in animals. Despite diverse effects of this medication, many of its underlying mechanisms are not yet known [4].'

[-] TrumpLyftAlles | 2 points | Aug 11 2020 07:35:59

The chance of dying from COVID was reduced by 13 fold in those who received ivermectin.

I'm not following how 49 deaths vs 11 deaths can produce a ratio of 13. Can someone explain please?

[-] BuscadorDaVerdade | 2 points | Aug 11 2020 10:07:14

You have to look at how many people received ivermectin and died vs how many didn't receive it and die.

75% received it, which is 3 times those who didn't.

82% of those who didn't receive it, died, vs 18% who did.

82% / 18% * 3 is \~13.

(To give you an intuition: multiply the number of those who didn't receive ivermectin by 3, to make it equal to the number of those who did receive it, to simulate a scenario where half received it, half didn't, which makes comparisons easier (comparing 'like with like'). This makes the number of those who didn't receive ivermectin and died 3 times larger, so the ratio is not 49 vs 11, but 49*3 vs 11.)

[-] stereomatch | 2 points | Aug 11 2020 19:40:22

I'm not following how 49 deaths vs 11 deaths can produce a ratio of 13. Can someone explain please?

From the comment above:

75% of the population of Itajaí received ivermectin (7/7/20) Since the beginning of the campaign, 60 people have died 49 out of 60 deceased (82%) DID NOT receive it

49/60 who died were from the non-ivermectin group

11/60 who died were from the ivermectin group

If 25pct of population not took ivermectin - and got 49 dead.

Then 75pct of population who did take ivermectin should have had 3x the deaths of the 25pct group (25pct x3 = 75pct). That is if ivermectin was irrelevant, would have had 49 x 3 deaths.

But instead they had 11 deaths which is (49 x 3)/11 = 13.36 times lower that 49 x 3 deaths.

So ivermectin-taking patients were 13x less represented in the death figures.

[-] TrumpLyftAlles | 2 points | Aug 11 2020 19:53:02

I never would have figured that out. Thanks! :)

[-] Bob_Joy | 1 points | Aug 11 2020 10:04:31

Itajaí - Brazil 08-11-2020 facebook post - 75% of the population of Itajaí received ivermectin (7/7/20) - Since the beginning of the campaign, 60 people have died - 49 out of 60 deceased (82%) DID NOT receive it
The chance of dying from COVID was reduced by 13 fold in those who received ivermectin.

[-] TrumpLyftAlles | 1 points | Aug 11 2020 10:17:30

Another excellent post from jpdowlin. Original research! Thank-you!

Here is the 2020-07-08 article about the ivermectin campaign's start:

#City of SC starts distribution of doses of ivermectin to residents... -

The city hall of Itajaí (SC) started yesterday afternoon to distribute ivermectin to the residents of the city against the coronavirus. More than 3 million doses were purchased.

Although there is no scientific proof about the effectiveness of the remedy in treating covid-19 in human beings, the substance has already been delivered to 4 thousand people on the 1st day, according to data from the city hall.

All ivermectin distribution is concentrated in the Centreventos de Itajaí, an 18 thousand m² complex, to "avoid agglomerations". The local health department said all people will be accompanied by doctors. The pick-up time is from 8am to 8pm.

The aim of the measure, according to local authorities, is "to treat residents early to prevent and mitigate the infection caused by the virus.

"The ivermectin is being used as a medicine that can help prevent covid-19 and, in case of contagion, that the patient has mild or moderate symptoms, because it decreases viral multiplication. We encourage the population to participate in this campaign, but also to maintain the other non-pharmacological prevention measures, such as the use of masks, hand hygiene, distance and social isolation," Volnei Morastoni (MDB), the city's mayor, said.

For immediate purposes, it's pertinent that the drug was delivered to 4000 people on the 1st day beginning on 7/8. Let's assume they get more efficient so the subsequent delivery rate is 5000/day, and further assume a 5-day work week.

By July 14th, about 25K residents would have received the ivermectin. By the 28th, 75K would have the drug, the number that JJ Chamie quoted per a post below.

How many days elapse between catching the virus and it appearing in the case count? Hmmm. It takes about a week to become symptomatic, then the person has to get to a facility to be sampled, then the sample has to be analyzed to determine whether the virus is present, then positive results need to be reported to the appropriate agency, and then all the results need to be added up and published. Let's guess 3 weeks, in the absence of any knowledge about the efficiency of Itajai's testing and reporting infrastructure.

Ivermectin would not have any effect on the July 14 numbers: given the lag, the people whose confirmed covid-19 shows up in the statistics on that date would have caught it at least two weeks before they started delivering ivermectin on July 8.

On July 28th, three weeks after distribution started, only the 4000 who received the drug on the 1st day of deliveries would fit in the three-week window. We can't expect ivermectin to effect the July 28 case count.

August 8 is 11 days after July 28. Three weeks before August 8 is July 18. There are 8 working days (Mon - Fri), between July 7 and July 18. At 5000/day, ivermectin would have been delivered to 40,000 people. That is the number we hope were protected, whose otherwise-infections do not appear in the August 8 cases total.

This is actually optimistic because it assumes that people (1) take the drug and (2) take it immediately. We know nothing about the citizenry's willingness to take the drug. This is a novel treatment; it's likely that a sizable portion of the recipients put the ivermectin on the shelf, waiting to see if their neighbors drop dead from ivermectin poisoning. Are there anti-IVMers in Brazil? Sounds like a bad joke, doesn't means it's wrong.

Let's go with the full 40,000, for discussion's sake. About one-fifth of the town's inhabitants would be protected from appearing in the 8/8 case count, if 100% of them took the ivermectin promptly and it was 100% effective.

The July 14 case rate (per 1000) was 12. By July 28 it increased to 17.5, a 44% increase, which is an average of 3.15% more cases per day over the 14-day period. If the same daily increase applies to the July 18 - August 8 period, then we would expect to see a (11 * 3.15 =) 35% increase in the case count, bringing it from 3,480 on July 28 to (3,480 * 1.35 =) 4,710 cases on August 8.

In fact the August 8 total cases was 3,999. For some reason, there were about 700 fewer cases on that date than expected. What could it be????

40,000 ivermectin treatments saved 700 people from catching the virus (under the ivermectin hypothesis), between July 28 and August 8. That's 63 people/day who didn't get covid-19. When the full 75,000 figure into the statistics, the 63 will go up to 118 people/day. Prophylaxis, baby!

3.15% more cases per day is too high for Itajaí, over the July 28 - August 8 period, hence the 700 case discrepancy. What was Itajaí's actual rate of increase, and how does it compare to its neighboring towns?

Looking at the "Daily % Increase" column to the right of the "7/28 - 8/8 Increase" column, we see that Itajai's actual 7/28 to 8/8 daily rate increase was 1.33%, not 3.15%. That rate is lower than all but one of the other 9 towns. The "Change in Case Rate" column (almost rightmost) compares the 7/14-7/28 rate to the 7/28-8/8 rate. The 2.37 for Itajai means that the 7/14 - 7/28 rate was 2.37 times higher than the 7/28-8/8 rate. That is a huge (IMO) reduction in the rate of new cases, again a bigger reduction than all but one town. It's a BIG REDUCTION.

In both cases, the town that did better is Palhoça, which did an amazing job, somehow dropping its daily rate from 4.19% to 1.07%. How did Palhoça do that?

I don't know why Palhoça's numbers improved so much. I tried to find an article saying that Palhoça is using ivermectin too. No luck. Could still be true! How good is your google fu???

What do we learn from this exercise?

1) Something dramatically brought down Itajaí's rate of increase in covid-19 cases, more than all but one of the 10 towns. I would like to attribute it to ivermectin, despite the fact that only a fifth of the residents could have taken the drug during the relevant time frame.

2) IMO, it's really too early to tell, because of the three week (or whatever) lag between taking the drug and its effect showing up in the case counts. August 16 is 21 days after 7/28; on that date, all 75,000 townspeople will have had ivermectin in their possession for at least three weeks. We should look at the numbers again. It would be cool if we also had data on two other Brazilian towns that are using ivermectin.

3) When someone is really committed to something, e.g. ivermectin, he might make assumptions that to lead to the result he wants. :)

Sorry if my math is wrong. I was born during the Truman Administration and the little gray cells don't work as well as they once did. And I have typed through the night; it's 6:40 AM.

Thanks again for the great post, jpdowlin!!

[-] jpdowlin | 2 points | Aug 11 2020 13:41:19

I will update the spreadsheet as more data arrives.

[-] jjchamie | 1 points | Aug 12 2020 04:19:24

The increase in cases had the largest drop in Itajai

14/7 to 28/7 grew 44%

28/7 to 10/8 grew 15%

The virus slow down their growth by 2/3

And is not because everyone in Itajai was infected, every other city with Cases/Pop higher than Itajai on 28/7 had a larger increase in cases.

[-] jjchamie | 1 points | Aug 12 2020 04:49:12

More data from Itajai:

The % of positive tests dropped. From being above 50% moved to 25%

The average in similar cities in the state remained stable close to 50%.

The average in the neighbored cities decreased but not as much (from 55% to 45%).