Zagazig University Randomized Controlled Ivermectin Study Results Confirms PI Hypothesis: Drug Effective Against COVID-19 (Egypt, 2020-08-28, TrialSiteNews)

[-] lemallette | 3 points | Aug 29 2020 03:26:40

Pertinent points:
• Total 340 patients, 2/3 receiving a "triple" dose of ivermectin on two days 72 hours apart (18 mg for 60-80 Kg).
• Not a blinded study. No placebo group, just an untreated group.
• Untreated group turned positive within 14 days at a very high rate, 58% (strangely high, considering the 15% reported in the recently published trial of HCQ for prevention of acquisition of Covid-19 after significant contact) - may suggest poor hygiene and isolation at home.
• Conversion occurred in IVM group in only 7.4%, an astounding result.
• Peer review pending. Study ran May-July 2020.
Comment: Why bother if you don't use a placebo control?
Better description of the study available at:
https://clinicaltrials.gov/ct2/show/results/NCT04422561?view=results

[-] fyodor32768 | 2 points | Aug 30 2020 13:33:01

I think that the fifteen percent number in the HCQ trial is "exposure" which at least for the one I'm thinking of, was ten minutes of close unmasked contact. So it's possible household rates are higher.

That being said, I've seen 25 percent for household contacts. 58 percent symptomatic seems impossibly high given that there's somewhere between 30-70 percent that are normally asymptomatic. It would mean everyone is getting it. While it's possible that Egypt has higher crowding or whatnot, their outbreak wasn't that bad and has been controlled, which suggests that they don't have crazily out of control conditions.

[-] TrumpLyftAlles | 1 points | Sep 05 2020 01:10:12

58 percent symptomatic seems impossibly high given that there's somewhere between 30-70 percent that are normally asymptomatic.

This is a great point. So what's the explanation? I don't want to believe that the researchers made up that number.

[-] fyodor32768 | 2 points | Sep 09 2020 12:49:33

I don't know. The whole thing makes no sense. I've never seen a household attack rate for any location anywhere near 58 percent. This study placed the attack rate for spouses at 28 percent. And I have to assume that even if Egypt is much more crowded than China that every household contact is not as close as spouses in China.

https://www.cebm.net/study/the-characteristics-of-household-transmission-of-covid-19/

When you add in 30-70 percent asymptomatic you'd expect even for the closest contacts a symptomatic attack rate of somewhere around 15-20 percent.

It's really strange to me that they didn't give everyone a PCR test, instead going with some kind of indirect bloodwork test. Normally you'd give everyone a PCR test X days after exposure and monitor who is symptomatic. Instead they tested people with symptoms with this bloodwork test.

I wonder if they swept up some people with non-specific COVID like symptoms who were COVID negative. But honestly, the whole thing makes no sense and is hard to resolve with the existing data.

[-] fyodor32768 | 1 points | Sep 09 2020 20:53:40

Another study today showing 17 percent household attack rate in Denmark. Given what we know about symptomatic/asymptomatic cases and household attack rates even the 12 percent symptomatic with Ivermectin is on the high end of what I would expect from a placebo.

https://www.medrxiv.org/content/10.1101/2020.09.09.20191239v1.full.pdf

[-] TrumpLyftAlles | 1 points | Sep 09 2020 21:18:51

even the 12 percent symptomatic with Ivermectin is on the high end of what I would expect from a placebo.

And yet there's that (suspiciously) high 58% infection rate among untreated household members. What's your theory: the researchers lied? I guess that's a possibility. If I was going to lie about this study's results, I would have picked a more reasonable transmission rate, like maybe 30%. 58% is too high.

And the 100% prophylaxis among 788 health workers in Argentina who used ivermectin and a carrageenan sprary. I guess you would give 100% credit to the carrageenan?

And Dr. Aquirre's abstract (without a backing report AFAIK) of 94% - 99% protection from the virus with just ivermectin.

And many reports of MDs etc taking ivermectin prophylactically in Bangladesh, Latin America and elsewhere.

And the Bangladesh trials that purport to show ivermectin clearing the virus relatively quickly.

And the (I believe?) consensus opinion that ivermectin's mechanism is blocking the imp a/beta1 dimers that the virus otherwise uses to send proteins into the cell to disable its defense mechanisms and (per the Bradykinin theory) upregulate the expression of ACE2 so the virus can better attack the cell.

I appreciate your skeptical attitude. This sub has a lot of true believers including me.

May I challenge you to look for supportive evidence? What are the high end estimates of household transmission?

even the 12 percent

12%? Where did that come from. Wasn't it 7.4% among the treated household members?

[-] fyodor32768 | 1 points | Sep 09 2020 22:57:19

"And yet there's that (suspiciously) high 58% infection rate among untreated household members. What's your theory: the researchers lied? I guess that's a possibility. If I was going to lie about this study's results, I would have picked a more reasonable transmission rate, like maybe 30%. 58% is too high."

Who knows? The fact that they came up with an implausibly high number doesn't somehow make it more credible. The author is writing from an authoritarian third world country. Maybe there was political pressure to come up with something. Maybe he wanted research funding. They didn't do any PCR testing of any of the purported contacts. Maybe their CBC testing isn't reliable. I've never seen a study that just talks about people being "symptomatic" or "asymptomatic." There is no discussion of what symptoms people had or anything like that.

So all of the following is suspicious

58 percent symptomatic is far higher than anything I've seen anywhere.
They did not PCR all of the contacts to find out who got infected.
They did not PCR test the symptomatic people, instead relying on some "CBC" test and chest x-rays.
Very weird not to summarize the actual symptoms.

"I appreciate your skeptical attitude. This sub has a lot of true believers including me.May I challenge you to look for supportive evidence? What are the high end estimates of household transmission?"

I understand that this is a scary time and you want to believe something is out there that helps- I hope that this turns out to help people. But I don't owe it to you to find you reassuring information that reinforces what you want to believe.

I've never seen anything higher than thirty percent, with most considerably less and it was a source of extreme interest to me after my mother, who was living with my father got it. And I've seen asymptomatic cases anywhere between thirty and seventy percent. So a sixty percent symptomatic rate is like eighty five percent getting infected. There's just no way that's even vaguely consistent with what's out there. And there is nothing to suggest that Egyptians are somehow prolific spreaders either by virtue of living conditions or something else. The epidemic never got bad there and it's now pretty well suppressed.

[-] TrumpLyftAlles | 1 points | Sep 10 2020 01:34:22

But I don't owe it to you to find you reassuring information that reinforces what you want to believe.

That's a nasty trick, implying that I suggested you owe me anything. Even nastier, suggesting that I'm looking for affirmation instead of the truth. Don't like it one bit. Please refrain in future from making similar insinuations.

I was inviting you to look for supporting evidence, flip the bit on the negativity. Maybe you'd find something different. Many of us tend to find what we're looking for. Never mind.

Otherwise you argue well.

They did not PCR all of the contacts to find out who got infected.

Some places can't afford $100 * 308 or whatever the cost would be. The ivermectin maybe cost them $2/subject. The PCR test would make it a lot more costly.

Today I listened to Michael Mina (Harvard Public Health School) talking on This Week in Virology about $1 paper tests that are less sensitive and that's a good thing because they effectively test whether the person is transmitting -- which is more pertinent than "does the person have fragments of RNA about which may or may not be below the transmission level", which is what the PCR test tests. There's a long tail during which the patient is NOT transmitting, but the PCR returns positive. It's too sensitive.

If those $1 tests come on board and are respected as valid endpoints by the science community, then researchers could afford to test every subject, every day, and get a really good picture of what's going on with the virus.

[-] fyodor32768 | 2 points | Sep 10 2020 12:11:08

I did not mean to insult or antagonize you. We are living in a historically terrifying time and I think a lot of people really want to believe there's something out there that will fix things. You described yourself as a "true believer" which I think is not a good way to think about something like this. There are cures and treatments that have been used for decades that we still really can't say confidently if they work.

Anyway, please accept my apologies if my comments unfairly characterized you or came across as harsher than I intended. I don't want to be a source of antagonism for anyone when everyone is dealing with so much else right now.

[-] TrumpLyftAlles | 1 points | Sep 10 2020 12:15:22

Thanks for your kind words.

I'm a true believer, based on evidence I hope, but I acknowledge that I bring a bias to that evidence. Contrary voices are welcome. Dope slaps are called for, ofttimes.

If ivermectin crashes and burns in subsequent research, I'll be disappointed but not heartbroken. It's a drug, not a lover. ;)