this are the official papers from a study done 2 month ago.

still amazing information, i hope this gets real global atention.

 

here is a full video of Dr. Héctor Eduardo Carvallo explaining the trial and protocol used

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I spent way too much time writing this on \r\covid19.

Things of note from the PDF:

• No advancement of disease

No mild patient became moderately or severely ill. It actually doesn't say if any moderate cases proceeded to severe disease.

• Quick recovery for mild cases

[E]ven though we did not have a quantitative follow-up of time to absence of symptoms, we have observed it to be less than 3 days in many mild cases.

• The researchers suggest using ivermectin for prophylaxis

Based on the outcomes of this study, a possible preventive strategy for COVID-19 in communities of high viral circulation might consist of an oral dose of ivermectin lower than 24 mg (proposed 12 mg) regularly administered once a week (approximately one incubation period) to low-risk people for a limited period of time, while high risk population remains isolated. This dose might be enough to reduce viral load at a low level to keep COVID-19 at a mild stage, without eliminating SARS-CoV-2 completely, so that immunity against SARS-CoV-2 is developed individually to finally reach herd immunity (“immunizing effect”). This hypothesis is worth further exploration for the prevention of transmission in healthcare workers and close contacts, and, if successful, may be further applied for prevention in the community. In the present situation in some American countries like Brazil and Argentina, this could help reduce overall mortality in the absence of a vaccine.

Complaints:

1) Why are moderate and severe patients lumped into one group? Why bother making the distinction if you don't report them separately? IMO this is suspicious, like, we only had one ICU patient and he died, and we're hiding that. ???

2) The controls are poor: (1) Argentina's overall death rate and (2) the deaths at another hospital. The sign is right: using those comparison groups, it looks like ivermectin (IDEA) probably saved lives. A better control group would have made the study more persuasive. The researchers explain why there's no real control group: it's unethical to withhold the treatment. True. That qualm makes for weak evidence, unfortunately.

Thoughts:

The prevention of advancement and quick recovery is typical for ivermectin. So is the low death rate (1 of 32 moderate/severe patients).

The suggestion of prophylaxis is good. In the last three weeks, three ivermectin studies have shown prophylaxis. They're all flawed, like this study, but IMO they're persuasive nonetheless. In the best study, 788 health workers took 15mg of ivermectin once a week and self-administered carrageenan nasal spray 5 times a day. Over the 10-week trial period, NONE got sick.

The poor controls (sorry this got long):

This is also typical of ivermectin studies. Two of the three completed clinical trials compared ivermectin + doxycycline to hydrochloroquine + azithromycin. They established that IVM + DOXY works better than HCQ + AZT. Now what?

The reason those two studies didn't have a real control group, one that didn't receive any treatment, is because MDs and nurses and hospital committees have problems with randomly selecting people and placing them in a group where they are more likely to die. It's wrong.

The other day I listened to an episode of This Week In Virology which opened with a kind of history of the changes in clinical practice toward covid-19 since the pandemic started. The commentator was an MD/PhD on the clinical and research side. He's located in NYC so he and his colleagues were hit first by the pandemic.

At the outset, standard practice was putting patients on ventilators when they needed oxygen supplementation. Eventually they figured out that was bad. The commentator said it could be an accident of scheduling: Joe and Moe are sharing a room and seem equally ill, when Joe is put on the ventilator first, and by the time they get around to Moe a few hours later, Joe is in dire straits and Moe's condition hasn't changed. They learned that putting patients in the prone position was helpful by trying it. There was huge controversy among doctors about the use of steroids during the cytokine storm stage, doctors literally shouting "You're going to kill your patient!" if the patient's doctor was or was not using steroids, depending on the shouter's deep-held belief -- deep-held despite a dearth of data. Remdesivir gradually came into use. Anti-coagulants gradually came into use. A lot of things were tried in a haphazard seat-of-their-pants way by doctors facing dying patients, trying hard to think of something that might work. It might be A on Monday and B on Tuesday and back to A on Wednesday.

That's the history, as I remember the podcast.

Throughout this period there were no random controlled trials to guide the MDs.

There was a crappy Remdesivir RCT released at the end of April that showed faster recovery before it was halted due to a high rate of adverse events. (The TWIV guys think Remdesivir is useless, by the way, or at least some do.)

While relating the history, the MD/PhD commentator moaned a half-dozen times about how medical practice was evolving because MDs would try something and it would seem to work -- but how could they really know they were right, since there were no RCTs? His attitude was that the medical profession had screwed up by failing to do the research.

Nonetheless he also said that standard care for covid-19 patients improved since the outset. The figure it out and try it method worked, though he didn't say that in so many words. Turns out that highly-intelligent MDs trying to follow the research and talking to each other can come up with solutions - eventually.

Why didn't RCTs happen? Because hospital committees and MDs were very reluctant to have no-treatment controls. They wouldn't do it.

Just like in this study, and the Broward Country, Bangladesh, Baghdad, and Argentina ivermectin studies. Only the Egypt study had a half-decent control arm.

Those NYC doctors could have tried treatment A on one arm and treatment B with the other arm, to get past their ethical constraint. /r/covid19 readers would have sneered. "This study tells us nothing." I suppose the NYC doctors felt the same way.

The commentator also brought up the HCQ problem: he personally tried to get two HCQ trials going, had the funding, but couldn't get the subjects, because half were convinced that HCQ was magic so they wouldn't risk being placed in the control group -- and the other half believed that HCQ would kill them.

He mentioned "the parachute problem" a half-dozen times. I didn't know what that was, so I looked it up. It's an amusing read. One guy said it will go into the archives next to Swift's A Modest Proposal.

I hope this doesn't spoil it:

If you want to know whether parachutes save lives, then you must have an RCT of course. RIGHT? There's no other way to actually know anything. So get your subjects to sign the informed consent document, then randomly assign them to the with-parachute and no-parachute groups, then give them working or non-working parachutes (must be blinded!), then have everyone jump out of the plane.

You see the problem.

The MDs who evolved away from ventilators, put their patients in the prone position, eventually put steroids and anticoagulants to use -- used their intelligence and the results they saw in their patients to figure out a better way -- without RCTs.

We should be able to look at the 6 (or so) published ivermectin studies, all of which are flawed, and infer something, even though most weren't RCTs and the RCTs have problems. The MDs inferred better practices without collecting any data, without any consistent pattern of care, with no time frames or endpoints. Can't we use our intelligence and the results of some compromised-design trials to make valid inferences? Figure it out?

TL;DR: This is another ivermectin success story, but a muted one because of problems with the research design. However, it's yet another addition to the uniformly positive pile of evidence supporting the efficacy of ivermectin -- RCTs be damned. So far, ivermectin is batting 1000.

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Extremely encouraging results that need to be replicated asap:

“None of the patient presenting mild symptoms needed to be hospitalized. Only one patient died (0.59 % of all included patients vs. 2.1 % overall mortality for the disease in Argentina today; 3.1 % of hospitalized patients vs. 26.8 % mortality in published data). IDEA protocol appears to be a useful alternative to prevent disease progression of COVID-19 when applied to mild cases and to decrease mortality in patients at all stages of the disease with a favorable risk-benefit ratio.”

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No info on whether this was per day, twice a day, once a year ...

Aspirin 250-mg tablets to prevent hypercoagulation in mild and moderate cases

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[deleted]

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This study was posted to /r/covid19 (47 comments).

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