massimaux | 16 points
Ivermectin May Make COVID-19 as Deadly as Seasonal FluImagine that Ivermectin-based therapy begins to be administered in an outpatient setting, i.e. any newly confirmed positive cases (or within the first few days from onset of symptoms) as well as any hospitalized patients with COVID-19 would be treated.
There are two key questions:
First, we know from the literature that the fatality risk of people confirmed to be infected with flu (case fatality rate - CFR) is estimated at 0.1%, while the IFR of influenza is half (0.05%) or even quarter of CFR (0.025%) due to the large number of unconfirmed and asymptomatic cases.
Now, let’s find a way to estimate the IFR of SARS-CoV-2 for those treated with Ivermectin-based therapy. We will start with CFR and then map it to IFR.
Predicting CFR of Ivermectin-treated COVID-19
According to clinical data reported by Prof. Tarek Alam of Bangladesh Medical College Hospital obtained from about 500 treated patients, if Ivermectin-based therapy is given in the early stages of the disease (within the first few days after the onset of symptoms), the hospitalization rate is about 2%, i.e., 98% of the confirmed cases treated with Ivermectin-based therapy will be cured at home. So, no one dies at home.
On the other hand, according to a German study, about 22% of hospitalized COVID-19 patients die despite the best possible treatment in hospitals.
According to a US study from Florida, the inpatient mortality rate for Ivermectin-treated patients was 40% lower than that for patients with standard of care.
It follows that the mortality rate of hospitalized patients can be reduced from the current 22% to 13% with the help of ivermectin-based therapy.
Hence, the CFR of SARS-CoV-2 for hospitalized patients treated with Ivermectin-based therapy would be 13% of 2%, or equal to 0.26%. For comparison, the current world CFR is around 2.8%.
Okay, we predicted CFR, but how do we derive IFR from CFR?
Mapping CFR to IFR in COVID-19
Let us recall that the difference between CFR and IFR is in the denominator of the fraction. In CFR, the denominator is the total number of confirmed cases, while in IFR the denominator is the total number of infected cases. Can we find a connection between these two? Fortunately, we can. And to cut a long story short, that ratio is about 10 times. This result has been confirmed in two studies. The first one for New York City from May, the second one for Stockholm from May.
This means that the number of infected cases is about 10 times larger than the number of confirmed SARS-CoV-2 cases. How does one explain such a difference? Simply put, most infected people are not tested - it is impossible to test them all.
To sum up, the number of infected cases is approximately 10 times higher than the number of confirmed positive cases and therefore, the IFR is 10 times lower than the CFR, or 0.26% reduced by 10 times comes down to 0.026%.
Conclusion
If all newly confirmed and hospitalized infected patients are treated with ivermectin-based therapy, the risk of death from SARS-CoV-2 infection may be reduced to 0.026%, which is approximately equal to the lowest risk (0.025%) of death from seasonal influenza infection.
[-] Ok-Film-9049 | 1 points
I think Ivermectin therapy can definitely cut the IFR. The IFR varies between countries. If you look at worldometers.info for New York state and then look at Queens, you will find Covid killed 0.32 % of the population. So the IFR is probably 2 or 3 times this. In Africa the IFR might be below 0.2%
Anyway you need to take into account the median age in Africa is decades younger than the US
[-] Ok-Film-9049 | 2 points
Agreed. We will probably have a higher IFR in the UK also. Part of the problem with the IFR looking bad in the UK was a weak flu season. This may have also impacted the rates in New York. Lots of people who would have died a few months earlier if the flu season had been bad.
[-] covid-19_throwaway | 1 points
I think that if you want to improve on this, you should use newer data. The NYC study covered 1 March - 6 June, so started off with no ratio, because you can't divide by zero tests. Testing then spent 5 weeks in a woefully inadequate range, with positive test rates of 19-50%. Hospitals quickly filled with patients nobody really knew how to treat yet, and the combination of ignorance and overload gave them a fugly CFR. I doubt that we've seen the last of overloaded hospitals, but much else about the fiasco that was spring in NYC seems very unlikely to persist or repeat, and well chosen, fresher data wouldn't be subject to that criticism. In particular, you'd probably want to steer clear of times/places where getting tested was difficult to impossible.
[-] TrumpLyftAlles | 3 points | Oct 17 2020 19:47:43
Thanks very much for this, massimaux. Data plus careful thought: excellent. A result like this could be coming out of Uttar Pradash or Peru, if only we had good data about who is using ivermectin and what the outcomes are.
Getting in the spirit of what-if:
1) What if everyone age 55+ took 12mg of ivermectin weekly, for prophylaxis? How would that change the course of the pandemic?
2) More realistically, what if the FDA made ivermectin over-the-counter? Then those of us who are aware of ivermectin could self-dose weekly or at whichever prophylaxis schedule we thought best. Create a web site where ivermectin users can register and publicize it on social media. Track outcomes. Hopefully see prophylaxis -- though naturally since it's not an RCT there will be many difficulties interpreting the data, and the FDA won't be impressed by the research.
3) Do an RCT with ivermectin fans recruited through social media. Since ivermectin is not OTC in the US, we would have to resort to the horse paste form, which has a distinct flavor. How would we blind the trial? The organizers order the horse paste and mix it with jam, putting it back into the original jam jars, at a concentration where a nice schmear on a piece of toast is a good dose, to be consumed once a week. Since it will be known that the jam flavor is off a little, put something else, inert but weird tasting, into control jam jars. Some WD40 (joke). Put numbers on all the jars and record which numbers have ivermectin and which don't, then distribute them to the volunteer subjects. Provide each with enough jam to last a good while, say 6 months. Ask subjects to email a photo each week of their jam on toast to encourage compliance. Ask subjects to email if they catch the virus. Researchers could send emails to all subjects asking them to confirm that they're self-dosing and asking for their covid-19 status.
Unfortunately, this RCT would need a very large N to have a chance of finding a significant result, since it is so rare for US adults to catch the virus -- if the study participants are just general citizens. This table shows which jobs present a higher risk of catching the virus (I think). Recruiting in those groups would make it easier to discern a result. Like the vaccine challenges, the research requires some incidence of controls catching covid-19.
All useless speculation, unfortunately.
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[-] massimaux | 3 points | Oct 17 2020 19:53:10
Thanks! I really hope the assumptions used are accurate enough. :)
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[-] massimaux | 3 points | Oct 17 2020 22:09:51
u/TrumpLyftAlles I know you are not very fond of Borody, but IMO he's the only global short-term chance for Ivermectin to enter protocols in the West. If he persuades the Australian health authorities to accept the Ivermectin-based therapy, other developed countries will follow and IVM will soon take over the world. Maybe I'm wrong, but for the time being, it looks like that.
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[-] TrumpLyftAlles | 1 points | Oct 17 2020 23:02:43
I know you are not very fond of Borody, but IMO he's the only global short-term chance for Ivermectin to enter protocols in the West.
Totally agree.
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