[-] massimaux | 5 points | Nov 03 2020 18:43:46

The sample:

Findings and Results:

A total of 3,099 patients were evaluated in the ER of the CMBO and CMPC from May 1 to August 10, 2020 and treated with Ivermectin.

Of the total number of hospitalized patients, 37 deaths (9%) were reported. Three (3) of them (8%) occurred in the regular isolation area, while 34 (92%) occurred in the COVID-19 ICU (table 4). The total mortality of the patients initially evaluated in the ER was 37 (1.2%). (Table 3 and Table 4).

This is an excellent statistical sample! Not seen so far.

The overall case fatality rate is 1.2%. The world's CFR is about 3% currently. It should be noted that many countries seem to have underreported their COVID deaths. Nevertheless, reducing from 3% to 1.2% is a huge gain!

Ivermectin dosing:

The outpatients were administered Ivermectin at 0.4mg / kg, orally (PO) in a single dose in the ER and Azithromycin 500mg PO per day for 5 days, with follow-up of the outpatients.

Hospitalized patients were administered Ivermectin PO at 0.3mg / kg, days 1 and 2, and the dose was repeated on days 6 and 7. They were given Azithromycin 500mg PO daily, for 7 days.

The outpatient group:

Initially, 2,706 patients (87.3%) received treatment on an outpatient basis, of which 2,688 (99.33%) did not progress the disease, so they did not merit new admission to the ER and subsequent hospitalization and there were no deaths. Of the patients treated as outpatients, 16 (0.59%) subsequently merited hospitalization in the COVID-19 area room with 0 (0%) deaths and 2 of them (0.08%) required hospitalization in the ICU, of which 1 died (0.04%). (Table 2).

This is great! Only 16 (0.67%) needed hospitalization of whom 1 (0.04%) of the 2,706 outpatients died. But check this:

The average between the onset of symptoms and the ER visit in outpatient treated patients, was 3.6 days,...

So, those who developed mild symptoms visited the ER 3.6 days after symptom onset on average. That's an important data. It will become clear why when we come to the other patient groups.

The moderate group:

In total, 411 patients (13.3%) were hospitalized, including patients initially treated on an outpatient basis and later merited hospitalization, of which 300 patients (73%) were admitted to rooms in the COVID-19 area, representing 9.7% of all patients admitted in the ER.

...being admitted at a COVID-19 room with a moderate disease 300 (9.7%) patients of which 3 (1%) died

Now, have a look at this:

The average between the onset of symptoms and the ER visit... ...in patients hospitalized in a COVID-19 isolation room it was 6.9 days...

This means that most of these hospitalized patients probably waited until symptoms got worse and then visited the ER for treatment. Of those 300 patients with moderate symptoms, 3 (1%) died.

Finally, the severe-to-critical patient group:

On the other hand, in the COVID-19 ICU, 111 patients (27%) were hospitalized, representing, 3.6% of the cases originally treated in ER. (Table 3 and Table 4)

...a severe to critical disease were hospitalized in the ICU 111 (3.6%), 34 (30.6%) of whom died.

Here is a possible explanation on why some of these people didn't make it even though they received not-small doses of ivermectin:

The average between the onset of symptoms and the ER visit... ...in patients hospitalized in ICU-COVID-19 of 7.8 days.

They simply waited too long at home and for many of them going to the hospital was too late.

The most important message of this study, at least to me, is:

EARLY TREATMENT AND PROPHYLAXIS WITH IVERMECTIN IS THE KEY TO SAVING LIVES!

[-] TrumpLyftAlles | 2 points | Nov 03 2020 22:29:21

Nevertheless, reducing from 3% to 1.2% is a huge gain!

I think the IFR is much lower -- at least it is in the first study I found. This 2020-10-14 WHO report (PDF) says:

Results I included 61 studies (74 estimates) and eight preliminary national estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118–500 COVID-19 deaths/million people and 0.57% in locations with 500 COVID-19 deaths/million people. In people < 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%.

IFR = 0.57% in places that had a lot of deaths.

I found another paper, another meta-analysis:

* Systematically reviewing the literature and meta-analysing the results show an IFR of 0.68% (0.53%–0.82%).

* This rate varied from place to place, with a lower range of 0.17% and a highest estimate of 1.7%.

I don't think the 3% IFR claim is valid.

Edit: Per massimux's comment, if we double the IFR's above, then depending on what IFR you choose, this study's 1.2% does look impressive. We don't really know what IFR to use, though. They range widely.

ALSO, I don't think it's really a valid comparison, since this study started with people who were pretty sick -- "3,099 patients with a definitive or highly probable diagnosis of infection due to COVID-19" -- sick enough to go to the ER -- which excludes all the asymptomatic and not-ill-enough-to-seek-help infected people who would be included in an IFR.

What's really needed is a IFR for people who were comparably sick. I don't think that exists, and/or we have no basis for knowing whether the IFR-calculated population was comparably sick.

A different number:

IMO, this is a number we can take heart from: 99.33% of 2706 outpatients who (apparently) had covid19 didn't get worse (presumably got better?) enough to require hospitalization -- after taking ONE dose of ivermectin at 0.4mg/kg, plus Azithromycin 500mg for 5 days. That's an amazing number: 99.33% one and done (plus the AZT).

It would be more convincing if we knew more about the outpatients' course of history. Were they feeling recovered after 10 days? 20 days? It would also help if the subjects of this study were PCR-confirmed.

Still, a strong result for ivermectin.

99% of covid19-infected outpatients were cured by a single dose of ivermectin.

And other stuff, but it's catchier if we keep it simple. 😄

Edit: Here's another more-positive number. From here, the Dominican Republic has had 127,848 cases and 2,252 deaths, for a case fatality rate of 1.7%. In this study ("Compassionate"), there were 38 deaths among 3,099 patients = 1.2%. So it's arguable that the IVM + AZT treatment reduced the CFR by 0.5%. That significant, IMO (not in the statistical sense).

But I still think it's snazzier, that 99% didn't require hospitalization, after a single dose of ivermectin (plus the AZT).

Contrast that with the US experience: "Yes, you've got covid. Sorry about that. Go home, use this oxygen meter, come back to the hospital if your 02 drops below 92% or you experience shortness of breath." Is would be SO much better to treat those people with ivermectin, per the experience of Dr. McCullough, who treated himself at home with IVM and HCQ.

[-] massimaux | 2 points | Nov 03 2020 22:54:46

I don't think the 3% IFR claim is valid.

They are talking about CFR, not IFR. Let us discuss the relevant ones.

IFR = #deaths / #infected

CFR = #deaths / #PCR_positive

CFR_sympt = #deaths / #symptomatic

#PCR_positive = #symptomatic + #asymptomatic

According to a number of references reviewed here, #asymptomatic is slightly less than #symptomatic. Hence, approximately:

#PCR_positive = 2 * #symptomatic

So, approximately: CFR_sympt = 2*CFR

Now, the DR's study computes ivermectin-based CFR_sympt. Let us denote it CFR_sympt(IVM).

CFR of the world is currently sligthly less than 3%, but most likely it is underestimated due to underreporting of deaths by many countries.

CFR_sympt(world) = 2*CFR(world) = 5-6%

Finally, compare CFR_sympt(IVM) =1.2%

and CFR_sympt(world) = 5-6%

The mortality reduction is at least 4 times.

[-] TrumpLyftAlles | 2 points | Nov 03 2020 22:58:27

Good point, well made. I'll take it.

[-] massimaux | 2 points | Nov 03 2020 23:08:09

One more non-mathematical point, quite important one.

As noted in the report, those that ended up in as moderately ill were placed in the isolation room and 1% of them died. They came to the ER late, 6.9 days on average after symptom onset.

Those that ended up as severely or critically ill were placed in ICU. 30% of them died. But, they came to the ER very late, 7.8 days on average after symptom onset.

Now, imagine that the system works differently. It doesn't wait for the patients to become very ill, instead, it administers IVM to ALL on the first or second day from symptom onset. Wouldn't that save even more lives?

I can speculate that at least half of those 411 hospitalized wouldn't end up in the hospital in the first place with timely early IVM treatment.

[-] TrumpLyftAlles | 3 points | Nov 03 2020 23:33:50

I totally agree. If God gets tricky and Dr. Fauci and I trade bodies, then I'll immediately call for everyone having ivermectin in their medicine cabinet so they can take it on the first sign of trouble. Also, everyone will have enough $1 at-home rapid tests so they can test themselves every day. Also, take vitamin D everybody!

Those policies implemented, I'll ask God to trade us back. I'm younger than the good doctor. ;)

[-] massimaux | 3 points | Nov 03 2020 23:44:38

It's a shame that reddit doesn't have easy FB-like reactions like laughing and others.

Your comments are full of great humor. :D

[-] TrumpLyftAlles | 1 points | Nov 04 2020 00:05:44

Gosh, thanks! I'm a jokey guy, try to refrain from over-doing it. Let me know if I do, please.

If you're on Windows, Windows-key+period (both keys at once) brings up an emoji list that works with any application. 😁

[-] massimaux | 2 points | Nov 04 2020 00:15:38

🤣 Thanks!

[-] TrumpLyftAlles | 1 points | Nov 04 2020 00:23:01

I find the Facebook UI totally confusing -- and maddening. I'm in the MD Ivermectin group, find it totally frustrating. 22 comments. Click to see the comments. It shows me 3. I can't figure out how to get them all. And it appears to be one timeline, shared by 5000 people. AFAIK there's no equivalent to the typical reddit sub page where you can see all the topics at once. Scroll, scroll, scroll. Ugh.

[-] TrumpLyftAlles | 2 points | Nov 03 2020 23:35:39

They came to the ER late, 6.9 days on average after symptom onset.

That's long after the virus has declined, in the midst of the cytokine phase, which isn't ivermectin's strength -- making your point.

[-] SwiftJustice88 | 1 points | Nov 03 2020 19:08:49

Thanks for breaking this down! Every study I read I’m always cautiously optimistic but knowing others see the benefit of Ivermectin too gives me great hope!

[-] massimaux | 3 points | Nov 03 2020 20:01:31

There is another very important catch here. All those 3,099 patients were symptomatic (although only a fraction of them were PCR confirmed). The point is, CFR in any country is computed as the ratio of number_of_deaths and number_of_PCR_positive. And, number_of_PCR_positive comprise both symptomatic and asymptomatic cases meaning that CFR_symptomatic is always higher than CFR_PCR_positive.

As far as I know, the number of asymptomatic cases is almost 50% of all PCR positive cases. So, CFR_symptomatic = (roughly) = 2*CFR_PCR_positive = (roughly) = 5-6%. Assuming substantial deaths underreporting worldwide, CFR_symptomatic may be even higher than 6%.

So, the IVM-based CFR_symptomatic in the Dominican Republic's study of 1.2% is, in fact, at least 4-5 times smaller than the world's CFR_symptomatic (of at least 5-6%).

[-] akaariai | 2 points | Nov 03 2020 20:18:59

Yes, this is for those who visit ER. You don't do that during pandemic just for fun.

[-] Haitchpeasauce | 2 points | Nov 03 2020 22:58:05

Something for us to remember is that COVID-19 has a distinct pathological signal once symptoms have progressed, clinicians can safely make a diagnosis without PCR confirmation. What we need now is for same day antigen tests to become more common, which are faster turnaround and have a higher predictive positive value, while being lower sensitivity which is fine with clearly symptomatic patients.

[-] SwiftJustice88 | 1 points | Nov 03 2020 21:34:12

Wow, great catch!

[-] [deleted] | 1 points | Nov 03 2020 22:46:52

[deleted]

[-] TrumpLyftAlles | 2 points | Nov 03 2020 18:34:17

Outcomes

Contrast with the normal course.

Abstract
Summary: No antiviral has been shown to reduce mortality in SARS-COV-2 patients to date. In the present observational and retrospective report, 3, 099 patients with a definitive or highly probable diagnosis of infection due to COVID-19 were evaluated between May 1st to August 10th, 2020, at Centro Medico Bournigal (CMBO) and Centro Medico Punta Cana (CMPC), and all received compassionate treatment with Ivermectin. A total of 2, 706 (87.3%) were discharged for outpatient treatment, all with mild severity of the infection. In 2, 688 (99.33%) with outpatient treatment, the disease did not progress to warrant further hospitalization and there were no deaths. In 16 (0.59%) with outpatient treatment, it was necessary their subsequent hospitalization to a room without any death. In 2 (0.08%) with outpatient treatment, it was necessary their admission to the Intensive Care Unit (ICU) and 1 (0.04%) patient died. There were 411 (13.3%) patients hospitalized, being admitted at a COVID-19 room with a moderate disease 300 (9.7%) patients of which 3 (1%) died; and with a severe to critical disease were hospitalized in the ICU 111 (3.6%), 34 (30.6%) of whom died. The mortality percentage of patients admitted to the ICU of 30.6%, is similar with the percentage found in the literature of 30.9%. Total mortality was 37 (1.2%) patients, which is much lower than that reported in world statistics, which are around 3%.

[-] TrumpLyftAlles | 1 points | Dec 10 2020 15:02:20

Only 0.59% of the 2706 were hospitalized (1st image) after taking 400mcg/kg of ivermectin, compared to the typical ~20% (2nd image). Just 2 IVM = ICU vs typical 81-205.

[-] TrumpLyftAlles | 2 points | Dec 10 2020 15:43:55

I tweeted about this study.

[-] TrumpLyftAlles | 1 points | Nov 08 2020 18:44:40

/u/massimaux posted a very long post which includes this study at the top of his post here.