Effectiveness of IVM vs vaccines

[-] stereomatch | 5 points | Mar 13 2021 14:32:28

If governments adopt a strategy of:

vaccines
pre-exposure prophylaxis (ivermectin every 14 days, vitamin d level improved)
early treatment - which includes post-exposure prophylaxis for all household - is a strategy which gives multiple opportunities to stop declines. First is with drugs like ivermectin and Famotidine and then when day 8/oximeter declines approaches, then with steroids - all under the care of physicians who are monitoring them via phone.

Then there is almost zero likelihood of death.

However there still is possibility of death because of various human factors:

patients and some doctors even will tend to underestimate the seriousness of this disease (when it goes bad they fail to grasp the speed with which declines occur)
delays in patients who want to first get PCR tested to "confirm" they have covid19, before they commit themselves to seeking treatment. Many people have a hard time believing THEY could get it (I don't know why this happens - perhaps they are religious and think they have been doing extra prayers, or are better than others and so it cannot happen to them?). Others have no such misconceptions, but STILL are being told those around them that testing first is the way. Also informing patients' preconceptions are the history of other diseases and the "accuracy" of testing which they have come to expect. Blood tests are expected to be accurate, so this one must as well. Some of this misconception is driven by early messaging by media - it was all about testing (which is good for demographic level estimation and planning), but media coverage failed to highlight the diagnostic uselessness of a PCR negative test. Now however, even the lab PCR test results have disclaimer text - that a negative PCR test means nothing.
patients relaxing because they got a negative PCR test. I know one case who botched his case thinking he had "pneumonia" because his PCR test was negative. His doctor too insisted it was pneumonia (there was a thinking prevalent at that time that "not everything is ~~pneumonia~~ covid19" and this doctor evidently subscribed to that). Also the media never really told the public that PCR negative means nothing This particular guy wound up in ICU and was out after a few weeks and still suffers deficits. His whole family was infected - half of them tested positive on PCR, and half tested negative - which makes it a good example to quote. His family (not him, he was in there care of the hospital - which gave him Remdesivir over many days as is the practice still in many hospitals). His family all took ivermectin and Famotidine and supplements (vitamin c, vitamin d, vitamin b1/b-complex, NAC) and recovered. Wife and 3 daughters showed partial reversal is taste/smell loss (anosmia) within 24 hours of taking first dose of Ivermectin (does not happen in everybody - perhaps in 25 percent of anosmia by my estimation - and anosmia occurs in maybe 25 percent of covid19 cases)
even in patients who are committed to helping themselves get early treatment, there can be such a long turnaround time in getting treated - mostly because patients trust every doctor who treat covid19, or knows how to (many openly admitted they don't - which is why they say take a paracetamol and stay at home as the only treatment). This strategy naturally makes the mild patients of this week the severe patients of next week. Ideally a family will have identified a doctor who treats early before hand so they don't waste time when they need him - the hostility in the media to early treatment also discourages doctors except the most conscientious (and brave) ones from trying early treatments, when it is so easy to say there is no treatment.
once you do find a doctor, the doctor may still be informed conventionally and not value the importance of time, and may not start early treatment until PCR test is positive instead of just starting it. Patients usually get a test first, then find the doctor again to get his opinion - this cycle may waste 2-3 days in some countries.
the practice I have seen many times - doctors who treat with anemic levels of steroids initially, then waste a few days and THEN increase it more after they see things are not improving. That is why MATH+ folks like Dr Paul Marik refers to the "homeopathic levels of steroids" that many hospitals give - which leads to uncontrolled deterioration and the physicians losing early opportunity to quell the hyperinflammatory syndrome.

I'm curious to compare this with IVM. When you take IVM as profylaxis (as you would do with a vaccine); can you still get the disease and pass it on to others? Or does it really stop you from getting infected all together? And if so; can we put a efficacy-percentage on that?

Ivermectin and other such medicines have the disadvantage that they require constant use - for pre-exposure prophylaxis using ivermectin the I-MASK+ protocol now recommends 12mg every 14 days (for a 60kg person). It used to be every week, but they have lowered it after seeing data from some later studies - so they 14 days may suffice, and reduces the long term exposure to the drug, and reduces the demand for the drug by half.

Now for ivermectin, while it is a safe drug with a long history - well known over 40 years with 3.7 billion doses, yet only 4600 adverse effects and 16 deaths, giving it a better safety record than aspirin or ibuprofen perhaps. What is less known is what happens if it is used for very long periods every 14 days.

Of course, if one did not have access to vaccines, and was dependent on ivermectin, but didn't want to take it all the time, they could make episodic use of it - ie take it whenever they feel they have been exposed (but not more often than ever 14 days). Of course this means asymptotic infection (which they will not notice) will not be addressed, and we know asymptotic infections can still lead to clotting (lung and heart damage in athletes) and such risk.

So this is the problem with ivermectin.

However if Ivermectin and other drugs are part of a government's policy of early treatment, and is executed in a timely manner, which means delivery of steroids on time, it can help achieve zero deaths.

Vaccines reduce infections by 9x. And may reduce serious disease to near zero. However the data on vaccines is not large enough (because you need many people to have some get infected accidentally, and then from those infected to have people die to get the data).

Ivermectin study from Zagazig Univ Egypt had shown a near 8x reduction in symptomatic infections. There were not enough deaths to get an idea since there were zero deaths. But it is possible you may get similar results as vaccines. This is for post-exposure prophylaxis ie when people take ivermectin as soon as their household people get infected.

The problem with this pandemic is that not enough time has passed, so many of the pronouncements about vaccines will require more time to get enough data to answer question about how long immunity will last, how will variants emerge etc.

The one advantage early treatment protocols have is that as far as we can guess, they will have efficacy for variants as well - because the early treatment drug cocktails cover a variety of pathways, and cover the hyperinflammatory stage as well using steroids. Thus it is likely that early treatment protocols will continue to have relevance, and may start to get the respect they deserve - so far they have been ignored by many governments because it is seen as a distraction from vaccines. As Dr McCullough testified in front of the Texas Senate hearing where he said that while the NIH had an emphasis on early treatment, they dropped all those efforts when vaccines started to come online.

That being said, even if you are on Ivermectin, a smaller fraction of people can still get the disease, so early treatment options still are needed. I know of 1 case who had been taking ivermectin (diabetic on insulin but otherwise healthy 55 year old) who got mild symptoms he may have otherwise not noticed - mild occasional tendency to cough, fever 99.3, 99.4 on two days. He tested PCR positive. However since he was high risk (diabetic) my suggestion was he start steroids on day 7-8 when he discusses with doctor - it turned out the doctor he showed to gave him steroids at day 6 which was a bit early in my opinion. He had no symptoms and recovered. So in this case we don't know what would have happened if his doctor had not started steroids since a serious dip in oximeter readings had not started.

The second case had taken ivermectin a week before. Diabetic on insulin, 60 year old, with history of heart disease (stents), otherwise healthy and active. Then on start of symptoms he took the full protocol. His symptoms went down. Then around day 7 he started to show beginnings of oximeter decline. On day 7 he took steroids and was without symptoms after that until recovery. It is possible he could have recovered without steroids, but given his comorbidities, perhaps the route he took was lower risk choice overall. Neither cases developed long hauler syndrome (been observed for 2 months after recovery).

[-] rondi7 | 2 points | Mar 13 2021 17:11:40

As usual--VERY nice explanation. I am not a medical person, but this is MY understanding. The 1st stage of CONID19 is you breath in the virus--usually thru your nose. This is where it starts replicating and invading your body. This occurs days BEFORE you have symptoms. Another 3 to 5 days you get symptoms--BUT you have already got a viral load and you are unknowing exhaling the virus. Other people can get it from you. IF you had been taking IVM and the MASK+ protocol vitamins as a prophylaxis for weeks before exposure--your symptoms should be reduced and if you are lucky--will go away because youwere able to prevent the virus from invading your cells--BUT for me the huge questions remains---at what point are no longer shedding the virus? As with vaccines--the question remains unanswered.

[-] stereomatch | 3 points | Mar 13 2021 19:18:14

BUT for me the huge questions remains---at what point are no longer shedding the virus? As with vaccines--the question remains unanswered.

My understanding is that after infection it takes around 5 days to show first symptoms. Now having observed patients in households, who were exposed to an index case in a house and checking their timing of appearance of symptoms, this seems roughly to be the case. You can roughly guess who got it from whom by interviewing them - and the way the appearance of first symptoms is staggered.

Though sometimes the timing may not be 5 days but shorter and sometimes longer, in which case it can be sometimes confusing. Which makes me think that perhaps if infection from within household is mild then maybe it takes longer to multiply enough to reach macro ie large levels. Or maybe it relates to the innate immunity of the individual.

Probably the most confusing are cases with very mild symptoms, which then become difficult to time estimate. But often they too can give a date where they got a backache or bodyache. This is why I suspect that many asymptomatics also may show symptoms useful for timing day1 etc., but the symptoms are so mild they attribute them to regular aches and pains.

From the information on live viral graphs provided by MATH+ and other sources, the live virus is replicating from day of exposure to the peak (which is typically when the first day of symptoms appear). However since the graph rises from very low levels to max within a day or so, this means (in most cases) you are infective from one day before day 1 of first symptoms (because the live viral load curve goes from near zero to max within one day).

Live viral graph goes from max at day 1 of first symptoms to near zero or undetectable levels by day 5, some by day 6, but nearly all by day 8 - as MATH+ asserts. And this is what others have said also.

This means infectivity may go down to near zero by day 8. However you may still want to be sure. This is why most governments suggestions are to wait 10 days or so. Earlier suggestions were 14 days.

However there may be some cases who are infective for longer - some immunocompromised patients have been shown to have live virus at 100+ days. But it is not clear how infective they are ie how numerous that virus is, ie there may be a theoretical risk, but in practice it may be low.

Studies have shown live virus is present in the gut for many days ie in immuno-privileged locations - which may be why some countries are checking stool using PCR testing.

But it is not clear how infective this is - though it is conceivably that the virus may get into waterways, and may get into other animals - but not clear how much of a threat this is - I suspect authorities are more concerned about transmission from human to human over the air, and so may be focusing less on the more obscure routes.

Regarding the timing to hyperinflammatory syndrome, at first thought the MATH+ protocol seems like it may be a rough timing estimate, but in practice it is quite accurate which was surprising to me - most people who show a dip in oximeter levels start to show it on day 7 and going forward. Some do show some modest fall during day 1-8 period as well to something like 97 (and the way to measure it as I would recommend it is to measure the max level achievable after breathing etc.). As day 7 comes around, the oximeter readings start to fall (for those where there is decline) - if you delay giving steroids they can fall to 93 or so by day 10. But some show 93 even sooner ie day 8. So for a physician monitoring a patient they need to be very nimble around day 7-8 in responding. And there can be some who (usually the milder cases) who may not show fast decline but after a few days may start to show steady deterioration happening by day 10 (long hauler syndrome developing in asymptomatics or mild cases who were given just paracetamol seem to be a special case of this).

This is why I would now advocate to physicians to as a rule be ready to give steroids by day 7-8 - esp. if logistically they know, if they don't give it on day 8, the patient may not come back for 2-3 days. Which is the recommendation of the MATH+ protocol. Now there may be a risk that virus has not reduced to very low levels by day 8, and giving steroids at day 8 may exacerbate the infection. However if at day 8 oximeter readings are falling (or pulse rate is elevated at 90s or 100+ at rest) then a physician doesn't have an option but give steroids to arrest the hyperinflammatory syndrome. Regarding the risk that virus hasn't gone down, the idea may be that since the virus is going down, and adaptive immune will be kicking in soon, it may be ok. This is perhaps why most of the patients given steroids when they show oximeter decline seem to do ok, with recovery and no long hauler syndrome (or at least lesser than the 25 percent long haulers usually reported) from the examples I have seen, and from what Dr Been reports, and the cases the MATH+ have seen.

Dr Been additionally reports that in some countries doctors are giving steroids too early which complicates their cases, and they are referred to him. But one thing he noted about them is that none of those seem to turn into long hauler cases. Which is interesting, and a good indicator that steroids at day 8 may not hurt and may actually help reduce risk of long hauler syndrome.

This all together seems to support a view that immunomodulation and moderate immunosuppressives may be beneficial, as long as they are not so strong that they suppress viral elimination during the day1-8 viral period.

Regarding the results of the RECOVERY trial that steroids are good, but the subset analysis that it may not be hugely good for patients who are not in oxygen - that information is used by some to justify not giving steroids to moderately severe patients ie those with oximeter declines but not oxygen yet. I suspect this is an artifact of this study - ie it could be because they were giving the low dose of 6mg dexamethasone which may not be arresting decline of those who were sick enough to have been admitted to hospital (less severe who were admitted may have had other comorbidities and thus were admitted desire despite being mild) - there could be all such kinds of confounders. Because it flies in the face of everything that doctors are seeing - early treatment doctors who have success are treating with steroids and they do better because the patient doesn't decline - the only difference is a real doctor prescribes steroids according to the patient (and not a preassigned non-changing dose of 6mg prednisolone as in the RECOVERY which is playing with the lives of patients by making the dosing not adjust for patient specific need).

So generally the infectivity period lasts from one day before first symptoms to day 8 or later.

There is some talk that asymptomatic people are infective also - but I find that hard to believe but maybe it happens. Since asymptomatics like young and children are expected to have a strong innate immune response that kills off the virus fast - so it has lower viral peak, and this lower viral debris and so lower inflammation in the post-day-8 period. But maybe there are asymptomatics that are immuno-compromised that have high viral peak but still have low post-day-8 inflammation because immune system is weak and responds slowly then.

[-] BernieTheDachshund | 5 points | Mar 14 2021 01:07:38

My family tested positive for covid in January but I tested negative. What's strange is my mom and I were in the same car, spitting into a little vial for the test and I could have got it then. My test came up negative, but I easily could have got it in the car (ironic, I know). I was feeling cruddy, as was she. I got my bottle of IVM and we both dosed. We both felt better within hours. When my 91 year old granny tested positive a few days later, we dosed her too even though she was asymptomatic. I feel like it kept us from getting sick. My sister had it and after 2 or 3 weeks she was really suffering from that long hauler syndrome (severe fatigue, feeling feverish, depression, brain fog, etc). I didn't know she felt that bad. Within hours of her dosing with IVM it was a total turnaround. So I don't know percentages, but there is something to it. It can't hurt, IVM is one of the safest meds on earth. We all got vaccinated (the first shot) at the end of February. I'm just mad that the CDC just said they don't know how long vaccines even last, that it could only be 3 months! I thought it would be for life, but no. Plus they're saying we'll need boosters for the variants. So glad Ivermectin is around as a safety net. Vaccines help, but they are not a silver bullet. Here's an article about the vaccine, how long it lasts. How long is the CDC estimating COVID-19 vaccine protection will last? (wbrc.com)

[-] Inner_G84 | 4 points | Mar 13 2021 14:28:05

Hmm, good question. I want to say it depends on the condition your in when you start taking ivermectin but I'm sure someone with more medical knowledge will have a better answer. As I understand it, once you're on ivermectin, it blocks the virus from replicating at all within your cells. So as long as you're dosage is appropriate and you don't have it already, then you're protected 100%. If you already have the virus, ivermectin stop any further replication and depending on how much currently exists will determine if you're infectious but ivermectin also works against already infected cells as well (though I'm not clear how exactly, I don't don't work in the medical field).

[-] traveler19395 | 3 points | Mar 13 2021 14:31:11

can you still get the disease and pass it on to others?

Possible.

Or does it really stop you from getting infected all together?

Possible.

And if so; can we put a efficacy-percentage on that?

No.

The broad strokes of IVM show it's effective at reducing severe outcomes, but the answers you seek aren't even clearly answered for the vaccines which had massive studies (both $$ and subjects), so there's no chance of having solid answers to those for IVM which has mostly been studied self-funded by medium sized hospitals and individual doctors, not massive pharmaceutical companies.

[-] vatiekaknie | 1 points | Mar 15 2021 11:40:13

Protection from vaccines is not immediate. It is only at about 40+ days after vaccination that the full protective effect is there, and I suspect very few in the population have reached that point. Also, I don't see this as ivermectin vs vaccines, both have to be a part of the eventual long term strategy. It is not inconceivable that if we did start using Ivermectin en masse and relied on it as our only strategy that eventually ivermectin resistant strains would start emerging, I have no proof of this but we have seen this with other diseases so seems at least plausible. Never put all your eggs into one basket. The same can be said for vaccines. Tldr: Therapeutics + vaccination , not therapeutics vs vaccination.