I understand there was an element of just trying anything and everything, but I just don‘t understand why someone would think an antiparasitic Would be the key to treating a viral infection. And not just once, but twice now. Is there something about them or these two specifically that would make them seem like good candidates?
From the science stand-point, here's how ivermectin entered the picture:
1) For any novel infectious agent, be it a virus, bacteria, fungus or parasite, the first step in researching treatments is to grow the agent
in vitro, then throw the kitchen sink at it to find possible treatment candidates. Most of these initial leads will end up as dead-ends on further in vivo research. Ivermectin did show some
in vitro promise.
2) Early in the pandemic, the "cytokine storm" was thought to be the major cause of mortality in COVID patients, so any treatment that could dampen this response received further attention. Ivermectin has some known mild anti-inflammatory properties, so it became a potential candidate. This is also how hydroxychloroquine entered the picture. Doxycycline and azithromycin also recieved some attention for the same reason, although they surprisinly flew under the public's radar.
We now known that the cytokine storm is of secondary importance to preventing unchecked viral replication in the first place, although corticosteroids have shown to give a modest survival benefit.
3) Because the developing world uses ivermectin far more often than the rich world, some doctors in these countries focused their search for treatments more closely on this drug (remdesevir or monoclonal antibodies, for example, would have been far more difficult for them to obtain). One published study from Argentina seemed to show ivermectin's efficacy, but this trial suffered from very poor randomization... patients in the treatment arm were much healthier at baseline, and thus more likely to survive anyway. This study initially caused a blip of attention, but the design flaws were soon thereafter apparent. But that didn't stop all the contrarians and "independent thinkers" from latching on to it.
Subsequently, many small trials have either shown a mild or no benefit, but they mostly suffer from basic design flaws. The kind of large-scale, high quality trials that would provide compelling evidence for or against ivermectin's use in COVID are either lacking or not yet published. Some trials were prematurely stopped because their was evidence the drug was actually causing harm.
So, here we are. Anecdotal evidence doesn't seem to suggest ivermectin will have any role in COVID-19 treatment, which is usually enough to move on to other candidates. If the data for molnupiravir matches the enthusiasm of the press releases, we'll have a new standard of care for outpatient treatment. That would further narrow the potential window for ivermectin, because now any new medication would need to be tested against the existing standard of care, and not merely against placebo. So, that would really only leave ivermectin's role as a possible treatment against severe COVID-19, and so far, the anecdotal evidence for this would argue against this use.
Barring the off chance some new compelling evidence surfaces, we should no more discuss ivermectin in the context of COVID than we should tincture of mercury for syphillis.
www.cnn.com
we gave the 2 shots too close together.
