Early COVID treatment Early treatment is one of the four pillars of pandemic management , the others being contagion control , late-stage hospitalisation ( as a kind of safety net for survival ) and finally vaccination to achieve herd immunity . 1 This was clearly described in December 2020 and yet it apparently remained absent from the Western pandemic policies . Instead , research efforts were focused on late-stage hospital treatments and the search for a vaccine . Indeed , in some quarters early-stage anti-viral treatments were seen as competition for vaccines . After all , they argued , if early treatment is possible why would people bother to be vaccinated ? Framing early treatment as a ‘ bad thing ’ instead of something to be welcomed as a way of treating disease , reducing spread and providing an option for those who could not be vaccinated was a serious mis-step . Fortunately , drug manufacturers and Western governments came round to the idea late in 2021 when the antiviral treatments paxlovid , molnupiravir and sotrovimab were launched .
However , there is no shortage of repurposed drugs for early treatment of COVID-19 – ivermectin , indomethacin and fluvoxamine , for example , are all supported by ample evidence for efficacy and safety together with clinical experience . 4 – 6
Ivermectin is a drug that has been used to treat parasitic infections for over 40 years , during which time about four billion doses have been administered . It is included in the World Health Organization Model List of Essential Medicines . It has anti-viral and anti-inflammatory properties which make it useful for early treatment of COVID-19 . It has been extensively trialled for COVID-19 . A systematic review of randomised controlled trials ( RCTs ) showed a 62 % reduction in mortality when used for treatment and an 86 % reduction in risk of infection , when used for prophylaxis . 6 One of the included studies examined index cases and household contacts in a randomised trial and showed unequivocally that that post-exposure use of ivermectin effectively prevented onward transmission of disease .
Of course , meta-analyses of RCTs are only one part of the evidence base . Clinical experience and population-based studies are also important . Two recent studies have further cemented the place of ivermectin in COVID management .
In Mexico City , a mass treatment programme was implemented in December 2020 . This was a prehospital home-care programme that combined early detection with antigen tests , a phone-based follow-up for positive patients with mild – moderate symptomatic COVID-19 , and the provision of a medical kit containing ivermectin .
The medical kit contained ivermectin ( four 6mg tablets – 12mg / day x two days ), paracetamol ( 500mg x 10 ) for symptom relief and acetylsalicylic acid ( 100mg x 30 tablets ). After one month 83,000 medical kits had been delivered .
Merino and colleagues reported a quasiexperimental evaluation of the effects of the medical kits on hospitalisation for COVID-19 in Mexico City . 7 They observed a 55 %– 70 % reduction in the risk of hospitalisation as a result of use of the ivermectin-containing medical kit . They noted that these findings are consistent with those of a previous study of mass treatment with ivermectin in Peru . 8
COVID prevention In Itajaí in Brazil , a prospective observational study of COVID-19 prevention with ivermectin was conducted between July 2020 and December 2020 . 9
The entire population of Itajaí was invited to enrol in the programme . In the absence of contraindications , ivermectin was offered as an optional treatment to be taken for two consecutive days every 15 days at a dose of 0.2mg / kg / day .
In the analysis , 113,845 ivermectin users were compared with 45,716 propensity-score matched non-users . Of these , 4311 ivermectin users were infected , among which 4197 were from the city of Itajaí ( 3.7 % infection rate ), and 3034 non-users ( from Itajaí ) were infected ( 6.6 % infection rate ). Thus , there was a 44 % reduction in COVID-19 infection rate ( risk ratio ( RR ), 0.56 ; 95 % confidence interval ( 95 % CI ), 0.53 – 0.58 ; p < 0.0001 ).
A further analysis was performed using propensity-matched scoring in which two cohorts of 3034 subjects suffering from COVID-19 infection were compared . The regular use of ivermectin led to a 68 % reduction in COVID-19 mortality ( 25 [ 0.8 %] versus 79 [ 2.6 %] among ivermectin non-users ; RR , 0.32 ; 95 % CI , 0.20 – 0.49 ; p < 0.0001 ). There was a 56 % reduction in hospitalisation rate ( 44 versus 99 hospitalisations among ivermectin users and non-users , respectively ; RR , 0.44 ; 95 % CI , 0.31 – 0.63 ; p < 0.0001 ).
The authors also noted that “ prophylactic ivermectin use appears to mitigate the additional risk of COVID-19 death due to T2D ( type 2 diabetes ), hypertension , and cardiovascular diseases .” They concluded that “ ivermectin [ should ] be considered as a preventive strategy , in particular for those at a higher risk of complications from COVID-19 or at higher risk of contracting the illness , not as a substitute for COVID-19 vaccines , but as an additional tool , particularly during periods of high transmission rates ”.
Molnupiravir On 4 November 2021 , it was announced that molnupiravir had been approved by the MHRA for use in adults who have mild – moderate COVID-19 and at least one risk factor for developing severe illness . Such risk
Repurposed medicines have long-established safety records , are usually cheap , generic drugs , are readily available and likely to be effective against all variants
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