The Checkup With Dr. Wen: Ivermectin (still) does not work against covid-19

Fortunately, other treatments do work. ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌

Try four weeks FREE, then $4 every four weeks for one year  Sign up for this newsletter Read online Guidance on navigating the pandemic and other public health challenges       By Leana S. Wen Opinions columnist  Email Remember ivermectin? That's the anti-parasitic medication that some people strongly believed would save them from covid-19, despite no credible evidence to that effect. Faith in the power of ivermectin to cure the coronavirus was such that family members in Virginia, California, Ohio, New York and other states sued hospitals to compel them to give patients ivermectin after the treating physician refused. A new study published in the New England Journal of Medicine provides additional evidence that ivermectin does not work as treatment for covid-19. This research is a randomized, placebo-controlled trial — the gold standard of clinical studies in which patients are divided into two groups and receive either the treatment or placebo, with neither the patients nor clinicians knowing which they are getting. Nearly 700 patients were randomly assigned to receive ivermectin; the same number received a placebo. As the researchers reported, "Treatment with ivermectin did not result in a lower incidence of medical admission a hospital due to progression of covid-19 or of prolonged emergency department observation among outpatients with an early diagnosis of covid-19." There was also no difference in viral load measured on the third and seventh days of treatment. Nor were there differences in the duration of hospitalization for those who became more severely ill, time to recovery or risk of death. ADVERTISEMENT   Researchers also looked to see whether taking ivermectin early in the course of illness made a difference. It did not. In fact, those who started ivermectin within three days of their symptoms had worse outcomes than those in the placebo group. In short: Ivermectin is not an effective treatment for covid-19. This is different from saying that there isn't evidence that ivermectin works. When the data aren't sufficient, one might make a case for compassionate use. If we don't know for sure, why not try it? That's not the situation with ivermectin. It doesn't work, period. When an intervention has no benefit, the risks will — by definition — outweigh the benefits, and ivermectin should not be used outside of clinical trials. Doctors need to stop prescribing ivermectin for covid-19. A JAMA study found that in a single week in August 2021, about 88,000 ivermectin prescriptions were dispensed in the United States. Before the pandemic, that number was about 3,600. (Ivermectin has legitimate uses in treating parasitic infections.) The researchers extrapolated that more than 84,000 prescriptions were filled for the purpose of treating the coronavirus, costing insurance companies $2.4 million in that week alone. That's not a cost insurers — or taxpayers — should have to cover. The human cost of ivermectin is even greater. Let's not forget the people who took veterinary doses of ivermectin and were poisoned or even died. Then there are those who, as exemplified by the podcaster Joe Rogan, did not get vaccinated in part because they believed in the "treatment" of ivermectin. ADVERTISEMENT   Fortunately, other treatments do work against the coronavirus. Paxlovid and molnupiravir are antiviral pills that are proven to reduce severe illness. Remdesivir, an IV infusion, can also be used to reduce the progression of illness, as can monoclonal antibodies.  And, of course, there are covid-19 vaccines, which have proved many times over to be safe, effective and lifesaving.   My latest column The Gridiron Club outbreak shows what living with covid-19 looks like Opinion ●  By Leana S. Wen ●  Read more »     Ask Dr. Wen Submit your question and I may answer it in a future edition of this newsletter.  Not subscribed yet? Questions to Dr. Wen from Washington Post subscribers are prioritized. Subscribe   "I'm confused about whether to get the second booster. I'm 55, work in health care, have had both vaccines and the first booster, and got omicron in January. I'm going on a trip out of the country in April and don't know whether I should get the second booster now or wait." — Margaret from Indiana You qualify for getting the second booster now, but I would hold off. You are already well-protected from severe illness due to the initial vaccine and the first booster. In addition, you just had covid-19. Because that infection was in January, it was almost certainly omicron. The chance of reinfection with the new omicron subvariant is very low. While it's unclear how long immunity from this infection will last, the combination of your already being vaccinated and boosted and having just recovered from omicron is such that I think you could safely wait. New data could emerge in the coming months that omicron-induced immunity is waning. Or a new variant might arise. Or infection rates could spike again. It might also be that the coronavirus vaccine becomes an annual vaccine, or at least something that requires another booster sometime this summer or fall. But I don't think you need to get your extra booster just yet. "Is it better to wait for a new covid-19 vaccine that will be more targeted to the new strain? I am in my 70s and immunocompromised. Already had two vaccines and one booster." — Ellen from New York You are in a different situation from the reader above. People who are moderately or severely immunocompromised have two major risk factors: First, they might not produce as much of an immune response from the vaccines. Second, they are at an elevated risk for severe illness if they contract covid-19. Therefore, this group should receive the additional booster now. Your age is another risk factor. I would lean more toward your getting the booster shot by age alone. In combination with immunocompromise, I would not advise waiting. (Of course, speak with your physician about your specific medical situation.) There are omicron-specific boosters and vaccines that are being studied. Those data might take weeks to come out, and by the time authorization comes around, it could be months. For some people, it would be reasonable to wait. For you, with both age and immunocompromise, I'd be in favor of getting the fourth dose now. Then you can receive the variant-specific booster in the future if needed. "Should an obese person, mid-30s, pre-diabetic get the second booster shot? Is it allowed under the new guidelines? Person also suffers from mental illness and takes medicines for it." — Bob from New Jersey The Food and Drug Administration and the Centers for Disease Control and Prevention are not allowing for people under 50 to receive a second booster dose, unless they are moderately or severely immunocompromised (which this person is not). Given this person's age, they are not eligible for the booster at this time. You mentioned obesity, pre-diabetes and mental illness. All of these could predispose to more severe outcomes. I encourage this person to find out from their physician what exactly their risk is based on their specific medical situation. Now is the time to optimize other elements of their health, including, in this case, to prevent pre-diabetes from progressing to diabetes. The Post has also compiled Q&As from my previous newsletters. You can read them here.   What I'm reading JAMA Network Open published a new study that estimates that case investigation and contact-tracing programs in the United States averted more than 1 million covid-19 cases and more than 27,000 hospitalizations over 60 days during the 2020-2021 winter peak of the pandemic. This finding is relevant, as many jurisdictions are ramping down or even closing their contact-tracing programs. Though this is a resource- and time-intensive intervention, it is a crucial tool for containing infectious diseases. An Associated Press/NORC poll shows that public concern about covid-19 continues to decrease. Americans are taking far fewer personal precautions than they were earlier, with vaccinated people taking more precautions than those who are unvaccinated. Only 25 percent of people report being extremely or very worried about someone in their family being infected with the coronavirus, compared with 36 percent in January. People who report wearing a mask outside their home always or often dropped from 65 percent in January to 44 percent. Politico has a sobering story on how states' plans to recover from covid-19 and prepare health agencies for future surges are severely underfunded. Alabama's health officer is quoted as saying, "You would think at some point, somebody could do a cost benefit analysis here and say paying for people to get tested and to get vaccinated or to get antivirals for Covid is going to be a cost-saving measure compared with ignoring that problem and letting more outbreaks happen."   More from The Post Biden announces long covid strategy as experts push for more By Dan Diamond and Frances Stead Sellers ●  Read more »   'Victory for the virus': Senators cut global aid from $10B covid deal By Dan Diamond and Rachel Roubein ●  Read more »   China said its covid strategy was superior. It's failing in Shanghai. Opinion ●  By the Editorial Board ●  Read more »   It's time to consider relaxing mask requirements on flights Opinion ●  By Joseph G. Allen ●  Read more »   Ukrainians should be on the lookout for a new battlefield enemy: Disease Opinion ●  By Max Brooks, Lionel Beehner and John Spencer ●  Read more »     We think you'll like this newsletter Check out Must Reads for a curated selection of our best journalism in your inbox every Saturday, plus a peek behind the scenes into how one story came together. Sign up »

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