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Ivermectin - Cheap and Probably Effective

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D_W

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They may, but in the U.K. by that time the approval will be virtually irrelevant to use in COVID-19 infections due to vaccination
We're estimating here that about 20% of the population won't get vaccinated. Some part of that cohort has already had covid (probably at least 25%).

The odd thing here in terms of cognitive conflict is the same group of folks screaming about variants also talks down things like this prophylactic study in india.

Imagine a variant that wasn't quick to vaccinate against. What's the chance that it would evade this ivermectin prophylactic effect in india? Probably pretty low. If there is efficacy, wouldn't you (talking about everyone) like to be aware that there's an easily produced alternative to bridge to a vaccine update?

Especially given that the drug in this case is proven to have an extremely low side effect profile, and it's persistent in the body, so you don't have to run around and take it every day or multiple times a day. You take it once every several weeks or two times early in a month and then the next month, and the amount taken is small.

To decry this as something dumb to look at or conspiracy theory fodder is dumb. No remdesivir study ever showed efficacy similar to the indian prophylactic study. The only thing we need to wait for is peer review to make sure the study wasn't gamed (but one would hope with the list of doctors involved in the study, that wouldn't be a problem), such as by giving the ivermectin to lower exposure workers in proportion. We can only wait and see. If the study holds up to peer review, it's sheer stupidity not to try to duplicate it in the western world and see if the effect can be observed independently.
 

sometimewoodworker

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To decry this as something dumb to look at or conspiracy theory fodder is dumb. No remdesivir study ever showed efficacy similar to the indian prophylactic study. The only thing we need to wait for is peer review to make sure the study wasn't gamed (but one would hope with the list of doctors involved in the study, that wouldn't be a problem), such as by giving the ivermectin to lower exposure workers in proportion. We can only wait and see. If the study holds up to peer review, it's sheer stupidity not to try to duplicate it in the western world and see if the effect can be observed independently.
You are absolutely correct on its efficacy but mistaken about having to wait on the results from the large Indian usage. There are already several (15 randomised controlled trials (RCTs) and observational controlled trials shows that ivermectin is remarkably effective both for prophylaxis and treatment of Covid-19.) prior studies that have already been peer reviewed. Yes the data from India will be helpful but it’s only following along from other studies. It isn’t breaking new ground so will only reenforce existing studies. It may well be larger than others but not unique.
 
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Woody2Shoes

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Another point about large scale use of ivermectin, whether as a covid prophylactic or as an anthelmintic in humans and animals, is that significant quantities are excreted into water courses and ground water with deleterious environmental effects - we need worms!
 

D_W

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Actually, that was something worth looking up. All of the studies that I found suggest most fish aren't sensitive to any avermectin types, but the flies and parasites that love cow pats don't survive in the pats. Earthworms and most non-parasites aren't sensitive to them, and plants don't take them up (so the animals don't end up re-metabolizing). According to this article, once the avermectins are tied to sediment (vs. just exposing fish to them in a way they aren't presented in nature), the toxicity (to the sensitive fish) is reduced.

Here in the states, when ivermectin came up, this was an attractive idea to farmers because it's out there in huge quantities in mixed pastes, powders, etc, for cows and sheep.

The other interesting things about studies is that some concluded that cow pat breakdown would be slowed by lack of the parasites and flies that feed on the pats, but this study actually checked that instead of just conceptualizing that it might occur, and mentioned only in artificially formed pats (hopefully nobody has that hobby) showed changes, but "Real ones" broke down as quickly (avermectins aren't antibacterial).

All in all compared to antibiotics and antidepressants that are very persistent in effluent, it seems pretty minor. The amounts given to cows and sheep are probably overdoses, too.
 

sometimewoodworker

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steroids are monstrously cheap over here, which means they are potentially valuable in terms of keeping patients off of oxygen in poor countries.
Sorry to rain on your parade, that doesn’t follow. You missed the point that, while yes steroids are both effective and cheap the also always require intravenous insulin with constant blood sugar monitoring because one of the side effects is to spike blood sugar. This is a standard ICU procedure in advanced countries but not available in the scale needed in poorer ones. As India is sadly finding out uncontrolled blood sugar leads quite often to fungal growth and tissue necrosis the cure for which is cutting out the necrotic tissue and they do not have the operating theatres or surgeons available, without an operation about 50% die and the ones who don’t are badly disfigured.
So they survive COVID-19 and die from the effects of the treatment, good idea?

What percentage get the fungus isn’t known, or if there is data it isn’t published yet. What is known is the high numbers with type 2 diabetes who already have insulin problems.

What works well in a first world ICU can easily kill in a country without the same facilities
 
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Woody2Shoes

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Actually, that was something worth looking up. All of the studies that I found suggest most fish aren't sensitive to any avermectin types, but the flies and parasites that love cow pats don't survive in the pats. Earthworms and most non-parasites aren't sensitive to them, and plants don't take them up (so the animals don't end up re-metabolizing). According to this article, once the avermectins are tied to sediment (vs. just exposing fish to them in a way they aren't presented in nature), the toxicity (to the sensitive fish) is reduced.

Here in the states, when ivermectin came up, this was an attractive idea to farmers because it's out there in huge quantities in mixed pastes, powders, etc, for cows and sheep.

The other interesting things about studies is that some concluded that cow pat breakdown would be slowed by lack of the parasites and flies that feed on the pats, but this study actually checked that instead of just conceptualizing that it might occur, and mentioned only in artificially formed pats (hopefully nobody has that hobby) showed changes, but "Real ones" broke down as quickly (avermectins aren't antibacterial).

All in all compared to antibiotics and antidepressants that are very persistent in effluent, it seems pretty minor. The amounts given to cows and sheep are probably overdoses, too.
My tenant bought in some cattle to join his existing herd and one or two of them came down with lungworm. It transpired that the previous owner had been regularly dosing them with "pour on" avermectin and they had not developed any natural resistance to the parasite. The existing herd had been slowly weaned off the stuff, with only occasional specific use. Needless to say, he gave them all a dose and will continue to do so for a while. From a sample size of one, I'd say that the pats definitely don't get so quickly returned to the soil (I haven't read the study you linked - I don't know how "real-world" their experiments were, [or who funded their research either!]).
Another - indirect - effect of the use of avermectins, which I think is undesirable is that farmers no longer feel the need to rotate animals on and off land (to break the life cycle of "pest" critter) and so concentrations of these chemicals can and do build up and the soil (and sward) quality suffers (requiring more chemical/mechanical interventions).
You're right that there are a lot of other synthetic chemicals getting into ground water that may have worse effects (neonicotinoids being a supreme example, but loads of others), but it's all cumulative and widespread - death by a thousand cuts.
It does make you wonder how farmers managed to successfully raise livestock for the few thousand years - and their wild ancestors thrived for hundreds of millennia before that - before all these chemicals were invented!
 

D_W

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I'm descended from diversified farmer, and could tell you how they did it, but you already know. Mainly has to do with each farmer producing only enough food perhaps for their family or another's with theirs.

I like the output of our current system, but it sure doesn't seem sustainable long term here. It probably is, but it's brute force fuel and chemicals.
 
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