Ivermectin and COVID-19: What You Need to Know

Has a promising therapeutic fallen victim to politics and misinformation?

Box of ivermectin tablets. Carl DMaster/Shutterstock

Judith Smentkiewicz of Cheektowaga, New York, was given a 20 percent chance to live. She had COVID-19 and was on a ventilator at Millard Fillmore Suburban Hospital. Her son and daughter asked the doctors to give her ivermectin.

When the doctors refused, the family hired two lawyers, Ralph C. Lorigo and Jon F. Minear, to sue the hospital. A state Supreme Court judge ruled in their favor and ordered the hospital to give Smentkiewicz the ivermectin.

According to an article in the Buffalo News, in less than 48 hours, Smentkiewicz was off the ventilator, out of intensive care, and able to sit up on her own. Her family and attorneys are sure that the ivermectin had saved her life.

At the same time, the U.S. Food and Drug Administration (FDA) doesn’t recommend ivermectin. The FDA hasn’t approved or authorized its use for the prevention or treatment of COVID-19 in people or in animals.

“Currently available data do not show ivermectin is effective against COVID-19,” the FDA’s website reads. “Clinical trials assessing ivermectin tablets for the prevention or treatment of COVID-19 in people are ongoing.”

Used for Decades 

Still, ivermectin, which was discovered in the late 1970s, has been in use for decades, initially as a veterinary medicine to kill parasites in commercial livestock and domestic animals. It was then found to be an effective anti-parasitic for humans as well, most notably to treat elephantiasis in Africa and Southeast Asia, as well as river blindness (onchocerciasis), which is also endemic in Africa and in several countries in Latin and South America.

The drug has helped hundreds of millions of people and literally billions of farm animals fight against parasites. In fact, it has been so useful in the fight against infections caused by roundworm parasites that two scientists, William C. Campbell and Satoshi Omura, were awarded the Nobel Prize in Physiology or Medicine in 2015 for their discoveries regarding the medicine, according to The Nobel Prize Committee.

Ivermectin also has antibiotic and anti-cancer properties, as well as well-documented antiviral properties. Indeed, ivermectin has been shown to be a potent anti-viral against several infectious viruses, including West Nile, Dengue, yellow fever, and influenza A.

But the drug remains extremely controversial for the treatment of COVID-19. Those who champion it insist that ivermectin is a cheap, widely available, and helpful treatment for SARS-CoV-2. Its critics say that not only is it not a miracle cure, but giving patients “false hope” by promising that ivermectin can help them “could have deadly consequences.”

A Working Mechanism

Ivermectin’s mechanism—how it works against viruses—is well understood. A virus can’t reproduce like a living cell: It has to enter another cell and hijack the DNA in the host cell’s nucleus in order to replicate. Ivermectin makes it harder for the virus to enter the host’s cells, inhibiting a virus from getting into the cell nucleus (where the DNA the virus needs to reproduce is located) and interfering with the virus’s ability to replicate.

Ivermectin also appears to have a side benefit in treating COVID-19: It seems to reduce the body’s cytokine response, dampening the dreaded cytokine storm that has been found to be one of the biggest dangers in acute COVID-19 infections.

Knowing that it’s an effective anti-viral, South African pulmonary critical care specialist Dr. Paul Marik, professor of medicine and chief of pulmonary and critical care medicine at Eastern Virginia Medical School in Norfolk, Virginia, who has authored more than 400 peer-reviewed journal articles, 50 book chapters, and four critical care books, along with Dr. Pierre Kory, who spent more than five years as the chief of the critical care service at the University of Wisconsin Hospital and Clinics, along with other doctors (including cardiologist Peter McCullough), decided to try this cheap and widely-available drug to treat their COVID-19 patients.

Early Treatment With Ivermectin

One of the reasons for trying ivermectin was accessibility. People in many poorer regions—including South America, India, and sub-Saharan Africa—had access to the drug to treat parasite diseases. In France, it was also available over the counter for the treatment of lice. In 2012, Reuters News reported on an industry-funded study that found that application of an ivermectin hair lotion could kill head lice and their eggs in just 10 minutes.

Although the federal government focused its attention on developing a vaccine to prevent infections in the first place, many front-line doctors looked for effective ways to treat patients who were coming down with COVID-19. According to an extremely detailed article published in Mountain Home magazine in May, from the beginning of the pandemic, Marik and Kory had good outcomes by treating COVID-19 with a combination of steroids and anti-coagulants. In March 2020, they shared this experimental clinical protocol, known as MATH-plus, and have shared it with other critical care specialists and the public.

The MATH part of the protocol stood for Methylprednisolone (a steroid), Ascorbic Acid (vitamin C), Thiamine (a B vitamin), and Heparin (an anticoagulant). The plus part of the protocol included second- and third-line treatments based on the individual patients presenting symptoms. The MATH-plus protocol was intended for hospitalized patients.

Seven months later, in October 2020, the frontline doctors added ivermectin to their original recommendations, calling it “a core medication in the prevention and treatment of COVID-19” on the covid10criticalcare.com website.

“Our medical discovery of a rapidly growing published medical evidence base, demonstrating ivermectin’s unique and highly potent ability to inhibit SARS-CoV-2 replication and to suppress inflammation, prompted our team to use ivermectin for prevention and treatment in all stages of COVID-19,” the frontline doctors—who have formed a nonprofit known as the Front Line Covid-19 Critical Care Alliance—explained on their site.

The I-MASK-plus protocol, which is centered around ivermectin, is now being used to prevent and treat COVID-19 before it gets severe.

“Fun fact,” Kory wrote on Twitter on Oct. 7. “Between 100-200 United States Congress Members (plus many of their staffers & family members with COVID) were treated by a colleague over the past 15 months with ivermectin & the I-MASK+ protocol at flccc.net. None have gone to [the] hospital. Just sayin’.”

Science Wars 

In 2020, a team of scientists from Australia decided to see if ivermectin could also treat SARS. Their study, published in June 2020 in the journal Antiviral Research, showed that it effectively prohibited SARS-CoV-2 from replicating in laboratory cells, resulting in a 5,000-fold reduction in viral load within 48 hours.

But, critics point out, testing a drug via cells in a petri dish is very different from testing a drug in humans. Yahoo News dismissed Marik and Kory as “fringe doctors” in September and, in October, the BBC reported that “false science” is the driving force behind the enthusiasm for ivermectin.

In the midst of dealing with a novel virus—as well as the fallout from government policies on how to stop it—it’s extraordinarily difficult to parse out which treatments are actually effective and which are working only due to the placebo effect.

Many dismiss ivermectin as “horse paste” and “quackery.” But a compilation of extensive data from studies across the world, which was published in the American Journal of Therapeutics four months ago, shows that ivermectin was effective across the board. In this peer-reviewed report, a team of five doctors, including Marik and Kory, analyzed the results of 24 randomized controlled trials involving 3,406 participants from countries across the world, ranging from Argentina to Bangladesh to Spain.

Their analysis suggested that ivermectin was effective prophylactically at preventing infection in Argentina, France, and Bangladesh. Indeed, among people who were already being treated with ivermectin for parasite prevention, infection rates were a fraction of the rates of the people in the same region who weren’t treated with ivermectin, which is one reason for the front-line doctors’ recommendation to use it as a prophylactic.

The same review showed that ivermectin may also be effective at other stages of COVID-19 infection. In studies of mildly ill outpatients given ivermectin in Spain, Nigeria, Iraq, and the Dominican Republic, thousands of patients improved with early treatment, experiencing better outcomes than patients who didn’t receive the drug.

The review also found that, among sicker, hospitalized patients in Iraq, India, Brazil, and Florida, severity and complications were decreased with ivermectin treatment, and fewer people died.

When critics challenged the integrity of one of the studies that was originally included in the review, which was from India but had been retracted, Marik’s team removed it from their data and published a response to the criticism in the next issue of the same journal. Even without the Indian study, Marik’s team insisted, the combined data from the other 30 studies were still positive, showing statistically significant and substantial improvement in outcomes with the use of ivermectin.

The same month that the review came out, a Forbes report claimed there was no evidence of ivermectin’s effectiveness, except for one study based on cell samples in Petri dishes. The Forbes report also came one month after a review of previous ivermectin studies had already concluded that people on the drug showed a 56 percent improved survival rate. Other mainstream media reports on the drug have ignored all clinical research and described it as nothing more than a horse dewormer.

Politics Muddy Ivermectin Waters

Shortly after the Buffalo News article about Judith Smentkiewicz’s successful treatment with ivermectin was published, I was temporarily banned from Facebook for posting a quote from the Buffalo News and a link to the article itself, with no other commentary, on my personal profile.

At the time when Facebook and other platforms were censoring news about ivermectin, preventive measures such as double masking, wearing personal protective equipment, draconian social distancing, and social isolation, as well as vaccination became associated with the political left, even though the U.S. government’s Project Warp Speed (to develop a safe and effective vaccine in record time) was initiated during a Republican administration.

News outlets began referring to ivermectin as “horse paste,” suggesting that the drug was only for animals. It’s unclear if those reporters or media outlets were aware that people regularly take ivermectin in pills sized for human dosages calibrated by body weight. Ivermectin is one of the 400 most commonly prescribed medicines for humans and won its inventor a Nobel Prize after it cured two major diseases.

While clinical trials of ivermectin are ongoing in regard to COVID-19, it’s included on the World Health Organization’s list of Essential Medicines with a long-established safety record.

Ivermectin Alternative

Interestingly, another antiviral that may slow the virus more effectively is on the way. Taxpayer money has funded a forthcoming drug to treat COVID-19 to the tune of several million dollars, according to an investigation by STAT News. Though its mechanism is completely different, Molnupiravir has been touted as a COVID-19 cure, and proponents say that it reduces viral replication several times more effectively than ivermectin. It also costs more than $700 per course of treatment, and it isn’t yet available to the public.

The fate of this drug, too, has swung with the politics: When the Trump administration poured money into it, it was reviled by most of the media. But now that the Biden administration is continuing to fund research about it, Molnupiravir is being hailed as a cure.

Oxford Study and Cochrane Review

Despite the controversy and politically motivated demonization, ivermectin is far from dead as a COVID-19 treatment. The University of Oxford is currently conducting a large-scale controlled study to see if it’s effective in preventing severe COVID-19 and keeping patients out of the hospital.

The Oxford data, once it’s published, will certainly help inform the debate around ivermectin. But controversies over effective treatments for COVID-19 likely won’t stop any time soon.

A Cochrane review of ivermectin is a case in point. Cochrane reviews are supposed to be the gold standard for research reviews. They are supposed to evaluate the available research and use existing evidence to provide a final opinion of sorts. But the Cochrane review used relatively narrow criteria to sharply limit the studies included. The reasoning was to better ensure that only studies that looked very closely at ivermectin were included, and not those that included ivermectin in more complex protocols that may see it paired with other drugs or treatments.

That limitation has raised concerns from other ivermectin researchers, including Edmund J Fordham, about the efficacy of the review. Meanwhile, the Cochrane review takes issue with the varying quality of clinical trials that have made up other reviews on ivermectin. It’s a complex issue with layers of issues, but the more research conducted, the clearer the picture becomes.

Jennifer Margulis is an award-winning journalist and book author. She has worked on a child survival campaign in Niger West Africa, taught post-colonial literature to non-tradition students in inner-city Atlanta, and appeared live on prime-time TV in Paris to champion an end to child slavery in Pakistan. A frequent contributor to The Epoch Times, she was granted a prestigious Fulbright Award in 2006. Learn more about her and sign up for her free weekly newsletter at JenniferMargulis.net.

This article was edited from an earlier version to include additional information about the Cochrane review of ivermectin and to remove references to the treatment protocol used on President Trump.