Ivermectin continues to make headlines in the U.S. after COVID-19 patients and their loved ones insist on being treated with the anti-parasitic drug. QAnon supporter Veronica Wolski, who once filmed herself confronting Staples employees over their mask policy, died on Monday of COVID-19 after her supporters demanded that she be treated with ivermectin.
Wolski’s death led some of her supporters to allege that she was the victim of medical malpractice, and the hospital where Wolski was treated has reportedly fielded bomb threats.
This is hardly the first instance of people struggling with doctors and hospital systems over the use of ivermectin, a medication that is not currently recommended to treat COVID-19. Some people have resorted to ordering animal formulations of ivermectin, prompting the Food and Drug Administration (FDA) to issue a warning against the practice.
But why do so many people outside the medical community insist that ivermectin works against COVID-19? Doctors break it—and the data—down.
What is ivermectin, again?
Ivermectin is an oral medication that has been approved by the FDA to treat parasitic worms. Some types of ivermectin are also used to treat head lice and rosacea. “Ivermectin is used as a ‘dewormer’—it interferes with the nerve and muscle functions of helminths and insects,” explains Jamie Alan, Ph.D., associate professor of pharmacology and toxicology at Michigan State University.
Ivermectin can also be used to treat heartworm disease, as well as certain parasites in animals, the FDA explains. But this is different than the types of ivermectin that are used in people. “People are taking veterinary doses, which are different in terms of potency and strength,” says infectious disease expert Amesh Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security. “People are misusing it and that’s why we’re seeing an increase in ivermectin poisonings. They shouldn’t be taking ivermectin for COVID-19 anyway, but they definitely shouldn’t be taking ivermectin intended for animals.”
Why do so many people insist that ivermectin is effective against COVID-19?
Much of the argument for ivermectin from people outside the medical community seems to stem from a laboratory study published in the journal Antiviral Research in June. That study detailed the effect of ivermectin on SARS-CoV-2, the virus that causes COVID-19, in a lab setting, and found that one treatment of ivermectin in a cell culture caused a 5,000-fold reduction in SARS-CoV-2 at 48 hours. The study’s researchers concluded that ivermectin “warrants further investigation” for a possible benefit in people to treat COVID-19.
Sounds promising, right? Here’s where things get misconstrued. “Lots of compounds have in vitro activity against COVID-19,” Dr. Adalja says. (In vitro, in case you’re not familiar with the term, means in a lab setting.) “Just because it works in a lab setting doesn’t mean it works in humans,” Dr. Adalja adds.
This particular lab study also used “very high doses [of ivermectin] that are toxic to humans,” explains Richard Watkins, M.D., an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University. Meaning, you would get very sick or possibly even die if you took that high of a dose of ivermectin. “I suppose a lot of medications would have a similar effect,” Dr. Watkins says.
There was also a randomized clinical trial of ivermectin in patients with mild forms of COVID-19 that was published in JAMA in March 2021. That study analyzed 476 patients and found that the duration of symptoms of those who received a five-day course of ivermectin and those who were given a placebo “was not significantly different” between the two groups. “The findings do not support the use of ivermectin for treatment of mild COVID-19,” the researchers concluded.
The National Institutes of Health (NIH) has also weighed in on ivermectin, saying that “there is insufficient evidence for the COVID-19 Treatment Guidelines Panel to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19.”
Why ivermectin is still controversial
The use of ivermectin as a so-called COVID-19 treatment has been “politicized,” Dr. Adalja points out. “Now, people are going to believe that it works no matter what the scientific data shows,” he says. “But it’s not a belief that’s based on evidence. People have picked up on something with a small element of truth and run with it.”
Some political leaders, like Wisconsin Sen. Ron Johnson have also promoted ivermectin as a treatment for COVID-19, a move that Alan calls “wrong and dangerous.”
Interest in the unproven treatment is complex: “People often have deeply held beliefs about issues that are improbable, and they are unwilling to alter those beliefs even when provided with incontrovertible evidence. Why they hold these beliefs are multifactorial, and related in part to education, politics, religion, biases, among other factors. In the case of ivermectin, there does appear to be some political basis and a general distrust of scientific evidence,” says Lewis Nelson, M.D., professor and chair of emergency medicine at the Rutgers New Jersey Medical School.
What to do if you contract COVID-19
If you contract COVID-19, Dr. Adalja recommends talking to your doctor about your treatment options. You may qualify for monoclonal antibody treatments, which have been proven to help reduce the risk of developing severe complications of COVID-19 if you’re at high risk. If you qualify, you’ll want to get on the treatment “as soon as possible,” he says.
Dr. Nelson adds: “There are medications, such as antibody treatment or antivirals such as remdesivir, that may have a marginal impact on the progression of COVID when patients are not very ill, and others that help sick patients, such as corticosteroids. The best way to ‘treat’ COVID is to prevent it with vaccination.”
What you definitely don’t want to do is take veterinary formulations of ivermectin, Alan says. “Ivermectin can also interfere with neuron function in humans,” she says. When given in the wrong doses, “it can cause GI toxicity resulting in nausea, vomiting, and diarrhea. It can also cause nervous system dysfunction, which can show up as hallucinations, confusion, drowsiness, and coma," Alan says. Basically, you don’t want to have to deal with that on top of having COVID-19.
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