Covid-19 Diary : Sunday 7 February, 2021

 

On Thursday, I said I’d like to open with some good news for a change.  Now, three days later, I’d like to repeat that good news.  The number of new virus cases, both world-wide, and within the US, continues to steeply drop.

This drop remains puzzling, all the more so because of the growing number of new virus variants that are more infectious, and their growing share of total cases.  This article reports that in the US, a more infectious virus variant is doubling in case numbers every 9.8 days.  Nevertheless, in the US, new cases (on a rolling seven day average) are now at less than half the number of three weeks ago.

Every extra day this delightful trend continues is a huge bonus to us all.  Its inexplicable nature and underlying cause means it could stop at any moment, but for now, every extra day of decline is making a huge difference to hospital loads and now we’re starting to see a gentle easing of daily deaths too, although that number is declining at a much less spectacular rate.

Let’s hope the death rate will soon start to match the dropping case numbers – with the case numbers being usually three weeks or more ahead of death numbers, it seems likely we’ll start to see good news there, too.

I’d like to give an astonishing example of the professional negativity, even verging on dishonesty, that continues to be lavished on ivermectin.

First, let’s set the scene.  The good news is that WHO is moving in its snail-like ultra-slow manner but in the general direction of approving ivermectin as a treatment for Covid sufferers.  Their current position has shifted and is now that IVM “has shown some promising results in some trials”.  That’s a long way from outright positively endorsing IVM as an immediate automatic “standard of care” treatment for anyone who has been exposed to the virus or in any stage of an infection, but it is also at least now acknowledging the presence of IVM and showing a slightly more positive than negative view of the drug.

Here also is an extremely measured and very careful and thorough analysis of many IVM studies.  You don’t have to fully understand it to understand and appreciate the care and open unbiased approach adopted by the article’s author, and there’s an abundance of discussion, explanation, and data.  Every statement and conclusion the author makes is backed up with abundant data.  It also includes 26 references in support of its statements.

The article concludes

  • Ivermectin is an essential drug to reduce morbidity and mortality from COVID-19 infection.

  • Placebo-controlled trials of ivermectin treatment among people with COVID-19 infection are no longer ethical and active placebo-controlled trials should be closed.

The article was written at the beginning of January, and considered only 27 studies then available for analysis.  Since then, the total of published studies has grown to 57, all of which, without exception, report positive results from using ivermectin.

One more data point to set the scene for the scurrilous “hit piece” in ivermectin that will follow.  What sort of standard should we seek for determining if a drug should be used or not?  How about the same standard used to evaluate the suitability of the AstraZeneca experimental vaccine for older people.  In the vaccine’s trial, 660 people over 65 took part, half being given the vaccine and half being given a placebo.  One person in the vaccinated group ended up being infected with Covid, as did one person in the non-vaccinated group.

Based on this small total group, and only one person in both halves being infected, any reasonable person might say “not enough people in the trial, and not enough difference in outcomes to establish effectiveness”.  Indeed, many people might go further and say “this is a very disappointing result showing no protection at all”.

But Europe and other countries are approving the AstraZeneca vaccine for use in the over 65 age group, saying “there is nothing to suggest lack of protection”, as quoted in this article.

So, to approve an experimental vaccine, we need a trial of no more than 660 people, an almost non-existent outcome that proves nothing, but as long as there is nothing negative (even if there is also nothing positive), we’ll give it the benefit of the doubt and say “there is nothing to suggest lack of protection”.

Surely this same standard could be applied now to approve ivermectin?  Let’s have a look at this odious article.

The article writer takes a strange approach to evaluating ivermectin, claiming to offer an “in-depth assessment” but not sharing a single piece of analysis, although he does refer to a chart which isn’t included.  Instead, what he says is

…. “you will see an asymmetric funnel plot beginning to develop, suggesting that there are unpublished studies showing no benefit that were not included in the analysis.”

It seems here that his concern is that all the studies are very positive, and so he believes there must be missing negative studies that have been deliberately hidden.  That’s not exactly showing an open mind, but perhaps it is good to be cautious.  He goes on to say

…. “I also performed an independent search of PubMed and Medrxiv to make sure there were no studies missing.  I could not find any published studies that were not included.”

So much for his theory that some studies had been deliberately excluded.  But he refuses to give up on this concept, even though he himself has checked and found no excluded studies.  He then says

…. “Based on my funnel plot analysis, there is likely publication bias in the ivmmeta data, meaning there are unpublished studies showing no benefit.”

But this is based on his own imaginings, which he has no proof of whatsoever.  He is saying “I’m astonished the results are so positive, and while I can’t find any reason to disbelieve them, I refuse to accept them at face value.”

He continues to create other reasons to hate ivermectin, first by comparing it to hydroxychloroquine, and claiming HCQ was proven to be inappropriate, based on, he says, at least five large randomized trials.  But he doesn’t cite the five trials (the negative trial I’ve looked at have been criticized as testing HCQ only in a way that minimized its chances of success), while ignoring the over 100 trials that have clearly shown HCQ benefits.

In any case, whether HCQ is either good or bad, that has no bearing on IVM.  Why is he talking about HCQ, other than as an admission that there’s nothing directly related to IVM that he can criticize.

He then repeats this irrelevancy by criticizing the early reluctance by most doctors to use steroids, without realizing that one of the strongest advocates for steroid use back when it was recommended against is one of the doctors now leading the fight to use IVM.  So one of the doctors he approves of is actually an IVM advocate.  However, mistakes made about steroid use in no way bear on how to evaluate IVM, other than pointing out that doctors often get it wrong to start with.

Then he reaches further into the standard bag of medical rhetorical tricks and worries about the safety of ivermectin.  He concedes the studies rarely reported any serious adverse events, but rather than concluding that is because ivermectin is extremely safe – something established over decades of use by millions, possibly billions of people, and something no longer needing any sort of further study or commentary, his conclusion is that it is impossible to evaluate the benefits of ivermectin without knowing more about the risks.

How many more decades and billions/trillions of doses of ivermectin would satisfy him on this point?  Remember, many countries have approved the AstraZeneca vaccine as safe and effective for seniors, based on a trial of 330 people taking the vaccine, and one becoming infected.  Why does this person demand millions more people should try ivermectin when 330 trying a new experimental vaccine is sufficient to approve it?

Next he comes up with another meaningless point

…. “The doses of ivermectin range from 6 milligrams once, to 12 milligrams every 12 hours for three doses, to 24 milligrams every 48 hours for two doses. Some doses were given with doxycycline, some with other therapeutic regimens, and some doses of ivermectin were given alone.”

This worries him – apparently he needs to see an undisclosed number of identical studies in every respect (should we point out the vaccine studies were all single studies, and, even worse, done by the pharmaceutical companies themselves – I wonder what he thinks about that!).  However, there is another perspective that he chooses not to consider.  All these studies, whether using low or high doses, alone or with other drugs, showed positive outcomes.  Isn’t that the most important point in the real world?  It also shows ivermectin is so effective and so safe that it can be taken in a range of different doses, all of which benefit the patient.  Surely that’s a good thing?

His final conclusion?

…. “However, the data supporting ivermectin’s use published on ivmmeta.com is not robust enough to inform a practice change or suggest the drug should be prescribed for COVID-19 patients.”

What sort of data would be robust enough?  He doesn’t tell us.  If we can approve experimental unknown vaccines based on a sample of 660 people and identical results in the control and test groups showing no benefit whatsoever from the vaccine, why do we need ten, or one hundred, or even more times more people to approve ivermectin?

Seriously, this is a life and death matter.  People are dying in the thousands, every day, and there’s a 99.9% (or greater) safe drug, well known and not at all experimental, costing less than $1/dose, available right now, with studies to date suggesting up to a 90% reduction in mortality when it is used.

But pompous fools like this sit on their hands, act as though we all have the luxury of time, and call for more, and more, and endlessly more, studies on a safe drug that has already proven itself, while yes, of course, eagerly reaching for experimental vaccines and rushing to inject them into our arms.

It is even worse than that.  Even though in the US, NIH is now “neutral” about IVM, and WHO is very slightly positive, YouTube decided to censor a C-SPAN of a submission to a Senate Committee by a noted physician speaking in favor of IVM.

How is it fair or appropriate for a multi-credentialed doctor, appearing as a spokesman for a group of physicians that have between them all, 2,000 peer-reviewed articles published, with his testimony filmed and published by C-SPAN, to then have the record of that deleted off YouTube?  What medical body guides YouTube in that decision?  Perhaps the guy who wrote the ridiculous article discussed immediately above!

You can see the banned video submission here.  What part of it deserves to be deleted?

There’s something very wrong when sensible sincere doctors, backed by 57 positive studies and no negative studies, get their advocacy for proven treatments against a disease killing thousands of American every day, using known safe drugs, deleted off YouTube, ridiculed by some politicians, and ignored or unfairly attacked by other doctors.

I’ve often reported on ivermectin’s acceptance and use in Africa, Asia, and South America.  News in the last few days now reports Slovakia becoming the first nation in the EU to formally approve IVM for use both as a treatment and as a preventative.  The IVM tide is clearly rising.  How long will it take us in the US to recognize this and join in?

The life it could save might be your own……

Adding fuel to the ivermectin (and hydroxychloroquine) fire is this excellent article that explains how many of the people who enjoy asymptomatic experiences with Covid can still suffer serious lung damage.  Just because you don’t get seriously unwell doesn’t mean that your lungs haven’t been seriously harmed.  Fools worry about the safety of ivermectin, sensible people acknowledge the dangers of Covid.

Current Numbers

An uneventful week in the US, with Rhode Island simultaneously moving down one position in the case rate list and up one position in the death rate list.  In the small country list, Aruba displaces Lichtenstein and moved onto the list at tenth place.

The UK is doubtless pleased to drop a place in the major country list.  On the death rate list, Portugal rose from 8th to 6th place, and seems likely to displace the US and move to 5th place within the next week.

US Best and Worst States

RankCases/MillionDeaths/Million
A week agoNowA week agoNow
1 BestHI (18,259)HI (18,694)VT (279)VT (293)
2VT (19,175)VT (20,673)HI (290)HI (295)
3MEMEAKAK
4OR (33,766)OR (34,882)MEME (472)
5WA (41,364)WA (42,495)OR (464)OR (480)
47TN (106,581)TN (109,032)MS (2,031)RI (2,088)
48RI (108,025)UT (110,609)RI (2,033)MS (2,106)
49UT (108,119)RI (111,285)MA (2,115)MA (2,176)
50SDSDNY (2,246)NY (2,312)
51 WorstND (128,113)ND (128,802)NJ (2,419)NJ (2,476)

 

Top Case Rates Minor Countries (cases per million)

RankOne Week AgoToday
1Andorra (128,488)Andorra (132,545)
2Gibraltar (122,132)Gibraltar (124,150)
3MontenegroMontenegro
4San MarinoSan Marino
5LuxembourgSlovenia
6SloveniaLuxembourg
7PanamaPanama
8IsraelIsrael
9LithuaniaLithuania
10Liechtenstein (65,275)Aruba (67,479)

 

Top Case Rates Major Countries (cases per million)

RankOne Week AgoToday
1Czech Republic (91,858)Czech Republic (96,537)
2USA (80,590)USA (83,122)
3Portugal (70,783)Portugal (75,198)
4Belgium (60,920)Spain (63,549)
5Spain (60,525)Belgium (62,294)
6Netherlands  (57,030)Netherlands  (58,618)
7UK (56,057)Sweden (58,009)
8Sweden (55,934)UK (57,938)
9FranceFrance
10BrazilBrazil
11Argentina (42,414)Italy (43,649)
12Italy (42,262)Argentina (43,576)

 

Top Death Rate Major Countries (deaths per million)

RankOne Week AgoToday
1Belgium (1,813)Belgium (1,837)
2UK (1,559)UK (1,651)
3Czech Republic (1,521)Czech Republic (1,608)
4Italy (1,465)Italy (1,511)
5USA (1,362)USA (1,430)
6Spain (1,247)Portugal (1,391)
7Peru (1,229)Spain (1,313)
8Portugal (1,226)Mexico (1,278)
9Mexico (1,219)Peru (1,272)
10France (1,164)France (1,208)

I Am Not a Doctor, But….

One of the enduring mysteries is the huge discrepancy between the Covid rate in South Africa and elsewhere in the African continent.  South Africa has a case rate of 24,701 cases per million.  Twenty of the other African countries have case rates below 1,000 per million, and only two micro-countries have higher rates than South Africa (Mayotte and Cabo Verde).

I was looking at the map shown here – part of a larger article showing first state by state policies in the US for being able to be prescribed and obtain HCQ (the HCQ hate is so extreme that in some cases, pharmacists are refusing to accept doctors’ prescriptions unless the doctors comply with pharmacist demands for documentation and “proof” of why the doctor is prescribing HCQ – how strange that pharmacists assert the right to veto doctors!), and then more generally, policies by country.

One thing struck me.  The red countries (with the most restrictive prescription policies) are generally also the ones with the highest case rates, especially in Africa.

I am not asserting this is proof of HCQ benefits (and there are plenty of exceptions to the red=bad rule of thumb).  It is, at best, a very very weak correlator, but it is, nonetheless, interesting to see how South Africa’s puzzling hugely higher Covid rate could be explained in part, perhaps, by their restrictive HCQ prescribing policies.

Does the weather influence the swings up and down of virus activity?  I’ve always thought the weather a very weak factor, and certainly, while weather might help explain the leap upwards in US cases numbers in November and December as we moved into winter, that leaves the drop in numbers in the thick of mid-winter, from early January, even more inexplicable.  But this article suggests weather is a contributing factor, and claims to have been able to independently predict previous peaks of virus activity.

I’d be more convinced if the people claiming to be able to fit past peaks to their model would now publish predictions for future peaks.  That’s the ultimate test.

It is very easy, when creating a model, to build the model parameters around the observed facts, and then claim the observed facts prove the model, whereas in truth, you’ve built the model around the parameters.  The proof comes from future success, not from past artificially created fits between model and facts.

While IVM (and HCQ) struggle to get a fair hearing and acceptance, it is interesting to see the contrast in terms of how experimental expensive new drugs are treated.  In theory, the well-known, low-cost, totally safe treatments should be the ones we rush to embrace, while we look slowly, carefully, and uncertainly at the expensive new drugs that don’t have a history of decades of safe extended use.

But instead we see positive reception given to treatments such as this – an encouraging but short-lived protection.  Would the doctor who penned the hate piece on ivermectin that I dissected above rush to complain that this is a single study with only 400 participants?…..

One thing I’m reluctant to consider as a factor in why expensive new drugs get favorable treatment while inexpensive drugs that have had their patents expire get overlooked and dumped on is due to conflicts by decision-makers with vested interests in big Pharma companies.  The reality is that being a senior member of a large pharmaceutical company or having done research funded by them in the past is as much a positive credential as it is a reason to demand the person be prevented from participating in studies, but it is still worthy of note that ten of the secretive members of the NIH panel evaluating Covid treatments have ties of one sort or another to companies involved in developing treatment drugs.

Eight of these people had ties to Gilead, the company who benefitted from a fast-tracked approval of their ultra-expensive remdesivir anti-viral product, a product that has been viewed with steadily less and less enthusiasm since its approval, with even WHO managing to find the courage to advise against its use.  Pretty soon, its only advocate will be Dr Fauci.  And perhaps the eight Gilead associated members of the NIH panel.

Here’s another article pointing out that even though you’ve been infected once already, you might get infected again a second time (and possibly third and more times too).

This article asks the wrong question.  They wonder what you can do if you test positive for the virus while traveling internationally.  We suggest the better question is to wonder if you should be traveling internationally at all, at present.

Vaccine News

Our discussions, on so many issues these days, seem to no longer be “what makes the most sense” but instead seek to create vague concepts of “social justice” wrapped around the new concept that a possibly disadvantaged group of people, in some respect, “deserve” priority treatment in some other respect so as to compensate for the other disadvantageous status.

This is aggressively being touted as a basis on which to choose who gets vaccinated first.  It shouldn’t be the people most at risk of dying, nor should it be the people most likely to be infected, and neither should it be the people most likely to be super-spreaders and infect other people, or so this (il)logic tells us.  Instead if should be whatever pressure group makes the loudest demands, wrapped up in some thin veneer of “social justice” as justification.

The most universally unattractive method for vaccine allocation seems to be “those who are willing to pay the most for it”.  One gets visions of the “one percent” being driven in their chauffeured limousines and being given personal special treatment and ill-deserved vaccines.

But let’s not forget that the 1% is, by definition, 1% of the population, and if they’re willing to pay a massive premium to get priority access, should we really refuse their money?  It could be used to fund social justice programs!

There are other considerations, too.  Sometimes, allowing need and value to be determined by willingness to pay makes great sense, even in a public health setting.  Here’s a great article by an economist who ponders these things.

It seems there’s always a new reason to express disappointment with Britain’s favorite vaccine (thankfully not yet approved in the US), the AstraZeneca/Oxford vaccine.  This is the vaccine I mentioned above that based on a test of 330 vaccinated people over 65, with no difference in infection rates between those vaccinated and those not vaccinated, was deemed by Britain’s official health authority to have demonstrated efficacy for over 65 yr olds.

South Africa has now stopped dispensing the AstraZeneca vaccine because it is showing as too ineffective against their local new variant of the virus (a variant that is of course “in the wild” and appearing all around the world).  Good for them.

Timings And Numbers

This is an interesting view on infection rates, showing the change in daily rates by selected countries and regions.  It is from this website.

Who Should Pay

Have you had to pay an extra “Covid fee” when buying a product or service?  If you have, there’s a chance that might be illegal, unless the fee was fully disclosed up-front.  This is an interesting article pointing out the awkward issues surrounding businesses desperate to make up for lost income and profit, and their customers, who many times are hurting just as much as the businesses.

Logic?  What Logic?

Iowa is the state with the seventh highest number of Covid cases in the nation.  Although numbers have been dropping, they are still way too high, in Iowa and everywhere else, and new more infectious virus variants are doubling every 9.8 days.

Now is the time to be even more careful than before, but Iowa has decided to lift most mask-wearing restrictions.

This is the type of crazy response that underpins so much of why we’re the second worst country in the world when it comes to controlling the virus.  Gov Reynolds in IA needs to understand that the virus doesn’t concede defeat and give up.  Now that she has relaxed restrictions, the virus will surge back into Iowa again, faster than presidential hopefuls in 2023.

Please stay happy and healthy; all going well, I’ll be back again on Thursday.

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