September 1, 2021
Horsefeathers
The pandemic has been a long haul and we are all tired. Over the long months, I have held onto my compassion and empathy for my patients who have fears and misgivings about COVID and vaccines. Last week, I spent 20 extra minutes with a patient, answering her questions about the safety of the COVID vaccines. I explained the process and approval, safety data, effectiveness, and why I got vaccinated. Not just for myself but others. I thought I was making progress, until she asked about the future long term effects. My effort to educate crashed to the floor. I had no answer because we don’t know. She opted against that vaccine, even as we gave her a booster for tetanus and immunized her against Chicken Pox because she was not immune to it. The mystery of the human mind never ceases to amaze me. I was disappointed but not surprised. People who are skeptical usually stay skeptical, despite reassuring information.
But this morning, I got a phone message from the same patient requesting a prescription for Ivermectin. My reaction was not a pretty one. My compassion and empathy escaped me. I asked my assistant to call because I wasn’t sure I would be kind. She had a new fever and cough and assumed it was COVID. The nurse told her Ivermectin was not FDA approved for COVID treatment and got her set up for testing.
Believe, me the irony does not escape me, but my empathy was already long out the door. I am glad someone else spoke with her instead of me.
The truth is messy. Ivermectin has been studied with mixed results. One of the first studies showed a good effect but the data was later shown to flawed and the study was retracted. But like Pandora’s box, once out in the world, the idea that Ivermectin can treat and prevent COVID cannot be put back into the box. We saw a similar reaction with hydroxychloroquine. Multiple studies have been done, some are on going. A meta-analysis, which is a special review looking at multiple studies to see if a pattern emerges, was done with inconclusive results. Lab studies done “in vitro”, meaning in test tubes and not live subjects (“in vivo”), did show effectiveness but at a dose 50 times the usual dose in humans. The best proof would be a randomized placebo controlled trial, which the NIH is doing now. Right now we just don’t know.
Sadly, many world wide are taking veterinary forms of Ivermectin hoping to treat or prevent COVID. Poisonings and toxicities are occurring, despite the lack of data showing efficacy. A judge in Ohio has ordered a hospital to give it to a desperately ill patient, despite the experts testimony.
My logical mind puzzles over this reaction. The fear of a COVID vaccine’s possible rare unknown effects caused a person to refuse it, but now infected, they want to take a medicine that can cause seizures and other issues at high doses and that is not approved for this by the FDA. Its long term effects are not known either.
I have finally reached my compassion fatigue. Wearing masks and getting vaccinated can prevent the need to take megadoses of Ivermectin, which is more likely to harm than help. I wish I had the right words to change this mis-guided approach.
Please wash your hands, cover your nose, keep safe six, and get your vaccine if you haven’t yet. If only for the sake of the health care providers who are burning out and losing their capacity to care.
And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.
https://www.statnews.com/2021/08/25/ivermectin-for-covid-19-abundance-of-hype-dearth-of-evidence/
https://www.nature.com/articles/d41586-021-02081-w
https://www.gavi.org/vaccineswork/ivermectin-why-potential-covid-treatment-isnt-recommended-use
https://journal.chestnet.org/article/S0012-3692(21)00476-1/fulltext
https://www.theguardian.com/science/2021/jul/16/huge-study-supporting-ivermectin-as-covid-treatment-withdrawn-over-ethical-concerns
https://www.usatoday.com/story/news/health/2021/08/25/ivermectin-livestock-deworming-drug-poison-control/5583817001/
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full
https://www.nih.gov/research-training/medical-research-initiatives/activ/covid-19-therapeutics-prioritized-testing-clinical-trials#activ6
https://www.nytimes.com/live/2021/08/30/world/covid-delta-variant-vaccine/demand-surges-for-a-deworming-drug-despite-no-evidence-it-can-treat-covid
https://www.seattletimes.com/nation-world/nation/a-hospital-refused-to-give-ivermectin-to-a-covid-patient-then-a-judge-ordered-doctors-to-administer-it/