Day: 3 May 2021

Ivermectin: Cheap Covid Treatment Shown to be Highly Effective in New Peer-Reviewed Study

A new peer-reviewed study by Dr Pierre Kory and colleagues on Ivermectin has been published in the American Journal of Therapeutics. Entitled “Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19“, it provides a new authoritative overview of the evidence to date and calls for the widely available drug to be “globally and systematically deployed in the prevention and treatment of COVID-19”.

The study summarises the impressive evidence base for the use of Ivermectin.

1. Since 2012, multiple in vitro studies have demonstrated that Ivermectin inhibits the replication of many viruses, including influenza, Zika, Dengue, and others.
2. Ivermectin inhibits SARS-CoV-2 replication and binding to host tissue through several observed and proposed mechanisms.
3. Ivermectin has potent anti-inflammatory properties with in vitro data demonstrating profound inhibition of both cytokine production and transcription of nuclear factor-κB (NF-κB), the most potent mediator of inflammation.
4. Ivermectin significantly diminishes viral load and protects against organ damage in multiple animal models when infected with SARS-CoV-2 or similar coronaviruses.
5. Ivermectin prevents transmission and development of COVID-19 disease in those exposed to infected patients.
6. Ivermectin hastens recovery and prevents deterioration in patients with mild to moderate disease treated early after symptoms.
7. Ivermectin hastens recovery and avoidance of ICU admission and death in hospitalised patients.
8. Ivermectin reduces mortality in critically ill patients with COVID-19.
9. Ivermectin leads to temporally associated reductions in case fatality rates in regions after ivermectin distribution campaigns.
10. The safety, availability, and cost of ivermectin are nearly unparalleled given its low incidence of important drug interactions along with only mild and rare side effects observed in almost 40 years of use and billions of doses administered.
11. The World Health Organisation has long included ivermectin on its “List of Essential Medicines.”

The quality of the evidence for Ivermectin has been challenged, leading many countries including the U.K. and U.S. not to recommend its use for COVID-19. The study takes this criticism head-on.

Although a subset of trials are of an observational design, it must be recognised that in the case of ivermectin (1) half of the trials used a randomised controlled trial design (12 of the 24 reviewed above) and (2) observational and randomised trial designs reach equivalent conclusions on average as reported in a large Cochrane review of the topic from 2014. In particular, OCTs that use propensity-matching techniques (as in the Rajter study from Florida) find near identical conclusions to later-conducted RCTs in many different disease states, including coronary syndromes, critical illness, and surgery. Similarly, as evidenced in the prophylaxis and treatment trial meta-analyses as well as the summary trials table, the entirety of the benefits found in both OCT and RCT trial designs aligns in both direction and magnitude of benefit. Such a consistency of benefit among numerous trials of varying sizes designs from multiple different countries and centres around the world is unique and provides strong, additional support.

A hint of the politics around Ivermectin can be gleaned in the discussion section, where the authors wonder how much more evidence a cheap, safe drug like Ivermectin needs in an international emergency before it can be approved.

The continued challenges faced by health care providers in deciding on appropriate therapeutic interventions in patients with COVID-19 would be greatly eased if more updated and commensurate evidence-based guidance came from the leading governmental health care agencies. Currently, in the United States, the treatment guidelines for COVID-19 are issued by the National Institutes of Health. Their most recent recommendation on the use of ivermectin in patients with COVID-19 was last updated on February 11th, 2021, where they found that “there was insufficient evidence to recommend for or against ivermectin in COVID-19”. For a more definitive recommendation to be issued by major leading public health agencies (PHA), it is apparent that even more data on both the quality and quantity of trials are needed, even during a global health care emergency, and in consideration of a safe, oral, low-cost, widely available and deployable intervention such as ivermectin.

Britain Records One Covid Death in Lowest Daily Toll in Nine Months – Yet Boris Doggedly Sticks to Roadmap

The U.K. recorded its lowest Covid death toll in nine months yesterday, while infections fell to a level not seen since September. MailOnline has more.

Department of Health statistics showed this was only the third time deaths had fallen to this level, after August 3rd and 30th. July 30th was the only day of the pandemic to see zero victims recorded.

Health bosses also posted another 1,649 coronavirus cases, down by a fifth on the 2,064 last Monday. It was the fewest positive tests since September 2nd, before the second wave spiralled out of control.

Figures tend to be lower on Mondays because fewer people are available over the weekend to process paperwork to record a death. Separate date of death statistics, which lag by around a fortnight, show around 15 Brits are still succumbing to the virus every day – similar to levels seen at the end of summer, when ministers were happy to let Britons mix with few curbs despite no one being inoculated.

Britain today passed the landmark of having dished out 50million Covid vaccines, after another 250,000 jabs were dished out yesterday. Around 34.6million people have now had their first dose, and 15.4million – or 30% of all adults – are fully inoculated.

Health Secretary Matt Hancock hailed the “massive” achievement and insisted we are going to have a “great British summer”, while Boris Johnson said he could see no reason why England’s next planned relaxation on May 17th could not go ahead.

Despite the success of the vaccine roll-out coming alongside falling cases and deaths, the PM poured cold water on holiday hopes, warning putting lots of countries on the travel ‘green list’ could risk an “influx of disease”. His comments came hours after the EU unveiled plans to let vaccinated Brits in for summer trips.

Mr Johnson insisted Number 10 will be “cautious” amid bitter Cabinet wrangling over how far to loosen the border restrictions this month. Mr Hancock and chief medical officer Chris Whitty are said to be among those pushing for quarantine-free states to be kept to an absolute minimum.

On a pre-election visit to Hartlepool this afternoon, Mr Johnson also claimed there is a “good chance” that current social distancing rules will be scrapped on June 21st – touted as England’s independence day.

Worth reading in full.

“Freedoms” Being Restored in Germany – but Only for Those Who Have Been Vaccinated Against Covid

Germans will soon be able to reclaim some of their freedoms – but only if they agree to be vaccinated against Covid. Under plans similar to those that have been rolled out in Hong Kong, people who are fully vaccinated or who have recovered from Covid will be permitted to engage in certain activities – such as visiting zoos and using the services of hairdressers – without prior testing. Rules on mask-wearing and “social” distancing will, however, remain in place for all. The Local, a German newspaper, has the story.

Several German states have already started easing restrictions for those who are fully vaccinated against coronavirus, as well as for people who have recovered from Covid.

But now the German Government is planning to push through new regulations to allow for freedoms for these groups of people – that would apply uniformly across the country…

Under the plans, the fully vaccinated, and people who’ve recovered from Covid, would be able to “enter shops, visit zoos and botanical gardens or use the services of hairdressers and podiatrists without prior testing”. 

They also wouldn’t have to stick to curfew rules. Mask and distance requirements would continue to apply to everyone. 

It comes after Health Minister Jens Spahn said last week the Government aimed to bring in the uniform regulations by the end of May. Several states pushed back, bringing in vaccination rights immediately. This move has clearly put pressure on the Government to act faster. 

Saarland’s State Premier Tobias Hans said he was pleased to see that “federal plans are now on the table” and wanted to see the nationwide law pushed through his week.

“The extensive restrictions on fundamental rights must not become permanent,” the CDU politician told the newspapers in the Funke media group on Monday.

Over a quarter of the German population has received at least one dose of a Covid vaccine and 7.7% is now fully vaccinated against the virus. Some of those who have been critical of the Government’s anti-Covid measures are being monitored by the country’s domestic spy agency for suspected sedition.

The Local’s report is worth reading in full.

“Social” Distancing Could Be Scrapped from June 21st, but Masks Will Remain and Numbers at Large Events Will Be Capped

Last week, Boris Johnson said there was a “very good chance” all Covid restrictions would come to an end on June 21st, yet the latest reports suggest that mask-wearing and caps on numbers attending large events could stay in place past the “end” of lockdown. The Government is said to have already told football’s UEFA that crowd sizes at upcoming events will be limited to 45,000. So when will restrictions actually come to an end? The Times has more.

The “one metre-plus” social distancing rule will be scrapped from June 21st under plans to ensure that all restaurants, pubs, theatres and cinemas can reopen fully, the Times understands.

Masks will have to be worn in some cases to mitigate the risks but it will mean venues can reopen at full capacity for the first time in 15 months.

Dominic Raab, the Foreign Secretary, confirmed yesterday that some coronavirus restrictions would remain beyond June 21st, causing concern in hospitality…

The Times understands this means theatre and cinema audiences must wear face coverings during performances and there will be strict guidance on ventilation and staggered entry.

Pubs and restaurants may keep one-way systems, screens and a requirement to wear masks while moving around but, crucially, there will be no restrictions on customer numbers.

The Prime Minister is expected to be presented with the recommendations as part of an interim report looking at the success of recent trials, including events held without social distancing. Removing the one metre-plus rule would be a lifeline for thousands of businesses that warned they faced bankruptcy if the Government kept social-distancing rules this summer.

However, the biggest events will still have a cap on numbers beyond June 21st, meaning Wembley Stadium will be half empty for the European Championship final on July 11st. The Government is said to have told UEFA, European football’s governing body, that crowd sizes will be limited to 45,000.

Government sources added that fears of “pinch points” on public transport and at bars around the stadium would prevent a full crowd of 90,000 fans. A source said: “If you’ve got 90,000 people in a stadium, it’s going to be very difficult. It was always quite ambitious to go to 50% but we’ve told UEFA we’re working on a 50% basis.”

Worth reading in full.

Stop Press: MailOnline columnist Dan Wooton says enough is enough. We must make sure June 21st is the day we get our old lives back and if we aren’t we should just take them back.

Stop Press 2: Just one Covid death was reported in the whole of Britain today, leading to further calls for the “roadmap” out of lockdown to be sped up – and for all restrictions to come to an end thereafter.

New Article by ex-New York Times Science Writer Claims Lab Leak Theory Is More Plausible Than Natural Origin Theory

The former New York Times science writer Nicholas Wade is no stranger to controversy. Now he has written a long essay arguing that the “lab leak” hypothesis is more plausible than the “natural origin” theory.

As readers may be aware, there are two main theories for SARS-CoV-2’s origin. One maintains that the virus originated in bats, and then jumped to humans, most likely via an unknown intermediate host species. The other states that the virus originated in a lab, but then accidentally escaped, perhaps due to inadequate safety protocols.

At the start of the pandemic, the lab leak hypothesis was dismissed as a “conspiracy theory” by many scientists and much of the mainstream press. Since then, however, more and more evidence has emerged that casts doubt on the alternative, natural origin theory.

Back in January, New York Magazine ran a long essay by the journalist Nicholas Baker, which tentatively argued the lab leak theory could be right. Then in March, Undark ran a piece by the science writer Charles Schmidt, stressing that the virus’s origin is very much an open question. At the end of March, The Telegraph ran a similar article by the author Matt Ridley and the biologist Alina Chan. (Indeed, Ridley is writing a book on the pandemic’s origin called Viral, due to be published later this year.)

In his new essay, Wade adopts a more forceful tone. Though he acknowledges “there is no direct evidence for either theory”, he maintains that the lab leak theory provides a far better explanation of the available facts. As Wade notes:

It’s documented that researchers at the Wuhan Institute of Virology were doing gain-of-function experiments designed to make coronaviruses infect human cells and humanized mice. This is exactly the kind of experiment from which a SARS2-like virus could have emerged. The researchers were not vaccinated against the viruses under study, and they were working in the minimal safety conditions of a BSL2 laboratory. So escape of a virus would not be at all surprising. In all of China, the pandemic broke out on the doorstep of the Wuhan institute. The virus was already well adapted to humans, as expected for a virus grown in humanized mice. It possessed an unusual enhancement, a furin cleavage site, which is not possessed by any other known beta-coronavirus, and this site included a double arginine codon also unknown among beta-coronaviruses.

By contrast, there are several pieces of evidence that the natural origin theory has great difficulty explaining:

No one has found the bat population that was the source of SARS2, if indeed it ever infected bats. No intermediate host has presented itself, despite an intensive search by Chinese authorities that included the testing of 80,000 animals. There is no evidence of the virus making multiple independent jumps from its intermediate host to people, as both the SARS1 and MERS viruses did. There is no evidence from hospital surveillance records of the epidemic gathering strength in the population as the virus evolved. There is no explanation of why a natural epidemic should break out in Wuhan and nowhere else. There is no good explanation of how the virus acquired its furin cleavage site, which no other beta-coronavirus possesses, nor why the site is composed of human-preferred codons. 

Though some scientists claim we may never pinpoint the exact origin of SARS-CoV-2, the debate will no doubt continue over the coming weeks and months. In the meantime, Wade’s essay is worth reading in full.

Sunetra Gupta’s Colleagues Come to Her Defence After Rude, Dismissive BBC Interview

Sunetra Gupta, Professor of Theoretical Epidemiology at Oxford, gave an interview to BBC News last week which may be a new low in the Beeb’s one-sided coverage of the lockdown debate. The interviewer, Annita McVeigh, treated the distinguished Oxford scholar as if she was a David Icke figure whose views were completely beyond the pale. At one point, as Prof Gupta was making the case for lifting all restrictions immediately, McVeigh cut across her, saying, “Sorry to interrupt you, Professor, but multiple scientists say lockdowns have worked, the Government says so too.” Gupta patiently replied: “That doesn’t mean it’s true.”

Professor Gupta’s fellow signatories of the Great Barrington Declaration, Jay Bhattacharya, Professor of Medicine at Stanford University, and Martin Kulldorff, Professor of Medicine at Harvard, have come to their colleague’s support.

Professor Kulldorff said: “After one year of covering the pandemic, it is surprising that some journalists still do not understand basic principles of epidemiology and public health. Rather than interrupt her, BBC could learn a lot from Professor Gupta, one of the world’s preeminent infectious disease epidemiologists.”

Professor Bhattacharya added: “Dr Gupta’s comments to the BBC were correct. There is a growing scientific consensus that the lockdowns have failed to control the spread of Covid in nearly every country that has imposed them. The scientific community even more strongly agrees that lockdowns have hampered vital public health priorities along other dimensions, including cancer prevention, mental health, and health inequality. That the BBC does not know these facts indicates how narrow a set of scientific advisors they rely on.”

Geography, Not Lockdowns, Explains the Global Pattern of Excess Mortality

Throughout the pandemic, commentators have relied on ‘COVID-19 deaths per million people’ as a measure of the disease’s lethality. While this is not unreasonable for making comparisons within Europe, it is less justifiable for other parts of the world, where there has been substantial underreporting of COVID-19 deaths.

A better measure to use is excess mortality, i.e., the number of deaths in excess of what you’d expect based on previous years. This measure does not vary with factors like testing infrastructure or the criteria for assigning cause of death. (Though the best measure is age-adjusted excess mortality.)

In an unpublished study, the researchers Ariel Karlinsky and Dmitry Kobak have compiled all the available data on excess mortality. Their database – which they’ve termed the ‘World Mortality Dataset’ – allows us to make more meaningful comparisons across countries. 

Unfortunately, data are not yet available for most of the countries in Sub-Saharan Africa, Asia and the Middle East. However, the database does encompass Europe, much of Central Asia and the Americas, and parts of East Asia. Countries with available data are shown in blue in the map below:

Note that Karlinsky and Kobak did not take the usual approach of using the average of the last five years as the baseline. Rather, they took the superior approach of using a linear trend over the last five years. If deaths have been increasing year-on-year, their approach will yield a higher baseline, compared to using the five-year average. (See here for a visual explanation.)

Foreign Domestic Workers in Hong Kong Face Mandatory Covid Vaccination

Foreign domestic workers in Hong Kong face being forced to take Covid vaccines. Non-compliance in the vaccine rollout could result in work contracts not being renewed under plans being drawn up by Carrie Lam’s Government. The Guardian has the story.

Hong Kong’s Government has sparked discrimination concerns over plans to force hundreds of thousands of foreign domestic workers to be vaccinated against Covid or face losing their job.

Authorities have embarked on mass mandatory testing of the city’s 370,000 domestic workers after a more infectious strain was detected in the community, and flagged plans for compulsory vaccinations.

Under the measures, workers would need to be vaccinated before their contracts could be renewed, and any incoming worker would be required to have the vaccination to enter Hong Kong.

The vast majority of Hong Kong’s domestic workers are migrant workers, primarily from the Philippines and Indonesia, and no other foreign workforce has been singled out for mandatory vaccines, drawing criticism from Philippines officials. The country’s Foreign Affairs Secretary, Teddy Locsin Jr., praised Hong Kong’s provision of free vaccines to domestic workers, but said singling them out to make it mandatory “smacks of discrimination”.

“If it is a special favour, it is unfair to other nationalities. Hong Kong can do better than that,” he said…

In explaining the new rules, Hong Kong’s Minister for Labour, Dr Law Chi-kwong, said the “high risk group” mainly spent their holidays with friends, which could lead to cross-family infections. The migrant workers, who usually travel alone to Hong Kong, have one day off a week and frequently gather in public places to socialise away from the home where they work.

“In the long run, we need to think about how to get more domestic workers vaccinated,” said Law.

Late last month the Hong Kong Government said that only vaccinated people can visit bars and nightclubs and their staff must also have had at least one dose of a Covid vaccine. A Government mobile app is being used as a vaccine passport. At restaurants, unvaccinated people must sit in designated areas, away from those who have received a vaccine.

The Guardian report is worth reading in full.

Pro-Lockdown MPs Tell Government to Discourage Holidays Abroad After May 17th

The All-Party Parliamentary Group on Coronavirus (APPG) – a zealously pro-lockdown group of opposition MPs – has urged the Government to discourage holidays abroad even when they’re legal so as to keep Covid variants out of the U.K. and prevent a third wave of infections. The Group said that, if implemented, this approach should only be reviewed every three months. The Guardian has the story.

Holidays abroad should be discouraged even once legal, a cross-party group of MPs have said as part of a suite of recommendations to prevent a third wave of coronavirus and further lockdowns.

Under the U.K. Government’s roadmap to relax coronavirus restrictions, international travel for leisure purposes could resume from May 17th.

Ministers have confirmed that a traffic light system is to be put in place in which countries will be added to green, amber and red lists, with different rules regarding issues such as quarantine of returning travellers for each list…

But on Monday the APPG issued a report recommending that holidays abroad should be discouraged in light of experts’ concerns about international travel.

“The U.K. Government should discourage all international leisure travel to prevent the importation of new variants into the U.K., in order to reduce the risk of a third wave and further lockdowns,” the report states, adding that financial support must be given to the travel industry. “This recommendation should be implemented immediately and reviewed on a quarterly basis.”

The SNP MP Dr Philippa Whitford, the Group’s Vice-Chair, said: “Our cross-party inquiry has heard how the U.K.’s border management is acting more like a sieve than a shield in the fight against coronavirus. Ministers must act on these recommendations and learn from the mistakes made last year, when the premature reopening of international travel contributed to a second wave. With the threat of importing dangerous new Covid variants, we must not throw away recent hard-won progress made through the sacrifices and efforts of the public.”

Worth reading in full.

Stop Press: Even if holidaymakers are allowed to travel abroad from May 17th, only a “tiny handful” of countries are expected to be included on the “green list”. Travellers to countries in this category will not have to quarantine upon their return to the U.K. but will have to pay for PCR tests. The Telegraph has the story.

The “green” list for quarantine-free travel, to be unveiled on Thursday or Friday, is expected to be limited to a “tiny handful” of countries including Gibraltar, Israel, Iceland and Malta. Most European nations will be on the “amber” list requiring 10-day home quarantine on arrival back in the U.K..

Amber-rated countries are expected to include Spain, Greece, France and Italy, as well as their islands. Portugal is the only big European holiday destination with a chance of making the green list from May 17th.

Also worth reading in full.

Stop Press: Boris Johnson poured cold water this morning on hopes of an extensive green list being announced shortly. “We do want to do some opening up on May 17th but I don’t think that the people of this country want to see an influx of disease from anywhere else,” he told reporters on an early morning visit to Hartlepool where a by-election is taking place on Thursday. “I certainly don’t and we have got to be very, very tough, and we have got to be as cautious as we can, whilst we continue to open up.”

Government Evidence on Masks is Weak and a Mess

Matthew Sweet has written in UnHerd about the importance of following footnotes in studies to find out if the references actually say what the studies claim they say and genuinely back up the argument being made. He suggests this indicates whether or not the study should be considered reliable.

One of his examples is the mask study by Dr Baruch Vainshelboim, now retracted, that I wrote about yesterday. He says a number of the footnotes are misrepresented (this criticism was part of the retraction notice).

If Dr Vainshelboim did misrepresent the papers he cites he would not be the first. As noted yesterday, a recent peer-reviewed study in PNAS claimed surgical masks filter out 95-99% of aerosol droplets. Yet the two papers it cites to back up this claim say nothing of the sort. One concludes: “None of these surgical masks exhibited adequate filter performance and facial fit characteristics to be considered respiratory protection devices.” This is not to defend Dr Vainshelboim’s misrepresentation of course, but to highlight the double standards applied to those who challenge political orthodoxies.

Today I thought I would follow Matthew Sweet’s advice for the Government’s own evidence. We learned yesterday that face masks may continue after June 21st, with no indication of when the mandate may be lifted or what conditions may trigger it. What scientific evidence is this seemingly permanent coercive public health measure based on? After all, the real world evidence for masks preventing outbreaks is feeble, to say the least, as Yinon Weiss has dramatically illustrated.

The Government has often been slow to publish evidence for its supposedly scientifically based interventions. But in January its scientific advisory group SAGE published a paper in which it set out its current evidence on masks. This included an important admission that masks give no real protection to the wearer, saying: “They may provide a small amount of protection to an uninfected wearer; however, this is not their primary intended purpose (medium confidence).” They say they are “predominantly a source control”.

Face coverings worn in public, community and workplace settings are predominantly a source control, designed to reduce the emission of virus carrying particles from the mouth and nose of an infected person. This may have measurable benefits in reducing population level transmission when worn widely, through reducing the potential for asymptomatic or pre-symptomatic people spreading the virus without their knowledge. Analysis of regional level data in several countries suggest this impact is typically around 6-15% (Cowling and Leung, 2020, Public Health England 2021) but could be as high as 45% (Mitze et al., 2020).

This is the key paragraph in terms of providing evidence for the effectiveness of face masks, and on closer inspection it is a mess. It says: “Analysis of regional level data in several countries suggest this impact is typically around 6-15%.” Yet the 6-15% figure comes from the Cowling and Leung paper, which is not an analysis of regional level data but an editorial article drawing on a December 2020 review paper by Brainard et al. The Brainard paper reviews 33 studies including 12 randomised controlled trials (RCTs), but none of these is an analysis of regional level data.

The Mitze paper actually is an analysis of regional level data, but only in Germany not in several countries. It was submitted in July 2020 and is based on data from the decline of the spring wave. As infections were falling then anyway it is very hard to distinguish the possible effect of masks from natural decline. In any case, the mask mandate in Germany did not prevent the winter surge, as the graph above depicts.