Category: pandemic

Should you get that bivalent booster shot?

October 4, 2022 • 12:00 pm

My primary-care physician, Dr. Alex Lickerman, discusses the question everyone’s asking: should you get that bivalent booster? (For most people it would be their third booster and the fifth Covid shot). You can access Alex’s post by clicking on the screenshot below. (Be sure to look at the graphs and read it all.)

Alex always looks at the science before he decides what’s to recommend, and by that I mean the primary literature. When I first asked him about whether to get a booster, he said he didn’t know because the data hadn’t been published, and all the existing studies were on antibody levels in mice. Now he looks at more data. I’ll give his conclusion below but do have a look at his post.

My own decision was to get the booster simply because I’m traveling tomorrow, but, as always, consult your own doctor or decide from the data themselves. People tend to get covid on airplanes these days (a friend who just returned from Boston said only 5% of the passengers on her Southwest flight wore masks), and Alex said that it couldn’t hurt me to get one before traveling—but it might not help me much, either.

CONCLUSION: Should you get the bivalent booster? In the absence of human trial data, we might think about this question as follows: We can be reasonably certain that the bivalent booster will produce a level of neutralizing antibodies that diminishes the risk of infection from COVID. We don’t know how long that protection will last, but a fair guess would be from 3 to 6 months. If there is some reason you feel the need to reduce your risk over the next 3 to 6 months, say, for travel, getting the bivalent booster would seem reasonable. On the other hand, if in addition to being vaccinated, you’ve had COVID recently (meaning you’ve been infected with an Omicron variant), likely the same level of protection accrues, obviating the need for the bivalent booster. If your main concern is dying from COVID and you’ve already received the primary series and one or two boosters, your risk is so low that getting another shot would seem superfluous. If you are at high risk for dying from COVID, while there is no data to suggest the bivalent booster might further reduce your risk beyond levels afforded by the primary series and one or two boosters, there is also likely little risk of getting it. In the absence of data to guide us, this would then be a personal decision.

Often Alex answers questions in the comments, so if you have any, put them below. I’ll tell him that he might look at the comments.

How to get your free covid-19 home tests from the U.S. government

July 25, 2022 • 9:00 am

Just a note that all Americans are now entitled to their third free set of rapid antigen test kits for covid-19.  Most of you are familiar with these: you swab your nostrils, swirl the swab in a special liquid, and then squeeze the liquid into a depression on a small plastic device (first picture below) In 15 minutes you get a simple readout that says whether or not the kit has detected antigens: the spike proteins presented by the SARS-CoV-2 virus that is responsible for COVID-19. (The vaccine is designed to prompt your body to produce antibodies to these antigens.)

The devices look like this; you also get a swab, a vial of liquid, and detailed instructions with diagrams.

And the results look like this after 15 minutes. If you have the one on the left with a “C”, no antigen was seen; you’re negative. (That does not mean for certain that you’re free from infection; these tests do give false negatives.) If you have two lines, at both site “C” and site “T”, you have antigen and are infected (again, there can be false positives).  A faint line a “T” still indicates infection.

These are not as good as PCR tests, which remain the gold standard for testing for covid, but they’re useful to have around, and when I was feeling stuffy the other day, I gave myself two tests a day apart (I was fine.)

I think they’re expensive if you buy them, but the U.S. government is sending Americans two free kits in a third round of distribution. Each kit has FOUR tests, so you can test yourself eight times. (It’s easy to do!).

To get yours, and you should get them now, go here to the government website, which explains the kits and allows you to order by phone, or go here to order them by email, as I did, by clicking on the blue button the first website. All you do is fill in your name and address, and the Postal Service will ship you two packages of four kits. There is no charge for anything, but be sure to push the green checkout button.

Two points. I’m not a doctor, so ask your physician for help in interpreting the results or finding out when to test and what to do if you are positive. Also, this is for American citizens only, provided as a service by the gubmint.

Covidiocy: Cathy Young’s take

March 16, 2022 • 11:15 am

Cathy Young often seems to me a voice of reason in the same way John McWhorter is: someone who’s not afraid to call things as they are. In her latest piece at Bulwark (click on screenshot below to read), Young, while reminding us that Covid is still with us, and Ukraine has not ended the virus narrative, calls out the various “covidiots” who were either stupidly wrong and overly precipitous in their take on the pandemic, or, worse, exacerbated it with their pronouncements. While Young gives both Left and Right their lumps, the Right turns out lumpier.

Here’s an example of party-typical behavior that Young sees as business as usual, but not explicitly dangerous:

Almost from the very beginning, responses to COVID-19 in the United States were (like everything else these days) polarized along political lines. Being Team Blue meant that you saw COVID as a very serious threat and supported drastic measures to contain and mitigate its spread. Being Team Red meant that you thought COVID wasn’t that big a deal and that its danger was being overhyped by safety freaks, people who wanted to give the government extraordinary powers, and Democrats who wanted to weaponize the pandemic to bring down Donald Trump. Obviously, not everyone fell neatly into those categories; but the tendency was undeniable.

This kind of stuff, however, she considers politically-based prognostications that can sort of be excused. Then the lump-production begins:

Chronicling Team Red covidiocy could easily fill a book: The estimate from Hoover Institution senior fellow Richard Epstein, a law professor, that just 500 Americans would die of COVID—followed by his comically desperate attempts to say he had really meant 5,000. The claims by talk-radio king Rush Limbaugh that COVID was just “the common cold” and was being overhyped by the media as part of “an effort to bring down Trump.” Trump’s rant at a rally about the Democrats’ “new hoax” and about the flu being far worse. (Yes, if you pick apart his word salad, he technically didn’t call the disease a hoax, only claims that he was mishandling it; but it’s ridiculous to deny that such talk boosted the “COVID hoax” narratives.) The #PlanDemic and #DemPanic hashtags (which still exist, but don’t look if you want to avoid brain damage). The war cries to “liberate” locked-down states. The obsessions with alleged miracle drugs, especially hydroxychloroquine and ivermectin. The Anthony Fauci Derangement Syndrome. The anti-vaccine propaganda and scare tactics peddled by the likes of Tucker Carlson.

And she also indicts the Left for being so eager to blame Trump for everything, noting this:

Did Trump’s feckless rhetoric and lack of leadership encourage irresponsible behavior with regard to social distancing and vaccination and thus cost lives? Most likely; but counterfactuals are always iffy, and it’s difficult to say with any confidence how different the outcomes would have been under a different president.

As for lockdowns, school closings, and mask mandates, Young takes a judicious position, saying that perhaps the “elite”, who could work from home, were too eager to embrace lockdowns, yet there is some evidence that mask wearing was indeed effective. Her point is that even now we have no strong and unilateral answers to the efficacy of these actions:

How well lockdowns, mask mandates, and other pre-vaccination COVID-19 mitigation strategies worked in reducing the spread of the virus and the resulting deaths is a massively complicated question.

She cites evidence on both sides, but reserves her strongest opprobrium for those whose actions were positively dangerous, contributing to the spread of the virus.  These include the ivermectin-pushers and the anti-vaxxers—again, mostly people on the Right. Curiously, though, she includes among this group Bret and Heather Weinstein and Bari Weiss, who by their own lights are liberals. We’ve discussed some of their stands before.

Young says this:

But no part of Team Red COVID discourse has been more insidious than anti-vaccine propaganda, often abetted by the “anti-anti-vax” crowd. Some of this discourse comes from people who are not, strictly speaking, Team Red but are part of the “anti-woke” side in the culture wars (a side with which I broadly sympathize). Brett Weinstein and Heather Heying, husband-and-wife biologists who attracted a lot of support a few years ago when they were run out of Evergreen College for opposing an “anti-racist” exercise in which white people were asked to stay away from campus for day, have emerged as two leading voices of COVID vaccine skepticism—rejecting scientific evidence for quackery.

Former New York Times editor and anti-“cancel culture” dissenter Bari Weiss initially urged her newsletter readers last May to get vaccinated and start living a normal life (and advised the vaccine-hesitant to “consider the data” and get with the program); but later, she shifted toward platforming vaccine skeptics as a legitimate side in the debate and giving sympathetic coverage to vaccine resisters including the protesting Canadian truckers, with no balancing pro-vaccination message or criticism of anti-vax agitprop and conspiracy theories.

It’s hard to say whether this is contrarianism or audience capture. Either way—and I say this as someone who generally admires Bari Weiss—it’s, well, deplorable.

Note, though, that the link to Bari Weiss supposedly giving “sympathetic coverage to vaccine resisters” actually goes to an article by Suzy Weiss, Bari’s sister (it’s a family act now), and the link to sympathy with the Canadian truckers goes to a piece by Rupa Subramanya.  While one can assume that Bari Weiss sympathizes with their views, especially after her announcement on Bill Maher’s show that she was “done with covid”, it should have been more explicit that Weiss hosts posts by people she agrees with, and that these two posts were written by others. (Young does say she “platforms” vaccine skeptics.)

As for Weinstein and Heying’s vaccine skepticism and enthusiasm about ivermectin, this was and is unforgivable, especially in view of the very weak or nonexistent evidence for ivermectin as a “palliative” (except when worms are a comorbidity) and the fact that the best single-blind study we have shows no effect of the drug.

At this stage, a true scientist would admit that this advice was misguided, especially in view of this unchallengeable statement: during the pandemic, unvaccinated people who took ivermectin were much more likely to get sick, die, and pass on the virus than those who were vaccinated and didn’t take the de-worming drug.  This itself warrants an apology from people who consider themselves wedded to data. It is, in my view, reprehensible to question properly tested vaccines at the same time you promote ivermectin.

At any rate, let us remember that although the headlines are dominated by the Russian invasion of Ukraine, covid is a problem that will remain with us for years to come.

This trip cancelled because of Covid

March 11, 2022 • 2:33 pm

All the passengers had an antigen test today, and I was okay, but I guess some people tested positive. The upshot is that our captain has informed us that this cruise, which is supposed to last another six days, is cancelled, and we’re heading back to Punta Arenas in Chile.

I don’t know what this means for me personally, as I was scheduled to be on another two-week journey after this one was over. For sure it means that at the very least I’ll be cooling my heels in Chile for a week, and it may be that Hurtigruten decides to cancel the next trip, too, in which case there will be quarantine, PCR testing, and an early trip home. None of us knows anything beyond that we’re headed back to our destination in Chile, and will get more information soon.

All I ask of readers is that they not tell me what I’m in for if we have to stay in our cabins for days or so. I’m already bummed out enough. I’ll convey what we learn when we learn it.

Predicting ivermectin and hydroxychloquine use by political affiliation

February 20, 2022 • 1:15 pm

This is a strange paper, though it makes sense . But the rationale for publishing it seems to be to say: “See? The Republicans took the quack drugs.” That happens to be true, but how does documentation help public health? Well, the authors of this JAMA Internal Medicine paper give a reason at the end, but it’s hardly convincing.

The paper—rather, a “letter”—was meant to determine how prescriptions for various drugs, including the bogus Covid remedies hydroxyquinone and ivermectin—were correlated with both time and with the political sentiments of the region where the drug was prescribed. The patterns are interesting, but I suspect the authors (all from Harvard or affiliates) were Democrats and really wanted to show that quackery is higher among Republicans.

They did—at least after mid-2020.

 

 

The authors looked at prescriptions written under insurance for four drugs from January 2019 to Dec 2020. The drugs were, as I said, ivermectin and hydroxychloroquine, as well as as the two drugs specified below, which are in effect “control drugs” not used to treat (or rumored to treat) Covid-19. The sample size was huge: 18,555,844 adults, pretty evenly divided between men and women, with the mean overall age of 49.1

The hypothesis:

We hypothesized that the county-level volume of prescriptions for hydroxychloroquine and ivermectin—but not other, similar medications—would be associated with county-level political voting patterns in the 2020 US presidential election.

What they’re trying to say is, “We hypothesized that Republicans fell for quack remedies more often than Democrats.” (I bet the authors are all Democrats.) And their hypothesis was confirmed, except for one brief span of time (see below).

The methods:

In this cross-sectional study, we used deidentified medical claims for all outpatient visits by adults aged 18 years or older in counties with 50 or more enrollees from January 2019 through December 2020 included in the OptumLabs Data Warehouse, which includes medical claims for commercial and Medicare Advantage enrollees, as well as US Census data and 2020 US presidential election results. The institutional review board at Harvard University deemed the study exempt from review and waived the requirement for informed consent because deidentified data were used. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

We divided the county-level Republican vote share in the 2020 presidential election into quartiles. We assessed county-level rates of new prescriptions for hydroxychloroquine and ivermectin (ie, patients with no fills for the medication in the previous 6 months) per 100 000 enrollees and 2 control medications, methotrexate sodium and albendazole (which have similar clinical applications as hydroxychloroquine or ivermectin, respectively, but are not proposed as COVID-19 treatments).

The four plots below show drug prescriptions throughout the survey region over two years. The first two show both methotrexate and hydroxychloroquine.

Plot A) shows total prescriptions, plot C) new prescriptions. In both graphs methotrexate (in orange) doesn’t change over time, while hydroxychloroquine (in green) spikes around April, 2020, and then goes down almost immediately, except for new prescriptions, which also shoot up around July of 2020, nearing election time (more on that later). The April spike for hydroxychloroquine presumably reflects the FDA’s allowing emergency use of hydroxycholoroquine for Covid-19 on April 3 and then revoking that usage on June 15. (I’d forgotten about that!)

Remember that there was a time when people thought hydroxychloroquine might be useful. The graph below is for ivermectin (green) versus Albendazole (orange). Total prescriptions on top, new prescriptions on the bottom. Prescrptions for Albendazole don’t change over the two years, but Ivermectin shoots up beginning in August, 2020, both in terms of general usage and new prescriptions. As we’ll see below, this reflects a general increase in Americans trying to get prescriptions for ivermectin, but most of the rise is due to Republicans seeking prescriptions.

The next four graphs show only new prescriptions for drugs, and this time there are four plots reflecting four levels of Republican voting by country in which prescriptions were written. Orange shows the highest quartile of counties (most Republican) and then in descending order light blue, gray, and green (most Democratic). During the two months of hydroxychloroquine being allowed (period between numbers 1 and 2 on the first graph), people of all political stripes got more prescriptions, but in fact the more Democratic counties got more prescriptions. This presumably reflects Democrats following health guidelines a bit more assiduously than Republicans, though the difference is tiny.

Towards election time, though, new prescriptions for hydroxychloroquine again rose steeply, though much more steeply for more Republican than for more Democratic counties (remember, these are quartiles for Republicanism, so blue, green, and grey lines don’t necessarily mean “Democratic-voting counties”).

Ivermectin doesn’t show the April-May spike that hydroxychloroquine does, as the government didn’t allow and then disallow ivermectin, but there’s a huge spike in new presciptions towards election time, again much more pronounced in the more Republican counties. Note that in the second graph, the numbers 1-4 correspond to different events that might cause more usage of ivermectin. I’ve put the ivermectin key in bold in the paragraph below:

Here’s what the numbers on the X-axis mean:

Arrows show key dates for hydroxychloroquine: (1) announcement of the US Food and Drug Administration’s emergency use authorization on March 28, 2020; and (2) revocation of the emergency use authorization on June 15, 2020. Key dates for ivermectin include: (1) the initial in vitro study claiming a potential antiviral effect of ivermectin5 on April 3, 2020; (2) the National Institutes of Health recommendation against ivermectin use2 on August 1, 2020; (3) release of a now-retracted manuscript preprint that described a clinical trial claiming 90% efficacy of ivermectin against COVID-196 on November 13, 2020; and (4) a widely publicized hearing of the US Senate Committee on Homeland Security and Governmental Affairs that included testimony by Pierre Kory, MD, of St Luke’s Aurora Medical Center, who promoted using ivermectin to treat COVID-19 on December 8, 2020. . . . . .

Not much going on with the two control drugs:

 

The conclusions. If you’re a Democrat, you’ll want to say that the Democrats were following the science (including the April-May spike in hydroxychloroquine use, since the government said it was okay), but the Republicans followed the rumors against the science, accounting for the higher number of new prescriptions at election time. But, as the authors emphasize, what we have here are correlations, not causations.

Why a spike around election time? The authors don’t really say, but i suppose one could theorize that Trump was whipping up Covid-19 sentiments with his pronouncements, making his people more liable to go for quack remedies. Note that the rise in all four quartiles doesn’t really imply that Democrats were taking more ivermectin around election time; the spike could be caused by prescriptions for Republicans in counties that were more likely to vote Democratic overall. I could dig deeper into that, but I don’t think the paper’s worth it.  Here’s the authors’ brief discussion:

In late 2020, the number of new prescriptions for hydroxychloroquine and ivermectin was higher in counties with higher Republican vote share, whereas in early 2020, before revocation of the Food and Drug Administration’s emergency use authorization, prescribing volume for hydroxychloroquine was higher in counties with a lower Republican (ie, higher Democrat) vote share. These findings were absent before the COVID-19 pandemic and for 2 control drugs.

This study has limitations. In an observational study, we could not address the causality of the association between county-level political voting patterns and prescribing of 2 ineffective COVID-19 treatments. Also, we were unable to assess the specific contribution of patient, physician, or other factors to the prescribing patterns.

These limitations notwithstanding, our findings are consistent with the hypothesis that US prescribing of hydroxychloroquine and ivermectin during the COVID-19 pandemic may have been influenced by political affiliation. Because political affiliation should not be a factor in clinical treatment decisions, our findings raise concerns for public trust in a nonpartisan health care system.

Here’s what I think the authors are saying, translated into normal language:

We found what we thought: Democrats follow the science and Republicans follow rumors and conspiracy theories. This raises concern for the American system because it shows that the damn Republicans endanger everybody by mistrusting the government.

Now of course I’m a Democrat and have exaggerated the “translation”. But if you read the paper, don’t you think this is what the authors really want to say?

Once again: Ivermectin doesn’t work

February 20, 2022 • 10:00 am

The paper at issue today reports the most thorough and well controlled study of the effect of ivermectin on Covid-19 around, and it was just published in JAMA Internal Medicine. What it supports, contra the claims of Joe Rogan, Bret and Heather Weinstein, and a whole slew of Republican loons, is that the drug ivermectin—as already asserted by the FDA—neither prevents nor cures covid-19. Or rather, this study shows that once adults over 50 who get the virus and are hospitalized with comorbidities, Ivermectin doesn’t help them get better. (An earlier study published in BMC Infectious Diseases, both randomized and double-blinded, and including a placebo, showed that taking ivermectin had no significant effect on keeping people out of the hospital.)

The upshot is that every well controlled study shows that ivermectin is useless in helping you once you get the virus. Another meta-analysis of reasonably well done studies that included prevention concluded that there was no good evidence that the drug even prevented infection.  The only studies that may show value of ivermectin are those in which many participants have high loads of worms as comorbidities. In such studies (which don’t apply in the US or UK), the drug may, by helping you get rid of worms (see below), make recovery from covid more likely. But even in that case there’s no excuse not to get vaccinated.  And of course you wouldn’t take ivermectin unless there was evidence you had worms.

Ivermectin is used in humans to cure parasitic worms and head lice, but can be dangerous if taken in doses high enough to kill viruses in vitro. Nevertheless, in this age of conspiracy theories and general lunacy, even credentialed scientists like the Weinsteins have recommended ivermectin and criticized vaccines, even though it’s beyond doubt that the vaccines prevent severe illness and hospitalization. You’d have to be crazy or paranoid to pass up vaccination in favor of ivermectin But thousands do it, so there you are.

With luck, you should be able to get the new study by clicking on the screenshot below, especially if you have the legal Unpaywall app. There’s also a link to the pdf, and if all else fails, make a judicious inquiry.

First, the background: the authors summarize what’s know about Ivermectin in studies to date. As I and others have mentioned before

Although some early clinical studies suggested the potential efficacy of ivermectin in the treatment and prevention of COVID-19, these studies had methodologic weaknesses. In 2021, 2 randomized clinical trials from Colombia and Argentina found no significant effect of ivermectin on symptom resolution and hospitalization rates for patients with COVID-19. A Cochrane meta-analysis also found insufficient evidence to support the use of ivermectin for the treatment or prevention of COVID-19. [JAC: The meta-analysis is linked above.]

The new study was done in Malaysia (other studies are ongoing, I believe), and iswasrandomized with respect to patient condition and age, but there was no placebo control. That is, half the infected patients were given “standard of care” (none were vaccinated) and the other half were given “standard of care” plus Ivermectin. The outcomes were followed over time.  The result: not only did Ivermectin not work, but there was a slightly higher, though nonsignificant, risk of the ivermectin treated patients progressing to the phase that required supplemental oxygen. That is exactly the opposite of what you would expect if some patients were taking placebos, for you might expect that if there’s a placebo effect, then placebo-ingesting patients would do better than those not taking placebos (i.e., the patients in this study). But despite the absence of placebos, there was still no effect of ivermectin in this study using any measure of “disease progression”.

I’m not going to summarize the results in detail, because the authors do a good job of that themselves.

There are three summaries of the results. First, the “TL/DR” version:

Note below that the 490 patients observed were all over 50 and had documented comorbidities—factors that make them more susceptible to complications and death.  Here is the protocol (indented, bolding is mine except in headers).

The Ivermectin Treatment Efficacy in COVID-19 High-Risk Patients (I-TECH) study was an open-label randomized clinical trial conducted at 20 public hospitals and a COVID-19 quarantine center in Malaysia between May 31 and October 25, 2021. Within the first week of patients’ symptom onset, the study enrolled patients 50 years and older with laboratory-confirmed COVID-19, comorbidities, and mild to moderate disease.

Interventions  Patients were randomized in a 1:1 ratio to receive either oral ivermectin, 0.4 mg/kg body weight daily for 5 days, plus standard of care (n = 241) or standard of care alone (n = 249). The standard of care consisted of symptomatic therapy and monitoring for signs of early deterioration based on clinical findings, laboratory test results, and chest imaging.

Note again: no placebo pills were given. And here’s how they measured outcome:

Main Outcomes and Measures  The primary outcome was the proportion of patients who progressed to severe disease, defined as the hypoxic stage requiring supplemental oxygen to maintain pulse oximetry oxygen saturation of 95% or higher. Secondary outcomes of the trial included the rates of mechanical ventilation, intensive care unit admission, 28-day in-hospital mortality, and adverse events.

The results are below. Note that slightly more patients in the ivermectin-dosed group (4% more) progressed to severe disease (i.e., requiring supplemental oxygen than those in the group treated the same but without ivermectin. Incorporating still other measures of “progression to severe disease,” there was again no significant difference, although there was slightly more deaths (nonsignificantly more) in the ivermectin versus control group. Finally, the most common side effect, diarrhea, was found more often in the ivermectin versus control group,but I can’t find the statistics for that difference.

Results  Among 490 patients included in the primary analysis (mean [SD] age, 62.5 [8.7] years; 267 women [54.5%]), 52 of 241 patients (21.6%) in the ivermectin group and 43 of 249 patients (17.3%) in the control group progressed to severe disease (relative risk [RR], 1.25; 95% CI, 0.87-1.80; P = .25). For all prespecified secondary outcomes, there were no significant differences between groups. Mechanical ventilation occurred in 4 (1.7%) vs 10 (4.0%) (RR, 0.41; 95% CI, 0.13-1.30; P = .17), intensive care unit admission in 6 (2.4%) vs 8 (3.2%) (RR, 0.78; 95% CI, 0.27-2.20; P = .79), and 28-day in-hospital death in 3 (1.2%) vs 10 (4.0%) (RR, 0.31; 95% CI, 0.09-1.11; P = .09). The most common adverse event reported was diarrhea (14 [5.8%] in the ivermectin group and 4 [1.6%] in the control group).

And the upshot:

Conclusions and Relevance  In this randomized clinical trial of high-risk patients with mild to moderate COVID-19, ivermectin treatment during early illness did not prevent progression to severe disease. The study findings do not support the use of ivermectin for patients with COVID-19.

Here’s the entirety of the discussion (bolding mine); note that the authors, as is proper, point out the limitations of the work.

Discussion

In this randomized clinical trial of early ivermectin treatment for adults with mild to moderate COVID-19 and comorbidities, we found no evidence that ivermectin was efficacious in reducing the risk of severe disease. Our findings are consistent with the results of the IVERCOR-COVID19 trial,17 which found that ivermectin was ineffective in reducing the risk of hospitalization.

Prior randomized clinical trials of ivermectin treatment for patients with COVID-19 and with 400 or more patients enrolled focused on outpatients.16,17 In contrast, the patients in our trial were hospitalized, which permitted the observed administration of ivermectin with a high adherence rate. Furthermore, we used clearly defined criteria for ascertaining progression to severe disease.

The pharmacokinetics of ivermectin for treating COVID-19 has been a contentious issue. The plasma inhibitory concentrations of ivermectin for SARS-CoV-2 are high; thus, establishing an effective ivermectin dose regimen without causing toxic effects in patients is difficult.27,28 The dose regimens that produced favorable results against COVID-19 ranged from a 0.2-mg/kg single dose to 0.6 mg/kg/d for 5 days29–32; a concentration-dependent antiviral effect was demonstrated by Krolewiecki et al.29 Pharmacokinetic studies have suggested that a single dose of up to 120 mg of ivermectin can be safe and well tolerated.33 Considering the peak of SARS-CoV-2 viral load during the first week of illness and its prolongation in severe disease,34 our trial used an ivermectin dose of 0.4 mg/kg of body weight daily for 5 days. The notably higher incidence of AEs  [“adverse effects”] in the ivermectin group raises concerns about the use of this drug outside of trial settings and without medical supervision.

Limitations

Our study has limitations. First, the open-label trial design might contribute to the underreporting of adverse events in the control group while overestimating the drug effects of ivermectin. Second, our study was not designed to assess the effects of ivermectin on mortality from COVID-19. Finally, the generalizability of our findings may be limited by the older study population, although younger and healthier individuals with low risk of severe disease are less likely to benefit from specific COVID-19 treatments.

Note as well the “limitatation” that placebos were not given. Another limitation is that this study didn’t assess the chance of getting infected in the first place when you take ivermectin, or of being hospitalized if you get infected, though other work (see above) has suggested no effect of ivermectin on either of these measures.

I was prepared to admit that my criticism of ivermectin was wrong had these properly-designed studies shown an effect, but of course because ivermectin is usually suggested as a substitute for getting vaccinated, the real thing you want to know is whether, compared to getting the jabs, you’re better off swallowing ivermectin.  Given the efficacy of the vaccines, which has now been conclusively demonstrated (and yes, the effects wane over time, so we may need a yearly booster), I was already pretty sure that those who touted ivermectin as a better substitute for vaccination were wrong.  But this study does nothing to convince me that I was wrong.

More studies will come out, and eventually we’ll have a pretty solid conclusion. And I’ll bet any reader $100 that it will show that ivermectin is no substitute for vaccination or the other new drugs that are being used to relieve symptoms and combat the virus.

The question now is whether people like Joe Rogan or, especially, Bret and Heather Weinstein will admit that ivermectin—at least in this study—has no effect. Ideally, scientists will admit when they’re wrong, and, as Richard Dawkins has emphasized, that is an admirable trait. Such admissions move science along faster than waiting for a generation wedded to an idea to die off and be replaced by those who have different ideas. Now I haven’t been wrong about ivermectin yet, but when I see a study showing it’s more efficacious than vaccines in keeping you out of the hospital, or alive, I’d like to think I’d say whose three words. Will the Weinsteins say them?

I predict no. We will see a lot of hemming and hawing frothe Quacksters, and perhaps qualifications like “well, the study showed X but didn’t show the real prediction, which is Y.” In fact, I don’t remember hearing anybody pushing quack remedies admit that they were wrong.

The reason I’m so dogged about this is because people who tout quack remedies when there are good ones can do harm. And it’s far worse if they push the quackery while wearing the mantle of science.

But listen up: STAY AWAY FROM THE DAMN IVERMECTIN!

 

h/t: Alex, Leslie

Vaccinations in school; why shouldn’t they be the parent’s “choice”?

February 12, 2022 • 12:20 pm

I have floated this question before, but want to raise it today to see if I can understand a distinction. And that distinction is between many people’s argument that they cannot be forced to get a Covid vaccination to stay on the job, but at the same time they allow their children to be forcibly vaccinated to attend public school.

Now there is no law in the U.S. saying that you must be vaccinated, period, though of course there are mandates specifying that you can’t work unless you’re vaccinated. New York City’s mandate for municipal workers went into effect today, after the Supreme Court turned down an emergency request yesterday to stall it. Up to 3,000 people might have lost their jobs this morning.  And yet many people still refuse to get vaccinated even if it means the loss of their livelihood. I see them on the news every night, making loud protests about their “rights” being violated by vaccine mandates. Along with that goes the mantra “this is my body and therefore it’s my choice.” And so they get fired, and some of them die, while others infect their fellow citizens.

This mass protest has culminated in the Great Truckers’ Protest of last week, and I hope it’s over now. (Did Trudeau show some moxie?) It was an act of civil disobedience, and therefore warrants punishment, but I had little sympathy for them.

What I don’t understand is this: these same people who assert their rights and bodily autonomy—and I see no “right” to be able to endanger the public safety by infecting others—make not a peep when they get shots for their kids to go to public school.

Not everyone understands that in the U.S., and presumably other countries, any child wishing to attend public school has to get a series of immunizations,

Here, for instance, are the vaccinations required for a child in to attend public school in Illinois.  I count 14 jabs needed to stave off ten diseases. That’s a lot of shots!

Click charts to enlarge:

 

 

Now why aren’t the parents protesting this forcible vaccination? Isn’t that a violation of either the parents’ or the students’ “rights”? If you’re one of the many who talk about “rights” and “my decision”, and yet still want to walk around in public, yes, it’s certainly hypocritical to not bring up “rights” for your children as well. But, except for a few fringe anti-vaxxers, or believers who want religious exemptions for their kids (I’m not sure these are even allowed for school vaccination), we hear no talk of rights for school immunization.

Is this hypocrisy? Well, I can think of several reasons why you could say “no”:

a.) The school vaccines have been proven safe and effective over years of trial, while, of course COVID vaccines have been around just a bit more than a year. The parents could say, “These vaccines work and don’t have bad side effects, so I won’t speak of “rights” But then you could ask them how much safety must be proven before vaccination becomes mandatory. As I recall, when the polio vaccine came out, it became mandatory within just a few years, and people were begging to get it.

b.) You could say that you have the right to decide for your own body, but not for the bodies of your kids, and therefore they should get vaccinated. But this doesn’t work because parents make decisions about the medical treatment of their kids all the time, especially before the kid is sentient enough to make its own choice, which is at a pretty advanced age. For school vaccinations, the parents have to agree by the time the child is five or six.  (Note as well that parents feel that have the right to decide their children’s religious beliefs before the kids are old enough to choose!)

c.) The parents could say that they have the alternative of no employment if they’re not vaccinated, but there’s no alternative for their kids if they’re not vaccinated. That’s not entirely true: there is homeschooling, which is free, and private (often religious) schools that don’t require vaccination. But The latter are often pricey.

d.)_ They are willing to risk getting Covid, but the children are too young to afford that risk. But this reverts back to a) above: if the vaccine isn’t risky for your children, why is it risky for you? (In fact, it’s more dangerous for adults to get Covid than for kids).

There is more to discuss here, but I won’t get into it. I’m just curious why parents who obediently let their kids be vaccinated (even with COVID shots for college!) turn into enraged don’t-tread-on-me” types when it’s their own jabs at issue.

If there’s a rational answer, I would say that a)—proven safety and effectiveness—would be the one, but of course the Covid data so far shows that the risk is minor compared to the effectiveness. Certainly we know that the chance of illness, hospitalization, and death is greatly reduced for adults if they get the shot (we’re talking about resistance of adults to getting vaccinated). Vaccination for adults is, without doubt, a net good save for those who are medically compromised.

But I suspect that more is at stake here—perhaps ideology.  People have largely lost control of their lives during the pandemic, and refusing shots is a way of getting control, and also of showing the government that they can’t control you. This is likely connected with a conservative or libertarian ideology that opposes government intervention. In the case of the truckers, it seems to me they’re pissed off about a lot of things, including  loss of jobs and rising prices, and protesting against vaccines is the nucleus around which these resentments coalesce.

But maybe I’m not asking a meaningful question. It’s just that when I see a bunch of angry people yelling about “rights” and “bodily autonomy” on television, it makes me wonder whey they go all quiet when the needle goes into the arms of their kids.

A reader’s Claptonesque vaccine rant

January 30, 2022 • 9:30 am

The politically charged topics I get the most pushback about, whether it be in personal emails or comments (not all of which I post) are two: transsexual issues and criticism of bogus remedies for Covid. I can’t tell you the rancor I’ve seen about my view that we should be very wary of letting biological men who have assumed the gender of women compete in women’s sports. For that I have of course been called a “transphobe”, but I brush off that invective for I have no fear or hatred of transsexuals; sports is an issue of fairness towards women, and you can’t ignore the evidence. And yes, there is evidence about the performance, physiology, and morphology of men who transition (with or without medical treatment), and it’s not favorable towards the idea that they should take part in in women’s sports.

And of course when I went after ivermectin, people tried to trounce me, even though there was no evidence that it worked to prevent or cure Covid-19 (and there still isn’t).(I got a long email, for example, from Heather Heying, who very politely tried to convince me of the error of my ways.) But most of the ivermectin-pushers have no sense of the scientific reality: even if ivermectin did work, it wouldn’t work nearly as well as vaccinations, for the latter have been tested thoroughly and if Ivermectin had equally profound effects, we’d know it already. Taking all the side effects into account, you’re way, way better getting the jab than taking ivermectin, a drug used in humans for non-covid purposes like parasitic lice and worms.

I just realized that one of the reasons I write here, and what gets me most fired up, is when people misuse science to promote their ideological ends. Both ivermectin and transsexual issues have involved that kind of misuse, as does the current flap in New Zealand, where a tsunami of Wokeness is getting the government and universities to promote Mātauranga Māori, or Māori “ways of knowing”, as a form of science that should be taught as coequal to science in the classroom. While MM contains kernels of empirical truth, the whole movement is little more than an ideology of valorizing the oppressed being turned into science. (This is also happening in the U.S. with nonsense like “sex in humans is not binary” being promulgated as sacred truths.)

Others can believe such nonsense if they want, but when they try to force it on others, or teach it as “science” or “fact” to others, it becomes something I can’t abide. As Hitchens said, more or less, “you can have your toys if you want, but you can’t make me play with them.” Nor can you make my children play with them—in this case “my children” being those who haven’t been exposed to (or who don’t know how to assess) scientific data.

But I digress. It was just a passing epiphany. At any rate, speaking of Covid-19, I got this rather unhinged comment trying to force its way onto my website this morning. I don’t know why reader “Alex” (this would have been his screen name) is so heated up about vaccinatoon, but he seems to be one of those Claptonesque people who cannot abide the idea of being forced to be vaccinated. These people apparently don’t realize that for children to attend public school in America, they need to get many vaccinations. Otherwise, “no school for you.”

I’ll leave it to readers to respond to the comment below. Say what you will to “Alex”, and I’ll send him a link to the comments here.  As always, try to be polite (granted, it’s hard with a hothead like this), and abide by the Roolz, even though Alex didn’t.

Here’s what I got:

A new comment on the post “Bret Weinstein and Heather Heying go unvaccinated for Covid, take and promote Ivermectin instead” is waiting for your approval

Author: Alex

Comment:It’s January 2022. Do you still want to keep banging the “pandemic of the unvaccinated” drum? Because, despite all of your willingness to smear and deride the unvaccinated, I believe those authoritarians who want to continuously ramp up punitive measures against the unvaccinated in the face of the facts before us are the true, anti-scientific deplorables..It’s appalling to me that people want to coerce others into getting this vaccine through loss of livelihood, stripping of freedoms, and even criminal penalties, especially given that we don’t have legal recourse against these companies. That fact alone to me excuses anyone for turning down the vaccine. It’s fine if you personally want to take that risk (I did myself), but to want punitive measures or even to just endlessly ridicule those who decide not to take those odds is reprehensible to me, given the more dubious efficacy of these vaccines than promised and the other repeated breaches of trust from our institutions through this entire pandemic.And I say this as someone who got two shots of Moderna, so you can’t hurl unoriginal “anti-vaxx” insults my way. Seriously, you all need to realize that the tone and comments expressed on this page are totally unconvincing and alienate those like me from your positions. Do what you will with that information.

What I did with this information is given Alex an entire post to rant about the vaccination. That’s better than just ditching his comment as medically uninformed and potentially dangerous, which was my first inclination.