This article looks at two different concepts to address the COVID-19 pandemic: Zero-Covid v. Ivermectin. Each of these concepts is presently supported by two petitions seeking signatures in Canada, and are contrasted in that context. But the importance of this debate goes very much beyond Canada, as it’s essentially a debate between further lockdowns and travel and other restrictions on the one hand, and much higher use being made of early outpatient treatment, with drugs such as Ivermectin, on the other hand, in view of reducing disease, hospitalizations, mortality and also the spread of the virus. After having contrasted the two concepts, the article looks at the recent negative WHO position regarding Ivermectin and also analyzes the trends over the past few months in Mexico, where Ivermectin-based early treatment kits have been widely used and where there is a remarkable, some will say stunning, reduction in cases and deaths. The article concludes that Mexico may serve as an example for Canada and other jurisdictions, as a way to bring down new infections and deaths, without unnecessarily disrupting society and the economy. (voir la version française)
There are two petitions presently seeking signatures in Canada that are worth contrasting: one about “Zero-Covid” and the second about the generic Ivermectin drug.
“The Federal and Provincial Governments should immediately begin a Zero Covid strategy with the target of eliminating SARSCoV2 and variants” calls the first petition, which has already gathered some 2900 signatures.
The second petition is about the drug Ivermectin and has gathered 1150 signatures so far. It’s a “call upon the Government of Canada to urgently examine the evidence in favour of ivermectin” with the goal of making it immediately available to Canadians.
For many, who have not heard about Ivermectin, the second petition may look a bit weird and unrelated to Zero-Covid.
Yet in reality, it’s all related, as both are aimed at controlling or even eliminating COVID-19 in Canada, but through very different means.
Of course, it’s not the number of signatures for each of the petition that is really important, but it’s the fact that they reflect very different perspectives about how to tackle the COVID-19 pandemic.
What is Zero-Covid?
In their petition, the proponents of the Zero-Covid approach maintain “Canada’s mitigation strategy — tolerating a limited number of cases that will not overwhelm hospitals — resulted in the second wave and has led to the deaths of 23 000 Canadians from a preventable disease.” They maintain that “trying to keep schools open during a pandemic has proven to be highly disruptive for children and families” and that “It ignores the vulnerable position of families, essential workers, marginalized communities, and those living in congregate care.”
“More transmissible variants render the current mitigation strategy even more precarious. It is unrealistic to think it is possible to have a small amount of B.1.1.7 spreading slowly. As soon as restrictions are relaxed, the virus spreads quickly. So, we can either aim to eliminate the virus completely or risk igniting a wildfire all over again. In sharp contrast to Canada’s mitigation strategy, New Zealand, Australia, Vietnam, Laos, Taiwan, Atlantic Canada and the Territories clearly demonstrate that a Zero-Covid strategy works and is sustainable.”
“There is tremendous urgency for Canada and each province to immediately enact a Zero-Covid strategy to stop all chains of community transmission as rapidly as possible.”
How would that be implemented? The key measures involve:
- international and interprovincial travel restrictions by mandating supervised quarantines for all travellers.
- priority vaccination and rapid tests for commercial truck drivers and essential workers.
- out-of-home supported isolation hotels for incoming travellers to ensure they do not bring new cases into the community.
- immediate strict, enforced and financially supported lockdowns.
- closure of all non-essential businesses during the lockdown. Restaurants are open for take-out only.
- in-person learning should transition to online learning immediately, with very limited exceptions for small in-person classes.
- aggressive Test/Trace/Isolate capacity to prevent chains of transmissions.
- prevention and control measures, with N95 masks and improved air filtration and ventilation.
The Zero-Covid proponents claim that “The Zero Covid strategy is best done on a region-by-region basis. Once at zero community cases, a region with well-managed borders can cautiously loosen restrictions and can return to relative normalcy.”
“Zero Covid regions may form a quarantine-free travel bubble with other Zero Covid regions, as the Atlantic provinces have done. While travel related cases or community flare-ups might still appear, they are manageable via quarantine facilities, local restrictions, and comprehensive testing and tracing.”
Regarding vaccination, the proponents of Zero-Covid claim not enough people have been vaccinated, that there are currently not enough doses, that the vaccination roll-out is too slow, that the national vaccination effort is also compromised by letting the virus spread in high numbers.
“Ultimately, we face too many uncertainties with immune-response evading variants. The basic reproduction number (R0) of the original variant and especially of the new variants is likely too high, so that even with 70% of the population vaccinated, the herd immunity threshold may not be reached.”
Ivermectin-Based Prevention & Early Treatment
Absent from the Zero-Covid strategy is any form of outpatient therapeutic approach to control COVID-19, which is what the petition about Ivermectin is about.
The Ivermectin petition is much shorter as it was filed in the House of Commons, which requires a strict short format. The petition is sponsored by Ontario MP Dean Allison from Niagara West.
The petition argues that “many Canadians will not be offered COVID-19 vaccinations for many months and in the meantime many will get sick or die from SARS CoV-2.” In addition, it notes that “protection by a vaccine takes weeks to develop;” and that “new variants may be resistant to current vaccines.”
The petition argues that “Ivermectin has been determined to be remarkably effective in prophylaxis (~86% fewer cases) and treatment (-68% fewer deaths) for COVID-19 prophylaxis.”
It argues that the drug has proven to be very safe, as one-third of the world’s population has taken ivermectin, including for mass community treatment to prevent various infections, and that only 16 deaths and 4673 adverse events have been reported from 1992 to 2021.
The petition also argues that “Several countries, including Japan, Slovakia, Bulgaria, India, Egypt, South Africa, Zimbabwe, Bolivia, Peru, Argentina, have made ivermectin readily available to their citizens (often over-the-counter purchase or free).”
The petition stresses that “Ivermectin is already approved in Canada for anti-parasitic use and is now generic and inexpensive.”
The petition concludes:
“We, the undersigned, physicians, scientists, and other concerned citizens and residents of Canada, call upon the Government of Canada to urgently examine the evidence in favour of ivermectin and give due consideration to making ivermectin available immediately to Canadians as a schedule II medication, which can be obtained directly from a pharmacist.”
Contrasting Zero-Covid with an Ivermectin Strategy
The Zero-Covid strategy does not rely on any therapeutic means, except late hospital treatment, where Canada in turn relies largely on “standard care,” including intubation, which is in stark contrast with the Ivermectin strategy, which calls for both the prevention and early home treatment of COVID-19.
While, broadly speaking, seeking the same objective, Zero-Covid and Ivermectin strategies cannot be further apart.
With Zero-Covid, one controls the population, with aggressive testing, tracing and isolation, with international and interprovincial travel restrictions, with mandatory supervised quarantines, with isolation hotels, with strict lockdowns, with mostly closed schools, with closed non-essential businesses, etc. Vaccination, which is voluntary in Canada, is also aggressively pushed as even a level of 70% is seen as insufficient.
With Ivermectin prevention and treatment, the strategy is very different. When someone gets COVID-19 symptoms such as fever or cough, he/she seeks immediate treatment from a doctor and is prescribed an outpatient therapy, typically combining Ivermectin with other agents such as Doxycycline and Zinc. Such therapy is typically short and lasts 5 days, even if some cases it may take a longer time to resolve. The patient isolates, typically home, yet is medically monitored on a daily basis, as additional medications and possibly oxygen may be needed.
Such early treatment must be sought within days of the first symptoms, i.e. exactly during the period of time when people are presently asked to isolate home without any form of treatment. This means a total paradigm shift is required in the way the disease is being handled. But, as the Mexican example presented below shows, this can easily be implemented in a matter of months. Early treatment is particularly needed for those at high risk of the disease, i.e. those above say age 50 or with health issues such as obesity or diabetes.
While those suffering from COVID-19 should be treated, those living in the same accommodation, typically family members, need also be given Ivermectin on a prophylactic basis – something that is being done a number of countries, to contain the propagation of the disease and to avoid any severe disease among those who have probably been contaminated because they were in contact with the sick person.
As Ivermectin is particularly safe and effective for prophylaxis, it can accordingly be used in high risk locations, such as nursing homes, aged care facilities and retirement homes and high risk industries (meat-packing etc.).
Note that such settings, especially nursing homes, have contributed to a considerable share of the mortality from COVID-19 in Canada, which has denied so far, and continues to deny, the use of early therapeutic approaches in these high-risk settings.
Ivermectin can also be used as a preventative agent for other high risk activities such as transportation, for example in planes, in buses and even in taxis.
Such therapeutic prevention and early treatment have the considerable advantage to not only prevent in many cases, hospitalization, long Covid symptoms, severe disease and death, but also to curb contagion.
Why? Because such interventions immediately target those who have COVID-19, treat them while they isolate, provide post-exposure prophylaxis to those who might have been exposed, which in turn limits contagion and contains any outbreak.
As we previously covered in this blog, early outpatient treatment reduces by at least 85% the need for hospital admission, and also considerably reduces the need for ICU transfer and the risk of death, which is then typically limited to high risk people who present late (i.e. were not treated early).
Canada’s Unfortunate Alignement with the WHO about Ivermectin
Before analyzing the implications for Canada of Zero-Covid and Ivermectin-based strategies, it’s important to explain the alignment of Canada with the World Health Organization when it comes to dismissing early outpatient treatment and rejecting drugs such as Ivermectin for treating the disease.
Canada has been mostly aligned with the WHO since the beginning of the pandemic. Canada rejects the use of Ivermectin for COVID-19, except in the context of clinical trials, and as such clinical trials are typically slow, badly designed as avoiding multi-drugs therapies that are required for treating the disease, there is little chance of any change in position any time soon.
To be noted, however, is that some hope has been placed in the “Together Trial” – a randomized trial testing not only Ivermectin but also fluvoxamine and metformin. This is a significantly sized study, with an expected 2724 patients, with an estimated completion date set for in about a year, on March 1 2022. There is word that some preliminary results are encouraging, but it’s unclear when information about those results will be made public. Also to be noted is that this trial regrettably involves a placebo arm, which may lead to deaths, as those patients are denied any form of therapy beyond “standard care.”
It’s also important to note the continuous use in Canada of the proven ineffective and unsafe drug remdesivir, which WHO has opined against last November . There are reports of liver and kidney toxicity etc. and complaints of manipulating the methods in terms of highlighting a lesser important patient important primary outcome. Therefore, similarly as WHO picks and chooses the studies to conduct its analysis of Ivermectin, Canada picks and chooses the drugs it wants to use for treating COVID-19. The result is that ineffective drugs are being used and effective drugs are being dismissed.
Today, there is considerable evidence that Ivermectin is effective, especially for the prevention and early treatment of the disease, which means avoiding a progression of the disease from its viral replication stage to an inflammatory stage (cytokine storm) and ensuing thrombosis, the two latter stages being truly dangerous and leading to long term symptoms, hospitalization and possibly death for the most vulnerable patients. Early treatment is critical as it will reduce the risk of hospitalization and/or death which increases as people getting Covid “shelter in place” – some say “worsen in place” because being denied any treatment during their isolation.
WHO’s Flawed “Living Guideline” on Ivermectin
It must be noted here that the position of the WHO on ivermectin is based on a flawed analysis, and is, in the opinion of the undersigned, an example of scientific bad faith that will likely make the history books, similarly as the April 29 “oval office pitch” that made ineffective remdesivir the standard of care for COVID-19 in the US, and in turn in Canada, Europe, Australia etc.
Here is a brief analysis to illustrate the bad faith of WHO when it comes to Ivermectin. According to the website c19ivermectin.com, there are presently 49 clinical trials on Ivermectin, including 26 randomized controlled trials. The evidence is massive, with an 89% improvement in prophylaxis, an 80% improvement in early treatment, a 50% improvement in late treatment and a 76% improvement in mortality.
Now, through some methodological “magic” that belongs to the authors of the awkwardly named “Living Guideline,” an amazing pick and choose process was implemented, followed by the dismissal of any findings pointing at any form of effectiveness. You can download the “Living Guideline” from the WHO website (1.2 MB).
The supposedly impartial authors conducted their own “risk of bias assessment” and decided based on their judgements, that a vast amount of the body of evidence was not of merit and dismissed it. However, a different set of scientists / adjudicators may have concluded otherwise and included several omitted studies and then the final result would have been different. Anyone reading this, including those who strongly believe in randomized controlled trials and evidence based medicine methodologies, should have serious concerns with this approach, given the massive body of evidence that points to benefit.
When it comes to mortality, on page 19 of the report, it’s stated that mortality with standard of care is 70 / 1000 while it’s only 14 / 1000 with Ivermectin. This is an 80% reduction in mortality. It’s based on 7 studies only (and the final use of 5), picked and chosen by the authors. Yet this is a dramatic 80% reduction in the risk of death.
But what do the authors do to dismiss this amazing result? They simply state the certainty of evidence is “very low due to serious risk of bias and very serious imprecision,” which brings them to their conclusion that “the effect of ivermectin on mortality is uncertain.”
Yes, there is “magic” implemented by the authors to turn an 80% reduction in the risk of death, consistent with other meta analysis, including the one by c19ivermectin.com. They claim there isn’t enough quality information. In reality, it’s not that there is no data. The data is there. They just did refrain from using it.
Another way to look at this is that all the researchers around the world involved into these many clinical studies about Ivermectin, who often conduct trials in very difficult conditions, are seen as imbeciles who cannot conduct any research. Accordingly, only the “gods of clinical trial methodology,” appointed by the WHO, detain the truth when it comes to identifying effective treatments for COVID-19.
Similar ploys are being used to dismiss other very positive results achieved with the use of Ivermectin. For example, when it comes to the key metric of hospital admission, there “Living Guideline” report shows a reduction of 64%. It’s based on only a single study, out of the many trials available.
And then, to dismiss this excellent result, the authors insist that the quality of evidence is “very low due to extreme imprecision” which brings them to conclude “the effect of ivermectin on hospital admission is uncertain.” This is a key metric. There are 49 trials, including 26 randomized ones. They only pick up one study. The results are positive. They just dismiss them.
Another major flaw of this analysis undertaken for the WHO is that prevention is not included. It’s obviously utterly nonsensical, as it plays such an important role for preventing outbreaks and contagion, as discussed above. Note that Ivermectin alone is shown to be 89% effective for prophylaxis in the c19ivermectin.com study, i.e. the drug is even more effective as a prophylaxis than as an outpatient or inpatient treatment.
WHO’s flawed position statement on Ivermectin follows the flawed position taken by the European Medications Agency, which did not even issue any form of analysis. Most probably, the Canadian authorities will now rely on some “international consensus” to continue rejecting the drug outside clinical trials and thereby continue to deny this effective treatment to the population.
The drug has actually become extremely difficult to procure today in Canada. Its principal producer, Merck, is actively seeking to bring a new, still being tested, patented early treatment drug to market, and seems to have discontinued or at least severely curtailed Ivermectin production.
A US$356 million supply deal with the US government was announced last December, for between 60,000 to 100,000 doses of the new drug, i.e. for between US$3650 and US$6083 per dose. Contrast this with Ivermectin, which typically sells for less than US$10, retail price, for a complete COVID-19 treatment …
Oh, maybe it’s time for a pause, to reflect and to connect some dots …
Zero-Covid or Ivermectin Strategy for Canada?
With one year of a constant media assault about the virtues of lockdowns, and the continuous dismissal of outpatient treatment by the federal and provincial authorities in Canada, it’s no surprise that the petition calling for Zero-Covid is gaining more support than the one about Ivermectin.
It’s also expected to be very difficult for health officials and politicians to admit that outpatient treatment is absolutely the way to go, as it immediately calls for embarrassing questions such as “why hasn’t there been any outpatient treatment for the population for the last year” or “why weren’t such treatments given in nursing homes, where considerable deaths occurred?”
Indeed, there were already pretty effective outpatient treatments for COVID-19 since the spring of 2020. These outpatient treatments have been vastly improved since, with the use of Ivermectin, and yet they remain denied to the Canadian people. Even the randomized controlled trial out of Oxford, showing the high effectiveness of inhaled budesonide given to outpatients, was ignored by the “Health Canada” agency.
Against this background, It may be hard for many to acknowledge the importance of outpatient treatment. Nobody is immune to cognitive dissonance. But if you read this and if you are skeptical, please assume for a moment that this is real, that such treatments exist and are effective. In that context, ask yourself the question: is it possible to justify a Zero-Covid strategy when both effective prophylaxis and outpatient treatment options do exist?
The answer is clearly no. Lockdowns, travel restrictions etc. are not effective in dealing with COVID-19. They have considerable negative consequences, in terms of mental health, economic poverty, depriving kids from in person schooling, pushing the hospital system at its limits because the disease is not treated prior to hospitalization, and of course generating huge inconvenience and cost, that considerably reduce the quality of life, with mandatory quarantines, restrictions to travel, curfews, lockdowns and more lockdowns and absolutely no clear time frame to get out of the crisis.
For certain, COVID-19 is not the flu, especially for the elderly and other high risk groups, but with prophylaxis and early outpatient treatment, COVID-19 becomes considerably less dangerous, with reduced transmission of disease, much fewer hospital admissions and a highly reduced mortality, as long as the knowledgeable, well trained, “covid medical doctors” care for these patients and the outpatient therapies are administered at the very early stage of the disease.
Mexico May Serve as an Example for Canada
What could happen in Canada with ivermectin-based therapies? What could be expected from an Ivermectin-based strategy. Best here is to look at a real world example, as the medication is widely used for COVID-19 in a number of countries.
Let’s have a look at what happened in Mexico, which had a huge spike in cases and mortality last fall, and where the authorities responded by offering home treatment kits, comprising Ivermectin, to people testing positive, starting in late December 2020. This is not a petri dish experiment; this is a real world large scale experiment, as Mexico has a population of 127 million inhabitants and has been most severely hit by the pandemic.
Since late December, the use of early treatment kits has become widespread in the country. There is no uniform treatment, and various kits are being used. Here is an example: Ivermectin + Azithromycin (antibiotic) + Paracetamol (to reduce symptoms). Also included in this free kit of an oximeter with a request to monitor oxygen saturation 3 times per day.
What followed this decision to treat early is a considerable reduction in hospitalizations and deaths from COVID-19. The two graphs below are from the the official website of the Mexican Ministry of Health. They show a considerable decline in cases and deaths, with the decline in deaths expected to continue, because of the lag between cases and deaths.
The low incidence of the virus can be seen on this map, showing that only two jurisdictions, Mexico City and Baja California, have yet to bring the virus under control.
The decline in confirmed cases in Mexico can also be contrasted with the situation in Canada, where they are considerably higher per million inhabitants. Rich Canada does worse than the world, while much poorer Mexico does much better.
This decline in cases and deaths cannot be explained by vaccination as, to this day, less than 1% of the Mexican population has been vaccinated.
What this Mexican example shows is that, in a matter of 3 months, it’s possible to bring considerably down the number of cases and deaths, and actually bring the pandemic under control in a jurisdiction, even a very large one, with a very large population, such as Mexico.
When the pandemic is brought under control, there is obviously no rationale for drastic lockdowns, travel and other harsh restrictions. When the pandemic is brought under control, there is no rationale for Zero-Covid.
Actually, an Ivermectin-based prevention and early treatment strategy appears to be the best solution to move towards zero new covid infections, without a disruption of our society and the economy.