In his book, “Summer of ‘49,” David Halberstam told the story of Boston Red Sox manager Joe McCarthy’s efforts to reform a talented, but troubled pitcher whose drinking binges made him unreliable.
McCarthy brought the player into the clubhouse where two glasses — one filled with water, the other with whiskey — sat on a table. McCarthy dropped an earthworm into the glass filled with water. The worm swam around with no ill effect. Then he dropped a worm into the glass of whiskey. The worm quickly sank to the bottom of the glass, dead.
“What does that tell you?” McCarthy asked.
The player pondered the demonstration for a moment, then responded, “If you drink whiskey, you won’t get worms?”
Halberstam’s story about someone drawing the wrong conclusion may be humorous, but in recent weeks a phenomenon — the use of a drug most commonly sold as a dewormer for livestock that has been hailed as either an alternative to the COVID-19 vaccine or a treatment for the virus — has prompted concern among health professionals.
Take ivermectin and you won’t get worms, but you may still get COVID-19 and its serious symptoms, health experts say.
Ivermectin is a drug used to kill parasites in both animals and humans. It is most commonly used as a dewormer for horses, cattle and swine, but it is also prescribed for human use to combat other parasites.
“The most common use is for bed bugs,” said Dr. Emily Landrum, who practices family medicine at The Family Clinic in Starkville. “I’ve prescribed ivermectin, but not very often.”
Booming sales
In recent weeks, demand for ivermectin has boomed after reports emerged that the drug has been studied as a treatment for COVID-19.
Over the past month, especially, ivermectin has been flying off the shelves at both pharmacies and farm supply stores alike.
“Normally, I stock one box of ivermectin,” said Chris Bonner, owner of Chris’ Pharmacy in Columbus. “Now, I’m ordering a dozen, 18 boxes at a time and still running out.”
The human form of ivermectin is available by prescription only, but no prescription is needed to purchase the ivermectin used for animals.
“I started seeing people buying it for COVID back in January,” said one farm supply manager who agreed to speak on the condition of anonymity because he realizes the drug may be controversial. “It’s really picked up in the last four or five weeks, about the time we started hearing about the Delta variant. Compared to last August, my sales of ivermectin have increased probably 50-fold.”
Bonner notes that purchasing animal medicines for human use is illegal.
“There’s no punishment for it, but if you do get sick after taking an animal medicine, you don’t have any liability claim,” he said. “You’re on your own. It was your decision.”
Study reveals insufficient evidence supporting ivermectin
Although ivermectin is not approved by the FDA for treatment of COVID-19, its use became popular after some studies indicated it was safe in patients with SARS-COVID-2 and reduced symptoms. Some of those studies suggested ivermectin might be useful in the treatment in patients with mild COVID-19 symptoms.
However, an analysis of 14 of those studies, published at the end of July by Cochrane, a London-based leader in compiling medical data, revealed insufficient evidence of ivermectin’s benefit.
According to the Cochrane report:
“The authors of this Cochrane systematic review found no evidence to support the use of ivermectin for treating or preventing COVID-19 infection, but the evidence base is limited. Evaluation of ivermectin is continuing in 31 ongoing studies.
“The lack of good quality evidence on efficacy and safety of ivermectin arises from a study pool that consists mainly of small, insufficiently powered random clinical trials with overall limited quality regarding study design, conduct, and reporting. Current evidence does not support using ivermectin for treating or preventing of COVID-19 unless they are part of well-designed randomized trials.”
State health officer weighs in
Until late last week, health officials have been slow to address the use of ivermectin to fight COVID-19.
Asked during his weekly COVID briefing about doctors prescribing ivermectin as treatment for COVID-19, Mississippi State Health Officer Dr. Thomas Dobbs was reluctant to criticize them.
“First off, if a physician thinks it’s the right thing to do to prescribe (ivermectin), we don’t want to interfere with the physician/patient relationship,” Dobbs said. “If a doctor wants to use it, we leave it to their discretion. It’s an evolving situation with different treatments being used. I personally don’t think it’s going to work, but if you do get ivermectin please also get antibodies. We know that monoclonal antibodies work. So if you do get COVID, don’t let it be ivermectin or … Let it be ivermectin and the antibodies.”
The farm supply store manager said he first realized people were purchasing ivermectin to treat COVID-19 in January.
“I’ve been taking it since January after seeing some retired doctors and veterinarians were taking it,” he said, noting that he received the Johnson & Johnson vaccine in March and uses ivermectin as a supplement to the vaccine.
“I haven’t had any side effects,” he said, noting that he takes the dosage recommended for swine.
Health department issues alert
There is growing concern that many people are taking ivermectin at much higher doses, mainly among those who purchase the drug at farm supply stores.
On Friday, the state health department issued an alert after The Mississippi Poison Control Center reported it has received an increasing number of calls from individuals with potential ivermectin exposure. At least 70 percent of the calls involved livestock or animal formulations of ivermectin purchased at livestock supply centers. Eighty-five percent of the callers had mild symptoms, but one individual was instructed to seek further evaluation due to the amount of ivermectin reportedly ingested.
On Friday, the state health department confirmed that one person has been hospitalized in Mississippi after ingesting ivermectin.
In its alert, the health department instructed providers, doctors and hospitals that identify patients with illness related to the ingestion of ivermectin, either prescribed or livestock formulations, to contact the Poison Control Center.
The incidents of ivermectin being taken in high does relate to the studies that showed the drug to be effective against COVID, Dobbs said.
“If we look at the biology of (ivermectin), the concentrations that we’re seeing in vitro that showed efficacy against the virus were 50 times higher than what can be achievable in humans under safe conditions,” Dobbs said. “I doubt it’s going to be very effective taken in doses safe for humans.”
‘I absolutely wouldn’t prescribe it’
While there is little doubt that prescriptions for ivermectin have risen significantly, Landrum believes most of those prescriptions aren’t being written by medical doctors.
“I absolutely wouldn’t prescribe it as a COVID treatment,” Landrum said. “I don’t know for certain, but I believe most of these prescriptions are being written by nurse practitioners at urgent care centers. I’d just hate to think that they’re mostly coming from doctors. We have two safe, effective options: the vaccines to prevent COVID and monoclonal antibodies if you have the virus. I can’t think of any reason why ivermectin would be useful.”
Bonner said he is dismayed, but not surprised, that people are asking about ivermectin as an alternative to COVID vaccines.
“I don’t mind telling people what I think,” Bonner said. “I tell them to get the vaccine. But that’s not what they want to hear.”
Although Dobbs is skeptical about ivermectin’s efficacy against COVID-19, there’s one thing he’s certain of:
“Please, please, please, don’t get it from a feed store,” he said.
Slim Smith is a columnist and feature writer for The Dispatch. His email address is [email protected]
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