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Ivermectin is the new hydroxychloroquine for COVID-19

The veterinary deworming drug ivermectin has become the new hydroxychloroquine in that it is being promoted as a highly effective treatment against COVID-19—and by many of the same people who previously promoted HCQ—despite evidence that is, at best very weak and at worst completely negative. Unfortunately, with the publication of two new and biased reviews, the “HCQ vibe” about ivermectin is stronger than ever.

I must admit that I approached this topic initially with a distinct lack of enthusiasm. The reason is quite simple: Been there, done that. The topic is ivermectin, the new-old wonder drug to treat COVID-19 that evidence can’t seem to kill, and I’m definitely getting flashbacks to a year ago when the first “miracle drug” for COVID-19 was being widely touted, used, and studied. That drug was hydroxychloroquine, and ivermectin is basically the new hydroxychloroquine.

So why write about ivermectin again now? For one thing, it’s still being touted, despite an evidence base that can be described most charitably as weak. Second, two new new review articles were recently published and are being touted by ivermectin fans as significant evidence that we should take the drug seriously as a treatment for COVID-19. Hint: They’re not.

To see why I’m getting a strong “hydroxychloroquine” vibe from ivermectin, let’s briefly review what happened with hydroxychloroquine early in the pandemic. After that, I’ll discuss the narrative about the drug being promoted by quacks like Joe Mercola. Finally, I’ll address the evidence for ivermectin in COVID-19, including the two papers cited above.

Hydroxychloroquine: A brief history

When the COVID-19 pandemic first hit early in 2020, it was a truly frightening time, particularly in hospitals in the hardest-hit areas, which were deluged with incredibly sick patients and no treatments other than supportive ones. Faced with dying patients for whom they couldn’t do a lot, doctors felt desperate and started trying something—anything—to save their patients’ live. They thus often threw “everything but the kitchen sink” at the disease, which, again, was understandable early on, when there was no evidence, but is less so now.

In that time of desperation, one drug was more popular than any other. It was an antimalarial drug, hydroxychloroquine (HCQ), which had been repurposed to treat COVID-19 based on in vitro observations of antiviral activity, its known mild immunosuppressive effect that had led it to become a mainstay of the treatment of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosis, and observations in Wuhan, China during the first epidemic that ultimately led to the pandemic.

How did hydroxychloroquine become the first “miracle drug” for COVID-19? In brief, Chinese researchers reported that none of their 80 patients with lupus erythematosus who were taking hydroxychloroquine went on to become infected with SARS-CoV-2. As a result of that and old evidence of antiviral activity for the drugs, they became interested in using these antimalarial drugs to treat COVID-19. (Never mind that immunosuppressed patients are exactly the patients most likely to assiduously follow the recommendations of public health authorities during a pandemic.) A number of clinical trials were registered, and, based on anecdotal reports and small clinical trials (nearly all of which are as yet unpublished), in February 2020 the Chinese government published an expert consensus recommending CQ or HCQ for patients with COVID-19. Soon after, a number of nations followed suit. From there, a French “brave maverick scientist” named Didier Raoult latched onto the drug as the “answer” to the COVID-19 pandemic, publishing risibly bad studies claiming to show its efficacy. Tech bros such as Elon Musk discovered the claims about hydroxychloroquine and Raoult’s bad science, leading to Donald Trump Tweeting favorably about his study and, ultimately, to the FDA issuing an emergency use authorization for the drug to treat COVID-19.

Unfortunately, it was not long before a drip-drip-drip of negative studies started to cast doubt on whether hydroxychloroquine had any activity against COVID-19, and by summer’s end last year it was pretty obvious that there was no “there” there with hydroxychloroquine, that it didn’t work. Even so, the drug continued to be promoted with enthusiasm ranging from just suggesting that it could prevent COVID-19 after exposure to the virus to full-blown “miracle drug” claims. I once referred to hydroxychloroquine as the “Black Knight” of COVID-19 treatments, a reference to the scene in Monty Python and the Holy Grail in which the Black Knight refuses to admit defeat even as Arthur lopped off limb after limb because evidence just couldn’t seem to kill it. The saga of hydroxychloroquine demonstrated the importance of randomized clinical trials, even in a pandemic, and the price of abandoning science- and evidence-based medicine in the face of hucksters and astroturf groups promoting the drug with bad science and “miracle cure” testimonials the drug and physicians making an honest effort to try something—anything—to save their patients.

As it became clear from more and more evidence that hydroxychloroquine doesn’t work against COVID-19, the narrative started to—shall we say?—evolve? For instance, Dr. Vladimir Zelenko claimed that you had to use zinc with hydroxychloroquine. Others started coming up with cocktails of drugs, vitamins and supplements willy-nilly, with no evidence for efficacy of any of the individual components except the steroids sometimes included in the mix, with grand claims that the cocktail was the miracle cure. Truly, 2020 was a year of physicians behaving badly.

In the midst of this massive shifting of goalposts came ivermectin, which many have dubbed “the new hydroxychloroquine.”

Enter ivermectin, the new hydroxychloroquine

Just as hydroxychloroquine was repurposed based on in vitro (cell culture and biochemical) studies showing antiviral activity that didn’t translate to in vivo (in experimental animals or humans) activity, it was proposed to repurpose ivermectin based on in vitro observations of antiviral activity. Just as hydroxychloroquine was widely used despite a marked lack of evidence, so, too, in many parts of the world ivermectin is being used to treat COVID-19 patients despite a marked lack of evidence. Just as an astroturf effort to promote hydroxychloroquine as an effective treatment for COVID-19 popped up, so, too, an astroturf campaign, complete with conspiracy theories about ivermectin—like hydroxychloroquine!—being an inexpensive drug that “they” don’t want you to know about because its wide use would harm big pharma profits and the sales of COVID-19 vaccines, has emerged.

As we’ve seen, hydroxychloroquine is an antimalaria drug that also has modest immunosuppressive effects sufficient to be useful for some autoimmune diseases, but what is ivermectin? Basically, as colleague and friend Scott Gavura described, ivermectin (Stromectol) is an antiparasitic drug used to treat intestinal strongyloidiasis (threadworm, caused by infection from Strongyloides stercoralis), onchocerciasis (river blindness, caused by the parasitic worm Onchocerca volvulus, and spread by the Simulium blackfly), and roundworm infestations. In veterinary medicine, ivermectin is commonly used to prevent heartworm in dogs and cats and is also used off-label to treat a number of other parasitic infections in animals, including mites in dogs (demodectic mange, scabies, and ear mites) and intestinal parasites (hookworms, roundworms), and Capillaria. In farming, the drug is also used as a deworming medicine in cattle, swine, sheep, goats, and horses.

The interest in ivermectin appears to have originated in an Australian study published early in the pandemic that showed that high concentrations of ivermectin in vitro demonstrated antiviral activities. I’m not going to rehash that study in detail, as Scott has already discussed it, other than to repeat and emphasize that the concentrations used in the experiments published were not concentrations that were achievable in the plasma using standard dosages and to cite a short article from June 2020 that pointed out that pharmacokinetic considerations made ivermectin a poor candidate as an antiviral drug, regardless of how much antiviral activity it might have exhibited at high concentrations in vitro. Basically, the article pointed out that it is likely not possible to achieve the same concentrations of the drug in the plasma, because the drug itself is tightly bound to blood proteins and that even 8.5X the FDA-approved dose (1,700 μg/kg) resulted in blood concentrations far below the dose identified for antiviral effects. I’ll also point out that Scott nicely summarized earlier studies that failed to find a significant impact on the clinical course of COVID-19.

Unfortunately, as was the case with hydroxychloroquine before, conspiracy theories have arisen around the supposed “suppression” of ivermectin. I hasten to point out that hydroxychloroquine hasn’t gone away. Indeed, it is still being touted in Brazil now, fed by the misinformation promoted by Brazilian President Jair Bolsonaro, even as Brazil’s death toll has hit 500,000 and looks likely to surpass that of the US, whose death toll recently hit 600,000 but is slowing down markedly as more and more people are vaccinated. Even so, ivermectin is the new hydroxychloroquine in much of the rest of the world, particularly in the antivaccine, COVID-19-minimizing conspiracy world. One example is how, a month ago, ivermectin was being offered to every citizen of India as the pandemic was killing thousands of people a day in that country, bizarrely leading to bogus claims that ivermectin had “crushed” COVID-19 in that country based on highly dubious “analyses” supposedly correlating ivermectin use with decreased numbers of deaths. Indeed, the Indian health ministry ditched ivermectin as a recommended treatment earlier this month.

Let’s look at the narrative.

COVID, ivermectin and the “crime of the century”

A week and a half ago, über-quack Joe Mercola published an article entitled “COVID, Ivermectin and the Crime of the Century“, naming it after an episode of Bret Weinstein’s podcast. It features an interview with Dr. Pierre Kory, one of the most prominent proponents of ivermectin for COVID-19 by evolutionary biologist Bret Weinstein, who has become prominent as a COVID-19 contrarian and spreader of disinformation, particularly about the “lab leak theory” of SARS-CoV-2 origins. He now likes to Tweet about “persecution” by Twitter:

It also turns out that Dr. Pierre Kory is president of the Frontline COVID-19 Critical Care Alliance (FLCCC) and has testified before Congress. During that testimony, Dr. Kory claimed that ivermectin, used with other medicines such as vitamin C, zinc and melatonin, could “save hundreds of thousands of people,” and cited more than 20 studies.

The narrative of Mercola’s article is eerily similar to the narratives we heard about hydroxychloroquine a year ago, namely that ivermectin is a cheap, safe, and effective drug that “they” don’t want you to know about that could have saved hundreds of thousands of lives if not for doctors’ fetish for randomized clinical trials.

For example:

Yet, despite stellar credentials and being on the frontlines treating hundreds of COVID-19 patients, they have been dismissed as “kooks on the fringe, making wild-eyed claims,” Weinstein says. How can that be? Initially, the FLCCC insisted, based on the evidence, that COVID-19 was a corticosteroid-dependent disease and that corticosteroids were a crucial part of effective treatment.


Since those early days, the FLCCC has been vindicated and corticosteroids, as well as blood thinners, are now part of the standard of care for COVID-19 in many places. The same cannot be said for the remainder of the protocols, however, including the use of ivermectin, which continues to be suppressed, despite robust clinical evidence supporting its use in all phases of COVID-19.

I do like how the FLCCC claims the “brave maverick doctor” and “brave maverick scientist” role and assumes that, because Dr. Kory was on the right side of a couple of areas then he must be right about everything. I also can’t help but note that Dr. Kory, contrary to his “brave maverick” claims, was nowhere near the only one proposing the use of anticoagulants and steroids as part of the supportive treatment of severe COVID-19. These were being debated at my hospital in March 2020 (admittedly, along with hydroxychloroquine).

And, of course, Dr. Kory pulls the favorite gambit of doctors promoting dubious treatments, the “we can’t do randomized clinical trials because it’s unethical” gambit:

With regard to calls for randomized controlled trials, Kory points out that once you can see from clinical evidence that something really is working, then conducting controlled trials becomes more or less unethical, as you know you’re condemning the control group to poor outcomes or death.

I suppose it’s the same reason that antivaxxers think a double-blind, randomized controlled trial of vaccinating versus not vaccinating children is ethical, because they falsely believe that vaccines cause harm. In this case, the ivermectin believers already fervently believe that ivermectin cures (or at least is a highly effective treatment for) COVID-19.

And, of course, ivermectin is being “suppressed”:

As noted by Weinstein, ivermectin appears to be intentionally suppressed. It’s simply not allowed to be a go-to remedy. The obvious question is why? Don’t they want to save lives? Isn’t that why we shut down the world?
“I would have these data arguments,” Kory says. “But it’s not about the data. There’s something else. There’s [something] out there that is just squashing, distorting, suppressing the efficacy of ivermectin, and its egregious.”
Indeed, as noted by Weinstein, it’s not even difficult to prove that ivermectin is being suppressed and censored. Censorship of certain COVID-related information, such as ivermectin, is written into the community guidelines. You’re not allowed to talk about it. If you do, your post will be censored, shadow-banned or taken down. If you persist, your entire account will be taken down.

Meanwhile, journalist Matt Taibbi, someone who really should know better but apparently does not, is promoting the conspiracy theory with an article on Substack entitled ‘Why Has “Ivermectin” Become a Dirty Word?’ Its subtitle? “At the worst moment, Internet censorship has driven scientific debate itself underground.”

Ask yourself if this sounds familiar:

A consequence is that issues like the ivermectin question have ended up in the same public bucket as debates over foreign misinformation, hate speech, and even incitement. The same Republican Senator YouTube suspended for making statements in support of ivermectin, Ron Johnson, has also been denounced in the press for failing to call the January 6th riots an insurrection, resulting in headlines that blend the two putative offenses.

“You have these ideas about the need to censor hate speech, calls for violence, and falsity,” Kory says, “and they’ve put science on the same shelf.”

Congratulations, Mr. Taibbi! You’ve used an argument identical to one that I’ve seen used by antivaxxers and quacks on many an occasion dating back 16 years, complete with a false characterization of quality control as “censorship.” Indeed, fans of cancer quack Stanislaw Burzynski loved to use similar arguments, claiming that their hero’s work was being “suppressed.”

Taibbi even uncritically quotes ivermectin fans saying just that:

Ivermectin may never be proven effective as a Covid-19 treatment, but its story has already appeared as a powerful metaphor of the Internet’s transformation. Once envisioned as a vast democratizing tool, which would massively raise global knowledge levels by allowing instant cross-global communication between all people, it’s morphed instead into a giant unaccountable bureaucracy for suppressing dialogue, run by people with an authoritarian vision for information flow. Many ivermectin advocates believe discussion of the the [sic] drug is being suppressed because of its status as a threat to a billion-dollar vaccine business, but it’s just as likely that its reputation worldwide as a “populist” treatment, a medicine taken by people not waiting for official validation, has made it a target of censors and pundits alike.

“I think what happened is that at the outset of the pandemic, it was decided that all information must go in one direction, from the Gods of Science down,” says Kory. “But that’s not the way it works. Science happens on the ground. That’s where the little discoveries are made. They don’t happen at the top of the mountain.”

As I said, Dr. Kory is pushing a classic conspiracy theory very much like the classic conspiracy theory about hydroxychloroquine last year, that ivermectin is a cure for COVID-19 that “they” don’t want you to know about. (And it’ll render vaccines unnecessary.) I see echoes of Kevin Trudeau.

Who is this “Gorski” character, anyway?

But what about the evidence?

Mercola cites in the interview the various lines of evidence listed by Dr. Kory. It turns out that Scott already dealt with a number of those studies. I’m going to focus mainly on the two that I cited initially. Both are being touted on Twitter.

Here’s the first:

And here’s the second:

Let’s dig in, starting with the “clinical review article.”

Mechanisms of ivermectin against SARS-CoV-2?

The first article is labeled a “clinical review article”. That immediately puzzled me, because it’s far more a basic science review article than it is a clinical review. The vast majority of the article is a rehash of in vitrostudies showing antiviral activity of the drug at high concentrations, as listed in Table 2. It is not really a systematic review, and it’s published in a relatively minor journal by two people who are part of a pro-ivermectin advocacy group, and people on Twitter also immediately saw a lot of issues with the studies cited, for example:

Basically, the authors cite a paper that found that ivermectin inhibits the activity of a protein, importin, that, according to them, “blocking the nuclear transport of viral proteins.” Given that the viruses replicate in the cytoplasm (the rest of the cell other than the nucleus), you can see why Ed was unimpressed. It is true that if even a part of the viral replication process takes place in the nucleus such inhibition might be useful, but even if that were the case, this is stretching.


Perusing the totality of the paper, I noted that the authors cite a lot of biochemical papers that purport to show that ivermectin interferes with various cellular processes relevant to the replication of SARS-CoV-2 in a sort of “shotgun” approach, all with a heaping dose of speculation. For instance, they cite computer modeling (in silico) work thusly:

Another in-silico study by Swargiary et al. demonstrated the best binding interaction of −9.7 kcal/mol between Ivermectin and RdRp suggesting inhibition of viral replication [33]. The RdRP residing in nsp12 is the centerpiece of the coronavirus replication and transcription complex and has been suggested as a promising drug target as it is a crucial enzyme in the virus life cycle both for replication of the viral genome but also for transcription of subgenomic mRNAs (sgRNAs) [34]. Ivermectin binds to the viral rdrp and disrupts it. The highly efficient binding of ivermectin to nsp14 confirms its role in inhibiting viral replication and assembly. It is well known that nsp14 is essential in transcription and replication. It acts as a proofreading exoribonuclease and plays a role in viral RNA capping by its methyltransferase activity [35]. Moreover, highly efficient binding of ivermectin to the viral N phosphoprotein and M protein is suggestive of its role in inhibiting viral replication and assembly [23].

This is a lot of handwaving and speculation. It might have value as pre-clinical evidence to support trying ivermectin in animal models of viral illnesses, but in and of itself, none of it is good evidence that ivermectin actually works in humans.

Then there was this red flag:

That’s a world-record time for acceptance of a review article for publication! The only other instances that I can recall of such rapid acceptance have been by “pay-to-publish” predatory journals.

Be that as it may, oddly enough, the only human evidence cited by the authors comes primarily from a pro-ivermectin website, Ivermectin for COVID-19: real-time meta analysis of 60 studies, whose abuse and misunderstanding of the use of p-values is epic:

The probability that an ineffective treatment generated results as positive as the 60 studies to date is estimated to be 1 in 2 trillion (p = 0.00000000000045).

I like how this was immediately mocked—and rightfully so:

I also can’t help but note that this website uses exactly the same dubious techniques as were used by another website,, to tout hydroxychloroquine. Indeed, it very much appears that the same people are behind the two websites, and it is rather clear to me that these websites represent an astroturf effort to promote unproven treatments for COVID-19.

There’s a saying I invoke all the time for meta-analyses and systematic reviews: GIGO, or “garbage in, garbage out”. Neither nor is a true meta-analysis, as neither properly takes into account the quality of the studies being pooled, as is pointed out here:

To quote the WHO analysis:

Compared with previous drugs evaluated as part of the WHO Living Guidelines for Therapeutics in COVID-19 (see below), currently there are far fewer RCT data available for ivermectin. The existing data on ivermectin also have a substantially higher degree of uncertainty, with included trials having enrolled substantially fewer patients with far fewer events.


For most key outcomes, including mortality, mechanical ventilation, hospital admission, duration of hospitalization and viral clearance, the panel considered the evidence of very low certainty. Evidence was rated as very low certainty primarily because of very serious imprecision for most outcomes: the aggregate data had wide confidence intervals and/or very few events. There were also serious concerns related to risk of bias for some outcomes, specifically lack of blinding, lack of trial pre-registration, and lack of outcome reporting for one trial that did not report mechanical ventilation despite pre-specifying it in their protocol (publication bias).

I also can’t help but note that there are other astroturf-like websites promoting ivermectin too, such as, which has identical formatting and methodologies to a previous website for hydroxychloroquine,

We have been warned about them for a long time:

Different websites (such as,,, among others) have conducted meta-analyses with ivermectin studies, showing unpublished colourful forest plots which rapidly gained public acknowledgement and were disseminated via social media, without following any methodological or report guidelines. These websites do not include protocol registration with methods, search strategies, inclusion criteria, quality assessment of the included studies nor the certainty of the evidence of the pooled estimates. Prospective registration of systematic reviews with or without meta-analysis protocols is a key feature for providing transparency in the review process and ensuring protection against reporting biases, by revealing differences between the methods or outcomes reported in the published review and those planned in the registered protocol. These websites show pooled estimates suggesting significant benefits with ivermectin, which has resulted in confusion for clinicians, patients and even decision-makers. This is usually a problem when performing meta-analyses which are not based in rigorous systematic reviews, often leading to spread spurious or fallacious findings.

This is as good a point as any to move on to the meta-analysis being touted by Dr. Kory. It comes from the UK, specifically from authors associated with the BIRD Group, a pro-ivermectin advocacy group that appears to me to be very similar to the FLCCC.

The BIRD Group “meta-analysis”: Bad science and undisclosed conflicts of interest

It wasn’t long after seeing the systematic review discussed above that I noticed this on Twitter:

Unsurprisingly, it’s being spread all over social media as “slam dunk” evidence that ivermectin works against COVID-19:

Actually, there are lots of “excuses” (otherwise known as scientific reasons) not to use ivermectin for COVID-19 treatment.
Ah, yes, the “big pharma can’t profit off of ivermectin” gambit!
Actually, Orac can say no to ivermectin.
Meta-analyses are only the “highest form of evidence” if they are well done.

No, this is not what meta-analyses necessarily do. They can do this if there are decent RCTs, but when the RCTs are mostly poor quality, well, GIGO applies.

The article, published in the American Journal of Therapeutics by investigators affiliated with the BIRD Group led by Andrew Bryant, purports to be a “Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines“. In fairness, what I can say from this meta-analysis is that, just like the case with hydroxychloroquine a year ago, it is possible that ivermectin has some clinically meaningful effect on COVID-19 disease progression and survival. It’s not particularly likely or plausible in light of the pharmacokinetics problem mentioned above, in which huge doses of ivermectin would be required to reach the same concentrations in the plasma that caused antiviral effects in the in vitro studies that I discussed above, but it’s not impossible.

I would add, however, that if there really is a clinical effect due to ivermectin on SARS-CoV-2 infection, this disconnect between pharmacokinetics and the concentration of the drug needed in vitro to see antiviral effects would strongly suggest an entirely different mechanism of action in vivo. Again, prior plausibility matters, as we have discussed so often in the context of, for example, homeopathy or reiki. No, I’m not saying that the level of plausibility of ivermectin as a treatment for COVID-19 is anywhere as low as that of homeopathy or reiki. Ivermectin is, after all, a real drug with real effects on biochemistry, not a claim that water has memory or that you can project healing energy into patients. However, overcoming this plausibility problem based on pharmacokinetics is not trivial, either. It would require high quality clinical evidence from large, well-designed, rigorous double-blind randomized clinical trials. Unfortunately, as I read, it became very clear to me that the meta-analysis does not include any large, well-designed, rigorous double-blind randomized clinical trials, which is why it suffers from the same problem that I discussed before, GIGO.

The selection strategy was described thusly:

We searched the reference list of included studies, and of two other 2021 literature reviews on ivermectin,9 as well as the recent WHO report, which included analyses of ivermectin.12 We contacted experts in the field (Drs. Andrew Hill, Pierre Kory, and Paul Marik) for information on new and emerging trial data. In addition, all trials registered on clinical trial registries were checked, and trialists of 39 ongoing trials or unclassified studies were contacted to request information on trial status and data where available. Many preprint publications and unpublished articles were identified from the preprint servers MedRxiv and Research Square, and the International Clinical Trials Registry Platform. This is a rapidly expanding evidence base, so the number of trials are increasing quickly. Reasons for exclusion were recorded for all studies excluded after full-text review.

Interesting. The authors contacted Dr. Kory and his fellow ivermectin advocates at FLCCC. I also note that the American Journal of Therapeutics published a systemic review of ivermectin for COVID-19 about a month and a half ago that basically reminds me of the “clinical review” that I discussed first. Hilariously, at one point, the FLCCC systematic review tries to compare COVID-19 case counts and death rates with areas with and without ivermectin distribution programs in order to argue that fewer people dying in areas where ivermectin was used suggests that ivermectin works. This is a fallacious ecological “analysis” very similar to the argument used a nearly a year ago by an astroturf group for hydroxychloroquine.

But back to the BIRD Group meta-analysis, the first thing I noticed was that all of the studies were small, one as small as 24 patients, many of them not double-blind, a significant number, in fact, open-label, in which everyone knows which patients are in which treatment group. The second thing that I noted is that, contrary to the way this meta-analysis is being represented, pooling data from a large number of small, low-quality clinical trials does not magically create one large, high quality clinical trials.

Another way of putting it:

Basically, this is a way of reiterating what I’ve been saying about meta-analyses all along: Garbage in, garbage out.

In fairness, the authors don’t actually say that meta-analyses of crappy studies do make good evidence, at least not in the paper. However, ivermectin advocates touting the study fans are certainly making that claim, and Dr. Kory sure did seem to me to imply the same in his interview with Bret Weinstein. In any event, one large, well-designed rigorous double-blind clinical trial for prevention, along with one large, well-designed rigorous clinical trial for treatment, could trump this entire meta-analysis.

Indeed, Gideon Meyerowitz-Katz did a reanalysis of the studies analyzed by the BIRD Group that shows that if you leave out two studies that are as yet only preprints, are very small, and actually appear to have been miscategorized as much higher quality than they actually are, the results of the BIRD Group meta-analysis change significantly:

This basically shows that without those two studies, the analysis demonstrates no benefit for ivermectin at all compared to placebo, with a confidence interval that includes everything from a big benefit to a large harm from the drug. Interestingly, the between-study heterogeneity also reduces when you do this from about 50% to 6.6%, which is lower than the value the authors give in their sensitivity analysis in the paper.

What this means is that, if you exclude some of the low-quality research on ivermectin, the paper goes from showing a massive benefit to no benefit at all. On top of this, there’s an interesting point — even if you don’t agree with these assessments, taking the only three studies that the authors of the meta-analysis considered to be at a “low risk of bias” (i.e. high-quality), you find that these high-quality studies have failed to find any benefit for ivermectin.

This is, of course, what those of us who’ve questioned whether ivermectin works for COVID-19 have been saying all along. The few existing higher quality clinical trials testing ivermectin against the disease uniformly have failed to find a positive result. It’s only the smaller, lower-quality trials that have been positive. This is a good indication that the drug probably doesn’t work.

Details matter, and, particularly the classification of risk of bias in the individual studies used. There’s another problem. Look at the funnel plot, which is a simple scatter plot of the intervention effect estimates from individual studies against some measure of each study’s size or precision used to look for publication bias. Publication bias is the tendency to publish positive studies and not publish negative studies. Figure 7 shows a funnel plot that Bryant et al characterize as not seeming “to suggest any evidence of publication bias.” However, if you look at the plot, the opposite is true, as, instead of seeing studies clustered on either side of 1.0, which is what you would expect in a funnel plot showing no evidence of publication bias, there is a clear preponderance of studies on the side of the plot less than 1.0 (meaning that the risk of death is lower in the ivermectin group), most of which are smaller, lower quality studies, with the larger studies more closely clustered around 1.0 (no effect).

That’s why I’m going to go back to a warning:

Nevertheless, assessments of ivermectin as prophylaxis or treatment for mild to severe COVID-19 continue being published in preprints26 27 and protocol repositories,28 29which do not follow the recommended process to ensure quality standards in publications; whereas peer-reviewed reports (both observational and experimental studies) are slowly emerging, yet methodologically limited by heterogeneity in population receiving ivermectin, dosis [sic] applied and uncontrolled cointerventions.28–30 Similarly, other studies that can be rapidly retrieved in, medRxiv and MEDLINE make up a quite heterogeneous body of evidence31–33 (including ivermectin as intervention, but with different underlying clinical questions), among other issues that do not contribute to the certainty of evidence—according to the systematic reviews that we comment on below.

What anyone considering any meta-analysis, be it this one or any other, needs to be aware of is the existence of a number of pitfalls in meta-analyses, for example:

Meta-analysis is a powerful tool to cumulate and summarize the knowledge in a research field through statistical instruments, and to identify the overall measure of a treatment’s effect by combining several individual results [4]. However, it is a controversial tool, because several conditions are critical and even small violations of these can lead to misleading conclusions. In fact, several decisions made when designing and performing a meta-analysis require personal judgment and expertise, thus creating personal biases or expectations that may influence the result [5, 6].

As statistical means of reviewing primary studies, meta-analyses have inherent advantages as well as limitations [7]. Pooling data through meta-analysis can create problems, such as nonlinear correlations, multifactorial rather than unifactorial effects, limited coverage, or inhomogeneous data that fails to connect with the hypothesis. Despite these problems, the meta-analysis method is very useful: it establishes whether scientific findings are consistent and if they can be generalized across populations, it identifies patterns among studies, sources of disagreement among results, and other interesting relationships that may emerge in the context of multiple studies.

One can’t help but wonder whether the known bias of an organization dedicated to promoting COVID-19 treatments like ivermectin crept into this meta-analysis. The first author Andrew Bryant, Tess Lawrie, and the most of the authors are affiliated with the Bird Group, a UK group whose website looks like this:

BIRD Group
Nope. No bias here. Nothing to see.

The BIRD Group touts ivermectin thusly:

Partnering with worldwide clinical experts, BIRD recognises the growing body of research that shows that ivermectin is a safe, effective medicine we could use to combat Covid 19. 

Although ivermectin is licensed in the UK, it cannot be prescribed for Covid 19 until it receives Government approval.

Ivermectin is readily accessible and very low cost and can effectively reach worldwide populations very quickly. Our aim is to get ivermectin approved soon in the UK and around the world. Time is critical and we know that the quicker we deploy, the more lives we can save.

Indeed, the second author, Tess Lawrie, is a founder of the group and appears tightly allied with Dr. Kory:

The seed was planted late in December, when Dr. Tess Lawrie watched Dr. Pierre Kory of the Front-Line Covid-19 Critical Care Alliance (FLCCC) testify before the US Senate on the potential of ivermectin for prevention and treatment of covid-19. She looked into the data and decided to conduct a rapid systematic review and meta-analysis to assess the data for herself. She was struck by the seeming efficacy of the drug in reducing mortality and morbidity, and, as a doctor, considered it her duty to inform the UK health authorities about this potential breakthrough treatment.

The FLCCC Alliance is listed as an affiliated organization, along with a number of others, including the Alliance for Natural Health International and the antivaccine group Physicians for Informed Consent, both of which we have encountered before.

Elsewhere, the BIRD Group claims that ivermectin can prevent “long COVID,” the syndrome of systemic illness that has been noted in some patients to last for months after recovering from the disease, and that it is “already saving lives around the world,” a claim for which there is no good evidence and identical to frequent claims by the FLCCC and other ivermectin advocates. Basically, it’s the idea that we could be saving so many lives in the US, UK, and other nations where ivermectin is not approved to treat COVID-19 if only we would change course.

Bias. It’s something one has to be very, very careful of when designing a meta-analysis, and bringing up the possibility is not an indictment of the motives of anyone involved in the study. What is an indictment of the study is that nowhere in the paper could I find a mention of the affiliation of Dr. Bryant and the other authors with the BIRD Group, although they did note that the revised meta-analysis was funded by a GoFundMe, “Help us get life-saving drug approved for covid-19“. It’s a simple recognition of human nature, and it’s particularly pernicious when it is an undisclosed conflict of interest.

Which is why:

Concluding, research related to ivermectin in COVID-19 has serious methodological limitations resulting in very low certainty of the evidence, and continues to grow.37–39 The use of ivermectin, among others repurposed drugs for prophylaxis or treatment for COVID-19, should be done based on trustable evidence, without conflicts of interest, with proven safety and efficacy in patient-consented, ethically approved, randomised clinical trials.

Italics mine. After all, what’s good for the goose, and all that. Ivermectin fans frequently automatically reject criticism of studies of the drug due to bias and even spread the conspiracy theory that the reason ivermectin hasn’t been widely adopted is because it’s a cheap drug off patent that big pharma can’t make much money from. It’s a fair criticism of the BIRD Group and FLCCC, and it’s an especially fair criticism given the undisclosed conflict of interest involved. I’m sure that Bryant et al. didn’t disclose it because they don’t consider a non-financial conflict of interest to be a true conflict of interest, but being associated with an advocacy group most definitely is.

Indeed, Dr. Kory himself was on Twitter the other day ranting about how his meta-analysis is a “game-changer” but “they” are “censoring” and “suppressing” it. He even completed the crank requirement of including a conspiracy theory positing that “big pharma” is “suppressing” ivermectin so that “they” can develop a new ivermectin-like drug for COVID-19 that can be patented, paving the way for lots and lots of profit:

Of course, Dr. Kory fails to note his conflict of interest, namely that he advised the authors on the paper. Also, maybe major news outlets actually showed the meta-analysis to experts, who told them that the included studies are nearly all very weak.

This led to these sorts of responses, which remind me, more than anything else, of the rhetoric of antivaxxers, first about Drs. Kory and Weinstein:

Harsh, but fair.

Then there was this:

What is this Tweet referring to? Simple. A few months ago, Frontiers in Pharmacologyprovisionally accepted a systematic review by Dr. Kory and FLCCC doctors that used many of the same studies as the current one and then decided to reject it:

Regardless of the publication stage or subject of a manuscript, if the integrity of an article is called into question, our policy is to investigate. Upon further scrutiny by our Research Integrity team about the objectivity of this paper during the provisional acceptance phase, it was revealed that the article made a series of strong, unsupported claims based on studies with insufficient statistical significance, and at times, without the use of control groups. Further, the authors promoted their own specific ivermectin-based treatment which is inappropriate for a review article and against our editorial policies.

In our view, this paper does not offer an objective nor balanced scientific contribution to the evaluation of ivermectin as a potential treatment for COVID-19. Frontiers’ has published more than 2,000 rigorously peer-reviewed articles on COVID-19 since the pandemic erupted via our Coronavirus Knowledge Hub, and we are acutely aware of just how critical high-quality, objective research in this area is at this time. Frontiers takes no position on the efficacy of ivermectin as a treatment of patients with COVID-19, however, we do take a very firm stance against unbalanced or unsupported scientific conclusions.

Which, predictably, led to cries of “Censorship!”:

I’m sorry, but Dr. Kory should not be surprised that someone would point out his own very blatant conflicts of interest when discussing his review. Live by accusations of conflicts of interest, die by accusations of conflicts of interest, scientifically at least, especially when the meta-analysis is as bad as this one and doesn’t disclose that it comes from members of an advocacy group dedicated to promoting the drug being studied:

So, am I rejecting this meta-analysis out of hand? Not at all, even in spite of its many flaws and the undisclosed conflict of interest! I’m simply pointing out that, contrary to the language being used by Dr. Kory and his admirers to promote it, this meta-analysis is, at bestmildlysuggestive that ivermectin might have activity against SARS-CoV-2. At worst, it’s a biased piece of scientific hackery that depends upon the—shall we say?—overly optimistic categorization of two preprint studies in order to produce its impressively positive result. Absent those studies, this meta-analysis would be resoundingly negative, as are all the higher quality clinical trials of ivermectin for COVID-19.

Certainly, given the extreme lack of biological plausibility based on the drug’s pharmacokinetics, this meta-analysis is by no means the “slam dunk” rejoinder to skeptics of the drug that ivermectin advocates think it is.

Ivermectin is the new hydroxychloroquine

Ivermectin advocates hate it when we say this, but it’s true. Ivermectin is the new hydroxychloroquine. It’s been promoted the same way and by the same people. The same conspiracy theories have sprung up around it as the scientific evidence supporting its use is weak at best, negative at worst. That’s why I’m going to go back to what I once wrote about hydroxychloroquine:

Because I’m dedicated to evidence and science when it comes to medical decision making, I always concede that it is still possible that hydroxychloroquine might still be found to have some anti-COVID-19 activity, although it’s becoming increasingly clear that, if there is any activity it will likely be very modest and require large clinical trials to detect, to the point where it’ll probably be clinically insignificant. That being said, it’s amazing how much believers in acupuncture, vitamin C to treat cancer, and hydroxychloroquine to treat COVID-19 have in common. It’s also distressing how much like the villain in a slasher flick the drug is. No matter how many times it appears to have died, it always comes back.

Substitute the word “ivermectin” for every instance of “hydroxychloroquine,” and the paragraph above is still accurate.

Again, I concede that it is possible that ivermectin has clinically relevant in vivo antiviral activity against SARS-CoV-2. Based on current evidence, however, it seems unlikely that it does, when pharmacokinetics considerations are taken into account. As I routinely used to say when discussing hydroxychloroquine, I’d be happy to change my mind if compelling scientific evidence for ivermectin were published. It’s just that neither of these reviews qualify, nor do any of the clinical trials I’ve seen thus far. That’s why I agree that ivermectin shouldn’t be used to treat COVID-19 outside of the context of a well-designed clinical trial with a strong scientific rationale.

Certainly, the conspiracy mongering by Bret Weinstein, Pierre Kory, and their fans are not leading me to reconsider that opinion.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

137 replies on “Ivermectin is the new hydroxychloroquine for COVID-19”

I think people arguing that clinical trials are unethical on this evidence kind of give away the game. They are not willing to subject their belief to potential falsification.

@ Dorit,

That’s what I think when people say clinical trials are unethical too.

The problem with the antivaccine call for a clinical trial for proven vaccines isn’t that experts don’t want effectiveness falsified. Extensive evidence shows vaccines work, and the issue is repeatedly studied.

The issue is that it’s unethical to deny a working preventive, and that no parent would sign up for a truly randomized trial.

Ivermectin does not have solid evidence that it works behind it. On this background, refusing trials is avoiding falsifiability.

Your comparison is flawed, or in bad faith.

The problem with your argument is that there have been hundreds of clinical trials on vaccines.

Demanding another go round just because you don’t like the results of the previous hundred trials or because no-one has met your particular goalpost-moving requirements for the trial is unethical.

Clinical trials involve real people and their safety and wellbeing needs to be cared for during the trial. That is why it is unethical to demand additional trials when there is already a strong evidence base. However, when the evidence base is weak, like with ivermectin, additional trials are necessary to ensure people are not being given treatments that do not work.

It is clear that this authors has spent a lot of time trying to debunk people using Ivermectin but the difference is that they spend that time healing people and the author does not. One can only wonder his or her agenda since we already know Dr Kory’s agenda-saving lives. There is nothing to be lost by trying it and indeed it is effective but so much to be lost by spending so much effort trying to be a contrarian without a causel

Every quack claims that he’s all about “saving lives,” often making excuses for not doing the science and clinical trials by saying “I’m too busy saving lives to do clinical trials!” Cancer quack Stanislaw Burzynski made exactly the same excuses, as have more quacks than I can remember. Your rebuttal is not the powerful rebuttal you think it is. In fact, it suggests Kory is indeed a quack.

I suspected that ivermectin, like HCQ, wasn’t the magic bullet it was presented as when I heard the anti-vaxxers and woo-meisters I survey praise it highly. .In fact, Mike Adams, following his prepper regime, got a prescription for it because we can soon expect a total societal collapse/ power grid failure/ civil- or- gang war/ supply shortages and Covid might remain . It cost 300 USD,, he carped but he found that you can buy a horse paste version at the feed store for 12. He tasted it- awful but a bargain!

Why do people like them who despise pharma accept a pharma product if it is for other conditions/ other species? ( rhetorical question= I know, they’re contrarians, that’s why)

You don’t need a neighborhood feed store to make purchases of ivermectin. Amazon lists a ton of ivermectin vet products and there are a few on eBay as well.

*both eBay and Amazon also happily sell bloodroot preparations/salves so that you too can become disfigured by burning off tissue from your nose or other body parts, in the false belief that this corrosive targets only cancerous tissue and leaves benign tissue unharmed.

“When the COVID-19 pandemic first hit early in 2020, it was a truly frightening time, particularly in hospitals in the hardest-hit areas, which were deluged with incredibly sick patients and no treatments other than supportive ones.”

Behold the mythopoesis of a narrative pandemic. We saw this narrative emanating from China in January 2020: SARS CoV 2 will overwhelm hospitals and outpace ventilator availability, leading to an overwhelm of medical facilities and a catastrophic death toll. One of the first things China did was build two emergency hospitals in Wuhan. Official morbidity and mortality statistics for COVID were complemented by videos of people “dropping dead” in the streets, rumors of mobile incinerators working overtime, rumors of a sulfur dioxide plume over Wuhan, rumors of 21 million missing Chinese cellular subscribers.

The narrative that Orac here advances, which is perfectly in line with the mainstream media (MSM), is that COVID is a Very Deadly Disease. This was the same narrative coming out of China in January 2020. Yet there is a glaring disconnect: the MSM studiously ignored the crisis in China until mid March. They did nothing to warn Americans or prepare them for a deadly pandemic. When they finally did raise an alarm, in March, when it was too late to stop the spread of COVID in America, they led off with a very big lie: that we would only need to stay home for two weeks to “flatten the curve”.

Then things got really weird: despite the CDC zealously regimenting the testing process for COVID, the USA quickly became the global leader in COVID cases and deaths. The velocity of the pandemic was greater in the USA than any other place on Earth. We could blame the media, who ignored the threat of COVID for two months. But maybe there is something deeper going on here. Maybe the USA has more COVID cases than anywhere else because the USA is ground zero for the outbreak of SARS CoV 2. Maybe it leaked out of Fort Detrick in mid 2019. Maybe the media and the CDC are complicit in a coverup of the real origin of the virus.

At any rate, why should anyone trust the MSM, given their inexplicable two month lapse in covering the COVID pandemic? Their track record on other matters is no better; they are quite evidently propaganda outlets with no regard for the truth. And if Orac is pushing MSM talking points, why should anyone trust Orac?

Because, unlike the anonymous troll known as Farmer Jill, Orac knows what he is talking about with respect to COVID-19, that’s why.

Unfortunately for you, science does not consist of snappy answers to stupid questions.

Unfortunately for you, science does not consist of snappy answers to stupid questions.

I agree with you. Your question was rather stupid.

There was plenty of evidence in the article. Your comment on the other hand was long on hand waving and short on evidence.

I concur with Chris P. that Farmer Jill’s comments are “long on hand waving”. However, as handwaving goes, i have to note that “Behold the mythopoesis of a narrative pandemic.” is pretty impressive.

The rest of the comment follows in kind, sketching out supposed faults in media coverage of COVID. Then, near the end — by which point many minions may have lost any thread of attention — Jill drops a conspiracy thesis: “Maybe the media and the CDC are complicit in a coverup of the real origin of the virus.”

Finally we get the “argument”, such as it is, which I shall reframe as a syllogism to show it’s “all men are Socrates” absurdity.
• The Media cannot be trusted.
• Orac has said things that have also been said by the Media.
∴ Orac cannot be trusted.

As Jill’s comments continue, she goes progressively deeper down a right-wing conspiracy rabbit hole — Lafayette Park, 1/6, Seth Rich, Tony Fauci! — all MSM lies, lies, lies! All to falsely malign Trump and benefit Joe Biden!

What me might regard as bizarre is how all this conspiracy theorizing undermines her initial claim about Orac. Her claim is that COVID is indeed “a Very Deadly Disease” that the CDC/Pelosi/MSM conspiracy insidiously and knowingly minimized. So you’d think she’d offer evidence that Orac was in on this scheme, cites for instances of his minimizing COVID’s risks. But she can’t, because he didn’t.

To perhaps state the obvious, what’s going on with all this MSM conspiracy theory handwaving is an attempt to absolve Trump and the Trumpers for the disastrous COVID response here during his administration. As if anything the CDC failed to do wasn’t framed by Trump appointees like Azar, Redfield, Caputo, Paul Alexander… as if Tony Fauci wasn’t constantly dancing a fine line to bring as much science to bear as he could without getting fired.

In mid January we knew that SARS CoV 2 had a high R0, long asymptomatic transmission period, possibly airborne and/or spread easily on surfaces, much more contagious and difficult to contain than the original SARS, and resulting in high levels of morbidity and mortality, which are exacerbated when ICU facilities run out of capacity. 2+2=4! So why did the MSM spend two months acting like there was no threat of pandemic to the USA?

As I do have a PhD in Media Studies from a School of Journalism, I feel some responsibility to answer this question, despite its dubious source. What the MSM “knew” in January was absolutely nothing. They’re not in the knowing business, they’re in the reporting business. In that, they are heavily reliant on official sources. While, as Trump revealed to Bob Woodward, he and his peeps knew very early exactly how deadly COVID was and why, in public the administration was minimizing the risk. This amplified the normal cautiousness of scientists to wait until they have more data to draw conclusions. So while the dominant peg in coverage wasn’t a Trumpy ‘it’s just the flu’, it was ‘we don’t know’. The official line not only influenced the substance of the coverage, but the amount and placement of the coverage. MSM news is highly reactive, spotlighting ‘things that happened here today’, and it would have taken a strong, focused unified dire warning from official sources to displace whatever else was dominating the news cycle at the time. As it happened, the MSM coverage caught up to the seriousness of COVID exactly when we could have predicted it would — when so many people were dying in a hub of the country’s media industry (NYC) that the hospitals were bringing in refrigerated trucks to hold the excess corpses.

Sadmar, I appreciate your comment, since it is substantive instead of memetic. However you get a few things wrong. Foremost, I am not a Trump supporter, and I will condemn him as a liar and con artist all day long. However, I will not let my feelings about Trump permit me a double standard when it comes to evaluating journalism and the media. They are documented liars as well.

Second. I do not believe that COVID is a Very Deadly Disease. I identified this as the mainstream narrative. Although I do think the virus is killing people, I think the narrative itself is more dangerous than the pandemic. I believe the death toll has been both overstated and overemphasized.

Justatech, you posited that the media did not know they were lying when they said “two weeks to flatten the curve”. But the lockdown was directly inspired by the pandemic modeling of Neil Ferguson, who called for lockdowns lasting 12-18 months. So yes, the media knew they were lying. As Fauci would say, they were telling the public what they thought they needed to hear. This strategy can be described as moving the goalposts, or boiling frogs.

The MSM knew in January that SARS CoV 2 was a highly infectious SARS variant (and yes, Narad, initial reports from China described an R0 between 3 and 4, this figure was continuously lowered as the pandemic progressed). They knew it had a long asymptomatic transmission period, they knew it would kill 3% of patients and even more when ventilator capacity was exhausted.

Blame Trump all you want, I will agree with you. But blame the media as well. They are supposed to be independent. Instead they are professional spokesmodels for the CDC and NIH, who also failed to protect and/or prepare Americans for COVID.

I believe the death toll has been both overstated and overemphasized.

Is somebody supposed to give a flying fuck about this? The only thing you have by way of a credential is whinging somewhat piteously about the media.

I strongly disagree with your assertion that the “mainstream media” did not cover COVID at all until mid-March 2020. I was already well aware of COVID (based on reading the news) when I traveled to Europe in February 2020, and canceled a planned trip to Italy for March 2020.

I read about this in my local American newspaper, on the BBC, on Twitter and from the science-news sites I read. (I don’t watch TV news because I don’t like it, so I have no idea what was being said there.)

As for this idea that there was a lot of COVID testing in the US – ha. I live in one of the early hot spots and I was never tested, because I never met any of the very strict criteria. Folks I know in other countries were (and are) tested regularly.

And I disagree that the “stay home for two weeks to flatten the curve” was a lie. It was wrong, but it was not a lie. A lie is known to be false before it is said. Being wrong is different. If you say “it looks like rain today” and it doesn’t rain, does that make you a liar? Or are you just wrong? The fact that you can’t seem to tell the difference is concerning.

Flatten the curve wasn’t a lie to those of us taking care of these patients. Many more would have died for want of equipment and personnel if not for that effort.

The MSM had stories about COVID in China before March 2020, yet despite the well publicized characteristics of the new disease, they conveyed no sense of warning or urgency to the public. They did nothing to prepare Americans for the coming “war” against COVID. As late as February 24th 2020, Nancy Pelosi was touring Chinatown in San Francisco, saying “everything is fine here” and “Come because precautions have been taken. The city is on top of the situation.” Do you think this was a lie or just another terrible forecast?

You are correct regarding the testing, but your point only reinforces my thesis, which is that the CDC stage managed COVID statistics by tightly regulating the testing process. Although they refused to test widely during the beginning of the pandemic, by the end of summer 2020 they were testing as many people as possible. In fact, the MSM switched tactics at this same time, choosing to only emphasize case numbers as mortality statistics trailed off. Throughout the election season, the MSM emphasized test results instead of mortality figures. And perhaps most damning of all, they relented on the case-based fear mongering as soon as Biden was inaugurated. Even before the vaccine was available, Biden’s inauguration marked a definitive statistical turning point in the course of the pandemic. I find that highly suspicious.

@ JustaTech:

Me too! I heard very early on about “”the new virus” through television news, computer news items, science sites and governmental websites. I think Orac started early here. My SO followed the local newspaper because his job is for a nearby town. Pandemic preparedness started in late January 2020 by the governor.

In fact, Wikipedia has rather dense entries about media coverage/ facts internationally starting with Timeline Covid-19 Pandemic January, 2020 and for each month following, day by day. EASY to FIND!
I live in another early hotspot and was never tested for the same reason as you
We also flattened the curve- TWICE! Spring 2020- with shutdowns and in spring 2021 with vaccines!

I am of course familiar with rants about MSM- so what are the other options?
— alternate media sources; Global Research, World News Daily?
— ultra right or ultra left wing mouthpieces?
— internet conspiracy mongers? Alt med? Facebook?

One of the loons I survey has spent many months spreading mis-information about nearly every SBM datum we’ve learned since the start of the pandemic and about the evil WHO, CDC and Anthony Fauci. Another regales his followers with tales of multi-national cartels’ plots and alien interference. All dispute the value of vaccination ( PRN, NN, CHD, AoA, Highwire, Mercola, Green Med Info)

One of the most common complaints from these sources is that MSM got it wrong before,..:
said by people who make shit up and have much poorer track records and more COIs: they sell products and/ or subscriptions to their services. MSM goes beyond borders for news coverage all over the world as does science news/ research

Obfuscation by dodgy sources is easy when highly technical topics or brand new research is involved, making Covid their dream topic..


@ Farmer Jill

The MSM had stories about COVID in China before March 2020, yet despite the well publicized characteristics of the new disease, they conveyed no sense of warning or urgency to the public. They did nothing to prepare Americans for the coming “war” against COVID.

That you are describing is the jobs of the politicians and other people in leadership position.
Especially the “prepare Americans about the coming war” bit.

Back in January 2020, those of us who have business in Asia received plenty of warning and sense of urgency from the news relayed by the media.. Lockdown, mandatory mask-wearing, thermographic scans in the airports…
As these media were relaying the Asian countries official stances… Well, in countries where the leaderships didn’t feel like making preparations, it’s quite logical the media would have nothing to report and wouldn’t necessarily feel like there was any urgency.

Farmer Jill- you are correct that science does not provide snappy answers to stupid questions. But Orac’s response to ‘why trust’ him was not intended to be a scientific answer so it would be more useful to you not to ask stupid questions if it’s science that interests you!

I would not trust Orac insofar as he is saying the same thing as the MSM. It is easy to prove that the MSM has no credibility. To take only a couple of recent examples, the MSM has had to recant their purely fabricated narratives related to Trump and Trump supporters. Last year they claimed Trump ordered the use of tear gas and rubber bullets to clear out Lafayette Park for a photo op. A few weeks ago a report from the Department of the Interior proved that story was totally false. Similarly, the MSM bleated for weeks, without evidence, that Brian Sicknick was bludgeoned with a fire extinguisher by Trump supporters on 1/6. They later scrambled to change their story and blame pepper spray. But all we really know is that he died of a stroke the following day. The fire extinguisher was a pure fabrication lacking any supporting evidence.

What about the murder of Seth Rich? The MSM has insisted for years that his shooting was a random, not politically motivated crime. But this year a heavily redacted report from the FBI showed that the “random criminals” took Rich’s laptop home after the shooting, despite leaving his wallet behind. The FBI has now been in possession of this same laptop for four years. Entire pages of their report on this “random” crime are redacted.

These are political examples, but they are not far removed from science, since both depend on facts and the interpretation thereof. The MSM proves that they do not need facts to push their interpretations. They are willing to blare falsehoods and only correct them in fine print months and years later. In regards to COVID, in addition to the falsehood that we only needed to lock down for two weeks, we have the flip flopping of Anthony Fauci. Fauci explained his reversals by stating quite clearly that he told people what he thought they needed to hear. He thus admitted to being a pious fraud when it comes to science communication. This attitude is simply indefensible. Fauci claimed to be “the science” but he is in fact “the propaganda”. His mendacity is part of the reason the public has lost faith in “the science”.

I’m still waiting for someone to explain why the MSM was unconcerned with the threat of the pandemic for two months. In mid January we knew that SARS CoV 2 had a high R0, long asymptomatic transmission period, possibly airborne and/or spread easily on surfaces, much more contagious and difficult to contain than the original SARS, and resulting in high levels of morbidity and mortality, which are exacerbated when ICU facilities run out of capacity. 2+2=4! So why did the MSM spend two months acting like there was no threat of pandemic to the USA? Why was there no attempt at prevention? Why did they not react until it was too late to protect this country? Why did this country then experience the fastest pace of cases and deaths on Earth?

@Farmer Jill I just meant that Tucker Carlson admits that he has no credibilty. I did not know that Fox News is MsM, though.

I have no idea what main stream media you were watching but what I watched/read started to terrify me sometime in mid-January. Even then, it was apparent where things might (and ultimately did go). Perhaps you just watched the networks that tried to pretend it wasn’t happening?

Listen: when Pelosi went to Chinatown and told everyone that everything was fine and under control, she was echoing the attitude of the liberal MSM. When I say MSM I primarily mean television news because that is the most mainstream media there is. Pelosi made her remarks at a time when SARS CoV 2 was already spreading uncontrollably through the community in neighboring Santa Clara county. This was on February 24th. At that time the vast majority of the general public had no idea that COVID threatened the United States. I knew, and you knew, because we are literate and numerate. But the general public had no idea at that time. This reveals an obvious failure of both journalistic media and public health capability. Trump was one of the few Americans who proposed strong prophylactic countermeasures, and he was mocked by the media as a racist for doing so. The media quite simply failed the nation. I would like to see a story from U.S. network or cable news published prior to March 1, 2020 that recommends prophylaxis or otherwise indicates that the COVID pandemic was a serious threat to the United States.

I knew, and you knew, because we are literate and numerate.

Nobody who thinks Sars-CoV-2 has a high R0 should be wandering around touting their numeracy.

As one of the non-Americans here this style of crankery sounds really weird. Especially with regard to a global pandemic. Internal American political conniptions are hardly relevant in the rest of the world. Well, it’s occasionally amusing if nothing else.

I have a response to Jill in moderation with some long press quotes from Feb 2020, but I wasn’t specifically trying to answer her question.

I’ll give her a kudo for providing links for most of her claims, but she didn’t give a citation for Trump recommending “strong prophylaxis”. I found this article from Feb 27.

President Donald Trump described the US response to the covid-19 outbreak as “a tremendous success” and asserted that the risk to Americans was “very low” during a rare nationally televised press conference on Wednesday 27 February.

He said that the 60 covid-19 patients in the US were mostly doing well, although one remained seriously ill.

To combat covid-19 he advocated screening people from infected areas, quarantining those at risk, and developing a vaccine, which was advancing “rapidly.” He said the country was “very ready” and was the best prepared country in the world to deal with the outbreak.

And this was about the time when he proposed cutting the CDC budget.

On April 21, the LA Times reported that

Two coronavirus-infected people died in Santa Clara County on Feb. 6 and Feb. 17, the medical examiner revealed Tuesday, making them first documented COVID-19 fatalities in the United States.

I guess that’s the uncontrolled spread. Of course, because of asymptomatic and pre-symptomatic infections and infectivity, the virus was already (and still is among the younger, unvaccinated population) spreading uncontrolled around the U.S. We just didn’t realize it.

“We just didn’t realize it.”

Yes we did. Some of us just didn’t say it.

When all is said and done, Farmer Jill’s position boils down to “I didn’t hear it so they didn’t say it.”
As a farmer, Jill should be well aware of the difference between chicken salad and chicken manure. Unfortunately, the farmer has apparently not yet acquired this knowledge.

You’re wrong. Cite a source. My whole point is that I did hear about the impending pandemic. But anyone who got their information from their television had no foggy clue that there was an impending pandemic. Because the pundits and sock puppets and apparatchiks on television made no attempt to warn people or prepare them. They were following the lead of the CDC.

CDC bulletin from Jan 30 2020:

“Given what we’ve seen in China and other countries with the novel coronavirus, CDC experts have expected some person-to-person spread in the US,” said CDC Director Robert R. Redfield, M.D. “We understand that this may be concerning, but based on what we know now, we still believe the immediate risk to the American public is low.”

From Feb 6:

“Our goal is early detection of new cases and to prevent further spread of the coronavirus,” said CDC Director Robert R. Redfield, M.D. “Distribution of these diagnostic tests to state laboratories, U.S. government partners and more broadly to the global public health community will accelerate efforts to confront this evolving global public health challenge.”

February 15:
“This is an evolving situation and every day we learn more about this virus. We continue to believe the risk of exposure to novel coronavirus 2019 to the general public is currently low.” [Uncontrolled community spread was occurring at this date]

February 26:
“Unprecedented, aggressive efforts have been taken to contain the spread and mitigate the impact of this virus. This is a rapidly evolving situation.” [What unprecedented efforts?!]

March 3:

“While information so far suggests that most COVID-19 illness is mild, a reportexternal icon out of China suggests serious illness occurs in 16% of cases. Older people and people with certain underlying health conditions like heart disease, lung disease and diabetes, for example, seem to be at greater risk of serious illness.”

Now you can blame the Trump administration for the CDC’s failure to, you know, control or prevent the spread of this disease; you can throw Redfield under the bus, but you are still left with the abject failure of the media to pick up the slack. They are supposed to be independent and opposed to Trump’s executive influence. Yet they let Trump’s CDC lead them around by the nose. No one conveyed a sense of urgency to the general public.

It’s not as if the CDC doesn’t engage in direct public outreach. Their anti smoking advertisements are legion. In fact, the CDC released a very telling advertisement in February of 2020. The narrator gravely intoned, “There’s an epidemic going around, but it’s not a virus.” The narrator was talking about EVALI. EVALI was that other outbreak of novel pneumonia that began in 2019. It looked just like a severe respiratory infection, it could not be positively diagnosed, it’s aetiology could not be described, and it required ventilator support in a significant proportion of cases. It also disappeared out by the end of February, just in time for COVID to take its place.

But that’s another story.

I barely watch regular TV news. I’m usually either working or listening to music and preparing dinner. But I looked online for a sampling of mainstream reporting from February 2020.

i.e. CNN Feb 19, 2020

The global death toll from coronavirus has risen to at least 2,120, with eight deaths reported outside of mainland China. Hong Kong and Iran have each reported two deaths from coronavirus. Taiwan, Japan, the Philippines and France have each reported one death.

The global number of confirmed coronavirus cases now exceeds 76,262, with the vast majority of cases in mainland China.

The letter from the researchers, which was published in The New England Journal of Medicine, details how the researchers monitored viral loads of the novel coronavirus in samples taken from the nose and throat of 18 patients: nine men and nine women ranging in age from 26 to 76 in Zhuhai, in China’s Guangdong province.

For those samples, a total of 72 nasal swabs and 72 throat swabs were collected and analyzed.

The analysis revealed that higher viral loads were detected soon after a person was showing symptoms, with higher viral loads found in the nose than in the throat. Among the patients, only one was asymptomatic.

Yet overall, “the viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients,” the researchers wrote in the letter.

or NBC Feb 26, 2020

The case could be the first person-to-person transmission among the general public in the United States involving a person not believed to have been exposed to the virus through travel or close contact with a known infected person.

The “CDC is concerned about reports that testing for COVID-19 for the California patient announced on February 26 was delayed as a result of CDC,” CDC press officer Richard Quartarone said Thursday in an email.

“We are investigating this carefully, however, a preliminary review of CDC records indicates that CDC was first informed about this case on Sunday, February 23,” Quartarone said.

He said that the federal agency requested samples that day from the patient in order to test for COVID-19 and that samples were sent via courier on Monday and received Tuesday. “Test results were confirmed and communicated on Wednesday, February 26,” Quartarone said.

Recall that there was delay of weeks in getting test kits out to the states, the first tests gave false results because one of the reagents was wrong, and early testing was limited to symptomatic patients.

Or the New York Times Feb 26, 2020

“Then the question was simply this: Are these evacuees?” Dr. Walters said. “And do we follow our protocol? And the answer to that was yes on both accounts.”

Dr. Kadlec added, “We had additional expertise and experienced eyes on these people and monitoring through the flight.”

The planes landed at Travis Air Force Base in California and Lackland Air Force Base in Texas. Most of the 14 passengers who had tested positive were then flown to Omaha for treatment and monitoring by experts at the University of Nebraska.

Since then, Japanese officials have informed American officials that several other passengers among the 328 brought back had also tested positive for coronavirus. On Friday, American officials said at least 34 people inside the United States have the virus — 18 of them from the Diamond Princess. All of the 34 cases have been linked to overseas travel. There has been no sign yet of the virus spreading among communities in the United States.

I got around to writing a little blog article in May with sources from USA Today, Time, the New York Times, the Dallas News, and elsewhere.

President Trump named Mike Pence to head the Covid-19 task force on February 26.

The White House didn’t start daily briefings until March 16.

California got their first official cases on January 26, but didn’t record a death until March 4 when they had a total of 53 cases.

So at the time Nancy Pelosi was showing support for the local Chinese community and their businesses, there were only a few dozen cases in the whole state and no deaths.

I blame our national leadership, in particular the President, for not taking responsibility and leading rather than passing the buck to the media.

Don’t get me wrong squirrele, I blame Trump and his leadership as well. The prophylaxis I referred to was the travel restrictions imposed by Trump on Jan. 31. This was the same day HHS secretary Alex Azar declared a national health emergency in the USA.

We must understand what was happening in China at that date. China admitted on Jan. 20 that human to human transmission was occurring. They locked down Wuhan less than three days later. The scenes that came out of Wuhan in the following weeks were hardly short of apocalyptic. Trump and the HHS acting to protect the USA one week after the lockdown of Wuhan was a timely response.

The only charitable explanation for the CDC’s subsequent insouciance is that they thought Trump’s actions were sufficient to prevent the outbreak of COVID in the USA. They apparently assumed the virus was contained. But when they reported the first known case of community spread on Feb. 26, it should have been obvious that the cat was out of the bag. China took 3 days to lock down after human to human transmission was admitted. The USA took 18 days after admitting community transmission to coordinate lockdowns.

The CDC’s attitude towards the pandemic can only be described as “wait and see”, a strategy at odds with their nominal objective of disease prevention. The CDC’s stance towards COVID was purely reactionary. The failure of early testing does not excuse the CDC, it only condemns them further. Test, trace, and isolate was rendered impossible by the paucity of test kits and their miserly application. The actions of the CDC ensured that the pandemic had time to take root in the U.S.

Which brings us back to the media. Even if they belittled Trump’s competence, they could have looked to China itself for an example of how to forestall the pandemic. Based on the characteristics of SARS CoV 2, they could have easily surmised that it would make its way onto US soil. My question is, why didn’t we flatten the curve starting Feb 26, when community transmission was known? Why didn’t we flatten the curve on February 1, for that matter? Then “two weeks” might have been an honest time frame, instead of a heinous inducement to 12+ months of “stay at home” orders.

Thanks for citing sources; although they reflect an awareness of SARS CoV 2 they do not reflect a sense of urgency. They do not provide public health messaging. This is what I am looking for. Who tried to warn or prepare the general public before March? Nobody. Instead the public had the rug pulled out from beneath its feet.

Apparently the only thing that convinced the Western world of the need for lockdown was Neil Ferguson’s opaque computer modeling. Why actual science was ignored until a dodgy software program predicted a horrendous death toll (2.2 million deaths in the USA) is a question that must be answered.

For Christ’s sake, Event 201 roleplayed a global pandemic of a highly infectious SARS variant one month before such a virus appeared in Wuhan. The U.S. has been preparing for such a situation for more than a decade. So why did they drop the ball so egregiously?

We must understand

TINW, Bitsy. If you want to give orders, try playing in traffic.

Dear Narad,

Who is Bitsy? What is TINW? Temple Israel of Northern Westchester? What does playing in traffic have to do with giving orders? “We” does not mean “everyone” and you are perfectly free to excuse yourself from understanding.

I realize that, as an acolyte of the great computer Orac, you aspire to wield devastating one liners against your ideological opponents. But I think you need a few more years of study and practice to approach anything resembling comprehensibility. Or maybe my country brain is just too simple to understand your devastating wit.

But I think you need a few more years of study and practice to approach anything resembling comprehensibility.

Precious, just precious.

@Farmer Jill,

Thanks for the reply.

I would credit two factors which are discussed by ABC on their special last year.

John Bolton disbanded the Pandemic Preparedness Office in the NSC and moved its functions back to the various offices in CDC, NIAID, etc. That led to a situation where there was not a specific leader in the White House directing and coordinating the response.
The White House did not follow the pandemic response playbook that had been developed under the Bush and Obama administrations. Some of the actions were taken anyway, but other important actions were skipped. Instead they tried to wing it resulting a hit-or-miss, disjointed and too often delayed response.

For example, we had both the Pence led pandemic response team and Kushner’s response team (with essentially no medical or procurement expertise) working side-by-side.

I’ll also note these events from the AJMC timeline.

January 31 — WHO Issues Global Health Emergency

With a worldwide death toll of more than 200 and an exponential jump to more than 9800 cases, the WHO finally declares a public health emergency, for just the sixth time. Human-to-human transmission is quickly spreading and can now be found in the United States, Germany, Japan, Vietnam, and Taiwan.

February 2 — Global Air Travel Is Restricted

By 5 pm on Sunday, those en route to the United States have to have left China or they can face a 2-week home-based quarantine if they had been in Hubei province. Mainland visitors, however, will need to undergo health screenings upon their return, and foreign nationals can even be denied admittance. Other countries beginning to impose similar air-travel restrictions at this point include Australia, Germany, Italy, and New Zealand.

February 3 — US Declares Public Health Emergency

The Trump administration declares a public health emergency due to the coronavirus outbreak. The announcement comes 3 days after WHO declared a Global Health Emergency as more than 9800 cases of the virus and more than 200 deaths had been confirmed worldwide.

So Trump blocked travel from China itself, but not from Europe or elsewhere. This probably had a lot to do with the difference in number of entry cases. (I remember seeing a quote of about 100 for New York versus 8 for California.)

And we only had symptomatic screening to rely on (temperature checks, respiratory symptoms, etc.) We later learned about asymptomatic or pre-symptomatic transmission.

The U.S. would never have accepted the draconian lockdown measures the Chinese could implement. And Trump left the chose of those measures up to each state, several of which waited many months to implement any mask requirements, etc.

Another charitable option was that the CDC expected SARS-CoV-2 to be sort of like the first SARS virus. The science to show otherwise took a few months to get confirmed and established. Perhaps with a different director and president, the CDC would have acted more forthrightly.

But this president wasn’t very good at either managing the response or delegating responsibility to someone more capable.

The CDC has their share of blame, but too many of their actions were forestalled or blocked by the White House.

The media are responsible for communicating the message. But it’s hard for their many disparate voices to override what the President is saying on TV every day.

So Trump blocked travel from China itself, but not from Europe or elsewhere.

More detail here, here, etc. It’s not as though this needs some sort of forensic reconstruction, especially following on to a post about ivermectin.

Squirrelle, what I think we can agree on is that the U.S. failed spectacularly to prevent the spread of COVID in America. If you believe the statistics, this conclusion is inescapable. In 2020 the U.S. swiftly became the global leader in COVID cases and deaths. The velocity of the outbreak in the U.S. has been nothing short of exceptional.

This demands an explanation. The two explanations you have offered are 1) federal incompetence and 2) American freedom (vis a vis Chinese totalitarianism).

You claim that the CDC just didn’t know how different SARS-2 is from the original. But as I have been saying, the unique threat of the virus was signaled from China very early on. The two numbers that concerned me were an estimate of the R0 at 3-4, and a claim that the incubation period was up to 14 days, during which time the virus could be spread asymptomatically.

You are correct that we could not have instituted totalitarian countermeasures in the USA, but that only makes the mission of journalism and public health outreach more critical. Since Americans can not be forced to lockdown, or wear a mask, or socially distance, we can only be convinced to do these things. The media is supposed to be the fourth estate. As Trump and the CDC failed, it was the putative responsibility of the media to inform the general public. But they failed as well. In fact, the fourth estate has not existed in the USA for a long time. They have become propaganda organs of the federal government.

When you are trying to solve a mystery, and you know that information is being withheld, you employ Occam’s razor. The mystery I am trying to solve is why COVID hit the USA harder than any other country on Earth. The most obvious answer is that the government and the media failed to prepare the public. This is what I have been arguing. But I ultimately believe that this failure was intentional and pre meditated. I believe the USA was hit hardest by COVID because the USA is ground zero for COVID. I believe the federal government and their lapdog media are complicit in a coverup.

Why? Because of three missing pieces of information. 1) What pathogen or toxin was released from USAMRIID at Ft. Detrick in mid 2019? 2) What caused the subsequent EVALI epidemic? 3) Why did EVALI disappear just as COVID officially started spreading in the USA? The symptoms of EVALI and COVID were identical, right down to the ground glass opacities in radiographic images of the lungs.

Occam’s razor suggests that SARS CoV 2 is what leaked out of Fort Detrick; SARS CoV 2 is what caused EVALI as well as other outbreaks of mysterious pneumonia in the summer of 2019, and the CDC has been engaged in a two-year coverup with the help of the Oval Office and the MSM. Thus there was actually no failure to keep the “China” virus out of the US. It was already here, and the failure was staged.

“Occam’s razor.” You keep using that phrase. I do not think it means what you think it does.

@Farmer Jill,

I have some immediate concerns so I’ll get back to most of your comment later.

But I suggest you speak for yourself and let me do the same.

AMRIID has had problems with anthrax and Ebola in the past. But the latest concerns involved problems with a steam sterilization system used to treat waste. Other problems were identified, but no people were exposed as a result of this issue (as far as we know).

I haven’t seen evidence that a really close genetic variant of SARS-CoV-2 was actually at Wuhan or AMRIID prior to the outbreak.

Farmer Jill will probably write this off, but South Korea, Iran, and Italy got hit hard earlier, and due to overdispersion, it takes multiple introductions on average to seed an outbreak. Countries like the US tried to observe growth in confirmed, most symptomatic cases before acting, like making assumptions about risk by watching the part of an iceberg above water.

Thank you for this analysis, which seems fair minded – although I think it can be said that you too, Dr. Gorski, have a conflict of interest in these matters as your reputation would suffer if things you’ve previously written were proven wrong, and I’m not sure the guilt-by-association comments are scientific, however relevant they may be. I hope to see Dr. Kory, in particular, respond in detail to your comments.

One thing you did not respond to is the claims that in the Indian states where ivermectin was adopted, there was a prompt marked decrease the severity of the epidemic, while in those states which did not adopt ivermectin there was no such marked decrease. And the same is being said for areas in some other countries. Please comment referencing the data people are citing, which I imagine you have seen.

In my post, I linked to an article that refuted the part about the Indian states. You must have missed it:

That analysis was utter nonsense, anyway, a badly done ecological “analysis” not unlike what advocates did for hydroxychloroquine last year:

Notice the similarity?

This letter, from someone claiming to be an MD, compares the difference between various states in India and Tamil Nadu, which did not adopt ivermectin:

I’m not sure where the figures are from. If they’re accurate, don’t they – and the data on Dr. Kory’s website – provide sufficient evidence that ivermectin is at least somewhat effective? With the CDC not responding, if I’m not mistaken, to various concerns being raised about the VAERS data (i.e. the analysis of Dr. Jessica Rose which I posted a link to under another article on this site) I personally am hesitant to get vaccinated and currently think ivermectin may be a safer and more effective alternative. I will grant that the vaccines may be doing a lot more good than harm – at least in the short term – but from what I’ve read and heard I also think they are causing a lot more harm than is currently being acknowledged and discussed.

I’m not sure where the figures are from. If they’re accurate,

The mindset of the conspiracy theorist/alternate reality warrior in a nutshell.
So in short, you are just here to spread rumors.

Damn it, “not sure where the figures are from”.
At least you are honest.
Cannot one of your pro-IVM genius be arsed in looking-up these figures, if there are so evident?

Without sources, this is nothing but gossip and propaganda.
Historically, these sorts of thing have lead to the death of innocents. Another commenter on another blog, citing the same stories, is gleefully also telling a story about an Indian lawyer association sending an official letter to a WHO official for “lying about the effectiveness of IVM”, and how she is going to be put on trial and to the death penalty.

I’m despairing of the human race. We are still as irrational as we first fell off the trees. Even getting out of the ocean was a mistake.

Interpreting Orac’s reasoned arguments as being tainted by “conflict of interest” because they might be shown incorrect later and you speculate he wouldn’t acknowledge being mistaken is…a bizarre definition of conflict of interest.

Yeah, lots of countries not Indian states. I would not trust that circle jerk site, but would prefer data from reliable dashboards, or a PubMed indexed study about ivermectin and India in a few months. But if is from cheerleader for parasite meds, I will take it with a grain of salt.

Because between India’s caste system (still going strong, along with its poverty), the oxygen shortage, fake tests and bodies floating down the Ganges:

…. I am just going to say the claims are extraordinary, and as Carl Sagan said: you need to provide extraordinary evidence.

“fake tests and bodies floating down the Ganges”

Dang. You want it darker?

@ carbonaceous

“You want it darker?”

There’s a lullaby in suffering and a paradox to blame.

Yeah…Brett really jumped the shark on this one. I really don’t get it. He seems hellbent on proving that the mRNA vaccines are dangerous. No clue why. He used to be an interesting voice…sadly…no more.

What I don’t get about these so-called “Frontline” doctors is this-if they’re truly practicing in a critical care environment, am I to believe they are really ordering up IV ivermectin on cue? I asked a pharmacist on rounds and she said all we have, to her knowledge, is tablets. Same at another hospital I work at. Same at a third.

So they are getting IV and no one is asking questions? Who is paying for it? Am I really to believe they are being reimbursed for it? I’m calling shenanigans. I order a CMP that could have been a BMP and I hear about it. I question how many times, if ever, they have actually used the protocol they have on their site.

What about their OP protocol? I was curious so I looked. 0.2 mg/kg. The standard dose for wormy badness is something like 150-200mcg/kg. So far so good. Problem is I can usually only order one dose. So I try to free text it…won’t take it. I walked over to our OP pharmacy. They could fill it but would have to order an awful lot more stock to do so. Doesn’t sound like something we can just “Roll out and try.” That also puts the average dose around 15-20mg meaning $25-50 a day for five days. Most of my patients can’t afford that.

I don’t know what these jokers are playing at but, back here in the real world, the vaccines are working.

So they are getting IV

The way I first read it, I thought it was a lazy/truncated shorthand for ivermectin. IV instead of IVM.

So maybe no intravenous injection involved.

Could be. When I listened to the JRE podcast Kory or whatever his name is was saying they were using IV but he could have misspoken there, too.

Yeah, Bret’s positions are strange. Virus was engineered, vaccines are dangerous, ivermectin is the cure. Guilt by association isn’t kosher, but OTOH, people who blame “Them” use it all the time, so here’s a go at it. Bret’s brother Eric works for Peter Thiel who funded Emily Oster’s work on Covid and schools which was used to push for in-class learning. Bret certainly doesn’t want kids vaccinated, so I wonder what his take is on sending kids back to class? Is he okay with kids getting infected with an engineered virus? I suppose there should be a supply of ivermectin for parents. Strange times.

Can we address the elephant in the room here? Who here thinks the YouTube censorship of Bret Weinstein is a good idea? Orac does thorough research of the science behind some of these “miracle” claims and I think Weinstein should have a debate with credentialed people who poke holes in these studies, but censorship is never the answer. Weinstein is an evolutionary biologist and he does appear skeptical of these new vaccines and the virus’ origin, but once YouTube censored him, he went on Joe Rogan’s podcast to discuss the whole debacle. And Rogan has an immensely popular podcast. It’s one thing if Weinstein and Dr. Kory have conflicts of interest in promoting ivermectin for financial gain, but a good scientific debate is what we need today, not more of the same propaganda being pushed without pushback.


I think Weinstein should have a debate with credentialed people who poke holes in these studies…

Unwise. Cranks have learnt to weaponise debates. They use techniques like the Gish Gallop and Ham Hightail to swamp science-based opponents in so many bad arguments that it is impossible to refute them all. Remember, in debates it’s not about who’s right, it’s about who’s the most convincing.

Yup. Cranks crave live public debates. Crave them! Why? Because debates give the appearance that there is a scientific controversy and value rhetoric and emotional appeals over science, thus allowing the crank to Gish gallop and use all manner of logical fallacies.

Debates are entertainment. Debates are not about who has the most or best data, it’s about who can spin the best story, who can convince the audience. The audience doesn’t only respond to the facts. They respond to emotional appeals, to rhetorical devices, to the rhythm of speech.

Debates don’t find truth, they find popularity. And science is rarely popular.

Whether Guilt By Association is kosher depends on the nature of the association and what sort of guilt we imagine it indicates. i don’t know what sort of relationship Bret and Eric Weinstein have — but proximity to Peter Thiel comes with a good chance of bad ideas.

Rogan asked them a couple times if they have ever debated someone who disagrees or if there are ppl who completely disagree with their findings and they never directly answered. Kind of speaks for itself, I’d say. Again-what are these jokers playing at? Why bother with any of this at all?

Could it be that the powers that be wherever that guy practices are closing in so he’s trying to go big for cover?

Still doesn’t answer my question. Does censorship do more harm than good? I would argue it does. Maybe the rhetoric or emotional appeals are convincing to the average person who doesn’t know any better, but when big tech overlords silence science (or dismiss contrarians as cranks), it can have the opposite intended effect and create more controversy (e.g., lab leak hypothesis).

The tide may have turned on the possibility that the virus originated in a lab in the court of public opinion. Google the statistics of covid cases in mainland China – they almost dropped off in March of 2020 and have not shot back up yet. Could that mean they reached herd immunity? Do you really trust the CCP? Why is it so hard to believe that this virus was released intentionally or inadvertently? Maybe I am just a conspiracy theorist, but I am not alone. It is good to have these debates and everyone should keep an open mind.

I’m not even intentionally spraying in your general direction, “Shut up shutting up.”

Nick, I am going to reply this once and stop engaging because I suspect you are not arguing in good faith. Now, I may be wrong, and if so, I apologize in advance. Here goes.

Does censorship do more harm than good? I would argue it does. Maybe the rhetoric or emotional appeals are convincing to the average person who doesn’t know any better, but when big tech overlords silence science (or dismiss contrarians as cranks), it can have the opposite intended effect and create more controversy (e.g., lab leak hypothesis).

Your point appears to be that censorship can be harmful beacuse

it can have the opposite intended effect and create more controversy

but before that claim, you say

the rhetoric or emotional appeals are convincing to the average person who doesn’t know any better

so you are aware that some may be swayed by fallacious arguments which I would claim is a benefit for said censorship, but you think the cost of creating more controversy is greater. Fair enough, but that is the end of your argument.

You also have this nice chunk of rhetoric and emotional appeal

when big tech overlords silence science

“Big tech overlords” is a “They” term. Funny because later you say to Google some stats. Why trust Google since they are trying to “silence science”? Also, “silence science” is information free aka noise. It has emotional appeal since what does not need to be said is “science is good” and who would want to “silence the good”? I call that phrase noise since removing it from your poorly arranged argument does not change its content.

Now, here is the doozy. You reference “lab leak hypothesis” as an example of creating more controversy, and instead of elaborating on your initial argument, launch into JAQing off about said controversy in the next paragraph.

The tide may have turned on the possibility that the virus originated in a lab in the court of public opinion.

Since when is a scientific question decided in the court of public opinion. And isn’t public opinion mostly the result of average people who don’t know any better?

Google the statistics of covid cases in mainland China – they almost dropped off in March of 2020 and have not shot back up yet.

Again, you trust the “tech overlord” Google? For that matter, you trust China’s stats? And even if both are fine, could it not be the result of China having better control over the spread of Covid?

Do you really trust the CCP?

You go from China’s stats to the communists. Who do you think is responsible for reporting those stats but China’s govt? This is starting to get tiresome.

I will move to ridicule.

Why is it so hard to believe that this virus was released intentionally or inadvertently?

Big jump here chief, lab leak != intentional release. Why don’t you just say “CCP bioweapon”, or is that too tin foil hat for you?

Maybe I am just a conspiracy theorist, but I am not alone.

Not maybe, and sadly you are not alone amongst “average people who don’t know any better”.

It is good to have these debates and everyone should keep an open mind.

Can’t disagree, but I just might be that your brain fell out.

Nick, folks like you misunderstand science. It is a tool to extract signal from noise, and it operates in a constrained environment. There are limits on time, money, attention, etc that must be balanced against the likelihood of extracting said signal. Your comments do nothing to help reduce noise or extract signal. In fact, you increase noise and produce uncertainty which by definition is anti-science.

“Does censorship do more harm than good?”

Should YouTube “censor” beheading videos? Or bomb-making videos? They do (thankfully).

They also “censor” any video that has copywritten music (my spouse has had his videos of bike commutes pulled because a car pulled up playing the radio).

Should YouTube “censor” the videos that tell children to soak strawberries in bleach to turn them white, and then eat the bleach-soaked strawberry? They don’t.

YouTube lets a huge amount of harmful content stay up, so anyone who’s gotten pulled must have done something serious.

But here’s the thing: YouTube is a private company. They aren’t the government. Just because you can’t be on YouTube doesn’t mean you can’t be on other platforms. If someone violates the Terms of Service on YouTube then they’re in breach of contract and can and should be pulled. That’s not censorship, that’s adhering to a contract.

YouTube lets a huge amount of harmful content stay up

FB and YT, and the countries implementing their own harsher rules, have bots to filter out the easier-to-identify “controversial” content (even if sometimes, Garfield gets marked as adult-only material), but then it comes to rantings by cranks, beheadings, and other gross stuff, some human has to watch it first to identify it as “not good”.

Watching the worst that humans can produce, one video after another.
I read somewhere how the people doing this watching have a high burnout rate.

There may be more rotted jobs, but I have a hard time thinking of one right now.

“They also “censor” any video that has copywritten music”

I’m just going to ass u me that people are aware that ‘law enforcement’ has taken to playing music at traffic stops/interactions so that if the victim films they get their channel striked and the vid taken down, right?

@ Nick

“Does censorship do more harm than good? I would argue it does.”

Not finding a platform to relay your views is not censorship. No one is obliged to propagate your ideas. Thank Orac for allowing you to do so on his blog.

The power of Big Tech is another issue. I’m not against breaking them up in two or three with an antitrust legislation. But that’s not really merely a “censorship” issue: even when broken up in two or three, the concerns about spreading bullshit, disinformation, ravings and outright lies will remain intact, and these Big Tech platforms will have to deal with the same pressures from civil society to, as you put it, “censor”…

Anyhow, the Internet needs to be cleaned up quite a bit. I miss good ol’ UseNet…

“Do you really trust the CCP?”

Who said we should trust the CCP ??? I do not trust the CCP. Nor should anyone. They have a proven track record of truth massaging, to say the least.

I did show some leniency towards China a few years ago, but not anymore. Xi Jinping did put in a lot of effort to turn the tables ! But that has, overall, not much to do with the pandemic but with concerns I consider to be more consequential.

“Why is it so hard to believe that this virus was released intentionally or inadvertently?”

Intentionally ? Yeah. That would be stupid. It would be an act of war. If China wanted Beijing to be nuked before having the time to invade Taïwan, yeah… sure… way to go: intentionally release an engineered virus. Good idea, bro !

Inadvertently ? It’s not that hard to believe. It never really was. But was not backed by evidence solid enough to make such a bold claim. And it just was completely bonkers to hear the shitload of rubbish conspiracy theorists were pushing on the matter; and the politicization of the issue was and remains so glaring that, in the end, it becomes quite pointless to discuss such a matter with random assholes on the Internet: nothing can come out of it except fear-mongering and increased paranoïa. It’s a signal to noise ratio issue, at the end of the day.

“Maybe I am just a conspiracy theorist, but I am not alone. It is good to have these debates and everyone should keep an open mind.”

Keep an open mind. Just do not fracture your skull by pushing yourself too hard to keep an open mind. We’ll have the cleaning up to do when your brain will have splashed to he ground.

Oh! And while you keep an open mind, also keep an open eye for data, evidence, and arguments contrary to your, ahum… views…

Gros bisous.

Annd, F68.10 also says it pretty good.

I don’t know from “essential workers” but I draw the line at mopping up uncooked brains. Sir, this is a Walgreen’s and I suspect winter is coming. An employee crunch or CBD joint cream falls through or something about the laxative isle.. more likely it’s DIY insulin.

Speaking of elephants in the room and bodies floating down the Ganges:

When are U.S. pro-vaxers going to stop ignoring the threat from north of the border?

True, the Canada1st Party of Canada (seemingly named with the help of the Department of Redundancy Department) is so far only harassing Canadians over anti-Covid-19 pandemic measures, but it can only be a matter of time before Americans including Orac and his RI minions are served with cease-and-desist notices. Under the guidance of party leader and Queen of Canada Romana Didulo*, stark Kent Heckenlively-esque warnings are being issued:

“At the firing squad, the military firing squad, you will receive not one, but two bullets on your forehead for each child that you have harmed as a result of injecting this experimental vaccine,” said Romana Didulo* to those involved in vaccination efforts in a recent video on Telegram. “So when you go home tonight, think about how many bullets.”

Queen a.k.a. Commander-In-Chief Didulo appears to have gotten a boost from QAnon influencers and is reputed to have thousands of followers, some of whom are running around western Canada handing out those cease-and-desist notices. Dairy Queen has already been targeted.


*an anagram for “I am our Donald”.

@ Dangerous Bacon

“At the firing squad, the military firing squad, you will receive not one, but two bullets on your forehead for each child that you have harmed as a result of injecting this experimental vaccine.”

Readaimfire !!!

No style, no finesse, but it gets the jobs done…

Points well taken. I figured someone would catch the “google” reference, but does anyone use “Bing” for a quick search? Of course the “intentional” release of this virus is pure speculation, but China (CCP, more specifically because it is under authoritative state control) is not trustworthy, plain and simple. Even the Biden administration has called for a more thorough investigation because the WHO did essentially nothing to determine its origins because China wouldn’t let them.

The pandemic has made some people more skeptical of mainstream media – go and “bing” the recent ratings since Trump has left office. We are living in strange times and everyone should be concerned of what people in power can do. Are we going to pretend big tech overlords do not maximize the potential of artificial intelligence? And just wait until CRISPR technology falls into the wrong hands of rogue scientists who manipulate germ-line cells … oh wait, that already has happened.

The trouble is MSM has all the good resources and contacts. You may not trust mainstream media but all of the smaller media sources have fewer resources and contacts and are usually niche suppliers. Basically they are more likely to be overtly biassed towards set political views, less likely to actually have top level access to foreign governments and facilities and information.

This is indeed why some people prefer to avoid MSM. The alternative media reinforces their existing prejudices and they can avoid contrary viewpoints. These people want bias. Whenever I hear that you cannot trust the MSM, this is my first response – MSM is insufficiently biased for this person.

Farmer Jill-your response to ‘don’t ask stupid questions’ if it’s science that is your interest is bizarre. I made no argument in defense or otherwise about MSM reporting about anything- science, politics, health and medicine or whatever. I’ll will simply say that MSM may be a first line of inquiry but anything contentious will need further investigation from different avenues, as this blog does, from Orac and the commenters, in abundance. Methinks that is
a normal approach – common sense for any critical thinker, the category of which I don’t think you are yet a member.

Arthur Dent-‘uncertainty’ is certainly not anti-science. There is little if any science that is certain- that is it will never change. Scientific Laws are the closest to unchangeable

You are correct. But I was referring to the production of uncertainty.

In fact, you increase noise and produce uncertainty which by definition is anti-science.

You can argue that uncertainty is healthy for science, and you would be right, but some use this aspect of science to spread misinformation by, for example, JAQing off. The most dangerous misinformation is wrapped around a kernel of truth.

@ Leonard Sugarman

I understood Justatech’s point being about the popularity of the decisions based on science, not the sciences themselves.
Or to put it another way, the answers provided by scientific researches are not often the answers we would have liked to hear.
As an example, studies showing environmental harm from human societies’ behavior. Most people don’t like to be told they should change their ways and stop using pesticides, or use their car less, or should not build a pool.

To go back on-topic, a popular response to the studies on ivermectin would have been “yes, it’s working, we don’t have to worry anymore about Covid19”. That’s not the one we got and a lot of people are disappointed.

Another one of life’s mysteries: what happened to the interview of Alan Dershowitz with the Health Deranger that Natural News was promoting the bejesus out of yesterday morning?

By later in the day the interview (featured on the alternative-to-YouTube channel, Brighteon) had vanished, not only from NN but from Brighteon as well.

Was it: 1) the result of hacking by Bill Gates’ depopulation desperadoes, 2) Biden Administration censorship*, 3) mind control caused by spike proteins shed by vaccinated people, which forced an unwilling NN into taking it down, 4) Dershowitz coming to his senses and demanding its removal, or ?

*NN is currently proclaiming that “anything that is not censored is a lie”, which means that anything you see on NN is a lie, which we kinda knew already.

“anything that is not censored is a lie”

Ah, but since that statement wasn’t censored it must be untrue. You weren’t censored so your statement must also be untrue. And, I haven’t been censored, so, umm, I’m in an infinite loop. But it’s a pleasant loop.

The truth of that which has been censored is left uncertain by this logical analysis. Your kilometerage may vary.

Yea?, well, I got to thinking about the I saw it on Dr. Who as a kid “one robot always lies and the other always tells the truth..” And started thinking about it.

You filthy **** ** ***** ** ***** *** ********* ** piece of shit. I’ve always tolerated short alphabetic series but, I have come to the conclusion that you are just a really nasty person.

@ DB

It’s definitely not #4. It’s entirely possible that it was Adams who “came to his senses” enough to decide being associated with Dersh is a bad look. Or maybe the video was zapped by the ETs from the UAPs, deciding to do us pitiful humans a small favor.

The first ivermectin paper now has the following warning: 22 June 2021 Editor’s Note: Readers are alerted that the conclusions of this paper are subject to criticisms that are being considered by the editors and the publisher. A further editorial response will follow the resolution of these issues.

Thank you for this thought provoking article.

Have you seen the controlled prospective observational trial of 1,195 HCWs in Argentina published by Dr Hector Carvallo in 2020 (peer reviewed)? He has no connection to Kory or Lawrie.

Control group was 407 people. 58% (237) of the control group got Covid – using only PPE to protect them.

788 were in the Ivermectin group – they took a dose every week throughout the trial period of 3 months and also used PPE etc in the same way as the control group.

Given this study was not a double blind randomized RCT, there is always the possibility of some placebo effect so you would need to see a pretty significant reduction to be confident of a measurable effect. Here is a link to the trial – before clicking it, maybe consider what reduction in infection percentage would convince you that ivermectin has some promising features as a prophylactic.

If ivermectin had no effect then you would expect 58% of 788 to have got Covid – which is 459 – so how many fewer than that would make you sit up and take notice?


There’s no power analysis, and the carageenan is a (strange) confounder. I’m not surprised this surfaced in Dove.

Respectfully, if you dismiss a study that demonstrated a reduction in Covid infection to that extent amongst 788 HCWs working in a hospital at the peak of a pandemic, using an incredibly safe drug, because there is no “power analysis”, or because of a “confounder” then you are missing the wood for the trees to a quite spectacular degree. It is just methodological fetishism to react like that to such results and it is this kind of blinkered insanity during a pandemic that has resulted, literally, in the unnecessary deaths of millions of people. In years to come, this will be seen as a historic and egregious failure of our scientific, political and media communities to make evidence-based decisions under pressure. Your reply is actually embarrassing.

What’s embarrassing is begging the question, which is your entire comment in a nutshell. You could raise Norman Vincent Peale from the dead, and he plus your overweening belief still wouldn’t automagically make ivermectin the wonder drug that you have plainly already concluded that it is.

You could perhaps suggest a hypothesis to explain why instead of 459/788 expected Covid cases (based on 237/407 in the control group), the actual figure for those taking ivermectin was, er, zero. Out of 788. Not 230. Not 153. Not 46. Not 5. Zero. This is in the middle of a raging pandemic focusing on HCWs working on the frontline in hospitals. Or perhaps the absence of a “power analysis” explains the presence of a fairly interesting “placebo” effect of, er, 100% – in the context of a disease for which there is an objective clinical test and, very frequently, clear and obvious physical symptoms. At what point does healthy scientific scepticism curdle into wilful disregard of compelling evidence?

I’ve already done that — you’re a credulous fool who thinks that reading what he wants in one obscure journal is enough to call it a day.

Your failure to posit any kind of plausible hypothesis for a reduction of expected infection rate from 58% to 0% compared to the control group in a prospective controlled trial is duly noted. I am happy to leave it there and let anyone reading this exchange make up their own mind. Good day.

Your failure to provide any plausible hypothesis that could explain a 100% drop in infection rates is duly noted – as is your ad hominem in place of actual argument. I am happy to leave it there and let the reader make up their own mind. Good day.

Plausible explanation. 100% success rate would be fantastic. It would imply a drug so powerful that its a miracle. So, why aren’t all of the trials with this drug as successful? Come on? How many drugs are 100% successful, anywhere? If this drug is a miracle then it should work anywhere. Having a 100% success rate is suspicious in itself. Having a 100% success rate when others aren’t showing the same is suspicious. Having a 100% success rate when the drug has low plausibility in the first place is suspicious. So it’s likely that the study is either seriously flawed or seriously fraud.

Isn’t necessarily true but it’s as plausible as unrealistic success rates.

I don’t think there’s ever been an “incredibly safe”*, moderately safe or even dangerous drug that is 100% effective in preventing or treating a serious medical condition, despite what these authors are claiming for their protocol.

*it would take a considerable amount of willing suspension of disbelief to conclude that ivermectin and carrageenan fall into the category of “incredibly safe”. That designation is reserved for wonder drugs like Devlin McGregor’s RDU-90 a.k.a. Provasic, which as you may recall had _absolutely no side effects_, though its makers didn’t go so far as to claim that it prevented heart disease 100% of the time.

One of placebo effects when trial is not double blinded is that the investigator tries to prove himself or herself right. This cannot happen if the trial is double blinded. I suggest that you look for double blinded trials. Why ivermectin seems to not work in this case.
(Check the error margin, too.)

“Every citizen in India” you state. The underlying article shows it was offered to every citizen in a state of India…Goa (one of the smallest states).

If you can’t even get your quotes right, what hope is there for credibility in the rest of the article?

Wow. Just lemmings walking off
The Cliff. With big articles and lots of sources of why it’s a no go with successful treatments. Anyone who cites WHO, China, even the CDC is just reading. Not actually looking.
So, we didn’t know much before mid-March. You weren’t paying attention to the real news, you were listening to the lemmings of socialism. While Trump was shutting down travel, Fauci was on every show who would have him stating that we had nothing to worry about in the US. MANY a appearances repeating that lie.
I suppose Orac finds Dr Robert Malone a quack as well, along with Dr Stephen Smith who have saved thousands of lives with their Covid cocktails and would have saved hundreds of thousands more if the lemmings did their job. Instead of listening to quacks like Fauci who changes his “science” with the wind, funded the lab which leaked the deadly virus which became a pandemic, and in 2014 touted “gain of function” research was worth the risk.
If he says something doesn’t work, that’s the first thing I’ll be headed for.

“Wow. Just lemmings walking off
The Cliff.”

But guided by our Cliff Notes. 😉

It had nothing to do with snow leopards, as we were taught for 13 years.
If anybody wants to pirate something worth a damn, I recommend Jungle Cruise in 2160p. It is really a fun ride. As you trolls here don’t have much time left (because of all the death and all) I really recommend grabbing a copy whilst you are still able. For practicality, 1080, because ya’ll probably don’t have much time left.

The NIH changed its official stance toward Ivermectin from “do not recommend” to “neither recommend for or against” (the same standard it applied to monoclonal antibodies and convalescent plasma) after Dr. Kory’s presentation to the US Senate in December 2020. Care to comment?

Citation(s) required.

Also, no need to comment. Ivermectin still doesn’t work. In fact, the story is getting even worse for it. I’ll have more to say about that tomorrow, probably. (I took the holiday weekend off blogging and didn’t have anything ready today.)

I’m not a scientist or doctor, just someone hoping to be educated about this issue. Is this the citation you’re seeking?

Doesn’t this mean that doctors have discretion to prescribe (or not) ivermectin?

And when you say “Ivermectin still doesn’t work”, what do you mean? Doesn’t work to eradicate Covid? Doesn’t work to keep people from getting worse or dying? Doesn’t work to protect people from getting Covid in the first place?

I appreciate your allowing that “…it is possible that ivermectin has some clinically meaningful effect on COVID-19 disease progression and survival.” If it’s possible, and we know from 50 years and billions of doses that IVM is safe, why not allow its use? I mean, c’mon, people are dying. Lots of people.

Now that the two large clinical trials for ivermectin use in COVID-19 prophylaxis or treatment have been established as fraudulent, there is no clinical evidence that ivermectin protects against COVID-19 infection, reduces the severity or time course of COVID-19 infection or provides improved outcomes for COVID-19 patients.
The doses of ivermectin that are being suggested are much greater than those shown to be safe in humans. Indeed, poisonings due to ivermectin are becoming common. Ivermectin at these elevated doses is not safe.
Recommending ivermectin when it is not effective for the disease has the potential to encourage people to not use effective prophylaxis or treatments, such as vaccination, or indeed to seek help if disease progression worsens. This will result in worse outcomes for those infected with ivermectin.
Recommending ivermectin as a prophylaxis will also discourage people who become infected with COVID-19 from limiting their interactions with others and hence they will be more likely to spread the disease putting other people at higher risk.

Doesn’t this mean that doctors have discretion to prescribe (or not) ivermectin?

Physicians are able to prescribe off-label, yes. This is independent of the guidelines that you found (and thanks for that). In other news, West Chester Hospital has prevailed in court and does not have to administer Jeffrey Smith the dewormer that Fred Wagshul prescribed. Without ever seeing the patient.

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