Because of the way they are constructed, Randomized Control Trials will never show any benefit for any antiviral against COVID-19. Not Remdesivir, not Kaletra, not HCQ, and not Ivermectin. The reason for this is simple; for the patients that they have recruited for these studies, such as Oxford’s ludicrous RECOVERY study, the intervention is too late to have any positive effect.
The clinical course of COVID-19 is such that by the time most people seek medical attention for hypoxia, their viral load has already tapered off to almost nothing. If someone is about 10 days post-exposure and has already been symptomatic for five days, there is hardly any virus left in their bodies, only cellular damage and derangement that has initiated a hyperinflammatory response. It is from this group that the clinical trials for antivirals have recruited, pretty much exclusively.
In these trials, they give antivirals to severely ill patients who have no virus in their bodies, only a delayed hyperinflammatory response, and then absurdly claim that antivirals have no utility in treating or preventing COVID-19. These clinical trials do not recruit people who are pre-symptomatic. They do not test pre-exposure or post-exposure prophylaxis.
This is like using a defibrillator to shock only flatline, and then absurdly claiming that defibrillators have no medical utility whatsoever when the patients refuse to rise from the dead. The intervention is too late. These trials for antivirals show systematic, egregious selection bias. They are providing a treatment that is futile to the specific cohort they are enrolling.
And here is a study which looks at viral load since days of symptom onset, showing that at the 72 hour mark there is still plenty of Covid-19 in the body: https://www.nature.com/articles/s41591-020-0869-5
I am not a medical expert, so there may be things to criticize about these studies. All I meant to point out is that people are looking into / have looked at the questions you raise. Doctors and nurses are pretty burnt out; I for one think that they'd be looking for prophylactic treatments.
It seems like your Ivermectin study is the type of information Youtube would be banning. It showed statistically significant improvements in symptoms and viral loads, which is the kind of information that walks a fine line between getting banned instead of just mocked.
There are two important sentences from the summary of findings:
First, the effects of Ivermectin on viral load were not significant:
"The ivermectin group had non-statistically significant lower viral loads at day 4 (p = 0·24 for gene E; p = 0·18 for gene N) and day 7 (p = 0·16 for gene E; p = 0·18 for gene N) post treatment as well as lower IgG titers at day 21 post treatment (p = 0·24)."
Second, Ivermectin did show earlier recovery:
"Patients in the ivermectin group recovered earlier from hyposmia/anosmia (76 vs 158 patient-days; p < 0.001)."
From the Washington Post article, a YouTube exec is quoted as saying “We’ll remove claims that vaccines are dangerous or cause a lot of health effects, that vaccines cause autism, cancer, infertility or contain microchips.” This leads me to believe the kind of medical misinformation YouTube is targeting is much more general.
Also, the medical consensus -- via things like Cochrane Review [0] -- is that there isn't enough data on Ivermectin. It's the statistical uncertainty around it that gives the medical establishment pause, and currently makes recommendations of using it misinformation. Should the scientific community discover something different, the definition of misinformation will change.
A bit off topic, but there are hundreds of millions of people in India who have been taking Ivermectin for significant amounts of time. In some states, serum positive levels are .01%. How are there not dozens of high quality studies being done during this period to quickly answer our questions?
> but there are hundreds of millions of people in India who have been taking Ivermectin for significant amounts of time.
Misinformation. Anti-vaxx groups are sighting India because a tiny state(Goa) with a population of 1.59 Million included Ivermecitin in their home isolation medicine kit along with zinc, doxycycline, homeopathy etc. and also announced that adults in the state would be given Ivermecitin.
A fraction of their population actually received that kit, Of which negligible population actually consumed those if any. Ivermecitin, Zinc, doxycycline were removed from that kit in Goa after federal medical authority asked it to do so and it was even removed from the treatment of COVID-19 patients in the hospitals throughout India.
So, No 'hundreds of millions of people in India' never took Ivermecitin and is no way related to the drop in cases of COVID in India. But Anti-vaxx groups are using this misinformation as an ammunition at unexpected places to further their agenda[1].
There's no need to be uncivil and slander people as anti-vaxx (I and literally everyone I know is vaccinated) or spreading misinformation just because you are misinformed.
I didn't call you particularly as anti-vaxx, I said anti-vaxx are promoting Ivermecitin using India/Goa and provided source for that claim.
What does the attached URLs has to do with your claim of "hundreds of millions of people in India who have been taking Ivermectin for significant amounts of time." and implying somehow that Ivermectin reduced the COVID case load in India which coincidentally is exactly what Anti-vaxx are peddling?
States which were using non-evidence based medication incl. Ivermecitin have dropped them after Directorate general of health services (DGHS) has issued guidelines to stop using them[1] and recently Indian Council of Medical Research have also dropped them from the list[2].
There's no reason to put India and Ivermecitin again in the same sentence unless it's to promote misinformation.
One description of the Spartacus letter is "A 41 page document chock full of disinformation about COVID-19 (including claims that the vaccines may be mind control technology)." And now that disinfo is being spread here on HN.
HCQ and Ivermectin aren't "antivirals" so obviously the OP is not concerned with a strict definition of antiviral. Besides, it's a meaningless semantic argument.
Except it's not irrelevant even. The central claim is encapsulated in the first sentence:
> Because of the way they are constructed, Randomized Control Trials will never show any benefit for any antiviral against COVID-19
By noting that there are indeed RCTs that show effective treatments for COVID-19 (fluvoxamine and monoclonal antibodies), it renders the entire point false.
The semantic argument about what constitutes an "antiviral" is meaningless as the OP themselves plays fast and loose with this by establishing that HCQ and Ivermectin (primarily used as antiparasitics) as antivirals.
> Because of the way they are constructed, Randomized Control Trials will never show any benefit for any antiviral against COVID-19. Not Remdesivir, not Kaletra, not HCQ, and not Ivermectin. The reason for this is simple; for the patients that they have recruited for these studies, such as Oxford’s ludicrous RECOVERY study, the intervention is too late to have any positive effect.
This claim is egregiously false itself. Several RCTs have been done for early exposure to covid or for prophylaxis.
Just out of memory I remember studies for HCQ prophylaxis (doesn’t work), remdesivir prophylaxis (does work), and monoclonal antibody prophylaxis (does work).
The lies created by anti vaccine activists are already spread widely and apparently convinced you these studies which happened didn’t happen.
The clinical course of COVID-19 is such that by the time most people seek medical attention for hypoxia, their viral load has already tapered off to almost nothing. If someone is about 10 days post-exposure and has already been symptomatic for five days, there is hardly any virus left in their bodies, only cellular damage and derangement that has initiated a hyperinflammatory response. It is from this group that the clinical trials for antivirals have recruited, pretty much exclusively.
In these trials, they give antivirals to severely ill patients who have no virus in their bodies, only a delayed hyperinflammatory response, and then absurdly claim that antivirals have no utility in treating or preventing COVID-19. These clinical trials do not recruit people who are pre-symptomatic. They do not test pre-exposure or post-exposure prophylaxis.
This is like using a defibrillator to shock only flatline, and then absurdly claiming that defibrillators have no medical utility whatsoever when the patients refuse to rise from the dead. The intervention is too late. These trials for antivirals show systematic, egregious selection bias. They are providing a treatment that is futile to the specific cohort they are enrolling.