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14 Nov, 4 tweets, 2 min read
Latest ivermectin COVID-19 RCT:

Enormous mortality reduction in severe COVID-19: crude relative risk ratio is 0.1.

Also reduced mortality to zero in mild cases and led to faster viral clearance.

To date, every single study on ivermectin in COVID-19 has been highly successful. ImageImage
See e.g. this thread for more ivermectin studies:

Here is a large thread containing a number of additional ivermectin studies--

The only in vitro experiment we had available on ivermectin used post-treatment 2 hours after infection, in Vero cells instead of pulmonary derived cell culture.

Later projections did not account for the long half life of the drug.

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More from @__ice9

ice9 Profile picture
16 Nov
I am not sure how best to say this, but:

The increasingly likely possibility that SARS-CoV-2 arose from a systematic gain-of-function study on the emergence of human pathogens from wildlife reservoirs does not invalidate the implications of the study.

It affirms them.
Bat caves are truly dangerous places, at manifestly global and historic scale.

The viral genomes recombined by the EcoHealth grant were not artificial.

They came from the cave that killed the miners and tourist and yielded RaTG13, and others like it.

It is imperative for human interaction with bats to be sharply curtailed, by government policy if necessary.



If emulating the virome of a bat cave in the lab gave us SARS-CoV-2, then that is damning evidence that this can and will happen again.
Read 4 tweets
ice9 Profile picture
15 Nov
Hospitals are getting full. There is still widespread practitioner ignorance about early treatment.

These are the antivirals proven to work in RCT against COVID-19 to date.

There are others that also look promising, but this is the short list.

Do with it what you will.
Addendum, as many replies mentioned other promising options that nonetheless still lack proper RCTs:



Each item on this list appears to have attainable EC90 based on pre-clinical data, and most have observational evidence in favor, but no RCT to date.
Also note the following options (not all of which are antivirals per se) are available OTC in at least some countries:

Read 8 tweets
ice9 Profile picture
13 Nov
Recent RCT demonstrates reduced viral load in patients treated with ivermectin.

papers.ssrn.com/sol3/papers.cf…

Along with the post-exposure prophylaxis trials, this further indicates genuine antiviral activity in vivo for ivermectin (not merely anti-inflammatory). ImageImage
See here for a few other relevant studies:

The only study in vitro for ivermectin against SARS-CoV-2 used Vero cells and did not pre-treat at all.



This made it difficult to infer much about the effect during an ongoing repository infection in humans. Initial estimates looked unhittable.
Read 4 tweets
ice9 Profile picture
4 Nov
Denmark orders military to kill all mink in the country after mutated, mink-passaged SARS-CoV-2 strain with supposedly poor antibody response (details pending) spreads back to humans.

Extensive prior culling was unsuccessful in halting mink infections.

bt.dk/politik/mette-…
Discussion among virologists trying to get more data--



So far, no further details.
Read 15 tweets
ice9 Profile picture
23 Oct
Terguride (5-HT2A/B antagonist) for prevention of PAH and ventricular or pulmonary fibrosis in conditions of acutely elevated plasma 5-HT @farid__jalali

hindawi.com/journals/bmri/…

pubmed.ncbi.nlm.nih.gov/28821451/

researchgate.net/publication/51…
This might complement the effects of cyproheptadine and/or famotidine in the treatment of acute serotonin syndrome:

Precedex (dexmedetomidine) has also drawn favorable commentary recently for ICU cases, and likewise has a history of use in serotonin syndrome.

Read 5 tweets
ice9 Profile picture
23 Oct
@Longco191 That is a more complex question.

There are various possible post-acute COVID-19 symptoms.

Cardiorespiratory functional capacity may sometimes take a few weeks to months to recover.

Patients who experienced extensive clotting may have longer-lasting damage to affected areas.
@Longco191 There may be a risk of developing an autoimmune or autoinflammatory condition, such as a new joint or connective tissue disorder, potentially requiring assessment by a rheumatologist for diagnosis and treatment. Anecdotally, this often does appear to be treatable to some extent.
@Longco191 Some acutely recovered patients have reported fairly strong indicators of developing POTS, which is usually symptomatically treatable with appropriate medication by e.g. GPs familiarized with the issue. The underlying cause is usually harder to address and may be neurological.
Read 6 tweets

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