Ivermectin: The Elephant in the Room
There are a great many unknowns and controversies associated with the COVID pandemic. Among the most urgent are those associated with appropriate therapeutic and prophylactic interventions. Some of the most intense disputes involve repurposed therapies — i.e., drugs that have been approved for treatment of some other condition being used as therapy for COVID. This is the case with the anti-parasitic agent ivermectin.
Much of the controversy regarding ivermectin involves “evidence” that the drug has a benefit in treatment of COVID. Detractors will often use the hyperbolic claim that there is no evidence that ivermectin is useful in this setting. The truth is that there is, in fact, some evidence. Ivermectin has been known since at least 2012 to have antiviral activity. It has been shown to have at least some antiviral activity against a number of viruses, including HIV-1, Zika, flaviviruses, and dengue. It is known to have in vitro activity against SARS CoV-2, the coronavirus that causes COVID. It has been shown to have some efficacy in Middle East Respiratory Syndrome, a disease caused by a coronavirus with similarities to SARS CoV-2. There are plausible mechanisms proposed for why ivermectin might be useful against viral infections: it inhibits a class of proteins that are necessary for the virus to replicate within human cells.
These observations are evidence. They are not definitive evidence. They are probably not sufficient, or even persuasive evidence, but these assessments should not be confused with “no evidence.”



