Officials have noticed a worrying increase in the use of a deworming medication routinely administered to livestock in the current COVID-19 wave. This has led to an increase in calls to poison control centres, empty shelves at farming supply stores, as well as pleas from regulators.
The Food and Drug Administration posted a blunt tweet this weekend: "You're not a horse." You are not a cow. Seriously. Stop it!"
The FDA has not approved ivermectin to treat or prevent COVID-19. There is also no evidence that it does so. The agency cautioned that it could cause severe side effects and overdoses which can prove to be fatal. Overdoses can cause nausea, vomiting and diarrhea, low blood pressure, allergic reactions (itching, hives), dizziness (problems with balance), seizures and even death.
Meet ivermectin
Ivermectin was used for years to treat parasitic infections in animals and people before the pandemic. Low concentrations of the drug can cause interference with certain ion channels in parasitic nematode-worm worms. However, this effect is not seen in humans or animals. Paralysis is caused by nematodes' ion channel disruption. This prevents the worms feeding and reproduces. Ivermectin is used routinely in small animals such as cats and dogs to prevent heartworm infection. It is used to deworm large livestock animals, including cattle, horses and pigs.
The FDA approved ivermectin tablets for human use to treat parasitic intestinal parasites. It also approved topical formulations that can be used to control external parasites like head lice. It is important to remember that the ivermectin medications available to people are relatively low doses and in safe formulations for human consumption. Over-the-counter drugs for livestock are, however, not intended for human consumption and contain much higher doses to accommodate larger animals. Higher concentrations of ivermectin can cause interference with not only nematode-ion channels but also other critical channels in animals and humans, such as neurotransmitter channel. This can be very dangerous.
Advertisement
Researchers highlighted data that suggested that ivermectin may also be antiviral in the midst of the pandemic. Preliminary data suggests that the drug may be able to thwart pandemic coronavirus SARS-CoV-2, at least in petri dishes. Ivermectin was found to block key intracellular transport proteins used by SARS-CoV-2 to infect human cells. It is possible that the drug could also hinder the virus's ability to attach to human cells using its spike protein.
Concerns about COVID
However, the data from the petri dishes has not been translated into clinical evidence that the drug is effective against COVID-19 in humans. Studies on humans have not been large and yielded inconsistent results. Meta-analyses that seek to exclude potential clinical benefits from faulty data have failed. Some have been retracted.
Researchers have doubts that ivermectin's effectiveness against COVID-19 will be proven by further research. According to the National Institutes of Health's clinical guidance, drug studies indicate that to achieve blood levels of ivermectin sufficient to reproduce the SARS-CoV-2-thwarting effects in petri dishes, "require administration of doses at least 100-fold greater than those approved for human use."
COVID misinformation machines on the Internet have continued to promote the drug and encourage people to buy it. For months, the FDA has warned of misuse. The FDA has been warning about misuse of ivermectin for months.
Dangerous drug use
The Centers for Disease Control and Prevention issued a health alert on Thursday warning that prescriptions for Ivermectin had risen dramatically this month. People who are unable to obtain a prescription have turned to the internet to purchase the over-the-counter drug for livestock, or cleared out their local farms. Poison control centers have reported a rise in calls about ivermectin in recent weeks. Additionally, reports of severe illnesses from overdoses are also increasing.
A recent analysis revealed that the average weekly rate of ivermectin prescribing went up from 3,600 to 39,000 prepandemic prescriptions during the week ending January 8, when COVID-19 cases increased. The CDC reported that ivermectin dispensing rates have increased along with COVID-19 case growth since early July. They reached more than 88,000 prescriptions during the week ending August 13. This is a 24x increase over the preandemic baseline.
Advertisement
Booms in poisonings followed the drug booms. The CDC reported that poison control centers in the US received three-times as many ivermectin related calls in January than the preandemic baseline. The CDC reported that ivermectin-related calls increased sharply in July, surpassing the baseline by fivefold. These calls are also linked to an increase in hospital and emergency room visits related to ivermectin.
Two cases were highlighted by the CDC alert. One was where an adult drank an injectable ivermectin formula intended for cattle to prevent COVID-19. The individual experienced confusion, visual hallucinations and tremors, and was admitted to the hospital for nine days. After taking unknown strength ivermectin tablets purchased online, another adult was admitted to the hospital. Five pills per day were taken by the person for five days. They developed an "altered mental state" in which they became disoriented and could not answer questions or follow orders.
State-level concerns
USA Today reported Wednesday on state trends in poison control center calls. For example, in Florida there were 27 calls related to ivermectin to the poison control centre in August, compared with 11 in July. Six calls were received from January through June. Similar to Texas, the state poison control center received 150 calls regarding ivermectin in Texas this year. 55 of these were in August. The poison control center in Georgia typically receives one ivermectin-related phone call per month. It has received around 15 calls so far this month.
Officials in Arkansas also noticed an increase of ivermectin-related phone calls to the poison control center. Washington County officials were particularly concerned to discover that the county's medical provider has been prescribing ivermectin inmates and employees. Over 500 people at the detention center have been tested positive for COVID since the outbreak. Unknown numbers of these inmates received the drug.
Dr. Rob Karas, the center's medical provider, said that he had taken ivermectin and gave it to his family. Since then, the Arkansas Medical Board has opened an investigation into this case.
Despite this, some state leaders continue sending dangerous messages about the drug. Robin Lundstrum, Arkansas State Representative, tweeted on Thursday that Karas' case had saved 500 lives and that taxpayers were saving money. Let's not thank Doc & Sherriff but stone Doc & Sherriff!
Similar in Alaska, Kenai Peninsula Borough Mayor Charlie Pierce continued promoting and defending ivermectin usage, saying in an interview on radio: Let the doctors experiment, perhaps with some things that haven't been approved by the Food and Drug Administration.
