Covid-19 Diary : Sunday 7 February, 2021

 

On Thursday, I said I’d like to open with some good news for a change.  Now, three days later, I’d like to repeat that good news.  The number of new virus cases, both world-wide, and within the US, continues to steeply drop.

This drop remains puzzling, all the more so because of the growing number of new virus variants that are more infectious, and their growing share of total cases.  This article reports that in the US, a more infectious virus variant is doubling in case numbers every 9.8 days.  Nevertheless, in the US, new cases (on a rolling seven day average) are now at less than half the number of three weeks ago.

Every extra day this delightful trend continues is a huge bonus to us all.  Its inexplicable nature and underlying cause means it could stop at any moment, but for now, every extra day of decline is making a huge difference to hospital loads and now we’re starting to see a gentle easing of daily deaths too, although that number is declining at a much less spectacular rate.

Let’s hope the death rate will soon start to match the dropping case numbers – with the case numbers being usually three weeks or more ahead of death numbers, it seems likely we’ll start to see good news there, too.

I’d like to give an astonishing example of the professional negativity, even verging on dishonesty, that continues to be lavished on ivermectin.

First, let’s set the scene.  The good news is that WHO is moving in its snail-like ultra-slow manner but in the general direction of approving ivermectin as a treatment for Covid sufferers.  Their current position has shifted and is now that IVM “has shown some promising results in some trials”.  That’s a long way from outright positively endorsing IVM as an immediate automatic “standard of care” treatment for anyone who has been exposed to the virus or in any stage of an infection, but it is also at least now acknowledging the presence of IVM and showing a slightly more positive than negative view of the drug.

Here also is an extremely measured and very careful and thorough analysis of many IVM studies.  You don’t have to fully understand it to understand and appreciate the care and open unbiased approach adopted by the article’s author, and there’s an abundance of discussion, explanation, and data.  Every statement and conclusion the author makes is backed up with abundant data.  It also includes 26 references in support of its statements.

The article concludes

  • Ivermectin is an essential drug to reduce morbidity and mortality from COVID-19 infection.

  • Placebo-controlled trials of ivermectin treatment among people with COVID-19 infection are no longer ethical and active placebo-controlled trials should be closed.

The article was written at the beginning of January, and considered only 27 studies then available for analysis.  Since then, the total of published studies has grown to 57, all of which, without exception, report positive results from using ivermectin.

One more data point to set the scene for the scurrilous “hit piece” in ivermectin that will follow.  What sort of standard should we seek for determining if a drug should be used or not?  How about the same standard used to evaluate the suitability of the AstraZeneca experimental vaccine for older people.  In the vaccine’s trial, 660 people over 65 took part, half being given the vaccine and half being given a placebo.  One person in the vaccinated group ended up being infected with Covid, as did one person in the non-vaccinated group.

Based on this small total group, and only one person in both halves being infected, any reasonable person might say “not enough people in the trial, and not enough difference in outcomes to establish effectiveness”.  Indeed, many people might go further and say “this is a very disappointing result showing no protection at all”.

But Europe and other countries are approving the AstraZeneca vaccine for use in the over 65 age group, saying “there is nothing to suggest lack of protection”, as quoted in this article.

So, to approve an experimental vaccine, we need a trial of no more than 660 people, an almost non-existent outcome that proves nothing, but as long as there is nothing negative (even if there is also nothing positive), we’ll give it the benefit of the doubt and say “there is nothing to suggest lack of protection”.

Surely this same standard could be applied now to approve ivermectin?  Let’s have a look at this odious article.

The article writer takes a strange approach to evaluating ivermectin, claiming to offer an “in-depth assessment” but not sharing a single piece of analysis, although he does refer to a chart which isn’t included.  Instead, what he says is

…. “you will see an asymmetric funnel plot beginning to develop, suggesting that there are unpublished studies showing no benefit that were not included in the analysis.”

It seems here that his concern is that all the studies are very positive, and so he believes there must be missing negative studies that have been deliberately hidden.  That’s not exactly showing an open mind, but perhaps it is good to be cautious.  He goes on to say

…. “I also performed an independent search of PubMed and Medrxiv to make sure there were no studies missing.  I could not find any published studies that were not included.”

So much for his theory that some studies had been deliberately excluded.  But he refuses to give up on this concept, even though he himself has checked and found no excluded studies.  He then says

…. “Based on my funnel plot analysis, there is likely publication bias in the ivmmeta data, meaning there are unpublished studies showing no benefit.”

But this is based on his own imaginings, which he has no proof of whatsoever.  He is saying “I’m astonished the results are so positive, and while I can’t find any reason to disbelieve them, I refuse to accept them at face value.”

He continues to create other reasons to hate ivermectin, first by comparing it to hydroxychloroquine, and claiming HCQ was proven to be inappropriate, based on, he says, at least five large randomized trials.  But he doesn’t cite the five trials (the negative trial I’ve looked at have been criticized as testing HCQ only in a way that minimized its chances of success), while ignoring the over 100 trials that have clearly shown HCQ benefits.

In any case, whether HCQ is either good or bad, that has no bearing on IVM.  Why is he talking about HCQ, other than as an admission that there’s nothing directly related to IVM that he can criticize.

He then repeats this irrelevancy by criticizing the early reluctance by most doctors to use steroids, without realizing that one of the strongest advocates for steroid use back when it was recommended against is one of the doctors now leading the fight to use IVM.  So one of the doctors he approves of is actually an IVM advocate.  However, mistakes made about steroid use in no way bear on how to evaluate IVM, other than pointing out that doctors often get it wrong to start with.

Then he reaches further into the standard bag of medical rhetorical tricks and worries about the safety of ivermectin.  He concedes the studies rarely reported any serious adverse events, but rather than concluding that is because ivermectin is extremely safe – something established over decades of use by millions, possibly billions of people, and something no longer needing any sort of further study or commentary, his conclusion is that it is impossible to evaluate the benefits of ivermectin without knowing more about the risks.

How many more decades and billions/trillions of doses of ivermectin would satisfy him on this point?  Remember, many countries have approved the AstraZeneca vaccine as safe and effective for seniors, based on a trial of 330 people taking the vaccine, and one becoming infected.  Why does this person demand millions more people should try ivermectin when 330 trying a new experimental vaccine is sufficient to approve it?

Next he comes up with another meaningless point

…. “The doses of ivermectin range from 6 milligrams once, to 12 milligrams every 12 hours for three doses, to 24 milligrams every 48 hours for two doses. Some doses were given with doxycycline, some with other therapeutic regimens, and some doses of ivermectin were given alone.”

This worries him – apparently he needs to see an undisclosed number of identical studies in every respect (should we point out the vaccine studies were all single studies, and, even worse, done by the pharmaceutical companies themselves – I wonder what he thinks about that!).  However, there is another perspective that he chooses not to consider.  All these studies, whether using low or high doses, alone or with other drugs, showed positive outcomes.  Isn’t that the most important point in the real world?  It also shows ivermectin is so effective and so safe that it can be taken in a range of different doses, all of which benefit the patient.  Surely that’s a good thing?

His final conclusion?

…. “However, the data supporting ivermectin’s use published on ivmmeta.com is not robust enough to inform a practice change or suggest the drug should be prescribed for COVID-19 patients.”

What sort of data would be robust enough?  He doesn’t tell us.  If we can approve experimental unknown vaccines based on a sample of 660 people and identical results in the control and test groups showing no benefit whatsoever from the vaccine, why do we need ten, or one hundred, or even more times more people to approve ivermectin?

Seriously, this is a life and death matter.  People are dying in the thousands, every day, and there’s a 99.9% (or greater) safe drug, well known and not at all experimental, costing less than $1/dose, available right now, with studies to date suggesting up to a 90% reduction in mortality when it is used.

But pompous fools like this sit on their hands, act as though we all have the luxury of time, and call for more, and more, and endlessly more, studies on a safe drug that has already proven itself, while yes, of course, eagerly reaching for experimental vaccines and rushing to inject them into our arms.

It is even worse than that.  Even though in the US, NIH is now “neutral” about IVM, and WHO is very slightly positive, YouTube decided to censor a C-SPAN of a submission to a Senate Committee by a noted physician speaking in favor of IVM.

How is it fair or appropriate for a multi-credentialed doctor, appearing as a spokesman for a group of physicians that have between them all, 2,000 peer-reviewed articles published, with his testimony filmed and published by C-SPAN, to then have the record of that deleted off YouTube?  What medical body guides YouTube in that decision?  Perhaps the guy who wrote the ridiculous article discussed immediately above!

You can see the banned video submission here.  What part of it deserves to be deleted?

There’s something very wrong when sensible sincere doctors, backed by 57 positive studies and no negative studies, get their advocacy for proven treatments against a disease killing thousands of American every day, using known safe drugs, deleted off YouTube, ridiculed by some politicians, and ignored or unfairly attacked by other doctors.

I’ve often reported on ivermectin’s acceptance and use in Africa, Asia, and South America.  News in the last few days now reports Slovakia becoming the first nation in the EU to formally approve IVM for use both as a treatment and as a preventative.  The IVM tide is clearly rising.  How long will it take us in the US to recognize this and join in?

The life it could save might be your own……

Adding fuel to the ivermectin (and hydroxychloroquine) fire is this excellent article that explains how many of the people who enjoy asymptomatic experiences with Covid can still suffer serious lung damage.  Just because you don’t get seriously unwell doesn’t mean that your lungs haven’t been seriously harmed.  Fools worry about the safety of ivermectin, sensible people acknowledge the dangers of Covid.

Current Numbers

An uneventful week in the US, with Rhode Island simultaneously moving down one position in the case rate list and up one position in the death rate list.  In the small country list, Aruba displaces Lichtenstein and moved onto the list at tenth place.

The UK is doubtless pleased to drop a place in the major country list.  On the death rate list, Portugal rose from 8th to 6th place, and seems likely to displace the US and move to 5th place within the next week.

US Best and Worst States

RankCases/MillionDeaths/Million
A week agoNowA week agoNow
1 BestHI (18,259)HI (18,694)VT (279)VT (293)
2VT (19,175)VT (20,673)HI (290)HI (295)
3MEMEAKAK
4OR (33,766)OR (34,882)MEME (472)
5WA (41,364)WA (42,495)OR (464)OR (480)
47TN (106,581)TN (109,032)MS (2,031)RI (2,088)
48RI (108,025)UT (110,609)RI (2,033)MS (2,106)
49UT (108,119)RI (111,285)MA (2,115)MA (2,176)
50SDSDNY (2,246)NY (2,312)
51 WorstND (128,113)ND (128,802)NJ (2,419)NJ (2,476)

 

Top Case Rates Minor Countries (cases per million)

RankOne Week AgoToday
1Andorra (128,488)Andorra (132,545)
2Gibraltar (122,132)Gibraltar (124,150)
3MontenegroMontenegro
4San MarinoSan Marino
5LuxembourgSlovenia
6SloveniaLuxembourg
7PanamaPanama
8IsraelIsrael
9LithuaniaLithuania
10Liechtenstein (65,275)Aruba (67,479)

 

Top Case Rates Major Countries (cases per million)

RankOne Week AgoToday
1Czech Republic (91,858)Czech Republic (96,537)
2USA (80,590)USA (83,122)
3Portugal (70,783)Portugal (75,198)
4Belgium (60,920)Spain (63,549)
5Spain (60,525)Belgium (62,294)
6Netherlands  (57,030)Netherlands  (58,618)
7UK (56,057)Sweden (58,009)
8Sweden (55,934)UK (57,938)
9FranceFrance
10BrazilBrazil
11Argentina (42,414)Italy (43,649)
12Italy (42,262)Argentina (43,576)

 

Top Death Rate Major Countries (deaths per million)

RankOne Week AgoToday
1Belgium (1,813)Belgium (1,837)
2UK (1,559)UK (1,651)
3Czech Republic (1,521)Czech Republic (1,608)
4Italy (1,465)Italy (1,511)
5USA (1,362)USA (1,430)
6Spain (1,247)Portugal (1,391)
7Peru (1,229)Spain (1,313)
8Portugal (1,226)Mexico (1,278)
9Mexico (1,219)Peru (1,272)
10France (1,164)France (1,208)

 

The rest of this newsletter is for the very kind Travel Insider Supporters – it is their support that makes all of this possible, and it seems fair they get additional material in return.  If you’re not yet a Supporter, please consider becoming one, and get instant access to the rest of the Diary Entry, additional material on previous diary entries, and much extra content on other parts of the website too.

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Items below include a possible explanation for why the virus rate is so amazingly higher in South Africa than elsewhere in Africa, the role of weather in virus growth, another example of the hypocrisy where costly experimental drugs are lauded while inexpensive proven drugs like HCQ and IVM are lambasted, is the NIH Covid treatment panel biased, more evidence that being infected once doesn’t spare you being infected more times in the future, a different way to allocate vaccinations, South Africa stops using the AstraZeneca vaccine, a great new chart, are Covid fees legal, and Iowa removes most mask-wearing requirements.

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Please stay happy and healthy; all going well, I’ll be back again on Thursday.

Please click here for a listing of all our Covid-19 articles.

3 thoughts on “Covid-19 Diary : Sunday 7 February, 2021”

  1. As I read your latest piece about IVM, I try to think of possible explanations. I think about the decades of Big Pharma marketing that has trained our doctors to focus more on treating symptoms than curing illness.

    I think about decades of government regulation that sets impossibly high standards for measuring risk (having dirt so clean that you could eat it, was one I recall; another was requiring the air inside office buildings have lower measures of pollution than outside air).

    The FDA has been so slow at approving meds that many other countries are using meds that are still not approved in the US (are UK, Germany, France regulators etc. really so much less sophisticated?),

    And lawyers forcing doctors to practice defensive medicine. Where the fear of liability exceeds the fear of letting people die from non-treatment. If I am not given potentially useful meds and then die, first, I’m not likely to sue, and second, the defense would be that there are no FDA approved treatments. A perfect defense.

    The entire system is biased toward inaction, complexity and expense. There is the legal theory Cui Bono, or “Who Benefits”? Apparently Doctors, Lawyers, Big Pharma, Big Insurance, Government, and Hospitals all benefit from this broken system.

    The obvious problem is that people are dying here in massive numbers. I can’t think of a word that described it. It’s more than malpractice. It’s something like indifferent parricide (the vast majority are our parents and grandparents, our elderly and most vulnerable).

    When my own personal physician, Harvard-trained, a very smart and kind man, sort of looks for evidence of my tinfoil hat when I try to talk to him about meds, and says that he’s always open to non-traditional treatments, but by open he means unwilling to discuss or prescribe.

    We desperately need some clear thinking, some common sense, some leadership and accountability. But I really doubt it will happen. As you have said, how can so many dedicated experts have been so wrong and so misguided?

  2. I read your Cases per Million comparison rankings of Countries, but wonder at the value of the data.

    I would much prefer the cases per million over the past, say, 14 days to get a more “now” picture. I believe (maybe wrong) the info shows total cases from day one. If a country had 10,000 cases starting in April 2020 but dropped to 500 cases in January 2021, the cumulative cases may show as high, but current cases much lower (# per million). Those countries that have improved greatly in the past month would move down the list vs. those that have become worse or at least not improved greatly. I know your 1st chart shows this trend, but not as compared to other countries. For those thinking of travel, we wish to look at current levels.

    Perhaps some of the reduction in recent cases is that those most at risk have been receiving the vaccine which helps them and those around them (especially nursing homes). In an active adult community I live in, I guess 75% have received their 1st dose already – and Nevada is one of those laggard states. So not only are the 75% more safe, so are the rest with fewer interactions with unvaccinated people.

    Just my 2 cents.

    1. Hi, Mike

      Your understanding about the cases per million count is correct. It is the total cumulative number. It has validity in some contexts, but in terms of “what is happening right now, is it safe to travel there”, not so much.

      You’re a valued, long-standing, and very generous supporter (thank you!). The new chart I showed in the supporter content shows current cases. That’s exactly the data you want, and if you go to the linked web page, you can select the countries you want to see/track.

      One more point. Neither the past nor the present predicts the future when it comes to trying to understand if it will be “safe” to travel anywhere at any time. Not only are the “current” case numbers at least a week behind what is actually happening in initial new infections occurring, but there’s no way of knowing if a country with very high daily rates mightn’t suddenly plunge down, or a country with very low rates mightn’t suddenly soar up. Look at the lines on the chart – there are plenty of examples of both happening. My feeling is that it is not advisable to travel anywhere at present, unless you’re able to conveniently accept a possible surprise two week detention/quarantine at some point. Remember, the vaccines are not measured in terms of preventing illness, so you’re still almost as likely to be infected after being vaccinated as before. The major benefit of a vaccine is simply that you’re not as likely to get sick or die, but those outcomes are also unclear for older people.

      The other point about “safe to travel” is to think also about “enjoyable to travel”. Is travel to a destination which has most restaurants, bars, and tourist sites closed actually an enjoyable experience at present?

      Now, your tentative explanation for the sudden plunge in global and US new cases. The vaccines don’t claim to stop people from getting infected, nor do they claim to stop vaccinated but infected people from passing the infection on to others. Furthermore, people in senior communities aren’t necessarily “super spreaders” per se.

      I don’t know what is causing this plunge, but I don’t think vaccination numbers explain any substantial part of it.

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David.