Brazil's tragic ivermectin frenzy is a warning to the US, experts say
In Brazil, ivermectin is a commonly prescribed anti parasitic drug.
Early on in the pandemic, Brazilians thought that ivermectin might also help treat and prevent COVID-19.
But, as one ICU doctor put it: "We Brazilians had to learn in the hardest way that ivermectin didn't work."
Many Brazilians used to spend about $30 a head on what they called the "kit COVID."
It was a mix of vitamins and other pills that President Jair Bolsonaro touted as early treatments for COVID-19, well before vaccines became widely available to prevent and minimize coronavirus infections.
Among the "kit" drugs were the malaria pill hydroxychloroquine and the antiparasitic tablet ivermectin.
Brazilian authorities even at one point launched an app, called TrateCov, (in English, an abbreviation of "treat COVID") which recommended the same seven "kit" drugs to all its users. (The evidence base for that protocol leaned heavily on data from Dr. Flávio Cadegiani, who's now a member of the FLCCC, a US-based ivermectin propaganda machine.)
But Brazilians quickly discovered - through heart-wrenching personal experience - the limits of treating COVID-19 with ivermectin. Brazil suffered some of its worst death rates yet in late 2020 and early 2021, even in heavily ivermectin-dosed areas, as the more transmissible P1, or Gamma, variant spread quickly across the country.
"Look at what happened in Brazil," Natália Taschner, a Brazilian microbiologist and research scholar at Columbia University in New York, said. "Then wonder: If this drug worked, would Brazil be in such bad shape?"
Entire cities took ivermectin. It didn't work.
A COVID-19 cemetery in Manaus, Brazil, on November 21. Michael Dantas/AFP via Getty Images
The ivermectin strategy was once so popular in Brazil that entire towns tried it out. (Ivermectin is cheap and available in pharmacies across the country.)
In July 2020, ivermectin was available for free to all residents of Itajaí, to the tune of about $826,000 in government spending. The mayor of Itajaí, the physician Volnei Morastoni, said at that time that ivermectin was but "one more weapon in our war against the coronavirus."
As infection rates soared, some people were taking excessively high doses of the medicine every day, hoping to stave off COVID-19, but in a few rare cases that move prompted liver failure.
Other patients were unknowingly given the "kit" drugs by doctors in private hospitals instead of more standard treatments - and some of them died.
Ivermectin "prescription practices didn't upend the tragedy of COVID here in Brazil in terms of preventing infections, preventing hospitalizations, and then preventing deaths," said Dr. Kevan Akrami, an infectious-disease and critical-care physician working in the northeastern city of Salvador. "Whether somebody was taking it or not didn't seem to have any impact on whether or not they got hospitalized or ended up dying from their COVID infection."
The use of ivermectin might have contributed to COVID deaths in other ways, researchers suspect, as some people who assumed they were well protected from infection by ivermectin tossed aside their masks.
"There was a political promotion behind it, to make people feel safe, so that they would continue with their regular life," Taschner said.
'I have already cared for many patients who took ivermectin and were still in the ICU'
The intensive-care physician Dr. Ana Carolina Antonio at work in Porto Alegre, Brazil, in July. Courtesy of Ana Antonio.
Dr. Ana Carolina Antonio, who works at a government hospital in Porto Alegre, Brazil, told Insider many of her ICU patients took ivermectin in the spring - some trying to prevent COVID-19, others "to early treat their first symptoms."
Their strategy didn't work.
In fact, Antonio estimated about 70% of her ICU patients said during the country's deadly second wave (in late 2020 and early 2021) that they had taken ivermectin, and "I regret to say most of those patients have died," she said.
About half of all her critically ill patients died, and 80% of ventilated patients didn't make it, regardless of whether they'd tried ivermectin.
She called the heartbreak of the situation "indescribable."
"I've never seen so many young and previously healthy patients dying," she said. "I have already cared for many patients who took ivermectin and were still in the ICU for COVID-19."
Antonio was telling the wives of patients "my husband's age" with "children like mine" that their spouse was dead.
She worried about getting her own family sick, including her husband who wasn't a healthcare worker and therefore was ineligible for vaccination at the time. (He's now vaccinated, she said.)
Brazilians now want vaccines, not more ivermectin
Brazilians protest President Jair Bolsonaro, demanding vaccines and calling attention to the more than 200,000 people killed by the coronavirus in Brazil, on January 8 in Brasilia. (The current death toll from COVID-19 in the country is near 600,000). Sergio Lima/AFP via Getty Images
Attitudes about ivermectin have quickly changed in the months since then.
"In the absence of evidence, we'll try certain things," Akrami said. "But at this point in the pandemic, we really don't have any reason to continue prescribing ineffective medications for prophylaxis or treatment."
The "kit" which was once widely prescribed (and self-dosed) in Cuiaba, Macapá, Natal, and Manaus, is now being thrown out by the government. Brazil has a new health minister - a cardiologist who replaced a military general - and vaccines are more widely available.
"We've seen a huge decrease in the number of cases and the number of hospital admissions," Antonio said of the period since vaccinations began. "We Brazilians had to learn in the hardest way that ivermectin didn't work."
More than nine in 10 Brazilians say they've been vaccinated or intend to get their shots, according to a May poll.
"Across political divides, most people still are being rational and saying, 'I should get vaccinated to protect myself,'" Akrami said. "There's a pretty proud tradition of getting vaccinated here. It's kind of seen as like your civic duty."
Itajaí Mayor Morastoni's Facebook page is peppered with celebrations of vaccine milestones in his city and information on how and where to get vaccinated. (He hasn't mentioned ivermectin once on his page since vaccinations started being administered to healthcare workers in his city in January.)
"People are tired of all the lies and the manipulation and the promotion of miracle cures that they realize don't work," Taschner said.
It's possible ivermectin could one day play a small role in COVID-19 treatment, but it's not looking terribly promising
Vanusa Costa Santos is inoculated with the CoronaVac Sinovac Biotech COVID-19 vaccine at a hospital in Sao Paulo on January 17. Nelson Almeida/AFP via Getty Images
More conclusive studies are on the way, but the most recent rigorous research of ivermectin for COVID-19 doesn't look promising.
The Brazilian government has issued new protocols for COVID-19 treatment, which recommend against using ivermectin in hospitalized patients, because they say there isn't good evidence it does anything.
"It might look interesting," Antonio said, referencing studies showing that ivermectin can kill COVID-19 in a petri dish, "but in humans, you have plenty of complex pathways competing for the virus in your body."
It is still possible that, in combination with other drugs, the antiparasitic could be one item used in a multilayered system of treatment for COVID-19, perhaps to speed recovery in the early stages of disease.
Take note, US and UK
Ivermectin is used to treat animals and people, usually for deworming. AP Photo/Mike Stewart, AP Photo/Ted Warren
It is "to my surprise," Antonio said, that countries including the US and UK are "becoming crazy for" ivermectin now, with weekly prescriptions for the drug surging across the US since before the pandemic, according to August data from the CDC.
"I really thought it was exclusive Brazilian stuff," she said.
When fear and frustration abound, it's tempting to put one's faith in a simple pill or a kit that promises to erase all suffering.
But "we're not snake-oil salesmen anymore," Akrami said.
Instead, the best medical care today is informed by rigorous research that examines which treatments actually work to improve a patient's status.
"'What's the harm?' is usually the argument," Taschner said of the common refrains given for using unproven treatments like ivermectin. "The harm is it gives people a false impression of security. It makes them feel safe when they are not safe. It drives people away from what really makes them safe, and that's vaccination."
"Take a hard look at Brazil, realistically," she said, "and then come to your own conclusions."