Ivermektin kot sredstvo za preventivo in zdravljenje okuženih s Covid-19 dokler ne bo dovolj cepiva?

Dostopnost cepiva proti Covid-19 in začetek cepljenja najbolj ranljivih skupin prebivalstva ter medicinskega in negovalnega osebja sta nedvomno odlična popotnica za boj proti Covid-19. Na žalost pa so dostopne količine cepiva zelo majhne, proces cepljenja pa zelo dolgotrajen. Slovenija trenutno dobiva okrog 18,000 doz cepiva (Pfizer/BioN-Tech in Moderna) in če bi se takšna dinamika nadaljevala tudi v naslednjih petih mesecih, bi do konca junija letos lahko cepili le nekaj manj kot 400,000 ljudi z eno dozo. Ker pa sta potrebni dve dozi cepiva za njegovo učinkovitost, pa to pomeni, da bo do konca junija učinkovito cepljenih manj kot 200,000  ljudi oziroma le 10% prebivalcev Slovenije.

Te številke pa ob novih mutacijah virusa, ki so precej bolj infektivne od dosedanjega seva, pomenijo, da bi vlada lahko sedanje ukrepe zaprtja javnega življenja in celih gospodarskih dejavnosti ohranjala še vse do poletja ali dlje. Vendar pa to ni potrebno, saj obstajajo – v vmesnem času, dokler ne bo dostopno dovolj cepiva – zelo preprosti načini tako za povečanje splošne odpornosti prebivalstva (denimo z rednim dnevnim uživanjem cinka ter vitaminov C in D, glejte tukaj za ustrezne količine) kot odpornosti proti okužbi s Covid-19 (preventiva) in zdravljenja blagih in hujših simptomov zaradi Covid-19 (z uporabo ivermektina).

Kot sem pisal pred dvema tednoma (tukaj, tukaj in tukaj), pregled rezultatov številnih znanstvenih raziskav in kliničnih testov v zadnjega pol leta kaže na veliko učinkovitost zdravila ivermektin v boju proti Covid-19. Učinkovito naj bi bilo tako v fazi preventive (v veliki meri, 80 do 90% preprečuje okužbo), kot v zgodnji fazi (v veliki meri, več kot 80%, preprečuje razvoj bolezni in potrebo po hospitalizaciji) in poznih fazah razvoja okužbe (v veliki meri, več kot 80%, preprečuje smrtnost okuženih). Ivermektin (in zdravila na njegovi osnovi) se sicer uporablja za zdravljenje infestacij s pljučno-srčnimi zajedalci.

Treba pa je povedati, da gre za (številne) razpršene klinične raziskave na podlagi različnih metodologij in da za zdaj še nobena velika mednarodna ali državna javna ustanova v razvitih državah ivermektina še ni uradno priporočila kot profilaktičnega zdravila ali kot zdravila za zdravljenje simptomov Covid-19.

Ameriški nacionalni inštitut za zdravje NIH je prejšnji četrtek posodobil svoja priporočila glede uporabe ivermektina kot sredstva za preventivo in zdravljenje pacientov s Covid-19. V svoji izjavi je poudaril, da zaenkrat zaradi premalo podatkov ne more izdati priporočila niti proti niti za uporabo zdravila in da so potrebne klinične na študije na večjih vzorcih:

The COVID-19 Treatment Guidelines Panel (the Panel) has determined that currently there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin for the treatment of COVID-19.

Tukaj je povzetek stanja po srečanju predstavnikov NIH in FLCCC (Front Line COVID-19 Critical Care Alliance), vplivnega zdravniškega združenja, ki v zadnjih mesecih močno promovira uporabo zdravila ivermektin.

Ob najmanj dveh ducatih znanstvenih objav in zdravniških združenjih sta se o učinkovitosti ivermektina nedavno pozitivno izrekla tudi Dr. Andrew Hill, ki dela pregled kliničnih študij o ivermektinu za Svetovno zdravstveno organizacijo (WHO), in dr. Tess Lawrie, ki je naredila neodvisni pregled študij in pred dnevi k uporabi ivermektina javno pozvala britanskega premiera Borisa Johnsona.

Mnoge države pa so v čakanju na zadovoljive količine cepiva že uradno uvedle ivermektin kot sredstvo za preventivo in zdravljenje pacientov s Covid-19. Pred dobrim tednom je makedonska vlada, po pregledu dosedanjih študij, sprejela ivermektin kot uradno zdravilo za preventivo in zdravljenje okuženih s Covid-19. Še pred tem so to naredile številne države ali njihove zvezne države v Južni Ameriki (Argentina, Bolivija, Mehika, Peru, Paragvaj, …).

Negativno povezavo med množično uporabo ivermektina in pojavnostjo okužbe s Covid-19 v svetu pa sta v še sveži statistični raziskavi “A COVID-19 prophylaxis? Lower incidence associated with prophylactic administration of ivermectin“, objavljeni v International Journal of Antimicrobial Agents,  potrdila tudi Martin Hellwig & Anabela Maia na podlagi javno dostopnih podatkov:

As COVID-19 (coronavirus disease 2019) continues to rapidly spread throughout the world, the incidence varies greatly among different countries. These differences raise the question whether nations with a lower incidence share any medical commonalities that could be used not only to explain that lower incidence but also to provide guidance for potential treatments elsewhere. Such a treatment would be particularly valuable if it could be used as a prophylactic against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) transmission, thereby effectively slowing the spread of the disease while we await the wide availability of safe and effective vaccines. Here, we show that countries with routine mass drug administration of prophylactic chemotherapy including ivermectin have a significantly lower incidence of COVID-19. Prophylactic use of ivermectin against parasitic infections is most common in Africa and we hence show that the reported correlation is highly significant both when compared among African nations as well as in a worldwide context. We surmise that this may be connected to ivermectin’s ability to inhibit SARS-CoV-2 replication, which likely leads to lower infection rates. However, other pathways must exist to explain the persistence of such an inhibitory effect after serum levels of ivermectin have declined. It is suggested that ivermectin be evaluated for potential off-label prophylactic use in certain cases to help bridge the time until a safe and effective vaccine becomes available.

It is important to note that the hypothesis that ivermectin might have a prophylactic effect against SARS-CoV-2 is merely based on a rather strong correlation. On the other hand, this correlation has grown increasingly stronger in the worldwide data set earlier this year and then been independently replicated within the African data set later in the summer. Both remain highly significant, suggesting that there may be a causal connection, which is also suggested by other recent findings reported in literature. We therefore hope that this communication may serve as an invitation to further investigate and consider ivermectin as a potential prophylactic against COVID-19. In addition to the obvious advantages of a potential prophylactic, more refined results could hopefully also deter the public from further dangerous self-medication with ivermectin that has sometimes included veterinary-grade products that contain additional ingredients [21]. In this sense, even negative results might be very valuable to the health community and to society at large.

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