On May 8, 2020, Peru’s Ministry of Health approved ivermectin (IVM), a drug of Nobel Prize-honored distinction, for inpatient and outpatient treatment of COVID-19. As IVM treatments proceeded in that nation of 33 million residents, excess deaths decreased 14-fold over four months through December 1, 2020, consistent with clinical benefits of IVM for COVID-19 found in several RCTs. But after IVM use was sharply restricted under a new president, excess deaths then increased 13-fold.
To evaluate possible IVM treatment effects suggested by these aggregate trends, excess deaths were analyzed by state for ages ≥ 60 in each of Peru’s 25 states. To identify potential confounding factors, Google mobility data, population densities, SARS-CoV-2 genetic variations and seropositivity rates were also examined.
The 25 states of Peru were grouped by extent of IVM distributions: maximal (mass IVM distributions through operation MOT, a broadside effort led by the army); medium (locally managed IVM distributions); and minimal (restrictive policies in one state, Lima). The mean reduction in excess deaths 30 days after peak deaths was 74% for the maximal IVM distribution group, 53% for the medium group and 25% for Lima. Reduction of excess deaths is correlated with extent of IVM distribution by state with a p value of 0.002 using the Kendall τb test, well below the confidence threshold of 0.05 for an established clinical effect.
Mass treatments with IVM, a drug safely used in 3.7 billion doses worldwide, most likely caused the 14-fold reductions in excess deaths in Peru, prior to their 13-fold increase under reversed IVM policy. This strongly suggests that IVM treatments can likewise effectively complement immunizations to help eradicate COVID-19. The indicated biological mechanism of IVM, competitive binding with SARS-CoV-2 spike protein, is likely non-epitope specific, possibly yielding full efficacy against emerging viral mutant strains.
Juan J Chamie-Quintero, Universidad EAFIT
Jennifer Hibberd, University of Toronto
David Scheim, US Public Health Service