The nation of Mexico generally, and more specifically Mexico City, one of the world’s most populated cities with 22 million people, experienced a greater spike in COVID-19 cases by December 2020. It was at the end of 2020 that the Mexico City Government, concerned about hospital capacity, implemented an expanded population-based health intervention to manage COVID-19. Based on the growing data available from ivermectin research, the government organized a prehospital home-care program combining early detection with antigen tests, a phone-based monitoring process for positive patients and the provisioning of a medical kit containing ivermectin. Testing, based on World Health Organization (WHO) recommendations, was extended into a massive testing program in 230 temporary mobile units or “kiosks.” Fundamental in the Mexican mission: lower access barriers to identifying COVID-19 at early stages, reduce opportunity for transmission via home isolation and care for patients early, right at onset, even if asymptomatic or mild symptoms. The overall study commenced July 8, 2020 with 3,000 tests administered daily and by the middle of November, the government expanded capacity to 24,000 daily tests. Again, public health workers followed up on those deemed positive via Locatel, (Mexico City Government call center) or WhatsApp text service. During that call, patients are informed if they are positive, asked if they can be in isolation, and the symptoms, if escalated, prompt a more intensive monitoring protocol (e.g. every couple days in more severe cases). Serious cases prompt 911 and hospitalization. Since December 28, the ivermectin-based medical kits were distributed to mild to moderate symptomatic patients. The Mexico City Government sought to measure the effectiveness of this population-wide intervention inclusive of the ivermectin-based medical kit in overall hospitalization during the pandemic. Using a quasi-experimental research design involving a Coarsened Exact Matching method leveraging hospital and phone call monitoring data, the study team estimated logistic-regression models with a range of observational data and found a significant reduction in hospitalizations among the cohort receiving ivermectin-based medical kit. In fact, the range of positive effect totaled 52% to 76% depending on model specification. The team concluded that ivermectin-based interventions in a well-designed population-level scheme mitigates the effects of the COVID-19 pandemic on the health system in the world’s fifth largest city. TrialSite includes diagrams of the impact these population-level schemes have had in the region. The results should trigger public health discussions in other large metropolitan areas. This study included over 200,000 people.
The Mexican City news was covered in various press and YouTube interviews but not widely translated in the rest of North America. Dr Vincent Mondragon explained how and when the Mexican IMSS started using ivermectin. Population health professional Juan Chamie reported to TrialSite that the IMSS was using ivermectin in the early stages of COVID. A government health plan, IMSS is used by about half of the Mexican population, and over 60 million people.
Study Research Centers/Agencies
The study was led by professionals in a number of agencies, including Mexico City Digital Agency for Public Innovation, the Mexican Social Security Institute (IMSS), and Ministry of Health Mexico City.
TrialSite notes that the IMSS helped sponsor this population-wide study across Mexico City. A governmental organization, they assist public health, pensions, and social security in Mexico operating under the Secretariat of Health and forms an integral part of the Mexican healthcare system.
Mexico City, situated in the State of Mexico, is the fifth most populated city in the world with about 22 million people.
The Mexico City Government sponsored this innovative, population-wide initiative across Mexico City based initially on observations at Monash University Australia in April and from then on, mounting data from dozens of clinical trials and observational studies evidencing positive outcomes associated with ivermectin.
In an effort to produce good covariate balance between exposure groups and hence lessen any impact of cofounding in observational causal inference the public health-led team employed a method known as Coarsened Exact Matching using administrative data from hospital and the comprehensive phone-call monitoring system established for purposes of this public health study.
The study team estimated logistic-regression models with matched observations adjusting by a number of elements from COVID-19 severity and comorbidity to gender and age, etc. They separated the effect of the kit from phone medical monitoring for “robustness checks” as well as modified consumption duration and “subsetted the sample by hospitalization occupancy.”
The Mexico City study team generated compelling results in that they reduced the pressures on hospital system by 52% to 76% depending on a number of factors. These results led to the confident conclusion that this population-level, ivermectin-based intervention in fact worked well, materially lessening hospitalizations, reducing suffering and undoubtedly saving many lives.
- José Merino, Digital Agency for Public Innovation, Mexico City
- Oliva López, Ministry of Health, Mexico City
- José Alfredo Ochoa, Ministry of Health, Mexico City
- Victor Hugo Borja, Mexican Social Security Institute
- Eduardo Clark, Digital Agency for Public Innovation, Mexico City
- Lila Petersen, Digital Agency for Public Innovation, Mexico City
- Saul Caballero, Digital Agency for Public Innovation, Mexico City
A contributor to TrialSite, Juan Chamie shared with TrialSite diagrams depicting the massively positive impact this ivermectin-based public health study has, in fact, had on Mexico City. See the diagrams below.
Call to Action: TrialSite asks a question to the TrialSite Community—why wouldn’t the press in United States or Europe pick up on such a compelling story?