"The next four to six months could be the worst of the epidemic", Bill Gates said during an interview recently. With Gates' prediction and second waves hitting several countries more severely than before, we have, indeed, come to a challenging forefront. Amidst all the uncertainties, the relentless efforts of researchers and doctors have yet again shone a ray of hope.
Ivermectin, a drug that has been highly acclaimed in the past few months for treatment of Covid-19 has once again come under the lime-light, but this time as a tool of prevention of the novel virus. A research on the preventive effect of Ivermectin on the SARS-COV-2 was published in the European Journal of Medical and Health Sciences on December 15, 2020, conducted by a research team in Bangladesh Medical College and Shomman Foundation under the guidance of chief investigator Dr Tarek Alam, professor and Head of Medicine Department in Bangladesh Medical College, and co-investigator Dr Rubaiul Murshed, Chairperson of Shomman.
A total of 118 healthcare workers actively engaged in taking care of Covid-19 patients were purposively selected and among them 58 subjects were given 12mg once monthly dose of Ivermectin for 4 months and the rest 60 subjects did not receive the drug. At the end of the study period, 44 out of 60 (73.3 percent) who did not receive a monthly dose of Ivermectin contracted Covid-19, whereas only 4 out of 58 (6.9 percent) who received the drug tested positive for the disease.
Earlier in July 2020, the research team led by Dr Alam and Dr Murshed had published a case series, combining Ivermectin and Doxycycline to treat Covid-19 patients with a higher rate of success, a major feat in combating the virus. This time, by resorting to the preventive function of the drug, the team has yet again reached another milestone. Although conducted in a small scale, this study has ignited hope in winning the battle against the SARS-COV-2 while waiting for vaccines to make their way into every household. The team has named the drug "People's Medicine" for its cost effectiveness and wide availability within the reach of all. However, the necessity of using masks and maintaining social distance still overpower all preventive protocols that have been recommended till date.
Study on Ivermectin as pre-exposure prophylaxis of Covid-19 has also been acknowledged across the globe by many doctors and researchers. Recently, Dr Pierre Kory, a well-known pulmonologist in USA and the President of Frontline Covid-19 Critical Care (FLCCC) Alliance emphasised on the preventive effect of the drug on his recent review article where he compiled all data of Ivermectin prophylaxis studies, being conducted across the world. In Dr Kory's manuscript, along with many studies from Argentina, India, France and Egypt, Dr Alam's research on the preventive effect of Ivermectin gained acknowledgement as a commendable achievement from Bangladesh. Also, Dr Thomas Borody, renowned Australian Gastroenterologist and discoverer of the triple therapy for peptic ulcer, addressed the anti-viral effect of Ivermectin on Covid-19 in his study.
Recently, news from India stated that over 20,000 kalpwasis who are likely to camp on the Magh Mela will receive prophylactic dose of Ivermectin along with the frontline workers assigned duties on the Mela campus. Internationally acclaimed trials have shown positive cure rates of Covid-19 with Ivermectin in the past few months and now with its preventive capabilities, the drug has taken over the podium yet again. Based on the mountains of data on Ivermectin, many hospitals have already included the "wonder drug" in their treatment protocol to fight this disease.
In USA research published in Chest (Chest is peer-reviewed medical Journal published by American College of chest physicians) on October 12, 2020 by Juliana Cepelowicz Rajter, MD et al shows label use of Ivermectin in 173 patients at 4 hospitals in Florida (when compared with 107 patients who were not treated with Ivermectin having similar level of disease severity) was associated with lower mortality rate (39 percent among Ivermectin treated patients versus 81 percent who were not treated with Ivermectin) during treatment of Covids-19, especially in patients with severe pulmonary involvement.
Being a Bangladeshi and having been trained in the medical field in this country, it is an honour to be part of such a historic achievement. A medical finding of such vehement importance by a third world country is a victory on itself. Bangladesh being the pioneer of recognising the treatment and preventive potential of Ivermectin against Covid-19 is, in fact, a success for the entire nation and its government.
Lastly, it must be remembered that the bigger portion of management of Covid-19 involves hand washing, social distancing (at least 2 m/6 feet with non-household as well as household members since recently published studies indicate that household transmission of coronavirus among family members may be responsible for the majority of infections) and using masks (N95 or at least other type of masks). As significant portion of coronavirus transmission occurs through eye exposure, eye shields can be a very important part of protection from coronavirus infection. To conclude, we must all be vigilant towards the virus and avail all forms of protection to fight through this pandemic together because as Charles Darwin said, "It is not the strongest of the species that survives, nor the most intelligent, but rather the one most adaptable to change."
Dr CM Hasan is Interventional Cardiologist and Associate Clinical Professor of Medicine and Cardiology, Mount Sinai Hospital, New York. Dr Pauline Francisca Gomes is Research Fellow, Shomman Foundation, Dhaka.