New Coronavirus News from 8 Feb 2023

The political polarization of COVID-19 treatments among physicians and laypeople in the United States [pnas.org, 8 Feb 2023]

Authored by Joel M. Levin, Leigh A. Bukowski, Julia A. Minson, and Jeremy M. Kahn

Abstract
In the United States, liberals and conservatives disagree about facts. To what extent does expertise attenuate these disagreements? To study this question, we compare the polarization of beliefs about COVID-19 treatments among laypeople and critical care physicians. We find that political ideology predicts both groups’ beliefs about a range of COVID-19 treatments.

These associations persist after controlling for a rich set of covariates, including local politics. We study two potential explanations: a) that partisans are exposed to different information and b) that they interpret the same information in different ways, finding evidence for both.

Polarization is driven by preferences for partisan cable news but not by exposure to scientific research. Using a set of embedded experiments, we demonstrate that partisans perceive scientific evidence differently when it pertains to a politicized treatment (ivermectin), relative to when the treatment is not identified. These results highlight the extent to which political ideology is increasingly relevant for understanding beliefs, even among expert decision makers such as physicians.

A growing literature on political polarization has documented unexpected links between political ideology and beliefs that are unrelated to the principles of liberalism or conservatism (1, 2). During the COVID-19 pandemic, liberal and conservative Americans have disagreed sharply on matters such as the origins of the virus (3), the severity of the pandemic (4, 5), and the effectiveness of a range of interventions, including masking, distancing, vaccination, and drugs like hydroxychloroquine and ivermectin (3, 5–7). Such disagreements inhibit cooperation, fuel partisan antipathy, and threaten public health.

Prior work offers clues about the roots of this polarization: Partisans consume different information (4, 8, 9), evaluate the same information in different ways (10, 11), and often lack the tools (12) or motivation (13, 14) to discriminate between accurate and inaccurate claims. On these bases, we might expect beliefs about COVID-19 treatments to be dramatically less polarized among people who are particularly informed, trained, and motivated, such as physicians.

In the present work, we examine physicians’ beliefs about treatments for COVID-19, benchmark their polarization against that of lay adults, and provide evidence for two psychological mechanisms that give rise to polarized beliefs among both groups.

Methods

We study two samples: a novel panel of 592 board-certified critical care physicians (“physicians”) and a sample of 900 adults recruited from an online panel (“laypeople”), all based in the United States. We focused on critical care physicians because they are important decision makers in the treatment of severe COVID-19 and because their day-to-day judgments are less influenced by patient preferences, compared to other physicians. Additional information about both samples and other methodological details are in SI Appendix.

We surveyed physicians in three phases between April 2020 and April 2022 and surveyed laypeople concurrently with the final physician survey. In each survey, physicians evaluated a clinical vignette about a severely ill COVID-19 patient and made decisions about which treatments to administer. For each treatment option, physicians reported beliefs about effectiveness and the quality of clinical evidence and made incentivized predictions about the proportion of their peers who made the same decision. Laypeople reported beliefs about treatments but did not make treatment decisions. All participants also reported beliefs about the effectiveness of COVID-19 vaccines and their support for vaccine mandates as well as a range of individual characteristics. Most estimates are based on data from Phase 3 surveys, administered in March and April 2022.

To investigate the role of information consumption on belief polarization, we asked participants in both samples to report how they consume news (e.g., print, social media, television) as well as their preferred cable news source (if applicable). Cable news consumption is a particularly plausible source of variation in public exposure to COVID-relevant information because partisans watch different cable news networks (4), and networks differed markedly in their coverage of hydroxychloroquine, ivermectin, and vaccination (9, 15, 16). Physicians also reported how they engage with scientific research.

To measure bias in the evaluation of information, we embedded an experiment in surveys administered to both samples. Participants read an abridged research abstract (physicians) or a research summary written in a journalistic style (laypeople), both of which reported the results of the TOGETHER trial (17), a well-powered randomized controlled trial that failed to find evidence that ivermectin was effective for treating COVID-19.* Between subjects, we randomized whether the treatment was identified as ivermectin or was anonymized (“GL-22”). We then elicited beliefs about the study’s informativeness, its methodological rigor, and the likelihood that its authors were biased. We expected partisans’ beliefs on all three measures to diverge more sharply when the drug was identified as ivermectin.

We measure political ideology on a 7-point scale bounded by “very liberal” and “very conservative,” with the midpoint defined as “middle of the road” (18). To compare polarization across samples and outcomes, we standardized all outcome variables by subtracting the mean response of political moderates (“slightly liberal,” “middle of the road,” “slightly conservative”) from each response and dividing by the standard deviation.† Our primary analyses control for a range of plausible confounding factors, including demographic, professional, and regional characteristics (Fig. 1A caption).

For simplicity and statistical power, we collapsed measures that were collected at multiple time points after ruling out significant temporal variation (ANOVAs; ps > 0.18).‡ The timing of key elicitations can be found in SI Appendix, Table S1. Full study materials are at https://github.com/pitt-healthsciences/covid_polarization/. A preregistration specifying some elements of our analytical approach can be found at https://aspredicted.org/11M_35D.

Following our prespecified exclusion criteria, we retained 410 physician responses and 882 layperson responses. Research was approved by the University of Pittsburgh Institutional Review Board. All subjects provided informed consent.

Results
We find robust evidence of polarization on eight of ten physician outcomes and all six layperson outcomes (ps < .001; Fig. 1A). To illustrate the magnitude of these effects, conservative physicians were approximately five times more likely than their liberal and moderate colleagues to say that they would treat a hypothetical COVID-19 patient with hydroxychloroquine (Cohen’s h = .37). On average, physicians’ beliefs were less polarized than laypeoples’ (

New Coronavirus News from 1 Dec 2022

Ivermectin shown ineffective in treating COVID-19, according to multi-site study including KU Medical Center [University of Kansas Medical Center, 1 Dec 2022]

By Anne Christiansen-Bullers

Results of the study of the antiparasitic medication, once a much-discussed potential treatment for COVID-19, were published in the Journal of the American Medical Association.

Researchers at the University of Kansas Medical Center were part of a multi-site collaboration that found that ivermectin has no measurable effect in improving COVID-19 outcomes.

In an article recently published in the Journal of the American Medical Association (JAMA), the researchers concluded that taking 400 mcg/kg ivermectin for three days, when compared with a placebo, did not significantly improve the chances for a patient with mild to moderate symptoms of COVID-19 to avoid hospitalization.

The use of ivermectin also showed no measurable decrease in the severity of COVID-19 symptoms or the length of time these patients experienced COVID-19 symptoms.

“The most important takeaway from the study is that ivermectin does not help improve outcomes from COVID-19 infection and thus should not be used as a treatment for COVID-19,” said Tiffany Schwasinger-Schmidt, M.D., Ph.D., associate professor of internal medicine at the University of Kansas School of Medicine-Wichita, director of the Center for Clinical Research and site director of the study for the KU Medical Center location in Wichita.
Mario Castro, M.D., MPH, vice chair for clinical and translational research and division director of pulmonary and critical care medicine for KU School of Medicine, provided oversight of the study.

About the study
KU Medical Center was part of a nationwide initiative that allowed research institutions to collaborate on COVID-19 studies in hopes of getting results sooner than any one site could achieve on its own.

This initiative, the Accelerating COVID-19 Therapeutic Interventions and Vaccines Study Group and Investigators, is also known as ACTIV. This study to examine ivermectin, as well as a few other current medications to gauge their effectiveness against COVID-19, goes by the name of ACTIV-6.

The ACTIV-6 study enrolled 1,800 participants. These participants received packages at their residences that contained either a dose of ivermectin or a placebo. Because it was a double-blind study, the participants did not know whether they received ivermectin or not.

Of the initial enrollment, 1,591 participants with confirmed cases of COVID-19 reported receiving their shipment, and follow-up data were collected by 93 separate study sites across the United States.

“This trial was innovative in that it used a remote clinical trial design, allowing people in all areas in the U.S. to enroll in a clinical trial and have the investigational drug shipped directly to their house,” explained Schwasinger-Schmidt. “This is different in that most clinical trials require participants to come to a center to receive study medication.”

The study results
When the participants’ data were analyzed, researchers came up with two results. The first was the median recovery time, or the amount of time it took patients to report having recovered from COVID-19. The second was the number of hospitalizations or deaths within each study group.

Researchers found that the median recovery time for those taking ivermectin was 12 days, and those on the placebo was 13 days. There were 10 hospitalizations or deaths in the ivermectin group and nine in the placebo group. But these differences failed to be statistically significant, leading researchers to their conclusion that “these findings do not support the use of ivermectin in patients with mild to moderate COVID-19.”

What is ivermectin?
Ivermectin is an oral medication initially introduced as an animal de-wormer in 1971 and approved for human use in 1986. Its main purpose (to remove parasites from the body of either animals or humans) means it was initially classified as an “anti-parasitic agent,” according to Schwasinger-Schmidt.

“It kills parasites that cause river blindness and other illnesses and has been used safely in millions of people,” she said.

Ivermectin and COVID-19
Ivermectin entered the American lexicon as a possible treatment for COVID-19 when Pierre Kory, M.D., a pulmonologist and president of Frontline COVID-19 Critical Care Alliance (FLCCC) testified before a U.S. Senate committee hearing in December 2020. Kory called ivermectin a “miracle drug” against COVID-19 and urged the government to issue prescription guidelines for its use in treating the coronavirus.

Prior to Kory’s testimony, Australian researchers in the spring of 2020 had observed that ivermectin killed the coronavirus in a laboratory setting. But a story in The Seattle Times pointed out that the amount used in the lab was much higher than the approved use for humans and could be fatal.

Tests continued throughout the world, however, building that hope that Kory shared with the Senate committee. “Ivermectin had been studied in the laboratory prior to implementation in this trial, and it appeared to decrease replication of the COVID-19 virus through decreasing responses in the inflammatory pathway to the virus,” Castro said.

Ivermectin became an especially hopeful solution for individuals not convinced in the safety or efficacy of the COVID-19 vaccine. But these worldwide studies — including a clinical trial of ivermectin in Brazil called TOGETHER and now the ACTIV-6 trial in the U.S. — have failed to find ivermectin helpful for COVID-19 treatment.

“In clinical trials, it is equally as important to discover which medications don’t work to treat illness as well as medications that do,” Schwasinger-Schmidt said. “This study showed what didn’t work.”

New Coronavirus News from 19 Mar 2023

COVID-19 pandemic expected to end this year 'as a public health emergency,' says World Health Organization [Kaiser Health News, 19 Mar 2023]

By Melissa Rudy

Optimism declared about declining deaths, though WHO falls short of declaring end of emergency now

The director of the World Health Organization (WHO) announced on Friday that he is "confident" the COVID-19 pandemic will end in 2023.

Director-General Dr. Tedros Adhanom Ghebreyesus made the comments to reporters at a media briefing in Geneva.

"We are certainly in a much better position now than we have been at any time during the pandemic," Dr. Ghebreyesus said.

He noted that in the past four weeks, the weekly number of reported deaths has been lower than it was before the pandemic was declared in March 2020.

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"I am confident that this year, we will be able to say that COVID-19 is over as a public health emergency of international concern," he added.

COVID-19 cases and deaths continue to trend downward worldwide.

As of March 6, weekly deaths stood at 5,048 globally.

That's a decrease of more than 26% from the prior week — and down from a peak of 102,000 deaths in January 2021, per data from WHO.

Weekly cases of COVID-19 are down to 812,255 globally, a 21.65% decrease over the prior week. They peaked at 44.3 million in December 2022.

"Last week, there were still more than 5,000 reported deaths."

In the U.S., as of March 15, weekly cases were down to 149,955, after peaking at 5.6 million on Jan. 19, 2022, per data from the Centers for Disease Control and Prevention (CDC).

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Weekly deaths in the country were at 1,706, down from an all-time peak of 23,478 on Jan. 13, 2021 and another surge of 17,357 on Feb. 2, 2022.

‘We are not there yet’

However, despite its optimistic prediction, the WHO is not quite ready to announce the end of the pandemic at this precise moment in time.

"We are not there yet. Last week, there were still more than 5,000 reported deaths," Dr. Ghebreyesus said during the briefing.

"That’s 5,000 too many for a disease that can be prevented and treated."

Dr. Ghebreyesus also stressed the need to determine how the pandemic began.

"Last Sunday, WHO was made aware of data published on the GISAID database in late January, and taken down again recently," he said.

"The data, from the Chinese Center for Disease Control and Prevention, relates to samples taken at the Huanan market in Wuhan in 2020."

Dr. Ghebreyesus said that while this particular data did not provide a "definitive answer" to the pandemic’s origins, all information is important in achieving that goal.

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"These data could have — and should have — been shared three years ago," he continued. "We continue to call on China to be transparent in sharing data, and to conduct the necessary investigations and share the results. Understanding how the pandemic began remains both a moral and scientific imperative."

"We are certainly in a much better position now than we have been at any time during the pandemic."

Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center in New York City and a Fox News medical contributor, said this weekend that he questions the WHO’s hesitancy to signal the end of the international emergency despite the weekly COVID death count being lower than pre-pandemic.

"Under the heavy influence of China, WHO leadership actions have been erratic at best, delaying calling it a pandemic for almost two months after it was spreading widely and failing at getting China to be open and transparent about origins," Dr. Siegel told Fox News Digital in an interview.

"The pandemic has revealed WHO at the highest levels to be woefully inadequate."

In January 2023, President Joe Biden announced that he would end the COVID emergencyon May 11.

He had previously declared the pandemic to be "over" in September 2022.

New Coronavirus News from 3 Mar 2023

When covid politics collides with covid science, public health loses [Grid, 3 Mar 2023]

By Jonathan Lambert

Quick takes about what works and what didn’t obscures the inherent uncertainty of the scientific process, eroding trust in science.

With covid now an afterthought rather than an emergency in the minds of many Americans, politicians and pundits are rushing to have the final word on who handled the crisis well — and who dropped the ball.

These recent declarations of pandemic winners and losers often ignore the iterative and uncertain nature of science in favor of blunt headlines and slogans bolstered by cherry-picked studies. And they often elide scientists’ and policymakers’ honest grappling with major decisions in the face of limited and evolving data.

“The Mask Mandates Did Nothing. Will Any Lessons Be Learned?” New York Times columnist Bret Stephens declared last month, flattening a highly nuanced, heavily caveated scientific study of mask-wearing into a single talking point. And after reports this week that the Energy Department concluded with “low confidence” that a lab leak in China likely caused the pandemic, several prominent Republicans touted it as ruling out a natural origin. They included Sen. John Barrasso (R-Wyo.), who tweeted that “China is responsible for COVID.”

Such black-and-white pronouncements can muddy the public’s understanding of what worked (like vaccines), what didn’t (ivermectin), and the wide gray area around other measures, like mask mandates or school closures, that scientists are still evaluating. Three years into the pandemic, the United States’ political war over covid has eroded public trust in science, with the biggest drop — more than 20 percentage points — among Republicans. That polarization makes responding to the next crisis, whether it’s a pandemic or something else, even harder.

“Those who have dogmatic positions and are playing to the politics can be extreme, use hyperbole and be definitive in their pronouncements,” said Timothy Caulfield, research director of the Health Law Institute at the University of Alberta. “Those who are trying to be close to what the science actually says have to have all these caveats and hedge what they say, and it’s just like [they’re] going to gunfight with a knife.”

Politicization leads to mistrust
Before covid entered the global consciousness in early 2020, Americans’ trust in science was largely bipartisan, with relatively small gaps between the parties.

“There just wasn’t much of a political divide,” said Cary Funk, director of Pew Research’s science and society team, which has tracked public opinion on the topic since 2016. But during the pandemic, a gap appeared — and it continues to widen.

In January 2019, a Pew poll found that 88 percent of Republicans had a great deal or a fair amount of confidence that medical scientists act in the best interests of the public, compared with 87 percent of Democrats. By September 2022, only 68 percent of Republicans reported the same, compared with 91 percent of Democrats. The partisan gap is even wider — 63 to 89 — for trust in scientists generally.

That split didn’t start right when the pandemic hit, said Funk. “For about six weeks, we saw very little partisan division about what was happening,” she said. “But shortly thereafter, we started to see this political division open up, and that really became a hallmark of public opinion around everything connected with the coronavirus outbreak.”

By that point, the country was in the throes of the first covid wave — battling a virus the world knew little about, while politicians sniped over how to handle it and who to blame.

President Donald Trump called the coronavirus a “new hoax” at a campaign rally in late February 2020, and continually downplayed the threat during weeks of daily White House press briefings. Democrats lobbed heavy criticism at Trumpfor moving too slowly and minimizing the potential risk, at times exaggerating how Trump’s policies affected the nation’s readiness to detect and fight pandemic threats.

“Those political cues can be very sticky and hard to strip away,” said Rebekah Nagler, a health communication researcher at the University of Minnesota. “When you introduce that politicization element, you’re inviting people to interpret new information through a political lens.” A recent history of polarization around health policy, including support for the Affordable Care Act, may have also primed the public to take political sides on covid, she said.

In those early weeks and months, uncertainty about the scale of the threat the virus posed, how it spread and what could be done to stop it further fueled the partisan divide, creating an opening for mis- and disinformation to flourish.

“Politicization can involve the strategic elevation of uncertainty around science for political gain,” said Sarah Gollust, a health policy researcher at the University of Minnesota.

In early 2020, “science was moving so rapidly, for good reason, as the scientific community was trying to make sense of a novel pandemic,” she said. Scientists raced to post new findings online as preprints, bypassing the normal slow process of peer review, to get information out as quickly as possible. That created a flurry of often conflicting information that was challenging for the research community to sift through, much less the public.

“There was so much evidence being produced so rapidly, there was so much more to pick from and potentially elevate conflict,” said Gollust.

Shifting guidance
Official guidance often shifted as a result of that evolving understanding and a dynamic environment. Initially, public health officials dissuaded people from buying masks to ensure limited supply could be used by medical professionals. But in early April 2020, that guidance changed, in part because of new science on how the virus spread.

The rapidity of such changes, while likely necessary, can erode trust, said Gil Eyal, a sociologist at Columbia University: “If the surgeon general says you don’t need masks, because they won’t protect you, and then the CDC corrects course, that sequence is not going to elicit trust.”

Often, public health officials failed to clearly communicate the rationale for those changes.

“Guidance was necessarily going to change because so much was unknown,” said Nagler. But how those changes get communicated is crucial for maintaining trust. “I think CDC in particular really let us down by not being more transparent and clear about setting that expectation,” she said. For example, in May 2021, the Centers for Disease Control and Prevention said vaccinated people no longer needed to wear masks indoors but abruptly reversed advice in July because of the delta variant. Administration officials tried to explain that the situation had changed, but not being explicit and forceful about that uncertainty upfront opened them up to charges of “flip-flopping.”

“Political actors weaponized this uncertainty,” said Caulfield. “It creates an opportunity for those who want to generate distrust to generate distrust because they can say, ‘This institution said X, and now they’re saying Y, that means you can’t trust them,’” he said. Fast-forward to today, and virtually every aspect of the pandemic — from treatments to the value of masking — is viewed through a partisan or ideological lens.

“Once something becomes about ideology, it becomes very difficult to change people’s minds,” said Caulfield. “It almost doesn’t matter what the science says.”

Despite evidence that covid vaccines and boosters are safe and effective, uptake remains lower among Republicans, likely contributing to partisan gaps in covid deaths that emerged after the vaccine. And ivermectin — an anti-malaria drug touted by Trump in 2020, which study after study has shown to be ineffective for treating covid — continues to be pushed by some doctors, who are even expanding their recommendations to diseases like RSV and flu. (In the meantime, the promotion of ivermectin as a covid cure resulted in a rise in poisonings linked to the drug, which is also used to deworm horses and other animals.

While evidence against ivermectin is well established, questions around the effectiveness of policies aimed at reducing covid’s spread, from masking to school closures, are still being studied. Answers are likely going to be complex and context-dependent, arising from many, many studies carried out in the coming years. Some questions, like whether the coronavirus was leaked from a lab or jumped naturally from animals to people, may never be definitely answered.

Polarization around these questions favors quick and easy answers, as the past several weeks have shown. Ideological actors can seize a study and label it as completely definitive when it’s anything but, said Caulfield. But that nuance can get lost among those of a similar ilk, he said, creating a revisionist history of the pandemic.

“There’s this profound cherry-picking, they select a favored scientific story, then try to ossify it as the truth,” said Caulfield. “It’s damaging on so many levels.”

Can trust in science be rebuilt?
Three years into the pandemic, the trust-in-science partisan gap shows no sign of shrinking.
Covid politicization is still on display as candidates and potential candidates for the 2024 presidential race look to score covid points, and as House Republicans launch inquiries into the Biden administration’s handling of the pandemic.

That has profound implications that go well beyond how we understand this pandemic — which is still killing more than 300 people a day in the U.S. — to what we do when the next public health crisis emerges.

Depoliticizing covid after so long may be challenging. “I wouldn’t say I’m super optimistic about a reframing at this point, in part because these beliefs are so sticky,” said Nagler. But there are strategies scientists and public health officials could employ going forward.

One is to be clearer about how science works. Emphasizing that the scientific process is our best way of making sense of the world, but that it’s iterative and inherently uncertain, can go a long way, said Nagler. “We have some data to suggest that if you remind people about how science works, it can be somewhat protective in how they respond to conflicting health information,” said Nagler. That doesn’t change the messy information environment, she said, but it can improve people’s ability to operate within it.

For public health officials, being transparent about decision-making is crucial, said Kasisomayajula Viswanath, a health communication researcher at the Harvard T.H. Chan School of Public Health. “We have to admit that we don’t know certain things and will get some things wrong, that’s just the nature of science,” he said. “But we’ll need to be honest and open [with the public] and provide that information,” on how decisions are being made, he said. “This needs to come from the highest levels of government.”

But public health messaging can’t come solely from on high, Viswanath said. Local organizations and leaders often hold more credibility for community members, making them better messengers, he said. “We need to engage them in this process of rebuilding trust.”

There’s no easy way to reverse the loss of trust in science and public health — but “we don’t have a choice,” said Viswanath. “How we do that is the big question.”

New Coronavirus News from 23 Mar 2023

Why China’s COVID Comeback Is Still In The Early Innings, With Upside Ahead [Forbes, 23 Mar 2023]

By Drew Bernstein

When you unshackle 1.4 billion consumers who have been penned up at home for three years, it’s reasonable to expect some fireworks.

For the residents of Mainland China, life under “zero COVID” policies was a dreary round of rolling travel restrictions and lockdowns – as if the United States was permanently stuck on a skipping record of the Spring of 2020. While most of the population was able to find a way to get back to work eventually, the everyday routines of travel, dining out, and visiting friends and family were severely curtailed. Wallets stayed snapped shut.

Since China executed its “COVID pivot” in late December 2022, economists have been scrutinizing the data to see if the country will be able to achieve its goal of 5% growth in 2023. If achieved, China will serve as an engine to help developed economies avoid tipping into recession. This is particularly relevant in the new era of higher interest rates, shrinking money supply, and rolling banking jitters.

Initial government data for the first two months provided some early hints. China’s retail sales jumped by 3.5% in January and February of 2023 after a decline of 1.8% last December.

Spending on catering leaped by 9.2% after dropping by 14.1% in December. Clearly, Chinese consumers are beginning to find their footing. China has also indicated the need to expand domestic demand and prioritize expansion of consumption.

PROMOTED
The Chinese government appears to be turning on the taps of fiscal stimulus, with infrastructure investment surging by 9% during the first two months this year. However, property buyers mostly stayed on the sidelines, with investment dropping by 5.7%. This raises the question of how long the government coffers can float the economy, given that the finances of so many local entities are already stressed from the burdens of financing years of COVID containment amid declining revenues from property sales.

Further, China’s fabled export machine appears to be still stuck in the mud. Exports slid by 6.8% by January and February, and imports were down by 10.2% in the same period, missing analysts' estimates by a country mile. The hopes of Australian raw materials producers and German machinery manufacturers' that China will enable them to dodge a downturn may be a mirage.

A Generation at Risk
The statistic that should catch the authorities' attention is youth unemployment, which remained stubbornly high at 18.1% for those aged 16 to 24 in February. These young people are the most educated and invested generation in China’s history, with nearly 58% of Chinese enrolling in tertiary education in 2021, up from just 12.5% in 2000 and 3.4% in 1990. These are the children whose parents have sacrificed everything to lift them to the next rung on the ladder of educational attainment and financial security. Now many are “lying flat” or sidelined by a lack of jobs.

If China is to leap into a technologically advanced, wealthy society, it must allow this generation to recognize its full productive and economic potential. Because if this cohort of talent is squandered, China indeed risks “getting old before it gets rich.”

China has an opportunity to build a more sustainable, balanced economic model that policymakers have recognized as desirable for over a decade.

1. Reopening – While China has lifted most of the formal travel obstacles, tremendous logistical friction remains. Airliners must be removed from mothballs, and routes to popular overseas destinations restored. After three years, China just announced that it would begin issuing tourist visas to U.S. citizens on March 15th. Hong Kong fully reopened to Mainland China in February 2023. Before this, even American CEOs have had to wait a month or more to visit their operations in the PRC, inhibiting their understanding of conditions on the ground and willingness to invest in growth. Chinese citizens wishing to visit Hong Kong or travel overseas must compete for a limited supply of visas. More important than the flow of tourists, China has now lifted the travel restrictions on Chinese students studying overseas, which peaked at more than 700,000 students in 2019 but has subsequently dropped by half.

The U.S. government has also played a role in discouraging the flow through sometimes baseless harassment of students and scholars in STEM fields. If China truly wishes to grow into a global leadership position in the coming decades, it will need a generation that can understand and negotiate various cultural, political, and business environments. Today, the post-COVID youth generation – the so-called “Generation N” - is reported to be both pessimistic and isolated and more nationalistic than their predecessors. Optimism is essential to embracing careers, starting families, and launching new businesses – all ingredients China desperately needs.

2. Rebalancing – For the past decade, Chinese policymakers have explicitly acknowledged that the asset-intensive growth model driven by speculative real estate development and infrastructure investment is inherently unstable. Capital investment rose from 24% of GDP in 1990 to 45% in 2013 and has remained in the low- to mid-40% range ever since. There has been increased recognition that much of this investment has gone toward piling up non-productive investment that increases the debt stock without producing economic returns. President Xi Jinping announced as much when he wrote that China needs “to shift focus to improving the quality and returns of economic growth, to promoting sustained and healthy development rather than inflated GDP growth.” Yet whenever the government has moved to restrain the non-productive, highly leveraged real estate sector, it has backed off for fear of instability. As economist Michael Pettis has pointed out, China’s household consumption accounts for less than 40% of GDP. Combined with 10 to 15% of government consumption, China has the lowest consumption share of any economy in the world. Coming out of the COVID era, the Chinese government can now act boldly to rebalance the economy toward private consumption, services, and internal demand. This will require putting in place more robust systems of social and health insurance to reduce China’s outsized savings rate, continuing to support robust capital markets that funnel savings towards productive enterprises, and creating incentives for family formation that make it feasible to raise more than one child in an ultra-competitive educational system.

3. Rallying the Private Sector – The undeniable economic miracle that took place in China had two central pillars. First, a state sector that prioritized economic growth and provided world-class infrastructure and a trained, plentiful workforce has proved irresistible to multinationals seeking to become more competitive in a globalizing world. Second, China made a very conscious decision to unleash the entrepreneurial energies of its people by destigmatizing the accumulation of wealth and promoting domestic champions through various implicit and explicit means. According to Harvard’s Kennedy School, China’s private sector contributes to 60% of China’s GDP but 70% of innovation, 80% of urban employment, and 90% of new jobs. Put another way, a bright future for China’s young college graduates is intrinsically tied to a vibrant private sector economy. Unfortunately, the combination of economic dampening during COVID and the drive to reign in the economic influence of China’s private technology sector has diminished the private sector’s expansion and business confidence. For the first time since the beginning of the reform era, the private sector’s share of employment and market value dropped significantly in 2020 and 2021. In recent weeks, Xi Jinping has been quoted in state media about the vital role of the private sector in economic development, saying on March 7th that “We should improve the development environment for private enterprises, remove the institutional obstacles that prevent them from fairly participating in market competition, and safeguard the property rights of private enterprises and the rights and the interests of private entrepreneurs according to law. We should… support the development of the private sector and the growth of private enterprises and boost market expectations and confidence.” If the government follows these warm words with consistent and predictable actions, the animal spirits of a revived private sector will provide a powerful “third leg” to the post-COVID snapback.

The markets appear confused about what to make of China’s COVID comeback prospects.

After an explosive 55% rally between November and late January to 22,688 points, Hong Kong’s Hang Seng Index has retraced about half of its gains. The word on the street is that no buyer wanted to get steamrolled by the COVID reopening train, but they were not “conviction owners” of the rally.

Investors will likely have the chance to dip their toes back into Chinese equities in the second half of 2023. Based on market activity, we expect many China tech names to seek to launch overseas IPOs, particularly via the SPAC vehicle. Of note, beginning on March 31st, China’s securities regulator, the CSRC, will, for the first time, implement a system for reviewing and approving overseas listings. Although this presents an additional hurdle to clear, it means that these issuers will have the government's imprimatur as appropriate for foreign ownership – removing one major risk factor for those who want to play the China comeback.

The Chinese government has also shown a tremendous talent for keeping equity investors on their toes, if not to say tearing out their hair. But if we begin to see the consistent implementation of the three “Policy Rs” outlined above, it would be foolish to bet against the vast, untapped commercial energies and appetite for a better life of China’s 1.4 billion people.

New Coronavirus News from 25 Mar 2023

The rest of the story — how to read the medical literature [Williamsport Sun-Gazette, 25 Mar 2023]

A recent Let’s end COVID! article (February 25th) talked about the process of medical research and how the results are communicated to the world at large via public and social media. Journalists who translate the mysterious pronouncements of medical researchers and other scientists provide a valuable public service by helping us non-scientists keep up with current developments. This is especially important in a public health crisis such as the current COVID-19 pandemic, where it is a matter of life and death.

Scientific research is supposed to be objective, impartial. Of course, scientists are human, and even the most careful scientist can unknowingly let bias affect their work and how they interpret and communicate their results. When scientific information is communicated by non-scientists to other non-scientists, it’s a little like the “telephone game” where one person whispers a word or phrase to the person beside them, that person whispers to the next one in line and so on, until the last person announces what they heard, which often is not what the first person said. Journalists reporting medical news may have their own biases that unintentionally color their communication.

Sometimes the people communicating research results deliberately misinterpret scientific findings that disagree with their own partisan agendas. We have seen this several times during the current pandemic including, for example, when some people continued to recommend using ivermectin to prevent or treat COVID-19 although no studies have shown that it works.

When reading a news article about COVID-19 (or any medical issue) I look for the source of the information. If the author hasn’t included a link to the study being discussed, or at least enough information (author and journal title) to find the study easily, I get suspicious. Does the author not want me to look at the original information for some reason? As the Russian proverb popularized by Ronald Reagan advises, I like to “trust but verify.” If I’m going to apply this new information to my own healthcare, I want to see–and decide–for myself.

Researchers strive for clarity, conciseness, and precision when reporting their results because they are communicating to other busy scientists who are coping with the same daily flood of information, and who need to determine quickly whether the article is relevant or provides new knowledge.

Fortunately, this helps the rest of us, too. Professional journals publish several kinds of articles, including editorials, case reports, and even letters to the editor, but when you are following up medical news you will be looking at primary research articles. These reports of studies and results follow a consistent outline:

• Abstract (Summary)
• Introduction (Context)
• Methods and Materials (The Experiment)
• Results (The Data)
• Discussion (Explanation)
• Conclusions (Interpretation)

The abstract reviews the article’s key points–the question being studied, why it’s important, how the research was conducted, and the study results and conclusions. Non-scientists should read the abstract first to get a sense of what information the article contains, but don’t stop there. Read the introduction next for context and background information, including previous studies on which the new research builds. It helps you understand where the new research “fits.” The introduction will clearly state the purpose of the research and the question (the hypothesis) it answers.

Some experts recommend reading the introduction first and the abstract last. That way you can draw your own conclusions and see whether they match the authors’.

It’s OK to skip the methods section, which explains in detail how the research was done so that other scientists can evaluate the study’s quality, repeat the research to confirm the results, or develop new studies based on its methods and findings. You may also–unless you are familiar with statistical concepts and vocabulary–skip the results section, which presents and analyzes the data the investigation produced.

Finally, read the discussion and conclusions (sometimes separate sections) to see how the authors interpret their findings. They should also tell you of any limitations in the study that might affect the results, the strength of their evidence, the implications for practice change and future research, and what additional studies may be needed.

Various online guides for nonscientist readers exist. “Anatomy of a Scientific Journal Article” by Erica Mitchell (https://blog.eoscu.com/blog/anatomy-of-a-scientific-journal-article) and “How to read and understand a scientific article” by Jennifer Raff
(https://cdn.ymaws.com/www.oandp.org/resource/resmgr/docs/skc/journalclub/How_to_Read_and_Understand.pdf) are good ones.
Michael Heyd, a retired medical librarian from Fairfield Township who spent more than 40 years searching the literature for professional hospital staff, is a member of Let’s end COVID!, a group of concerned people in Northcentral PA working to overcome the COVID-19 pandemic through education, outreach and mitigation. Currently the Lycoming County COVID-19 Community Level used to define interaction in general public spaces is low. At this level the CDC recommends optional masking any time for extra protection.

FDA warning shuts down ivermectin site [North Platte Telegraph, 25 Mar 2023]

By GEORGE HAWS

website promoting ivermectin to treat COVID-19 has been shut down. The action was in response to a warning letter issued by the U.S. Food and Drug Administration on March 16.
Legal products containing ivermectin have long used for control of parasites, especially in livestock, and are available only by prescription.

However, according to the FDA warning, ivermectin4covid.com was promoting a product called Iverheal 12mg, manufactured by Healing Pharma, to control not only parasites, but also COVID-19, a viral infection.

The FDA’s letter noted that Iverheal 12mg is not an approved product and that ivermectin is not approved for COVID-19. The letter listed a number of alleged violations related to lack of FDA approval, mislabeling, violations of rules related to interstate commerce, etc.

The letter also lists addition concerns related to unapproved or misbranded drugs, and contains the following statement:

“There are inherent risks to consumers who purchase unapproved new drugs and misbranded drugs. Unapproved new drugs do not carry the same assurances of safety and effectiveness as those drugs subject to FDA oversight,” the warning said. “Drugs that have circumvented regulatory safeguards may be contaminated, counterfeit, contain varying amounts of active ingredients, or contain different ingredients altogether. We request that you cease the sale of any unapproved and misbranded products, whether for the mitigation, prevention, treatment, diagnosis, or cure of COVID‐19, or any other disease for which the drugs you are selling are not approved by FDA for distribution in the U.S.”

The warning letter was also posted to the FDA website.

New Coronavirus News from 21 Mar 2023

FDA Warning Letter Issued to Website Purveying Ivermectin Pills for Covid-19 [MedCity News, 21 Mar 2023]

By FRANK VINLUAN

The FDA has issued a warning letter to a website that has been selling the antiparasitic drug ivermectin as a treatment for Covid-19. The correspondence directs the company to stop selling its products and correct any misleading language in its marketing material.

A website that markets ivermectin as a Covid-19 treatment has run afoul of the FDA. The agency issued a warning letter notifying the site that it is selling unapproved and misbranded products over the internet to consumers in the U.S.

The warning letter, dated March 16, was posted by the FDA on Tuesday. According to the agency, the website ivermectin4covid.com stated: “Ivermectin (Iverheal 12) is an antiparasitic, and also an antiviral drug manufactured by Healing Pharma. It is used to kill the parasites in the body. It is also useful in Covid 19 care.”

Iverheal12 is a generic version of ivermectin manufactured by Healing Pharma, a Mumbai, India-based generic medicines company. The drug is a 12 mg dose that Healing Pharma offers in packages of 10 tablets per box. The language the FDA quoted from ivermectin4covid’s site is a word-for-word restatement of language in Healing Pharma’s description of the product.
The FDA letter states that that while approved versions of ivermectin are available in the U.S., the Iverheal 12 mg product from Healing Pharma is not one of them. The agency also said approved versions of ivermectin are for treating parasitic infections, and they are available only by prescription.

“In addition, ivermectin has not been approved by FDA for use in the prevention, diagnosis, treatment, mitigation, or cure of COVID-19,” the warning letter stated.

The letter tells the company to review its website, labels, and promotional materials to ensure that they do not misleadingly represent products as safe and effective for uses that are not approved by the FDA. Furthermore, the company is directed to respond to the FDA within 48 hours with an email describing the steps it has taken to address violations and to prevent their recurrence.

The ivermectin4covid website now shows a single page stating it has been temporarily suspended according to guidance by the FDA. An archived version shows it was also selling hydroxychloroquine in packages of 100 tablets per box. According to a check of the website on hostingchecker.com, ivermectin4covid.com is hosted in Singapore by DigitalOcean, a New York-based company that operates data centers across the world.

Ivermectin traces its origins to Japan, where scientists isolated a microorganism from a soil sample in the 1970s, according to a 2011 paper published in Proceedings of the Japan Academy, Series B. This microorganism was found to have properties useful in killing internal and external parasites. A partnership between Kitasato Institute in Japan and pharmaceutical giant Merck led to the development of broad-spectrum antiparasitic agents called avermectins.

Ivermectin is a semisynthetic antiparasitic derived from avermectin and made for oral dosing.

Merck brought the product to market under the name Stromectal. Though patents on this product have long expired and generic versions are widely available, Merck still sells Stromectal. In 2021, during the height of the pandemic, the company reiterated that preclinical and clinical research found no scientific basis for using ivermectin to treat Covid-19.
Well-controlled scientific studies continue to show that ivermectin does not help in the treatment of Covid-19. A randomized, placebo-controlled study that enrolled more than 1,500 U.S. patients when the delta and omicron variants were dominant found that ivermectin did not significantly improve the time to recovery from mild-to-moderate Covid-19. The peer-reviewed results were published last October in the Journal of the American Medical Association.

New Coronavirus News from 21 Mar 2023

FDA Warning Letter Issued to Website Purveying Ivermectin Pills for Covid-19 [MedCity News, 21 Mar 2023]

By FRANK VINLUAN

The FDA has issued a warning letter to a website that has been selling the antiparasitic drug ivermectin as a treatment for Covid-19. The correspondence directs the company to stop selling its products and correct any misleading language in its marketing material.

A website that markets ivermectin as a Covid-19 treatment has run afoul of the FDA. The agency issued a warning letter notifying the site that it is selling unapproved and misbranded products over the internet to consumers in the U.S.

The warning letter, dated March 16, was posted by the FDA on Tuesday. According to the agency, the website ivermectin4covid.com stated: “Ivermectin (Iverheal 12) is an antiparasitic, and also an antiviral drug manufactured by Healing Pharma. It is used to kill the parasites in the body. It is also useful in Covid 19 care.”

Iverheal12 is a generic version of ivermectin manufactured by Healing Pharma, a Mumbai, India-based generic medicines company. The drug is a 12 mg dose that Healing Pharma offers in packages of 10 tablets per box. The language the FDA quoted from ivermectin4covid’s site is a word-for-word restatement of language in Healing Pharma’s description of the product.
The FDA letter states that that while approved versions of ivermectin are available in the U.S., the Iverheal 12 mg product from Healing Pharma is not one of them. The agency also said approved versions of ivermectin are for treating parasitic infections, and they are available only by prescription.

“In addition, ivermectin has not been approved by FDA for use in the prevention, diagnosis, treatment, mitigation, or cure of COVID-19,” the warning letter stated.

The letter tells the company to review its website, labels, and promotional materials to ensure that they do not misleadingly represent products as safe and effective for uses that are not approved by the FDA. Furthermore, the company is directed to respond to the FDA within 48 hours with an email describing the steps it has taken to address violations and to prevent their recurrence.

The ivermectin4covid website now shows a single page stating it has been temporarily suspended according to guidance by the FDA. An archived version shows it was also selling hydroxychloroquine in packages of 100 tablets per box. According to a check of the website on hostingchecker.com, ivermectin4covid.com is hosted in Singapore by DigitalOcean, a New York-based company that operates data centers across the world.

Ivermectin traces its origins to Japan, where scientists isolated a microorganism from a soil sample in the 1970s, according to a 2011 paper published in Proceedings of the Japan Academy, Series B. This microorganism was found to have properties useful in killing internal and external parasites. A partnership between Kitasato Institute in Japan and pharmaceutical giant Merck led to the development of broad-spectrum antiparasitic agents called avermectins.

Ivermectin is a semisynthetic antiparasitic derived from avermectin and made for oral dosing.

Merck brought the product to market under the name Stromectal. Though patents on this product have long expired and generic versions are widely available, Merck still sells Stromectal. In 2021, during the height of the pandemic, the company reiterated that preclinical and clinical research found no scientific basis for using ivermectin to treat Covid-19.

Well-controlled scientific studies continue to show that ivermectin does not help in the treatment of Covid-19. A randomized, placebo-controlled study that enrolled more than 1,500 U.S. patients when the delta and omicron variants were dominant found that ivermectin did not significantly improve the time to recovery from mild-to-moderate Covid-19. The peer-reviewed results were published last October in the Journal of the American Medical Association.

New Coronavirus News from 27 Feb 2023

High-dose ivermectin does not reduce COVID-19 symptom duration among mild-to-moderate outpatients [News-Medical.Net, 27 Feb 2023]

By Pooja Toshniwal Paharia

In a recent study published in JAMA, researchers evaluate the efficacy of ivermectin in a maximum dosage of 600 μg/kg/day over six days in treating early mild-to-moderate coronavirus disease 2019 (COVID-19).

Background
The continual emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with greater transmissibility and immune evasiveness has threatened the efficacy of COVID-19 vaccines and therapeutic agents such as antiviral drugs and monoclonal antibodies. As a result, research is needed to identify new drugs with anti-SARS-CoV-2 activity.

It remains unknown whether a daily dose of ivermectin 600 μg/kg can reduce the duration of symptoms or prevent hospital admissions in individuals with mild-to-moderate SARS-CoV-2 infections in outpatient settings.

About the study
In the present accelerating COVID-19 therapeutic interventions and vaccines 6 (ACTIV-6) randomized controlled trial, researchers investigate whether 600 μg/kg/day of ivermectin for six days reduces the duration of symptoms among individuals with symptomatic mild-to-moderate SARS-CoV-2 infection in outpatient settings.

In the ongoing, national, double-blinded, randomized, decentralized, and placebo-controlled clinical trial investigating repurposed drugs for treating individuals with mild or moderate SARS-CoV-2 infections 1,206 confirmed-SARS-CoV-2-positive individuals 30 years or older who experienced at least two acute symptoms for less than one week were recruited across 93 sites throughout the U.S.

Individuals were recruited between February 16, 2022, and July 22, 2022, and followed up through November 10, 2022. COVID-19 diagnosis was confirmed by polymerase chain reaction (PCR) assay or SARS-CoV-2 antigen testing, including at-home tests.

In the analysis, 602 participants received ivermectin at a maximum dosage of 600 μg/kg/day, whereas 604 individuals received a placebo daily for six days. The prime study outcome was the duration of sustained COVID-19 recovery or at least three successive and asymptomatic days.

Secondary study outcomes included hospital admissions, deaths, or emergency department visits by COVID-19 outpatients through week four. The team excluded individuals who were hospitalized, consumed ivermectin within the two previous weeks, or had known contraindications or allergies to ivermectin.

The other study drug under investigation during the period was fluvoxamine. Proportional hazards regression modelling was performed and the hazard ratios (HR) were calculated.

Ivermectin was supplied in bottles comprising 7.0 mg tablets to participants’ homes.

Dosing schedules were based on participants’ weight. Participants were asked to complete daily assessments and report adverse events through week two.

Self-documented data were obtained on individual demographics including age, sex, body mass index (BMI), race, ethnicity, history of medical diseases, concomitant medications, COVID-19 symptoms, the status of vaccination, and responses to questionnaires distributed for assessing the quality of life.

Study findings
Among the study participants, 59% were female with a median age of 48 years and 84% were fully vaccinated against COVID-19. In both groups, the median duration for sustained recovery from COVID-19 was 11 days.

The median dose of ivermectin was 498 μg/kg/day. In the large vaccinated outpatient population, the posterior probability for benefit using ivermectin was 0.7 for the primary outcome of time to COVID-19 recovery. The posterior probability of reduction of COVID-19 symptom duration by one or more days using ivermectin was less than 0.10% with an HR value of 1.0.

Among ivermectin-treated individuals, 6% were admitted to hospitals, died, or visited the emergency department as compared to 36 placebo-treated individuals with an HR 1.0. Among ivermectin-treated individuals, four were hospitalized and one died. The number of corresponding individuals was two and zero among placebo-treated individuals.

The team did not commonly observe adverse events in any group. Adverse events documented more than two times following ivermectin treatment included cognitive impairments, blurring of vision, increased sensitivity to light, dizziness, asthma, and photophobia. The death of an ivermectin-treated individual was documented as occurring by accident and was not associated with COVID-19 or ivermectin use.

The difference in the duration spent feeling sick due to COVID-19 was estimated as three hours and 20 minutes faster with ivermectin as compared to the placebo. The COVID-19 clinical progression scale scores at weeks one, two, and four could not meet predetermined threshold values for therapeutic benefit from ivermectin.

Conclusions
Overall, the study findings showed that ivermectin at a maximum dose of 600/μg/kg/day treatment for six days did not reduce the duration of sustained COVID-19 recovery among mild-to-moderate outpatients with SARS-CoV-2 Omicron variant infections. Taken together, these data do not support the use of in treating individuals with mild-to-moderate SARS-CoV-2 infections.

Journal reference:
• Naggie, S., Boulware, D. R., Lindsell, C. J., et al. (2023). Effect of Higher-Dose Ivermectin for 6 Days vs Placebo on Time to Sustained Recovery in Outpatients With COVID-19 A Randomized Clinical Trial. JAMA. doi:10.1001/jama.2023.1650.

New Coronavirus News from 6 Oct 2021

Ivermectin: How false science created a Covid 'miracle' drug [BBC News, 6 Oct 2021]

By Rachel Schraer & Jack Goodman

Ivermectin has been called a Covid "miracle" drug, championed by vaccine opponents, and recommended by health authorities in some countries. But the BBC can reveal there are serious errors in a number of key studies that the drug's promoters rely on.

For some years ivermectin has been a vital anti-parasitic medicine used to treat humans and animals.

But during the pandemic there has been a clamour from some proponents for using the drug for something else - to fight Covid and prevent deaths.

The health authorities in the US, UK and EU have found there is insufficient evidence for using the drug against Covid, but thousands of supporters, many of them anti-vaccine activists, have continued to vigorously campaign for its use.

Members of social media groups swap tips on getting hold of the drug, even advocating the versions used for animals.

The hype around ivermectin - based on the strength of belief in the research - has driven large numbers of people around the world to use it.

Campaigners for the drug point to a number of scientific studies and often claim this evidence is being ignored or covered up. But a review by a group of independent scientists has cast serious doubt on that body of research.

The BBC can reveal that more than a third of 26 major trials of the drug for use on Covid have serious errors or signs of potential fraud. None of the rest show convincing evidence of ivermectin's effectiveness.

Dr Kyle Sheldrick, one of the group investigating the studies, said they had not found "a single clinical trial" claiming to show that ivermectin prevented Covid deaths that did not contain "either obvious signs of fabrication or errors so critical they invalidate the study".

Major problems included:
• The same patient data being used multiple times for supposedly different people
• Evidence that selection of patients for test groups was not random
• Numbers unlikely to occur naturally
• Percentages calculated incorrectly
• Local health bodies unaware of the studies

The scientists in the group - Gideon Meyerowitz-Katz, Dr James Heathers, Dr Nick Brown and Dr Sheldrick - each have a track record of exposing dodgy science. They've been working together remotely on an informal and voluntary basis during the pandemic.

They formed a group looking deeper into ivermectin studies after biomedical student Jack Lawrence spotted problems with an influential study from Egypt. Among other issues, it contained patients who turned out to have died before the trial started. It has now been retracted by the journal that published it.

The group of independent scientists examined virtually every randomised controlled trial (RCT) on ivermectin and Covid - in theory the highest quality evidence - including all the key studies regularly cited by the drug's promoters.

RCTs involve people being randomly chosen to receive either the drug which is being tested or a placebo - a dummy drug with no active properties.

The team also looked at six particularly influential observational trials. This type of trial looks at what happens to people who are taking the drug anyway, so can be biased by the types of people who choose to take the treatment.

Out of a total of 26 studies examined, there was evidence in five that the data may have been faked - for example they contained virtually impossible numbers or rows of identical patients copied and pasted.

In a further five there were major red flags - for example, numbers didn't add up, percentages were calculated incorrectly or local health bodies weren't aware they had taken place.

On top of these flawed trials, there were 14 authors of studies who failed to send data back. The independent scientists have flagged this as a possible indicator of fraud.

The sample of research papers examined by the independent group also contains some high-quality studies from around the world. But the major problems were all in the studies making big claims for ivermectin - in fact, the bigger the claim in terms of lives saved or infections prevented, the greater the concerns suggesting it might be faked or invalid, the researchers discovered.

While it's extremely difficult to rule out human error in these trials, Dr Sheldrick, a medical doctor and researcher at the University of New South Wales in Sydney, believes it is highly likely at least some of them may have been knowingly manipulated.

A recent study in Lebanon was found to have blocks of details of 11 patients that had been copied and pasted repeatedly - suggesting many of the trial's apparent patients didn't really exist.

The study's authors told the BBC that the "original set of data was rigged, sabotaged or mistakenly entered in the final file" and that they have submitted a retraction to the scientific journal which published it.

Another study from Iran seemed to show that ivermectin prevented people dying from Covid.
But the scientists who investigated it found issues. The records of how much iron was in patients' blood contained numbers in a sequence that was unlikely to come up naturally.

And the patients given the placebo turned out to have had much lower levels of oxygen in their blood before the trial started than those given ivermectin. So they were already sicker and statistically more likely to die.

But this pattern was repeated across a wide range of different measurements. The people with "bad" measurements ended up in the placebo group, the ones with "good" measurements in the ivermectin group.

The likelihood of this happening randomly across all these different measurements was vanishingly small, Dr Sheldrick said.

Dr Morteza Niaee, who led the Iran study, defended the results and the methodology and disagreed with problems pointed out to him, adding that it was "very normal to see such randomisation" when lots of different factors were considered and not all of them had any bearing on participants' Covid risk.

But the Lebanon and Iran trials were excluded from a paper for Cochrane - the international experts in reviewing scientific evidence - because they were "such poorly reported studies".

The review concluded there was no evidence of benefit for ivermectin when it comes to Covid.
The largest and highest quality ivermectin study published so far is the Together trial at the McMaster University in Canada. It found no benefit for the drug when it comes to Covid.

Calls over suspected ivermectin poisonings in the US have increased a lot but from a very small base (435 to 1,143 this year) and most of these cases were not serious. Patients have had vomiting, diarrhoea, hallucinations, confusion, drowsiness and tremors.

But indirect harm can come from giving people a false sense of security, especially if they choose ivermectin instead of seeking hospital treatment for Covid, or getting vaccinated in the first place.

Dr Patricia Garcia, a public health expert in Peru, said at one stage she estimated that 14 out of every 15 patients she saw in hospital had been taking ivermectin and by the time they came in they were "really, really sick".

Large pro-ivermectin Facebook groups have turned into forums for people to find advice on where to buy it, including preparations meant for animals.

Some groups regularly contain posts about conspiracy theories of ivermectin cover-ups, as well as pushing anti-vaccine sentiment or encouraging patients to leave hospital if they aren't getting the drug.

The groups often provide a gateway to more fringe communities on the encrypted app Telegram.

These channels have co-ordinated harassment of doctors who fail to prescribe ivermectin and abuse has been aimed at scientists. Dr Andrew Hill, from the University of Liverpool, wrote an influential positive review of ivermectin, originally saying the world should "get prepared, get supplies, get ready to approve [the drug]".

Now he says the studies don't stand up to scrutiny - but after he changed his view, based on new evidence emerging, he received vicious abuse.

A small number of qualified doctors have had an exaggerated influence on the ivermectin debate. Noted proponent Dr Pierre Kory's views have not changed despite the major questions over the trials. He criticised "superficial interpretations of emerging trials data".

Dr Tess Lawrie - a medical doctor who specialises in pregnancy and childbirth - founded the British Ivermectin Recommendation Development (Bird) Group.

She has called for a pause to the Covid-19 vaccination programme and has made unsubstantiated claims implying the Covid vaccine had led to a large number of deaths based on a common misreading of safety data.

When asked during an online panel what evidence might persuade her ivermectin didn't work she replied: "Ivermectin works. There's nothing that will persuade me." She told the BBC: "The only issues with the evidence base are the relentless efforts to undermine it."

Around the world it was originally not opposition to vaccines but a lack of them that led people to ivermectin.

The drug has at various points been approved, recommended or prescribed for Covid in India, South Africa, Peru and much of the rest of Latin America, as well as in Slovakia.

Health authorities in Peru and India have stopped recommending ivermectin in treatment guidelines.

In February, Merck - one of the companies that makes the drug - said there was "no scientific basis for a potential therapeutic effect against Covid-19".

In South Africa, the drug has become a battleground - doctors point out the lack of evidence but many patients desperately want access as the vaccine rollout has been patchy and problematic. One GP in the country described a relative, a registered nurse, who didn't book a coronavirus vaccine she was eligible for and then caught the virus.

"When she started getting worse, instead of getting proper assessment and treatment, she treated herself with ivermectin," she said.

"Instead of consulting a doctor, she continued with the ivermectin and got home oxygen. By the time I heard how low her oxygen saturation levels were (66%), I begged her daughter to take her to casualty.

"At first they were reluctant, but I convinced them to go. She passed away a few hours later."
Additional reporting by Shruti Menon