Arizona doctors wary of ivermectin treatment for COVID-19

PHOENIX – As the first wave of the pandemic picked up speed in Arizona in the spring of 2020, Juan and Rosa Aguirre heard that doctors in Mexico were prescribing a medicine thought to prevent and cure COVID-19. 

Like countless other American citizens, the Aguirres, who were both 57 and lived in Nogales, Arizona, crossed into Mexico to obtain and fill prescriptions. They brought back antibiotics, steroids, and the alleged COVID-19 miracle cure—ivermectin, a medicine approved by the Food and Drug Administration to kill certain intestinal worms and head lice in humans. 

The FDA has also approved the medicine as an antiparasitic for veterinary use. It comes in liquids, pastes and tablets for various animals, including heartworm chewables for dogs and apple-flavored dewormer paste for horses. 

Medical experts contend there isn’t yet enough credible science to justify using ivermectin as an off-label prevention or treatment for COVID-19. And some doctors warn there are risks to taking the drug, which can cause dangerous side effects. They’re especially concerned about people self-medicating with ivermectin formulated for animals. 

The FDA does not approve ivermectin formulated for either humans or animals to prevent or treat COVID-19. The National Institutes of Health in January issued guidelines that said, absent rigorous scientific studies, the NIH cannot “recommend either for or against the use of ivermectin for the use of COVID-19.”  

Merck & Co. Inc., which manufactures ivermectin for humans under the brand name Stromectol, on Feb. 4 released a statement saying there is “no scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies,” adding there is “a concerning lack of safety data in the majority of studies.”

The Arizona chapter of the Association of American Physicians and Surgeons on Jan. 26 sent a letter to Gov. Doug Ducey asking him to make the controversial medicineimmediately available” to the state’s high risk populations, like prisoners and nursing home residents. Dr. Jane Orient, a Tucson physician and executive director of the AAPS, said she prescribes ivermectin to her patients for COVID-19.  

The governor’s office, meanwhile, has passed the AAPS letter to the Arizona Department of Health Services for review, said C.J. Karamargin, the governor’s spokesman.

The state health department refers questions regarding guidance for COVID-19 treatments to federal health agencies, ADHS spokeswoman Holly Poynter wrote in an email. “Currently, there is not an emergency use authorization for ivermectin in the U.S. to prevent or treat coronavirus or COVID-19,” she wrote. 

In a time of distrust of public health agencies and skepticism over government-approved vaccines, it’s not clear how many Arizonans are taking ivermectin to prevent or treat  COVID-19. But heightened controversy over the medicine is sweeping through the state at the very time health officials struggle to get residents vaccinated, new and more potent strains of the virus loom and Arizona battles an unprecedented wave of the virus. The Arizona Department of Health Services reports the state is nearing 800,000 coronavirus infections since the pandemic began in 2020, with nearly 14,000 Arizonans dying from the virus as of early February 2021.

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Juan Aguirre and his wife Rosa ended up contracting coronavirus in June 2020. They think they were infected by their asymptomatic grandson, and immediately began taking the medicines they’d obtained in Mexico, including the ivermectin. Aguirre suffered intense fatigue, chest congestion and muscle aches, but recovered after a week. Rosa had a high fever and a paralyzing headache for several days. She recovered less quickly, with lingering side effects that eventually went away. 

Aguirre understands ivermectin might have had no impact on his recovery. It could have been any of the medicines he’d taken. Or none. Maybe the virus simply ran its course. 

Still, he can’t shake the feeling the ivermectin helped. He had been so sick and desperate, Aguirre said, if he hadn’t purchased the ivermectin pills for humans, he probably would have resorted to taking the veterinary medicine. 

Horse dewormer “incredibly risky” for humans

The ivermectin controversy gained heft in Arizona when a Wisconsin pulmonologist, Pierre Kory, told a Senate Homeland Security and Governmental Affairs Committee in December 2020  that mountains of data from around the world support ivermectin’s “miraculous impact” as a preventative and healing agent of COVID-19. 

“If you take it you will not get sick,” Kory said. 

The message reached into conspiracy-theory-tinged corners of the internet, including the recently deplatformed social media site Parler. 

Facebook has scrubbed some ivermectin posts and labeled others as misinformation. “Since COVID-19 was declared a global health emergency last January, we’ve removed misinformation about the pandemic that could contribute to imminent physical harm – including false claims about cures and treatments,” Kevin McAlister, a Facebook spokesman, wrote in an email. 

Arizona Sen. Nancy Barto, a Republican from Phoenix who chairs the Senate Health and Human Services Committee, has posted positive information about ivermectin on Twitter. “Doctors shouldn’t have to wait for national experts to give them permission to save lives when they have good evidence to believe they can make a positive difference in the lives of their patients,” Barto wrote in an email. 

It can be dangerous when those without medical backgrounds seek treatment information online, said Dr. Ross Goldberg, president of the Arizona Medical Association. He said people can hurt themselves when they self-prescribe.

There’s no telling how many Arizonans are taking the medicine now. Ivermectin for humans can be prescribed off-label by Arizona doctors like Jane Orient, or online in telehealth sites. The ivermectin veterinary medicine, which has not been tested on humans, can be purchased online or in feed stores.

“I understand that people are scared and people are anxious and COVID-19 fatigue is setting in, and I empathise with all that, but I am not a policy maker” said Dr. Aditya Shah, a physician and infectious disease expert at the Mayo Clinic in Rochester, Minnesota.

Still, Shah said, most studies purporting that ivermectin is safe and effective in treating COVID-19 patients lack scientific rigor.  

Even one dose of ivermectin can cause troubling side effects, Shah said. They can include rashes, joint pain, enlargement of lymph nodes, elevated heart rate, low blood pressure, nausea, and effects on liver and kidney function. A little less than 1 percent and as many as 10 percent (depending on the side effect) of people who take ivermectin experience side effects, he said. 

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Taking veterinary ivermectin, like horse dewormer, is “incredibly risky,” he added. And it sets patients up to have “hospital admission with life threatening side effects like liver failure, cardiovascular side effects and allergy issues.” 

Ivermectin users also may be putting others at risk. If they aren’t following public health safety guidelines and take ivermectin to prevent or treat COVID-19, Shah said, they may wrongly assume they are protected from infection. If they are asymptomatic, they could infect others. 

Dr. Daniel Derksen, a physician and the director of the Arizona Center for Rural Health at the University of Arizona, where he is also a professor, said he’s puzzled “that some individuals and a few health providers are skeptical about the Pfizer and Moderna vaccines but are so gung-ho on ivermectin.” 

“We saw this previously with hydroxychloroquine,” he said, “which has been strongly discouraged by the CDC [Centers for Disease Control] and the scientific community for COVID-19.”

Waiting for the vaccine 

Arizona’s Dr. Jane Orient also spoke before the senate committee in December 2020. In a phone call, she maintains ivermectin for humans is a safe, effective medicine that has been taken by millions of people. Studies around the world, she said, provide evidence of the medicine’s efficacy in treating COVID-19 patients. 

“People are dying,” she said. “The drug has a positive effect. However, the public health authorities have been extremely negative.”  

If people are taking horse dewormer paste to prevent or cure COVID-19, she said, it’s probably because they’ve been denied ivermectin prescriptions by their doctors. But she warns some animal dewormers are “poisonous to humans.” 

“So if you’re going to resort to veterinary medicine make sure you know what’s in it,” Orient said.

As for Juan and Rosa Aguirre, they’re just counting the days until they can get vaccinated.

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