No Agenda Episode 1379 - "Afghaniscam"

  No Agenda Episode 1379 - "Afghaniscam"
    "Afghaniscam"
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  Credits
    "Afghaniscam"
    Executive Producers:
      Sir Emiloseph
      Anonymous
      Sir Kevin of the Burning River
      Nessworks
      William Ackermann
      Alexa Delgado
      Lee North
      Grand Duke Thomas Nussbaum
      Tylan Selby
      Isaac Barnes
      Alex McIntyre
    Associate Executive Producers:
      jacob long
      Sir Otaku, Duke of NE Texas and the Red River Valley K5VZ
      Terry Niebeling
      Sir Ever of the What
      Kevin Matz
      Sir C A H
      Alex Salahshour
      Bill Walsh
    1379 Club Members:
    Become a member of the 1380 Club, support the show here
    Boost us with with Podcasting 2.0 Certified apps: Podfriend - Breez - Sphinx - Podstation - Curiocaster - Fountain
    Title Changes
      Dame Acara of Campton Hills-> Baroness of Campton Hills
    Knights & Dames
      Erin Torrelio -> Dame Erin the Breastfeeding Mom
      Joseph Heister -> Sir Emiloseph
    Art By: Darren O'Neill
    End of Show Mixes: Neal Jones - Sound Guy Steve
    Engineering, Stream Management & Wizardry
      Mark van Dijk - Systems Master
      Ryan Bemrose - Program Director
    Back Office Aric Mackey
    Chapters: Dreb Scott
    Clip Custodian: Neal Jones
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  Cover Art
    Art By: Darren O'Neill
  Shownotes
    Party with the School Teacher
      My New Rain Stick Black Rain Ordinance AR15
      SB8 and SB3
      Deputizing
        The bounties are horseshit. Must SUE
      Loophole
      Markup
      Supreme court did not TAKE the case
      A Closer Look at the Text of the Texas Abortion Prohibition and Its Unusual Provisions
        There is an exception for "medical emergency."
      Anti-Abortion Whistleblowing Site Gets New Home With Provider Known for Hosting Right-Wing Extremists
      Abortion ok if executions broadcast on TV
    Occult Fan's Analysis of my birthday
      Hey Adam ~
      I just realized your birthday takes place during the auspices of the 33rd Angel in the Shem HaMephorash. This Angel reigns over Virgo 10° to 14°, where, at least this year, your birthday will be taking place.
      This Angel is known as Iehuiah or alternately Yehuiah. They are associated with "Submission to a higher order. Identifies traitors and destroys their plans."
      Seems fitting to say the least.
      Hence a great show today!
      Warmest showday wishes,
      Angelic Sir Nathan Lee
      🌺🦁🌴
    My Plan:
      We hay have to call on The Dudes named Ben and Bernadette
      Take down media websites and transmissions, including satellite
      Take over Hospital management and start treating
      Take over School Boards
    Megyn Kelly 'New' Show on SiriusXM hmmm
    Saturn Lizards BOTG Homeless in Austin
      Happy birthday Adam Curry! (Belated) I hope you had a good time and got (are you high?)
      I still laugh about that. When you asked me if I was high. That cracked me up! I was in Austin for few weeks. I flew back to Jersey to spend time with my daughter, then I'm going to Colorado to camp and get high Rocky mountain high. And possibly crash my airplane into the ocean. I'm meeting up with a friend I made in Austin and he's going to travel thru Colorado with me. This dude looks like Tommy Chong but with a lazy eye. He even sounds like him. People we're even calling us Cheech and Chong. Too funny! I didn't like Austin. I slept in the streets. That's no big deal because I'm used to it. But I didn't feel safe. I was hanging out with this other dude named Izzy and he told me he kept getting mugged and jumped when he first got there. It seems like the homeless don't mess around with the tech fake liberals with money but they have no problem fucking with new homeless people. Or robbing them. I saw no interaction between the two. It's two separate worlds. I noticed those phoney liberals will walk right past you and make comments. But they won't look at you when they do. These two guys walked past me and one of them said "everyone is pissed off they're turning that hotel into a place for the homeless" He looked pissed off about it himself. Austin's has the worst homeless situation I've ever seen in all of my travels. I'm sure you know. I noticed a lot of them were high and psychotic. I only see that from time to time in other places. They watch you to see what you got. Good weed in Austin though! I bought some from the brothers off of 6th Street because they had the good shit! Of course I went back to them. (I was high) I'm never going back to Austin.
      Pfftt... Phoney liberals... They even pretend to like gay cigarettes in Austin... Picture of an ashtray at Austin international airport included...
    Mu Variant name
      Fun fact from crackpot to crackpot: A Mu is a measurement of surface area equaling 666 2/3 meters. 2/3 also=.666.
    New Domains
      www.outbreakinfo.info
      www.covid23.info
      www.covid24.info
      www.sarscov4.com
      www.sarscov4.info
      ************************************************************
      Pete Kokkinis
    ----------------------------------------------------------------------------------------------------------------------------------------
    Immunity as a Service (new business model)
      Israeli Virus czar calls to begin readying for eventual 4th vaccine dose
      The Snake-Oil Salesmen and the COVID-Zero Con: A Classic Bait-And-Switch for a Lifetime of Booster Shots (Immunity as a Service)
      Pharma wants to Bypass doctors all together
      Pfizer FDA approval signed by Mary A. Malarkey Director
      CDC/FDA smoking gun of smoking guns
        They confess: they had no virus when they concocted the test for the virus; they “contrived” a model by pretending to find what they wanted to find; it’s called a self-fulfilling prophecy
        This is the con and the crime that drove millions of lives, and economies, into ruin
        Link
      Government expects Chris Whitty to green light vaccines despite JCVI experts' refusal to back mass immunisation for 12 to 15-year-olds
      Biden's high-stakes booster tension with Moderna
        A disagreement between the Biden administration and Moderna over booster shot details has thrown a wrench in the administration's plans, and may result in the booster effort beginning with only some Pfizer recipients later this month.
        Why it matters: How the dispute shakes out could have implications for the global vaccine supply chain — as well as for Moderna's bottom line.
        State of play: Moderna completed its booster dose submission with the FDA yesterday, asking the agency to evaluate the authorization of a third shot of the vaccine.
        But the company's submission was for a 50-microgram dose, or half of the dose included in the first two shots.
        The Biden administration wants to see data for boosting with 100 micrograms as well. The FDA needs both datasets to evaluate what elicits a more durable immune response, a senior Biden administration official told Axios.
        The big picture: The Biden administration's booster effort is already under fire for getting ahead of the data and for poor messaging.
        The administration argues that it doesn't have any time to lose when it comes to staying ahead of the virus.
        Between the lines: If Moderna booster shots are a half-dose of the original level, that vastly expands the company's global supply overnight.
        That means more shots would be available around the world. But it also means Moderna could make a lot more money.
        “FDA has requested Moderna to submit both. Moderna’s focused only on its 50. Yes, that increases supply, but it’s also in its economic interests," the senior administration official said.
        Link
      3 vaccine for nursing homes in Denmark
        From next week (week 36) old people in nursing homes in Denmark will start getting the 3 vaccine. And as I understand the workers at the nursing homes will soon after be offered the same. It is the union FOA that fought for it, so they could get it.
      Vaxx Definition to immunization
      ‘This is life from now on’: Israel’s coronavirus czar warns people to prepare for a ‘fourth injection’ of Covid vaccine
    Ivermectin etc
      Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis,
        and Trial Sequential Analysis to Inform Clinical Guidelines
      Instagram massive purge of functional medicine accounts including vaccine insert shots
      India Could Sentence WHO Chief Scientist to Death for Misleading Over Ivermectin and Killing Indians
      Ivermectin for COVID-19: real-time analysis of all 113 studies
      CDC recommends migrants take Ivermectin
      Chloroquine is a potent inhibitor of SARS coronavirus infection and spread | Virology Journal
    Mandates
      Israeli vaccine passport expires after 6 months
      Protesters stormed a French mall without show proof of vaccination
      Google contractors vaxx mandate
        Long story short, Google/YT and contractor Accenture have mandated the vax to work in office by the 7th. For people seeking exemption, including myself, they have asked to fill out a leave of absence request with no further explanation describing what that entails.
        They mentioned accommodations for medical and/or religious reasons but have not said what that would mean. I will keep you posted as this continues to unfold. I have also gotten word that Apple and FB in Austin are mandating the vax as well.
      Anti-Vax Radio Hosts Keep Dying From COVID
      Mandates are easy way to trim staffing
      Blood Donor Study Estimates Over 80% of American Adults Now Have Coronavirus Antibodies
      NSW considers vaccination measures for truckies
      Judge Dismisses Un-vaccinated Jurors
      Sports Rona Report from Prof JJ
        University of Wisconsin (a fairly good team) has their star Linebacker, Leo Chenal, OUT for two weeks.
        Surprise, news report makes NO mention of his MIE (mRNA injection experience).
        But ... we can presume double-jabbed on this:
        (A) in July, 85% of team was double-jabbed; and
        (B ) as of 2021.08.07 - MORE than 85% were doubled tapped.
        (C) maybe 90% (August 19, 2021)
      NSW BOTG Rona app check-ins
        Report #1
          Hey Adam,
          Quick update from the prison state. From my perspective the governments authoritarian 1984 police state has over estimated its ability to track people with covid. My son was identified as a close contact to someone with covid from his day care. The QR code’s we sign in everywhere with haven’t done shit. It took nsw health 4 days to contact me from the “exposure”. They didn’t know his name, my name, what time we were at the day care, where we live, they knew nothing. The integration between nsw health and service nsw who do the tech side of things is very broken from what I can tell. They keep sending me the attached text (with the wrong name in it) for me to click on some link. I’m ignoring to see if they send the fuzz round to check on me.
          At the moment we can’t leave our house for any reason. Not even exercise or groceries. This state is fucked and as soon as this is over we’ll be looking to move somewhere that’s isn’t shit.
          Love your work on the show.
          Cheers
          Steve
        Report #2
          Update: the police came around yesterday to check we are isolating. The cop called me from the car while I was doing a dump. He was not interested in eye balling me to check I was home. He was in uniform but not in a police car, he was being driven around in a Sydney trains vehicle for some reason. The impression I got was he was ticking the box to say that he checked on me but really didn’t give a shit. Again, he knew nothing only my phone number and the incorrect name they had for my son. More theatre. So the limit is 3 ignored texts from NSW Heath.
      The Oz Rona app
      Sweden bans travelers from Israel, one of the most vaccinated countries in the world, into the country from September 6 due to the record-breaking rise in #COVID19 cases.
      Cases of polio-like illness may increase among children, CDC warns
    Supply Chains and Human Resources
      45 minute wait at Whataburger - no people!
    BLM LGBBTQQIAAP2 Noodle Gun
      Tim Cook gets letter from Apple employees demanding changes
        The second demand calls for the company to "provide transparent livable, equitable, and fair compensation across all of Apple," in part by auditing "all promotions and performance reviews for gender, racial, disability, and heteronormative biases that may lead to wage gaps and a lack of opportunity and compensation within the company in each part of it." The workers further asked that Apple "provide a transparent feedback loop into how these issues will be addressed long-term within the scope of Inclusion & Diversity."
      Jamaica calls LGBT flag at US Embassy Cultural Imperialism
      The 6 Pre-approved Social Justice Messages the NFL Will Allow on Helmets This Season
        Players will be able to choose from the following messages for their helmet decal: "End Racism,'' "Stop Hate,'' "It Takes All of Us,'' "Black Lives Matter,'' "Inspire Change'' and "Say Their Stories.''
        Additionally, the phrases, “End Racism” and “It Takes All of Us” will appear in the end zones unless another cause, like the Salute to Service game, is being promoted.
    IDA
      Louisiana resources outside New Orleans. No.workers
    Afghanistan
      The Biden administration apparently wants to make a scapegoat out of the intelligence community
      Sir Onymous explains Afghanis
        Some time ago, about October 2001, I shared how a CNN translation of an Afghani man who said "I will follow the Taliban" actually said "everything I have is in these bags, I will follow whomever feeds me". Most still only have two bags and will follow whomever feeds them. Funny, when we invaded the US military had ZERO Pashto speakers.
        These tribes have provided a "buffer" between empires for generations and completely left alone. The Duran Line even went through individual tribes to make it chaotic. This is not a graveyard of empires but a group of people that remain after each empire departs and know by resisting change, they will outlast every invader.
        So much of this area is tribal, completely isolated, uneducated, illiterate, and practice customs passed down for generations. They have tribal wars, true blood feuds, kill over land disputes and family insults and protect their lifestyle at all costs.
        Most are honorable in their own sense of honor (killing over insults), but certainly some tribal leaders have become enriched beyond measure from Intelligence Agencies. Baluchistan (India), the K in ISIS (Iran), TTP (US to keep the roads open), are not big secrets, and they recruit the poor boys to do their bidding.
        An 18-year old with a wife and child that are literally starving is promised they will be taken care of if he puts on a suicide vest - what are his choices? Cost, about $1,000 - the price of a Kalashnikov.
        Training these men is extremely difficult. They cannot read - so how do you use a "training manual" or have them watch and record license plates or even vehicles? Some could better identify by horse than car. They are raised to be fearless "warriors" in their tribes, yet are mostly young, have never seen a movie, eaten at a restaurant or been with a woman except sisters and mothers.
        We focused on educating the girls and women, yet they marry uneducated men such as these and the next generation returns to these standards.
        It is far more complex that these simple lines, but some things I do know and the western, educated, industrialized, rich and democratic (WEIRD) people do NOT understand.
      White House proposes removing penalties for fentanyl trafficking-related offenses
        The White House on Thursday proposed removing certain penalties associated with trafficking of fentanyl-related substances (FRS), prompting criticism that it would weaken illicit drug enforcement.
        President Biden and former President Trump temporarily placed FRS under schedule I of the Controlled Substances Act. Thursday's proposal would make that change permanent while removing certain quantity-based mandatory minimums.
        In a letter to Senate leaders reviewed by Fox News, the Office of National Drug Control Policy (ONDCP) described the plan as the result of collaboration with the Justice Department (DOJ) and Department of Health and Human Services (HHS).
        "We are pleased to present to Congress a long-term, consensus approach that advances efforts to reduce the supply and availability of illicitly manufactured FRS, while protecting civil rights, and reducing barriers to scientific research for all schedule I substances," said ONDCP acting Director Regina LaBelle.
        Link
      Top defense firms spend $1B on lobbying during Afghan war, see $2T return – Responsible Statecraft
      China will be our main partner, say Taliban
    The Purge
      FB algos --> canning food = Extremism
      Operation Starfall
      Instagram massive purge of functional medicine accounts including vaccine insert shots
      Build Back Better
        Feds Are Reportedly Looking Into Why McDonald's Ice-Cream Machines Are Always Busted
    Mink
      Long Island company shifts COVID-19 vaccine trial focus from cats to mink
        Hard to find a mink that doesn't have it
    OTG
      Amazon to proactively remove more content that violates rules from cloud service
    STORIES
      Google Clock bug means some Android users are sleeping through their alarms | TechRadar
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 23:49
        If the Google Clock app on your Android phone hasn't been sounding off and waking you up for the last few days, you're not alone '' plenty of disgruntled users have reported the bug, which seems to be relatively widespread.
        As reported in several places, including Android Authority, there's now a Reddit thread on the problem, and the app listing on the Google Play Store is getting hit by a lot of one-star reviews that mention alarms not ringing when they should.
        What's not clear is exactly what the bug might be related to: some people's issues seem to be linked with using a Spotify playlist as an alarm, or with their phone's Do Not Disturb settings, but for others that doesn't appear to be the case.
        Google Clock can wake you up with musicThe Pixel 6 is on the wayPick up some of the best Android appsThe problems look to be primarily related to Pixel phones, with a variety of models affected. However, users who have the Google Clock installed on phones from other manufacturers are also chiming in to say they've been affected.
        Can they fix it?Android Police reports that a Reddit post from Google's Pixel Community account mentions a fix: "We've identified a fix and will roll it out soon" reads the message, which also recommends not using Spotify as the alarm sound.
        Using one of the default on-device sounds does appear to solve the issue for some users, but not others. There's also a thread on Issue Tracker about the bug, which states that the product and engineering teams at Google are looking into it.
        With many of us relying on our phones to get up in the morning (or any other time in the day), this is a bigger problem than it might at first appear to be. Google and Spotify do at least look to have worked quickly to figure out what might be happening.
        At the time of writing, we're still waiting on a full fix for the issue to be rolled out. In the meantime, there are plenty of free third-party alarm clock apps for Android on the Google Play Store, which you should be able to use without any issues.
        Here's everything you need to know about Android 12
      U.S. Spies Didn't Cause Kabul to Fall - WSJ
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 13:38
        The Biden administration apparently wants to make a scapegoat out of the intelligence community.
        Biden administration officials may try to blame the U.S. intelligence community for the Afghanistan debacle. The New York Times on Aug. 18 cited an unidentified senior administration official, who claimed that as the situation grew more volatile in July, U.S. intelligence agencies never offered a clear ''high confidence'' prediction of an imminent Taliban takeover. But the role of intelligence in critical national security decisions is to reduce uncertainty, not to provide perfect clarity.
        Intelligence is difficult to collect...
        Advertisement - Scroll to Continue
        Biden administration officials may try to blame the U.S. intelligence community for the Afghanistan debacle. The New York Times on Aug. 18 cited an unidentified senior administration official, who claimed that as the situation grew more volatile in July, U.S. intelligence agencies never offered a clear ''high confidence'' prediction of an imminent Taliban takeover. But the role of intelligence in critical national security decisions is to reduce uncertainty, not to provide perfect clarity.
        Intelligence is difficult to collect and sometimes hard to analyze, especially when considering factors like how a foreign fighting force will react to battlefield pressure. Intelligence isn't perfect'--if it were, it would be called information. It is best used to warn against surprises and to understand developments well enough to avoid adverse consequences. Based on the information made public so far, intelligence failure doesn't appear to be a critical factor in President Biden's policy decisions leading to the Taliban takeover of Afghanistan.
        The U.S. intelligence agencies filed public testimony before Congress in April, five days before Mr. Biden's withdrawal speech, saying that the collapse of the Afghan National Security Forces was possible. ''Kabul continues to face setbacks on the battlefield'' and remains ''tied down in defensive missions,'' according to that assessment. The testimony even said that ''the Afghan government will struggle to hold the Taliban at bay if the coalition withdraws support.'' This should have warned the Biden administration not to make rash policy decisions.
        Mr. Biden was hell-bent on withdrawal. Intelligence gives policy makers an advantage, but it isn't the fault of the intelligence community if policy makers ignore their reports. Many media reports indicate that Mr. Biden rejected options to keep troops in Afghanistan longer because he believed policy makers were being gamed by generals who supported a greater military presence. He dismissed questions about whether the Afghan government would fall. On July 2 he said, ''Look, we were in that war for 20 years. Twenty years. . . . I want to talk about happy things, man.'' His public remarks since the Kabul collapse revealed his firmly rooted desire to withdraw on his timeline without regrets.
        Though it is true the intelligence community at first assessed in April the Afghan National Security Forces could hold off the Taliban for 18 months to two years, cascading failures in the execution of the withdrawal shrunk that timeline. The policy review that led to the April announcement was conducted with the secrecy of the Osama bin Laden raid, and the Biden administration didn't sufficiently consult Congress, the Afghan government or U.S. allies. The April announcement that withdrawal would begin little more than two weeks later was unexpected. Imagine the demoralizing effect the news had on Afghan soldiers. The announcement gave the Taliban momentum and likely caused an increase in desertions among Afghan soldiers. The original withdrawal deadline of Sept. 11 suggested that the White House was motivated by public relations, not concern for the Afghan troops left behind.
        Advertisement - Scroll to Continue
        The intelligence community's job is to gather and analyze the secrets of foreign governments, not our own. As far as the intelligence community knew, Mr. Biden intended to withdraw troops as he said he would: ''responsibly, deliberately, and safely . . . in full coordination with our allies and partners.'' Yet the U.S. pullout from its military installation at Bagram shows the opposite. U.S. troops shut off the electricity and left in the middle of the night, apparently without notifying the base's new Afghan commander. While the U.S. departed stealthily for security reasons, the transfer was poorly executed, and a small army of looters soon invaded the base. The midnight departure made the Afghans feel the U.S. had abandoned them, and it shocked Central Intelligence Agency officials.
        Congress shouldn't let the Biden administration pin its failures on the intelligence community. As the congressional intelligence committees begin their review this fall of the intelligence supplied by the intelligence community to policy makers, they should consider whether the Biden administration's timing, method and execution of the withdrawal contributed to the downfall of the Kabul government. A simple review of whether intelligence assessments proved true would be inadequate. Congress should also look at whether the April 14 pullout announcement made the collapse inevitable. Midnight pullouts, a diplomatic withdrawal, and U.S. commanders returning home before the withdrawal was complete made the situation worse. To focus solely on the intelligence community, so often the scapegoat for policy failures, insults America's 20 years of sacrifice in Afghanistan.
        Mr. Allen served as special assistant to the president and senior director for counteproliferation strategy (2007-09) and majority staff director of the House Intelligence Committee (2011-13). He is author of ''Blinking Red: Crisis and Compromise in American Intelligence After 9/11.''
      Julius Ruechel: The Snake-Oil Salesmen and the COVID-Zero Con: A Classic Bait-And-Switch for a Lifetime of Booster Shots (Immunity as a Service)
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 13:34
        If a plumber with a lifetime of experience were to tell you that water runs uphill, you would know he is lying and that the lie is not accidental. It is a lie with a purpose. If you can also demonstrate that the plumber knows in advance that the product he is promoting with that lie is snake oil, you have evidence for a deliberate con. And once you understand what's really inside that bottle of snake oil, you will begin to understand the purpose of the con.
        One of the most common reasons given for mass COVID vaccinations is the idea that if we reach herd immunity through vaccination, we can starve the virus out of existence and get our lives back. It's the COVID-Zero strategy or some variant of it.
        By now it is abundantly clear from the epidemiological data that the vaccinated are able to both catch and spread the disease. Clearly vaccination isn't going to make this virus disappear. Only a mind that has lost its grasp on reality can fail to see how ridiculous all this has become.
        But a tour through pre-COVID science demonstrates that, from day one, long before you and I had even heard of this virus, it was 100% inevitable and 100% predictable that these vaccines would never be capable of eradicating this coronavirus and would never lead to any kind of lasting herd immunity. Even worse, lockdowns and mass vaccination have created a dangerous set of circumstances that interferes with our immune system's ability to protect us against other respiratory viruses. They also risk driving the evolution of this virus towards mutations that are more dangerous to both the vaccinated and the unvaccinated alike. Lockdowns, mass vaccinations, and mass booster shots were never capable of delivering on any of the promises that were made to the public.
        And yet, vaccination has been successfully used to control measles and even to eradicate smallpox. So, why not COVID? Immunity is immunity, and a virus is a virus is a virus, right? Wrong! Reality is far more complicated... and more interesting.
        This Deep Dive exposes why, from day one, the promise of COVID-Zero can only ever have been a deliberately dishonest shell game designed to prey on a lack of public understanding of how our immune systems work and on how most respiratory viruses differ from other viruses that we routinely vaccinate against. We have been sold a fantasy designed to rope us into a pharmaceutical dependency as a deceitful trade-off for access to our lives. Variant by variant. For as long as the public is willing to go along for the ride.
        Exposing this story does not require incriminating emails or whistleblower testimony. The story tells itself by diving into the long-established science that every single virologist, immunologist, evolutionary biologist, vaccine developer, and public health official had access to long before COVID began. As is so often the case, the devil is hidden in the details. As this story unfolds it will become clear that the one-two punch of lockdowns and the promise of vaccines as an exit strategy began as a cynical marketing ploy to coerce us into a never-ending regimen of annual booster shots intentionally designed to replace the natural "antivirus security updates" against respiratory viruses that come from hugs and handshakes and from children laughing together at school. We are being played for fools.
        This is not to say that there aren't plenty of other opportunists taking advantage of this crisis to pursue other agendas and to tip society into a full-blown police state. One thing quickly morphs into another. But this essay demonstrates that never-ending boosters were the initial motive for this global social-engineering shell game ― the subscription-based business model, adapted for the pharmaceutical industry. "Immunity as a service".
        So, let's dive into the fascinating world of immune systems, viruses, and vaccines, layer by layer, to dispel the myths and false expectations that have been created by deceitful public health officials, pharmaceutical lobbyists, and media manipulators. What emerges as the lies are peeled apart is both surprising and more than a little alarming.
        “Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth.” - Sherlock Homes” ― Sir Arthur Conan Doyle
        Table of Contents:
        Viral Reservoirs: The Fantasy of EradicationSARS: The Exception to the Rule?Fast Mutations: The Fantasy of Control through Herd ImmunityBlind Faith in Central Planning: The Fantasy of Timely DosesSpiked: The Fantasy of Preventing InfectionAntibodies, B-Cells, and T-Cells: Why Immunity to Respiratory Viruses Fades So QuicklyManufacturing Dangerous Variants: Virus Mutations Under Lockdown Conditions — Lessons from the 1918 Spanish FluLeaky Vaccines, Antibody-Dependent Enhancement, and the Marek EffectAnti-Virus Security Updates: Cross-Reactive Immunity Through Repeated ExposureThe Not-So-Novel Novel Virus: The Diamond Princess Cruise Ship Outbreak Proved We Have Cross-Reactive ImmunityMother Knows Best: Vitamin D, Playing in Puddles, and SweatersThe Paradox: Why COVID-Zero Makes People More Vulnerable to Other VirusesIntroducing Immunity as a Service - A Subscription-Based Business Model for the Pharmaceutical Industry (It was always about the money!)The Path Forward: Neutralizing the Threat and Bullet-Proofing Society to Prevent This Ever Happening Again.Viral Reservoirs: The Fantasy of Eradication
        Eradication of a killer virus sounds like a noble goal. In some cases it is, such as in the case of the smallpox virus. By 1980 we stopped vaccinating against smallpox because, thanks to widespread immunization, we starved the virus of available hosts for so long that it died out. No-one will need to risk their life on the side effects of a smallpox vaccination ever again because the virus is gone. It is a public health success story. Polio will hopefully be next ― we're getting close.
        But smallpox is one of only two viruses (along with rinderpest) that have been eradicated thanks to vaccination. Very few diseases meet the necessary criteria. Eradication is hard and only appropriate for very specific families of viruses.
        Smallpox made sense for eradication because it was a uniquely human virus ― there was no animal reservoir. By contrast, most respiratory viruses including SARS-CoV-2 (a.k.a. COVID) come from animal reservoirs: swine, birds, bats, etc. As long as there are bats in caves, birds in ponds, pigs in mud baths, and deer living in forests, respiratory viruses are only controllable through individual immunity, but it is not possible to eradicate them. There will always be a near-identical cousin brewing in the wings.
        Even the current strain of COVID is already cheerfully jumping onwards across species boundaries. According to both National Geographic and Nature magazine, 40% of wild deer tested positive for COVID antibodies in a study conducted in Michigan, Illinois, New York, and Pennsylvania. It has also been documented in wild mink and has already made the species jump to other captive animals including dogs, cats, otters, leopards, tigers, and gorillas. A lot of viruses are not fussy. They happily adapt to new opportunities. Specialists, like smallpox, eventually go extinct. Generalists, like most respiratory viruses, never run out of hosts to keep the infection cycle going, forever.
        As long as we share this planet with other animals, it is extremely deceitful to give anyone the impression that we can pursue any scorched earth policy that can put this genie back in the bottle. With an outbreak on this global scale, it was clear that we were always going to have to live with this virus. There are over 200 other endemic respiratory viruses that cause colds and flus, many of which circulate freely between humans and other animals. Now there are 201. They will be with us forever, whether we like it or not.
        SARS: The Exception to the Rule?
        This all sounds well and good, but the original SARS virus did disappear, with public health measures like contact tracing and strict quarantine measures taking the credit. However, SARS was the exception to the rule. When it made the species jump to humans, it was so poorly adapted to its new human hosts that it had terrible difficulty spreading. This very poor level of adaptation gave SARS a rather unique combination of properties:
        SARS was extremely difficult to catch (it was never very contagious)SARS made people extremely sick.SARS did not have pre-symptomatic spread.
        These three conditions made the SARS outbreak easy to control through contact tracing and through the quarantine of symptomatic individuals. SARS therefore never reached the point where it circulated widely among asymptomatic community members.
        By contrast, by January/February of 2020 it was clear from experiences in China, Italy, and the outbreak on the Diamond Princess cruise ship (more on that story later) that the unique combination of conditions that made SARS controllable were not going to be the case with COVID. COVID was quite contagious (its rapid spread showed that COVID was already well adapted to spreading easily among its new human hosts), most people would have mild or no symptoms from COVID (making containment impossible), and that it was spreading by aerosols produced by both symptomatic and pre-symptomatic people (making contact tracing a joke).
        In other words, it was clear by January/February 2020 that this pandemic would follow the normal rules of a readily transmissible respiratory epidemic, which cannot be reined in the way SARS was. Thus, by January/February of 2020, giving the public the impression that the SARS experience could be replicated for COVID was a deliberate lie - this genie was never going back inside the bottle.
        Fast Mutations: The Fantasy of Control through Herd Immunity
        Once a reasonably contagious respiratory virus begins circulating widely in a community, herd immunity can never be maintained for very long. RNA respiratory viruses (such as influenza viruses, respiratory syncytial virus (RSV), rhinoviruses, and coronaviruses) all mutate extremely fast compared to viruses like smallpox, measles, or polio. Understanding the difference between something like measles and a virus like COVID is key to understanding the con that is being perpetrated by our health institutions. Bear with me here, I promise not to get too technical.
        All viruses survive by creating copies of themselves. And there are always a lot of "imperfect copies" — mutations — produced by the copying process itself. Among RNA respiratory viruses these mutations stack up so quickly that there is rapid genetic drift, which continually produces new strains. Variants are normal. Variants are expected. Variants make it virtually impossible to build the impenetrable wall of long-lasting herd immunity required to starve these respiratory viruses out of existence. That's one of several reasons why flu vaccines don't provide long-lasting immunity and have to be repeated annually ― our immune system constantly needs to be updated to keep pace with the inevitable evolution of countless unnamed "variants."
        This never-ending conveyor belt of mutations means that everyone's immunity to COVID was always only going to be temporary and only offer partial cross-reactive protection against future re-infections. Thus, from day one, COVID vaccination was always doomed to the same fate as the flu vaccine ― a lifelong regimen of annual booster shots to try to keep pace with "variants" for those unwilling to expose themselves to the risk of a natural infection. And the hope that by the time the vaccines (and their booster shots) roll off the production line, they won't already be out of date when confronted by the current generation of virus mutations.
        Genetic drift caused by mutations is much slower in viruses like measles, polio, or smallpox, which is why herd immunity can be used to control these other viruses (or even eradicate them as in the case of smallpox or polio). The reason the common respiratory viruses have such rapid genetic drift compared to these other viruses has much less to do with how many errors are produced during the copying process and much more to do with how many of those "imperfect" copies are actually able to survive and produce more copies.
        A simple virus with an uncomplicated attack strategy for taking over host cells can tolerate a lot more mutations than a complex virus with a complicated attack strategy. Complexity and specialization put limits on how many of those imperfect copies have a chance at becoming successful mutations. Simple machinery doesn't break down as easily if there is an imperfection in the mechanical parts. Complicated high-tech machinery will simply not work if there are even minor flaws in precision parts.
        For example, before a virus can hijack the DNA of a host cell to begin making copies of itself, the virus needs to unlock the cell wall to gain entry. Cellular walls are made of proteins and are coated by sugars; viruses need to find a way to create a doorway through that protein wall. A virus like influenza uses a very simple strategy to get inside ― it locks onto one of the sugars on the outside of the cell wall in order to piggyback a ride as the sugar is absorbed into the cell (cells use sugar as their energy source). It's such a simple strategy that it allows the influenza virus to go through lots of mutations without losing its ability to gain entry to the cell. Influenza's simplicity makes it very adaptable and allows many different types of mutations to thrive as long as they all use the same piggyback entry strategy to get inside host cells.
        By contrast, something like the measles virus uses a highly specialized and very complicated strategy to gain entry to a host cell. It relies on very specialized surface proteins to break open a doorway into the host cell. It's a very rigid and complex system that doesn't leave a lot of room for errors in the copying process. Even minor mutations to the measles virus will cause changes to its surface proteins, leaving it unable to gain access to a host cell to make more copies of itself. Thus, even if there are lots of mutations, those mutations are almost all evolutionary dead ends, thus preventing genetic drift. That's one of several reasons why both a natural infection and vaccination against measles creates lifetime immunity ― immunity lasts because new variations don't change much over time.
        Most RNA respiratory viruses have a high rate of genetic drift because they all rely on relatively simple attack strategies to gain entry to host cells. This allows mutations to stack up quickly without becoming evolutionary dead ends because they avoid the evolutionary trap of complexity.
        Coronaviruses use a different strategy than influenza to gain access to host cells. They have proteins on the virus surface (the infamous S-spike protein, the same one that is mimicked by the vaccine injection), which latches onto a receptor on the cell surface (the ACE2 receptor) ― a kind of key to unlock the door. This attack strategy is a little bit more complicated than the system used by influenza, which is probably why genetic drift in coronaviruses is slightly slower than in influenza, but it is still a much much simpler and much less specialized system than the one used by measles. Coronaviruses, like other respiratory viruses, are therefore constantly producing a never-ending conveyor belt of "variants" that make long-lasting herd immunity impossible. Variants are normal. The alarm raised by our public health authorities about "variants" and the feigned compassion of pharmaceutical companies as they rush to develop fresh boosters capable of fighting variants is a charade, much like expressing surprise about the sun rising in the East.
        Once you got immunity to smallpox, measles, or polio, you had full protection for a few decades and were protected against severe illness or death for the rest of your life. But for fast-mutating respiratory viruses, including coronaviruses, within a few months they are sufficiently different that your previously acquired immunity will only ever offer partial protection against your next exposure. The fast rate of mutation ensures that you never catch the exact same cold or flu twice, just their closely related constantly evolving cousins. What keeps you from feeling the full brunt of each new infection is cross-reactive immunity, which is another part of the story of how you are being conned, which I will come back to shortly.
        Blind Faith in Central Planning: The Fantasy of Timely Doses
        But let's pretend for a moment that a miraculous vaccine could be developed that could give us all 100% sterilizing immunity today. The length of time it takes to manufacture and ship 8 billion doses (and then make vaccination appointments for 8 billion people) ensures that by the time the last person gets their last dose, the never-ending conveyor belt of mutations will have already rendered the vaccine partially ineffective. True sterilizing immunity simply won't ever happen with coronaviruses. The logistics of rolling out vaccines to 8 billion people meant that none of our vaccine makers or public health authorities ever could have genuinely believed that vaccines would create lasting herd immunity against COVID.
        So, for a multitude of reasons, it was a deliberate lie to give the public the impression that if enough people take the vaccine, it would create lasting herd immunity. It was 100% certain, from day one, that by the time the last dose is administered, the rapid evolution of the virus would ensure that it would already be time to start thinking about booster shots. Exactly like the flu shot. Exactly the opposite of a measles vaccine. Vaccines against respiratory viruses can never provide anything more than a temporary cross-reactive immunity "update" ― they are merely a synthetic replacement for your annual natural exposure to the smorgasbord of cold and flu viruses. Immunity as a service, imposed on society by trickery. The only question was always, how long between booster shots? Weeks, months, years?
        Feeling conned yet?
        Spiked: The Fantasy of Preventing Infection
        The current crop of COVID vaccines was never designed to provide sterilizing immunity - that's not how they work. They are merely a tool designed to teach the immune system to attack the S-spike protein, thereby priming the immune system to reduce the severity of infection in preparation for your inevitable future encounter with the real virus. They were never capable of preventing infection, nor of preventing spread. They were merely designed to reduce your chance of being hospitalized or dying if you are infected. As former FDA commissioner Scott Gottlieb, who is on Pfizer’s board, said: "the original premise behind these vaccines were [sic] that they would substantially reduce the risk of death and severe disease and hospitalization. And that was the data that came out of the initial clinical trials.” Every first-year medical student knows that you cannot get herd immunity from a vaccine that does not stop infection.
        In other words, by their design, these vaccines can neither stop you from catching an infection nor stop you from transmitting the infection to someone else. They were never capable of creating herd immunity. They were designed to protect individuals against severe outcomes if they choose to take them - a tool to provide temporary focused protection for the vulnerable, just like the flu vaccine. Pushing for mass vaccination was a con from day one. And the idea of using vaccine passports to separate the vaccinated from the unvaccinated was also a con from day one. The only impact these vaccine passports have on the pandemic is as a coercive tool to get you to roll up your sleeve. Nothing more.
        Antibodies, B-Cells, and T-Cells: Why Immunity to Respiratory Viruses Fades So Quickly
        There are multiple interconnected parts to why immunity to COVID, or any other respiratory virus, is always only temporary. Not only is the virus constantly mutating but immunity itself fades over time, not unlike the way our brains start forgetting how to do complicated math problems unless they keep practicing. This is true for both immunity acquired through natural infection and immunity acquired through vaccination.
        Our immune systems have a kind of immunological memory ― basically, how long does your immune system remember how to launch an attack against a specific kind of threat. That memory fades over time. For some vaccines, like diphtheria and tetanus, that immunological memory fades very slowly. The measles vaccine protects for life. But for others, like the flu vaccine, that immunological memory fades very quickly.
        On average, the flu vaccine is only about 40% effective to begin with. And it begins to fade almost immediately after vaccination. By about 150 days (5 months), it reaches zero.
        Fading immunity after flu shot (Science, April 18th, 2019)
        The solution to this strange phenomenon lies in the different types of immune system responses that are triggered by a vaccine (or by exposure to the real thing through a natural infection). This has big implications for coronavirus vaccines, but I'll get to that in a moment. First a little background information...
        A good analogy is to think of our immune system like a medieval army. The first layer of protection began with generalists - guys armed with clubs that would take a swing at everything - they were good for keeping robbers and brigands at bay and for conducting small skirmishes. But if the attack was bigger, then these generalists were quickly overwhelmed, serving as arrow fodder to blunt the attack on the more specialized troops coming up behind them. Spearmen, swordsmen, archers, calvary, catapult operators, siege tower engineers, and so on. Each additional layer of defense has a more expensive kit and takes ever greater amounts of time to train (an English longbowman took years to build up the necessary skill and strength to become effective). The more specialized a troop is, the more you want to hold them back from the fight unless it's absolutely necessary because they are expensive to train, expensive to deploy, and make a bigger mess when they fight that needs to be cleaned up afterwards. Always keep your powder dry. Send in the arrow fodder first and slowly ramp up your efforts from there.
        Our immune system relies on a similar kind of layered system of defense. In addition to various non-specific rapid response layers that take out the brigands, like natural killer cells, macrophages, mast cells, and so on, we also have many adaptive (specialized) layers of antibodies (i.e. IgA, IgG, IgM immunoglobulin) and various types of highly specialized white blood cells, like B-cells and T-cells. Some antibodies are released by regular B-cells. Others are released by blood plasma. Then there are memory B-cells, which are capable of remembering previous threats and creating new antibodies long after the original antibodies fade away. And there are various types of T-cells (again with various degrees of immunological memory), like natural killer T-cells, killer T-cells, and helper T-cells, all of which play various roles in detecting and neutralizing invaders. In short, the greater the threat, the more troops are called into the fight.
        This is clearly a gross oversimplification of all the different interconnected parts of our immune system, but the point is that a mild infection doesn't trigger as many layers whereas a severe infection enlists the help of deeper layers, which are slower to respond but are much more specialized in their attack capabilities. And if those deeper adaptive layers get involved, they are capable of retaining a memory of the threat in order to be able to mount a quicker attack if a repeat attack is recognized in the future. That's why someone who was infected by the dangerous Spanish Flu in 1918 might still have measurable T-cell immunity a century later but the mild bout of winter flu you had a couple of years ago might not have triggered T-cell immunity, even though both may have been caused by versions of the same H1N1 influenza virus.
        As a rule of thumb, the broader the immune response, the longer immunological memory will last. Antibodies fade in a matter of months, whereas B-cell and T-cell immunity can last a lifetime.
        Another rule of thumb is that a higher viral load puts more strain on your immune defenses, thus overwhelming the rapid response layers and forcing the immune system to enlist the deeper adaptive layers. That's why nursing homes and hospitals are more dangerous places for vulnerable people than backyard barbeques. That's why feedlot cattle are more vulnerable to viral diseases than cattle on pasture. Viral load matters a lot to how easily the generalist layers are overwhelmed and how much effort your immune system has to make to neutralize a threat.
        Where the infection happens in the body also matters. For example, an infection in the upper respiratory tract triggers much less involvement from your adaptive immune system than when it reaches your lungs. Part of this is because your upper respiratory tract is already heavily preloaded with large numbers of generalist immunological cells that are designed to attack germs as they enter, which is why most colds and flus never make it deeper into the lungs. The guys with the clubs are capable of handling most of the threats that try to make through the gate. Most of the specialized troops hold back unless they are needed.
        Catching a dangerous disease like measles produces lifetime immunity because an infection triggers all the deep layers that will retain a memory of how to fight off future encounters with the virus. So does the measles vaccine. Catching a cold or mild flu generally does not.
        From an evolutionary point of view, this actually makes a lot of sense. Why waste valuable resources developing long-lasting immunity (i.e. training archers and building catapults) to defend against a virus that did not put you in mortal danger. A far better evolutionary strategy is to evolve a narrower generalist immune response to mild infections (i.e. most cold and flu viruses), which fades quickly once the threat is conquered, but invest in deep long-term broad-based immunity to dangerous infections, which lasts a very long time in case that threat is ever spotted on the horizon again. Considering the huge number of threats our immune systems face, this strategy avoids the trap of spreading immunological memory too thin. Our immunological memory resources are not limitless - long-term survival requires prioritizing our immunological resources.
        The take-home lesson is that vaccines will, at best, only last as long as immunity acquired through natural infection and will often fade much faster because the vaccine is often only able to trigger a partial immune response compared to the actual infection. So, if the disease itself doesn't produce a broad-based immune response leading to long-lasting immunity, neither will the vaccine. And in most cases, immunity acquired through vaccination will begin to fade much sooner than immunity acquired through a natural infection. Every vaccine maker and public health official knows this despite bizarrely claiming that the COVID vaccines (based on re-creating the S-protein spike instead of using a whole virus) would somehow become the exception to the rule. That was a lie, and they knew it from day one. That should set your alarm bells ringing at full throttle.
        So, with this little bit of background knowledge under our belts, let's look at what our public health officials and vaccine makers would have known in advance about coronaviruses and coronavirus vaccines when they told us back in the early Spring of 2020 that COVID vaccines were the path back to normality.
        From a 2003 study [my emphasis]: "Until SARS appeared, human coronaviruses were known as the cause of 15–30% of colds... Colds are generally mild, self-limited infections, and significant increases in neutralizing antibody titer are found in nasal secretions and serum after infection. Nevertheless, some unlucky individuals can be reinfected with the same coronavirus soon after recovery and get symptoms again."
        In other words, the coronaviruses involved in colds (there were four human coronaviruses before SARS, MERS, and COVID) all trigger such a weak immune response that they do not lead to any long-lasting immunity whatsoever. And why would they if, for most of us, the threat is so minimal that the generalists are perfectly capable of neutralizing the attack.
        We also know that immunity against coronaviruses is not durable in other animals either. As any farmer knows well, cycles of reinfection with coronaviruses are the rule rather than the exception among their livestock (for example, coronaviruses are a common cause of pneumonia and various types of diarrheal diseases like scours, shipping fever, and winter dysentery in cattle). Annual farm vaccination schedules are therefore designed accordingly. The lack of long-term immunity to coronaviruses is well documented in veterinary research among cattle, poultry, deer, water buffalo, etc. Furthermore, although animal coronavirus vaccines have been on the market for many years, it is well known that "none are completely efficacious in animals". So, like the fading flu vaccine profile I showed you earlier, none of the animal coronavirus vaccines are capable of providing sterilizing immunity (none were capable of stopping 100% of infections, without which you can never achieve herd immunity) and the partial immunity they offered is well known to fade rather quickly.
        What about immunity to COVID's close cousin, the deadly SARS coronavirus, which had an 11% case fatality rate during the 2003 outbreak? From a 2007 study: "SARS-specific antibodies were maintained for an average of 2 years... SARS patients might be susceptible to reinfection >3 years after initial exposure." (Bear in mind that, as with all diseases, re-infection does not mean you are necessarily going to get full-blown SARS; fading immunity after a natural infection tends to offer at least some level of partial protection against severe outcomes for a considerable amount of time after you can already be reinfected and spread it to others - more on that later.)
        And what about MERS, the deadliest coronavirus to date, which made the jump from camels in 2012 and had a fatality rate of around 35%? It triggered the broadest immune response (due to its severity) and also appears to trigger the longest lasting immunity as a result (> 6yrs)
        Thus, to pretend that there was any chance that herd immunity to COVID would be anything but short-lived was dishonest at best. For most people, immunity was always going to fade quickly. Just like what happens after most other respiratory virus infections. By February 2020, the epidemiological data showed clearly that for most people COVID was a mild coronavirus (nowhere near as severe than SARS or MERS), so it was virtually a certainty that even the immunity from a natural infection would fade within months, not years. It was also a certainty that vaccination was therefore, at best, only ever going to provide partial protection and that this protection would be temporary, lasting on the order of months. This is a case of false and misleading advertising if there ever was one.
        If I can allow my farming roots to shine through for a moment, I'd like to explain the implications of what was known about animal coronaviruses vaccines. Baby calves are often vaccinated against bovine coronaviral diarrhea shortly after birth if they are born in the spring mud and slush season, but not if they are born in midsummer on lush pastures where the risk of infection is lower. Likewise, bovine coronavirus vaccines are used to protect cattle before they face stressful conditions during shipping, in a feedlot, or in winter feed pens. Animal coronavirus vaccines are thus used as tools to provide a temporary boost in immunity, in very specific conditions, and only for very specific vulnerable categories of animals. After everything I've laid out so far in this text, the targeted use of bovine coronavirus vaccines should surprise no-one. Pretending that our human coronavirus vaccines would be different was nonsense.
        The only rational reason why the WHO and public health officials would withhold all that contextual information from the public as they rolled out lockdowns and held forth vaccines as an exit strategy was to whip the public into irrational fear in order to be able to make a dishonest case for mass vaccination when they should have, at most, been focused on providing focused vaccination of the most vulnerable only. That deception was the Trojan Horse to introduce endless mass booster shots as immunity inevitably fades and as new variants replace old ones.
        Now, as all the inevitable limitations and problems with these vaccines become apparent (i.e. fading of vaccine-induced immunity, vaccines proving to only be partially effective, the rise of new variants, and the vaccinated population demonstrably catching and spreading the virus ― a.k.a. the leaky vaccine phenomenon), the surprise that our health authorities are showing simply isn't credible. As I have shown you, all this was 100% to be expected. They intentionally weaponized fear and false expectations to unleash a fraudulent bait-and-switch racket of global proportions. Immunity on demand, forever.
        Manufacturing Dangerous Variants: Virus Mutations Under Lockdown Conditions — Lessons from the 1918 Spanish Flu
        At this point you may be wondering, if there is no lasting immunity from infection or vaccination, then are public health officials right to roll out booster shots to protect us from severe outcomes even if their dishonest methods to get us to accept them were unethical? Do we need a lifetime regimen of booster shots to keep us safe from a beast to which we cannot develop durable long-term immunity?
        The short answer is no.
        Contrary to what you might think, the rapid evolution of RNA respiratory viruses actually has several important benefits for us as their involuntary hosts, which protects us without the benefit of broad lifelong immunity. One of those benefits has to do with the natural evolution of the virus towards less dangerous variants. The other is the cross-reactive immunity that comes from frequent re-exposure to closely related "cousins". I'm going to peel apart both of these topics in order to show you the remarkable system that nature designed to keep us safe... and to show you how the policies being forced on us by our public health authorities are knowingly interfering with this system. They are creating a dangerous situation that increases our risk to other respiratory viruses (not just to COVID) and may even push the COVID virus to evolve to become more dangerous to both the unvaccinated and the vaccinated. There are growing signs that this nightmare scenario has already begun.
        “In this present crisis, government is not the solution to our problem; government is the problem." — President Ronald Reagan in 1981.
        Let's start with the evolutionary pressures that normally drive viruses towards becoming less dangerous over time. A virus depends on its host to spread it. A lively host is more useful than a bedridden or dead one because a lively host can spread the virus further and will still be around to catch future mutations. Viruses risk becoming evolutionary dead ends if they kill or immobilize their hosts. Plagues came, killed, and then were starved out of existence because their surviving hosts had all acquired herd immunity. Colds come and go every year because their hosts are lively, easily spread the viruses around, and never acquire long-lasting immunity so that last year's hosts can also serve as next year's hosts ― only those who have weak immune systems have much to worry about. In other words, under normal conditions, mutations that are more contagious but less deadly have a survival advantage over less contagious and more deadly variations.
        From the virus' point of view, the evolutionary golden mean is reached when it can easily infect as many hosts as possible without reducing their mobility and without triggering long-term immunity in most of their hosts. That's the ticket to setting up a sustainable cycle of reinfection, forever. Viruses with slow genetic drift and highly specialized reproductive strategies, like polio or measles, can take centuries or longer to become less deadly and more contagious; some may never reach the relatively harmless status of a cold or mild flu virus (by harmless I mean harmless to the majority of the population despite being extremely dangerous to those with weak or compromised immune systems). But for viruses with fast genetic drift, like respiratory viruses, even a few months can make a dramatic difference. Rapid genetic drift is one of the reasons why the Spanish Flu stopped being a monster disease, but polio and measles haven't. And anyone with training in virology or immunology understands this!
        We often speak of evolutionary pressure as though it forces an organism to adapt. In reality, a simple organism like a virus is utterly blind to its environment — all it does is blindly produce genetic copies of itself. "Evolutionary pressure" is actually just a fancy way of saying that environmental conditions will determine which of those millions of copies survives long enough to produce even more copies of itself.
        A human adapts to its environment by altering its behaviour (that's one type of adaptation). But the behaviour of a single viral particle never changes. A virus "adapts" over time because some genetic copies with one set of mutations survive and spread faster than other copies with a different set of mutations. Adaptation in viruses has to be seen exclusively through the lens of changes from one generation of virus to the next based on which mutations have a competitive edge over others. And that competitive edge will vary depending on the kinds of environmental conditions a virus encounters.
        So, fear mongering about the Delta variant being even more contagious leaves out the fact that this is exactly what you would expect as a respiratory virus adapts to its new host species. We would expect new variants to be more contagious but less deadly as the virus fades to become just like the other 200+ respiratory viruses that cause common colds and flus.
        That's also why the decision to lock down the healthy population is so sinister. Lockdowns, border closures, and social distancing rules reduced spread among the healthy, thus creating a situation where mutations produced among the healthy would become sufficiently rare that they might be outnumbered by mutations circulating among the sick. Mutations circulating among the healthy are, by definition, less dangerous since they did not make their hosts sick enough to confine them to bedrest. That's precisely the variant you want to spread. Mutations circulating among the bedridden are much more likely to be dangerous, which is why their host is stuck in bed with a fever and not out dining with friends.
        As long as the majority of infections are among the healthy, the more dangerous variants circulating among the bedridden will be outnumbered and will become evolutionary dead ends. But when public health officials intentionally restricted spread among the young, strong, and healthy members of society by imposing lockdowns, they created a set of evolutionary conditions that risked giving a competitive advantage to more dangerous variants. By locking us all up, they risked making the virus more dangerous over time. Evolution doesn't sit around to wait for you while you develop a vaccine.
        Let me give you a historical example to demonstrate that this rapid evolution of a virus towards either more or less dangerous variants isn't mere theory. Small changes to the environment can lead to very rapid changes in the virus' evolution. The first wave of the 1918 Spanish Flu was not particularly deadly, with mortality rates similar to regular seasonal flu. However, the second wave was not only much deadlier but, rather unusually, was particularly deadly to young people rather than just the old and the weak. Why would the second wave be the deadly one? And what would cause the virus to evolve so quickly to become both more deadly and better adapted to preying on young people? At first glance it would seem to defy all evolutionary logic.
        The answer demonstrates just how sensitive a virus is to small changes in evolutionary pressure. The Spanish Flu spread in the midst of the lockdown-mimicking conditions of World War One. During the first wave, the virus found a huge population of soldiers trapped in the cold damp conditions of the trenches and a near endless supply of captive bedridden hosts in overflowing field hospitals. By the Spring of 1918, up to three-quarters of the entire French military and half of British troops had been infected. These conditions created two unique evolutionary pressures. On the one hand, it allowed variants that were well adapted to young people to emerge. But on the other hand, unlike normal times, the cramped conditions of trench warfare and field hospitals allowed dangerous variants that immobilize their hosts to spread freely with little competition from less dangerous variants that spread through lively hosts. The trenches and field hospitals became the virus incubators driving the evolution of variants.
        Normally young people are predominantly exposed to less dangerous mutations because the healthiest do all the mingling while the bedridden stay home. But the lockdown conditions of war created conditions that erased the competitive advantage of less dangerous mutations that don't immobilize their hosts, leading to the rise of more dangerous mutations.
        Thanks to the end of the war, the lockdown-mimicking conditions also ended, thereby shifting the competitive advantage back to less dangerous mutations that could spread freely among the mobile healthy members of the population. The deadliness of the second wave of the 1918 Spanish Flu is inextricably linked to the First World War, and the end of the war is linked to the virus fading into the background of regular cold and flu season.
        Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston
        It is therefore highly likely that the 1918 Spanish Flu would never have been more than a really bad flu season had it not been for the amplifying effect of lockdown conditions created by a world at war.
        It also raises the question, for which I don't have an answer, whether the lockdown strategy during COVID was intentionally used to reduce spread among the healthy in order to keep the virus from fading into harmless irrelevancy. I use the word "intentionally" ― and it's a strong word ― because the deadly second wave of the 1918 Spanish Flu and its causes are hardly secrets in the medical community. You'd have to be a completely reckless and utterly incompetent idiot, or a cynical bastard with an agenda, to impose any strategy that mimics those virus-amplifying conditions. Yet that's what our health authorities did. And what they continue to do, while shamelessly hyperventilating about the risk of "variants" to force us to submit to medical tyranny based on mandatory vaccines, never-ending booster shots, and vaccine passports that can turn off access to our normal lives. This is cynicism at its finest.
        Leaky Vaccines, Antibody-Dependent Enhancement, and the Marek Effect
        The experience of the 2nd wave of the 1918 Spanish Flu also raises another question: What kind of evolutionary pressures are being created by using a leaky vaccine?
        A vaccine that provides sterilizing immunity prevents the vaccinated from being able to catch or transmit the virus. They become a dead end for the virus. However, as I've already mentioned, the current crop of COVID vaccines, which are meant to train the immune system to recognize the S-spike proteins, were not designed to create sterilizing immunity. By their design, they merely help reduce the risk of severe outcomes by priming the immune system. The vaccinated can still catch and spread the virus ― the definition of a leaky vaccine ― and epidemiological data makes it very clear that this is now happening all around the world. Thus, both the vaccinated and the unvaccinated are equally capable of producing new variants. The idea that the unvaccinated are producing variants while the vaccinated are not is a boldfaced lie.
        Source: "Israel hopes boosters can avert new lockdown as COVID vaccine efficacy fades." August 23rd, 2021, Financial Times, From an evolutionary perspective, this is a potentially dangerous scenario. What has been done by temporarily blunting the risk of hospitalization or death, but without stopping infection among the vaccinated, is to create a set of evolutionary conditions where a variant that is dangerous to the unvaccinated can spread easily among the vaccinated without making the vaccinated very sick. For lack of a better term, let's call this a dual-track variant. Thus, because the vaccinated are not getting bedridden from this dual-track variant, they can continue to spread it easily, giving it a competitive advantage, even if it is highly dangerous to the unvaccinated.
        Furthermore, since COVID vaccination only offers temporary short-term protection, as soon as immunity fades, the vaccinated themselves are also equally at risk of more severe outcomes. Thus, this creates the evolutionary pressure for the virus to behave as an increasingly contagious but relatively mild virus as long as everyone is vaccinated but as a dangerous but also very contagious virus as soon as temporary immunity wears off. The call for boosters every 6 months is already here. (Update: now it's being revised down to 5 months.)
        So, the pandemic really does have the potential to become the Pandemic of the Unvaccinated (the shameless term coined by public health officials to terrify the vaccinated into bullying their unvaccinated peers), but reality comes with a twist because if a dual-track variant does evolve it would be the unvaccinated (and those whose boosters have expired) who would have reason to fear the vaccinated, not the other way around as so many frightened citizens seem to believe. And the end result would be that we all become permanently dependent on boosters every 6 months, forever.
        Hold on, you might say, the flu vaccine chart shown earlier also never provided sterilizing immunity. The flu vaccine is notoriously leaky but hasn't gotten more dangerous, has it? The answer is complicated because the comparison is less useful than it first appears. As long as the majority of the population does not get the flu vaccine, more dangerous variants will face stiff competition from less dangerous ones circulating among the healthy unvaccinated population (average flu vaccination rates in most western countries are between 38-41%, with most other countries around the world doing very little vaccination against the flu). And since the vaccine is only 40% effectiveness to begin with and since immunity fades rapidly after the shot, the flu vaccine doesn't provide much protection to begin with, thus reducing the chance that separate mutations would circulate among the vaccinated. And public health frequently gets the strain wrong (influenza has many strains that are constantly evolving so there is a lot of guesswork that goes into creating the right vaccine formula each year). In other words, lack of universal coverage and poor protection are likely preventing the emergence of a dual-track variant.
        Furthermore, flu vaccination is not evenly distributed across the population. It is mostly the vulnerable and those who work around them that get it while children, young adults and other healthy members of society don't get it. So, even if more deadly variants were to arise in nursing homes or hospital settings, the high number of healthy unvaccinated visitors to those facilities would constantly bring less deadly more contagious variants with them, thereby preventing more dangerous variants from gaining a competitive edge in nursing home or hospital settings. But if the leaky flu vaccinations were to be extended to everyone, or if nursing home populations continue to be kept isolated from the rest of society during COVID lockdowns, things might begin to look a little different.
        However, what I am warning about is far from theoretical. There is a very clear example (well known to public health officials and vaccine developers) from the poultry farming industry where a universal leaky vaccine pushed a virus to evolve to become extremely deadly to unvaccinated chickens. It is called the Marek Effect. It began with a leaky vaccine that was rolled out to fight a herpes virus in industrialized high-density chicken barns. Vaccinated chickens were protected from severe outcomes but nevertheless continued to catch and spread the virus, so evolutionary pressure led to the emergence of a dual-track variant that become the dominant strain of this herpes virus. It continues to spread among the vaccinated chickens without killing them but kills up to 80% or more of unvaccinated birds if they get infected. Thus, a never-ending stream of vaccinations is now required just to maintain the status quo. I bet the pharmaceutical industry is smiling at all those drug-dependent chickens though — talk about having a captive audience!
        It's not a certainty that this will happen with the COVID vaccines, but the longer this fiasco continues and the higher that vaccination rates rise around the world, the more likely it becomes that we re-create the conditions for some kind of Marek effect to develop. A leaky vaccine used sparingly to protect small pockets of vulnerable individuals is very different than a leaky vaccine applied to everyone. The rapid change in behaviour of the 1918 Spanish Flu should be a warning to us all that a virus can adapt very quickly in response to small changes in evolutionary pressure. The closer we get to universal vaccination, the greater the danger that leaky vaccines will lead to dual-track variants that become more dangerous to the unvaccinated.
        There is one other danger from leaky vaccines that is worth mentioning because researchers are already starting to see the first signs of it, as you can see discussed in this paper published on August 9th, 2021, in the Journal of Infection. It's called antibody-dependent enhancement (ADE). It happens when a poorly designed vaccine trains antibodies to recognize a virus as an intruder without being strong enough to kill/neutralize them. Instead of the virus being neutralized inside the antibody when the antibody attacks and "swallows" it (antibodies envelope intruders in order to neutralize them), the virus takes over the antibody cell that attacked it and uses it as a host to start making copies of itself. Thus, the attacking antibody opens the door to the inside of the cell and becomes the virus' unwitting host, thereby accelerating rather than stopping the infection.
        Antibody-dependent enhancement is a well-documented phenomenon in attempts to develop vaccines against the RSV virus, dengue fever, and other coronaviruses. This is one of the reasons why previous attempts to develop a human coronavirus vaccine against the SARS virus failed. It kept happening in animal trials. And many doctors warned from day one that it would happen with these vaccines as well as new variants gradually emerge that are sufficiently different from the original variant upon which the vaccine is based. ADE doesn't show up on the day after vaccination. It emerges gradually as new variants spread that are different from previous variants.
        Quote from the aforementioned study: ADE may be a concern for people receiving vaccines based on the original Wuhan strain spike sequence (either mRNA or viral vectors). Under these circumstances, second generation vaccines with spike protein formulations lacking structurally-conserved ADE-related epitopes should be considered.
        In other words, your previous vaccination protects you only until new variants arise, then the training that your previous vaccination gave your immune system becomes a liability as your immune system switches from protecting you to increasing your risk from the disease. Your only way to protect yourself is to dutifully get your next "updated" booster shot to protect you for next few short months. You become a permanent drug dependent vaccine customer. And you better hope next year's formulation doesn't get it wrong. And you better hope that updates can keep you safe indefinitely because there's also the risk that updates will get less effective as the bad training from previous boosters begins to add up.
        It puts a whole new spin on "trust the scientists." Your life will literally be at their mercy.
        I bet the pharmaceutical industry will be smiling at all those drug-dependent chickens loyal customers though — talk about having a captive audience! And what a sweet deal - vaccine makers have been granted an exemption from liability and, if it goes wrong, they are the go-to guy to solve it... with more boosters.
        And with every booster, you'll get to play Russian Roulette all over again with side effects: death, autoimmune diseases, reactivation of dormant viruses, neurological damage, blood clotting, and more. Here's where the reported side effects on the US VAERS system stand at the time of writing (August 28th, 2021).
        OpenVaers Search, August 28th, 2021Leaky vaccines are playing with fire. All vaccine makers and public health authorities were aware of the potential for ADE with the development of a coronavirus vaccine. Yet they pushed for mass vaccination, from day one, without completing the long-term trials that are meant to rule out this kind of risk. They knowingly gambled with your future in their eagerness to get you onto your regimen of never-ending boosters and vaccine passports. Why not, if more boosters are the solution if something going wrong. They can always blame it on the "variants". The media won't challenge them - not with billions of vaccine advertising dollars floating around.
        Anti-Virus Security Updates: Cross-Reactive Immunity Through Repeated Exposure
        And now we come to the second way in which our immune systems benefit from the rapid evolution of RNA respiratory viruses and to the sinister way in which public health policy is interfering with that system.
        The once deadly 1918 Spanish Flu is still with us today; now it is part of the smorgasbord of viruses that cause colds and flus every winter precisely because subsequent variants evolved to be less deadly. As unpleasant as flu season is, for most of us it is not lethal unless we have weak or compromised immune systems. But each subsequent exposure teaches our immune system how to keep up with its gradual evolution over time .
        In other words, each year's fresh exposure to the latest strain of cold or flu virus functions as a sort of antivirus security update to partially prepare you for the next one. Fading immunity and changing mutations means you'll never be 100% immune to the next one, but as long as updates are frequent enough, you'll also never have 0% immunity. There will always be enough carry-over to protect you from the most serious outcomes unless you are unfortunate enough to have a weak immune system. That is why it is called cross-reactive immunity.
        A broad smorgasbord of viruses cruising around during cold and flu season makes it less likely that we will die or get seriously ill when exposed to some new "variant" from London, India, or Brazil, or if we are exposed to a new "cousin", like COVID, which crawls out of some bat cave or wet market or escapes from some lab in Wuhan.
        Partial cross-reactive immunity requires periodic re-exposure. Modified from Nature, 4704, September 17th, 2020.
        But when we think about it for a moment, what was once dangerous when it was new soon becomes our most important ally for the future to protect us from the next dangerous new thing. As long as we are re-exposed frequently, before immunity fades to zero, cross-reactive immunity is the only realistic evolutionary strategy that humans have to protect us from the next viral variant or viral cousin of these fast-mutating respiratory viruses.
        With sufficient leftover cross-reactive immunity from your last exposure, exposure to the latest variant of a virus may simply result in your immune system getting updated without you even noticing a single thing. That's what it means to get an "asymptomatic" infection. Before we started tormenting the healthy with never-ending PCR tests to make us aware of all these "asymptomatic infections", we were constantly getting lots of these "antivirus security updates" each time we encountered one of the more than 200 respiratory viruses circulating among us, often without even noticing the "infection".
        Many of these encounters are asymptomatic because our immune systems are able to neutralize them without even ruffling enough layers of our defenses to trigger any symptoms. Almost everyone gets a few immune system updates to the viruses that cause common colds, every single year, yet only a small percentage will ever get very sick. The rest may barely get a runny nose, or nothing symptoms at all.
        Mass PCR testing during COVID created a massive freak-out over every single asymptomatic COVID update when we should have only been focused on those people who come down with severe symptomatic disease. There was never any justifiable reason to roll out PCR tests to asymptomatic citizens other than to heighten fear in the population in order to make them receptive to mass vaccination.
        So, in a sense, those 201 respiratory viruses that cause our colds and flus are not just an inconvenience, they are nature's solution to software updates ― even though they are dangerous to those with weak immune systems, for the rest of us our immune systems depend on them to give us partial protection against new strains that emerge through mutation or when new strains jump across species boundaries. Getting rid of those already circulating in society would make us more vulnerable to new variants that emerge. Adding another 200 will make us even safer once we get our first contact behind us.
        Eradicating a relatively benign respiratory virus is therefore not a desirable goal. But making it fade into the background is a desirable public health goal so that what was once dangerous can now keep protecting us against the next one through cross-reactive immunity. Focused protection for the vulnerable, not lockdowns, was always the only realistic public health response to this respiratory virus, unless someone wanted to seize the opportunity as a way to rope the public into mass vaccinations.
        Nature evolved this fascinating strategy of self-updating immunological countermeasures by continually testing us with mild versions of previous closely related respiratory viruses. Our immune system is therefore somewhat similar to an Olympic weightlifter whose muscles not only stay strong but get even stronger by routinely putting his muscles under a little bit of stress. Our immune system functions the same way ― it must be continually stress-tested with mild challenges to these fast-mutating viruses in order to develop the robust arsenal of defenses to keep us safe. It is a concept called anti-fragility, which was described in detail by Nassim Taleb in his ground-breaking book, Antifragile: Things That Gain from Disorder #Commissions Earned . Once you understand this concept, your fear of "variants" will rapidly dissolve.
        The eradication of these fast-mutating respiratory viruses is therefore not just unachievable, it would actually be dangerous if we succeeded because it would eliminate the security updates that we need to protect us against new variants that crawl out of bat caves or jump species boundaries. This year's runny nose is your protection against COVID-23. Your cross-reactive immunity to last years annoying flu might just save your life if something truly dangerous arrives, as long as it is at least somewhat related to what your immune system has seen before. COVID could easily have turned out to be as dangerous to us as the Spanish Flu if it hadn't been for the saving grace of cross-reactive immunity. As this study shows, up to 90-99% of us already had some level of protection to COVID thanks to partial cross-reactive immunity gained from exposure to other coronaviruses. The high percentage of infections that turn out to be asymptomatic bears that out.
        Someone needs to remind Bill Gates, his fawning public health bootlickers, and the pharmaceutical companies that whisper sweet-nothings in his ear that in the natural world of respiratory viruses, most of us don't need a regimen of never-ending booster shots to keep us safe from COVID variants ― we already have a perfectly functioning system to keep bringing us new updates. Respiratory viruses are a completely different beast than smallpox, polio, or measles; and pretending otherwise is not just silly, it's criminal because anyone with a background in immunology knows better. But it's a fantastic and very profitably way to scare a wide-eyed population into accepting never-ending booster shots as a replacement for the natural antivirus updates that we normally get from hugs and handshakes. Protect the vulnerable. Stop preying on the rest of us.
        The Not-So-Novel Novel Virus: The Diamond Princess Cruise Ship Outbreak Proved We Have Cross-Reactive Immunity
        A truly novel virus affects everyone because no-one has pre-existing cross-reactive partial immunity to it. That's why the diseases that accompanied Christopher Columbus to the Americas killed up to 95% of North and South America's indigenous populations (see Guns, Germs, and Steel, by Jared Diamond #Commissions Earned ). To them, these diseases were novel because they had no previous exposure to them and therefore lacked the antivirus security updates acquired through pre-existing infections. They would have benefited greatly from access to a vaccine prior to first contact.
        Thankfully, COVID-19 was not that kind of virus. Yet the media and public health officials shamelessly provoked fear that it was by using the scientifically accurate term novel to describe it, knowing full well that all scientists would understand this to mean a newly emergent strain while the general public would jump to the conclusion that this was an entirely new virus (also called a novel virus by scientists), like when tuberculosis or influenza accompanied Columbus to the Americas. This was a grotesque example of public health officials misusing scientific terminology, knowing full well that the public would misunderstand the term novel according to how we use the word in everyday language and not according to how the scientific community uses it.
        That little game successfully sparked a wave of fear that is so strong that not only is everyone desperate for a leaky jab to lead them to safety, they are so scared that they won't rest until all their friends, neighbors, and family members get one too, even if it requires extreme levels of coercion to get the job done. Canada has even recently gone as far as making vaccination mandatory for all federal employees, employees of Crown Corporations, employees of federally-regulated companies (i.e. utilities) and for all travellers on commercial airlines and trains (CBC, August 13th, 2021) !
        Despite the scary numbers put out by the Chinese government in the early days of the pandemic, the outbreak on the Diamond Princess cruise ship served as an inadvertent petri-dish to study the COVID virus. Thanks to that example, by the end of February 2020, we knew that COVID was not some monster virus like the 1918 Spanish Flu but was simply another coronavirus strain that was closely related to previous coronaviruses and that most of us already carried some level of cross-reactive immunity to protect us.
        How do we know that? The virus circulated freely onboard the ship, yet age corrected lethality remained between 0.025% and 0.625% (that's on the order of a bad flu season and nothing at all like the fatality rate of the 1918 Spanish Flu, which was between 2% and 10%). Only 26% of the passengers tested positive for the virus and of those that tested positive 48% remained completely symptom free despite the advanced age of most of these passengers!
        Diamond Princess Cruise Ship, Alpsdake, CC BY-SA 4.0.
        The Diamond Princess didn't turn into the floating morgue of bygone eras when ships carrying a disease were forced into quarantine. That should have been the first clue that this virus was anything but novel in the colloquial understanding of the term. Like most cold and flu viruses, only those with weak immune systems were in danger while everyone else got off with little or no symptoms. That is simply not how a truly novel virus behaves when it encounters a population without any pre-existing cross-reactive immunity. The only plausible explanation for that lack of deadliness (deadly for some, annoying for some, and asymptomatic for most others) is that most people already have sufficient pre-existing cross-reactive immunity from exposure to other coronaviruses.
        Research subsequently confirmed what the Diamond Princess outbreak revealed. Cross-reactive immunity. As I mentioned before, studies like this one demonstrated that up to 90 - 99% of us already have some residual level of partial protection to COVID. And we also subsequently found out that most people who were exposed to the deadly SARS virus in 2003 have little to fear from COVID, again because of cross-reactive immunity. COVID was never a mortal threat to most of us.
        The important thing to remember is that the Diamond Princess data was already publicly available since the end of February of 2020. Operation Warp Speed, the vaccine development initiative approved by President Trump, was nevertheless announced on April 29th, 2020. Thus, our health authorities knowingly and opportunistically recommended lockdowns and promoted vaccines as an exit strategy after it was already clear that the majority of us had some kind of protection through cross-reactive immunity. The Diamond Princess example provided the unequivocal proof that the only people who might benefit from a vaccine, even if it worked as advertised, were the small number of extremely vulnerable members of society with weak immune systems. Likewise, lockdowns should have been recommended only for nursing home residents (on a strictly voluntary basis to protect their human rights) while the pandemic surged through the rest of us.
        The only plausible explanation for why our international health authorities ignored the example of the Diamond Princess is if they wanted to stoke fear among the public and if they wanted to bamboozle credible politicians in order to opportunistically achieve some other public health agenda. They pushed vaccination on everyone knowing full well that most people don't need it and that protection would fade quickly even if the vaccines had been 100% effective, which they also knew was not going to be the case either. And yet they continue to push these vaccines using the same deceitful tactics even today. Water does not run uphill.
        “We know they are lying, they know they are lying, they know we know they are lying, we know they know we know they are lying, but they are still lying.” ― Attributed to Aleksandr Isayevich SolzhenitsynMother Knows Best: Vitamin D, Playing in Puddles, and Sweaters
        Just like during other cold and flu seasons, the vulnerable to COVID are overwhelmingly those with compromised immune systems: those whose immune systems are shutting down as they approach death from old age and those whose immune systems are compromised due to severe pre-existing conditions that reduce immune function.
        For everyone else with a strong immune system and cross-reactive immunity, we have little to fear from the virus and its never-ending stream of mutations unless our immune systems are temporarily suppressed through illness, environmental conditions, or nutritional deficiencies.
        Your mother's warnings about putting on a sweater, hat, and dry socks, tucking in your shirt to cover your kidneys, and not playing in puddles were not about preventing infection by a cold or flu, it was about preventing symptomatic infection. Research has demonstrated that getting chilled can temporarily suppress your immune system. Thus, getting chilled increases the chance that an infection leads to symptomatic disease rather than merely updating your immune system through an asymptomatic infection. Your sweater won't prevent you from catching an infection. But it might prevent that infection from becoming a symptomatic disease. It could be the difference between experiencing nothing and ending up in bed with a fever.
        In the same way, topping up on vitamin C and D, eating properly, getting enough rest, getting hugs from loved ones, adopting a positive attitude in life, and smiling when you see a rainbow are all strategies that help keep your immune system strong. They don't prevent infection, but they might reduce your risk of a bad outcome.
        Ask the staff in a nursing home what happens to their patients when any of these important ingredients is missing ― vitamin and nutrient deficiencies, poor sleep, loneliness, and depression lay out the welcome mat for the Grim Reaper. A temporarily suppressed immune system cannot mount an adequate immune response even when we do have cross-reactive immunity.
        Our public health authorities also all know this. This is not a mystery. Yet, instead of promoting these strategies as ways in which people could reduce their risk to severe outcomes, they have systematically downplayed, ignored, or labeled these strategies as "fake news". Maximize the risk of death. Then promote the vaccine as the exclusive path to safety. Criminal.
        You cannot control other people forever to avoid getting exposed to a respiratory virus. COVID Zero is an authoritarian fantasy. But you can control your food, your sleep, and your attitude so that your immune system can mount the strongest attack it can muster. The odds are that you already have all the cross-reactive immunity you need to survive this virus without a hitch. Look inwards to find freedom from fear. Take good care of yourself. Go play in the sun with your friends. And listen to your mother —tuck in your shirt!
        The Paradox: Why COVID-Zero Makes People More Vulnerable to Other Viruses
        As is so often the case when politicians try to run our lives for us, the government response to COVID is not just wrong, it is actually making us more vulnerable, both to COVID and to other respiratory viruses. Depriving nursing home patients of their loved ones, locking them in isolation, locking people in their homes, shutting down gyms, driving us into depression, and paralysing us with fear and uncertainty ensures that our immune systems will be working at suboptimal levels. Broken marriages, children deprived of social contacts, insomnia, the remarkable surge in obesity that occurred during COVID, and so many other consequences of these ill begotten strategies all have a toll on our ability to mount a strong immune response when we are inevitably exposed to any respiratory viruses.
        Equally devastating is that, by disrupting our normal social contacts, we have reduced how much training our immune system is getting through repeated exposure to other respiratory viruses. A computer that stops getting security updates becomes increasingly vulnerable to future versions of viruses. The same goes for our immune system. COVID is not the only risk. Remember, there are more than 200 other respiratory viruses that are also circulating. They may not be getting much attention and may be temporarily starved for hosts while we are cooped up at home, but they haven't gone away. They are waiting. And when they find us, they find hosts whose antivirus security updates are out of date.
        In other words, by breaking our ability to socialize with our peers, what was once relatively harmless is becoming more dangerous to us because our immune systems are out of practice. This isn't some theoretical risk. We're already beginning to see the fallout from that lack of updates, with deadly consequences.
        For example, New Zealand was praised internationally for adopting a COVID-Zero policy and for the low COVID cases that resulted. But the lockdowns, social distancing measures, and border closures also had another effect ― there was a 99.9% reduction in flu cases and a 98% reduction in cases of the RSV virus. Sounds good, right? Not so fast...
        Systems that depend on constant challenges to become antifragile will become fragile if those challenges stop happening. A tree that grows up sheltered from the wind will break when it is exposed to the storm.
        Now New Zealand's myopic focus on COVID as the one and only risk is coming home to roost. Its hospitals are overflowing with children. But they're not being hospitalized by COVID. They are falling ill with RSV virus because of the "immunity debt" that built up from not being continually exposed to all the respiratory viruses that make up normal life. These children are, quite literally, the next wave of victims of COVID-Zero. Being cut off from normal life has left them fragile. Instead of praise, it now is becoming apparent that New Zealand's authoritarian strongwoman, Jacinda Ardern, and her public health advisors ought to be standing trial for gross negligence for ignoring the long-established research about how our immune systems depend on continual exposure to respiratory viruses in order to stay healthy.
        Source: The Guardian, July 8th, 2021.
        As long as our social contacts are restricted, we are all becoming increasing vulnerable to all these other respiratory viruses because of the "immunity debt" that has built up during lockdowns and social distancing rules. It turns out that handshakes and hugs are not just good for the soul. Our public health officials have blood on their hands for denying us our normal lives.
        This heightened risk to other viruses isn't an unexpected outcome; there were plenty of doctors who warned about precisely this risk as lockdowns were being imposed. For example, Dr. Dan Erickson and Dr Artin Massihi warned about this phenomenon back in May of 2020. YouTube censored their video. Yet they were citing long-established science that was uncontested until society collectively lost its mind in 2020.
        Introducing Immunity as a Service – A Subscription-Based Business Model for the Pharmaceutical Industry (It was always about the money!)
        As you can see from everything I have laid out in this essay, this misbegotten vaccine-enabled fever dream was never a realistic solution to stop COVID. At best, if the vaccines worked as advertised, all they could ever have been was one tool among many to provide the vulnerable with focused protection while the rest of us went about our normal lives, largely unaffected by our periodic antivirus security updates through exposure to the natural virus.
        COVID-Zero in all its variations was a fantasy.
        But it was not an accidental fantasy.
        Water does not run uphill.
        Every single public health official in the world has the education to know that what they have been promoting, from day one, is gibberish. What I have laid out in this essay is pretty basic virology and immunology knowledge. Which raises a rather alarming question: how can any virologist, immunologist, vaccine maker, or public health official knowingly promote this lie?
        Why is there such a blind obsession with getting us all to take a vaccine that most people do not need and that can never provide long-lasting herd immunity?
        It's no mystery why pea-brained politicians might fall for this fantasy; they are only as good as the advisors they listen to. And politicians are shameless opportunists, so it is not surprising that they are now exploiting the situation to increase their powers and to harness this emerging command-and-control economy in pursuit of their own ideological goals — redistribution, carbon net zero, social credit score systems, you name it. In this Orwellian world, if you have a podium and a utopian dream, the world is your oyster, at least as long as the band keeps playing and the pitchforks can be kept off the streets.
        "You never let a serious crisis go to waste. And what I mean by that it's an opportunity to do things you think you could not do before." — Rahm Emanuel
        "I really believe COVID has created a window of political opportunity..." — Chrystia Freeland, Deputy Prime Minister of Canada
        But our public health officials and international health organizations are trained to know better. Yet they nevertheless set this nightmare in motion in violation of all their own long-established pandemic planning guidelines. They know eradication is impossible. They know most of us already have cross-reactive immunity. They know most of us are healthy enough so that our immune systems will protect us against severe outcomes from this virus. They know about the negative consequences imposed on our immune systems when we are prevented from living normal lives. They know they are increasing our risk to other viruses by preventing us from socializing. It's their job to know. And, as I have demonstrated, they have known since day one.
        But what if a shameless pharmaceutical industry could manipulate public health policies by capturing politicians, policymakers, and public health agencies through generous donations? What if the boundaries between public health agencies, international public health organizations, and pharmaceutical companies have become blurred to such a degree that each benefits from reinforcing one another's best interests? What if they have all come to believe that vaccines against respiratory viruses are the holy grail of public health (and of generous funding), even if they have to play fast and loose with the truth to get humanity to accept them and even if they have to do a little evil to achieve some imagined future "greater good"?
        What if the revolving door between pharmaceutical companies, public health, and international health organizations has created a kind of blind groupthink within this holy trinity? What if anyone caught up in that system is forced to bite their tongue because to speak out is a deathblow to their career? What if many of those caught up in the system genuinely believe the lies, despite a lifetime of training that should tell them otherwise? The powerful effect of groupthink, demonstrated by the Ash Conformity Experiments, can make people blind to what is staring them in the face. Even the medieval kings knew they needed a court jester to prevent the king from growing a big head. But what if, in the hallowed halls of this holy trinity, all the court jesters have long since been purged or cowed into silence?
        "It's dangerous to be right when the government is wrong." ― Voltaire
        A quote that best sums up the thinking inside many of our public health institutions comes from Peter Daszak, head of EcoHealth Alliance, a non-profit non-governmental organization that works closely with public health agencies like the National Institutes of Health (NIH) and intergovernmental organizations like the WHO (published in a 2016 report by the National Academy of Sciences): "Daszak reiterated that, until an infectious disease crisis is very real, present, and at an emergency threshold, it is often largely ignored. To sustain the funding base beyond the crisis, he said, we need to increase public understanding of the need for MCMs [medical counter measures] such as a pan-influenza or pan-coronavirus vaccine. A key driver is the media, and the economics follow the hype. We need to use that hype to our advantage to get to the real issues. Investors will respond if they see profit at the end of process, Daszak stated." [Emphasis mine]
        In the presence of so much conflict of interest, in the absence of the checks and balances provided by individual rights, in the censorious atmosphere of cancel culture that has infected all our public institutions, and with so many institutional donors (private and governmental alike) being enamored with social-engineering projects and blinded by their own arrogance, it would perhaps be more surprising if this vaccine-fueled hysteria hadn't happened.
        In view of the circumstances, what happened almost seems inevitable. To the eyes of profit-hungry pharmaceuticals and funding-hungry national and international public health institutions, this virus must look like manna from heaven. They must feel like a fox that has been invited into the henhouse by ripe chickens that are begging to be plucked.
        History never repeats itself, but it does often rhyme. What has emerged during COVID is simply a bigger, better, bolder replay of what happened during the 2009 swine flu hysteria. I'd like to share a few quotes with you - and keep in mind that these are about the 2009 Swine Flu scandal, not COVID:
        From a 2010 article entitled: European Parliament to Investigate WHO and "Pandemic" Scandal [Emphasis mine]:
        "In his official statement to the Committee, Wodarg criticized the influence of the pharma industry on scientists and officials of [the] WHO, stating that it has led to the situation where "unnecessarily millions of healthy people are exposed to the risk of poorly tested vaccines," and that, for a flu strain that is "vastly less harmful" than all previous flu epidemics.""For the first time, the WHO criteria for a pandemic was changed in April 2009 as the first Mexico cases were reported, to make not the actual risk of a disease but the number of cases of the disease [the] basis to declare "Pandemic." By classifying the swine flu as [a] pandemic, nations were compelled to implement pandemic plans and also t[o] purchase swine flu vaccines."
        And here are a series of even more revealing quotes from a 2010 report published by Der Spiegel called: Reconstruction of a Mass Hysteria — The Swine Flu Panic of 2009:
        "Researchers in more than 130 laboratories in 102 countries are constantly on the lookout for new flu pathogens. Entire careers and institutions, and a lot of money, depend on the outcomes of their work. "Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur," says flu expert Tom Jefferson, from an international health nonprofit called the Cochrane Collaboration. "And all it took was one of these influenza viruses to mutate to start the machine grinding.""Does this mean that a very mild course of the pandemic was not even considered from the start? At any rate, efforts to downplay the risks were unwelcome, and the WHO made it clear that it preferred to base its decisions on a worst-case scenario. "We wanted to overestimate rather than underestimate the situation," says Fukuda [Keiji Fukuda was the Assistant Director-General for Health, Security and Environment for the WHO at that time].""The media also did its part in stoking fears. SPIEGEL, for example, had reported at length on the avian flu. Now it devoted a cover story to the new "global virus," a story filled with concerns that the swine flu pathogen could mutate into a horrific virus.""The pharmaceutical industry was particularly adept at keeping this vision alive.""We expected a real pandemic, and we thought that it had to happen. There was no one who suggested re-thinking our approach.""the vast majority of experts on epidemics automatically associate the term "pandemic" with truly aggressive viruses. On the WHO Web site, the answer to the question "What is a pandemic?" included mention of "an enormous number of deaths and cases of the disease" -- until May 4, 2009. That was when a CNN reporter pointed out the discrepancy between this description and the generally mild course of the swine flu. The language was promptly removed.""'Sometimes some of us think that WHO stands for World Hysteria Organization,' says Richard Schabas, the former chief medical officer for Canada's Ontario Province.""A party with strong connections in Geneva had a strong interest in phase 6 being declared as quickly as possible: the pharmaceutical industry.""Meanwhile, a debate had erupted over whether Germany had chosen the wrong vaccine, Pandemrix [it was later found to have caused narcolepsy in some patients, which is an autoimmune disease]. It contained a new type of agent designed to boost its effectiveness, known as an adjuvant, which had never undergone large-scale human trials in connection with the swine flu antigen. Were millions of people about to receive a vaccine that had hardly been tested?""But the contracts for Pandemrix had been signed in 2007, and they came into effect automatically when the WHO decided to declare phase 6.""The ministers felt pressured from all sides. On the one hand, the media were stoking fears of the virus. The German tabloid newspaper Bild, in particular, was printing new tales of horror almost daily. On the other hand, the pharmaceutical companies were upping the pressure and constantly setting new ultimatums.""Oct. 9, 2009: Wolf-Dieter Ludwig, an oncologist and chairman of the Drug Commission of the German Medical Association , says: 'The health authorities have fallen for a campaign by the pharmaceutical companies, which were plainly using a supposed threat to make money.'""Oct. 21, 2009: A BILD newspaper headline, printed in toxic yellow, warns: "Swine Flu Professor Fears 35,000 Dead in Germany !" The professor's name is Adolf Windorfer, and when pressed, he admits that he has received payments from the industry, including GSK and Novartis. Next to the BILD headline is an ad for the German Association of Pharmaceutical Companies.""According to Wodarg, the WHO's classification of the swine flu as a pandemic have earned the pharmaceutical companies $18 billion in additional revenues. Annual sales of Tamiflu alone have jumped 435 percent, to €2.2 billion."
        Rinse and repeat in 2020-2021.
        What if, upon recognizing the emergence of a new pandemic, those in the know opportunistically made vaccines the endgame? What if all the vaccine injuries recorded on VAERS and all the risks they are taking with our lives are simply collateral damage - a calculated investment risk - in order to turn their dream of subscription-based "immunity as a service" into reality.
        In the words of Bill Gates, “we kind of caught mRNA half way to prime time.” Maybe we should believe him — and gape in awe at the recklessness and contempt they have shown for their fellow citizens in order to capitalize on this "window of opportunity". Carpe diem (seize the day). Don't sweat the small stuff. Keep your eye on the ball... and on the year-end bonuses.
        What if COVID-Zero, in all its variations, was merely a strategy to herd us together so we obediently line up for an endless string of booster shots as a trade-off for access to our lives?
        In other words, what if someone could bamboozle our leaders into believing that the only way back to a normal life is for vaccines to replace the role that hugs and handshakes used to play in order to update us with the latest antivirus security updates?
        What if, by depriving us of normal life, those who stand to gain from vaccines can forever cement themselves at the center of society by providing an artificial replacement for what our immune systems used to do to protect us against common respiratory viruses back when we were still allowed to live normal lives?
        The headlines tell the story:
        "Pfizer CEO says third Covid vaccine dose likely needed within 12 months." (CNBC, April 15th, 2021)
        "Variants could be named after star constellations when Greek alphabet runs out, says WHO Covid chief." (The Telegraph, August 7th, 2021)
        "Fauci warns Americans may face having booster shots indefinitely" (Daily Mail, August 13th, 2021, and Dr. Fauci in his own words on YouTube on August 12th, 2021)
        "Biden OKs booster shots 5 months after 2nd dose" (Boston Globe, August 27th, 2021)
        What if the fast mutation of RNA viruses ensures that no vaccine will ever be fully effective at providing lasting immunity, thus creating the illusion that we are permanently in need of vaccine boosters?
        What if politicians could be convinced to make vaccination mandatory in order to prevent potential customers from opting out?
        What if, by relying on lockdowns during the winter season, our vulnerability to other viruses increased, which could then be used to rationalize expanding the jab, via mission creep, to simultaneously vaccinate us against RSV, influenza, other coronaviruses, the common cold, and so on, despite knowing full well that the protection that these vaccines offer against respiratory viruses is only temporary?
        And what other social engineering goals can be rolled into your annual booster shot in the future once you are permanently bound to these annual jabs and vaccine passports? In an atmosphere of hysteria, it's a system ripe for abuse by opportunists, ideologues, power hungry totalitarians, and Malthusian social engineers. The snowball doesn't have to grow by design. Mission creep happens all on its own once Pandora's Box is opened to coerced vaccinations and conditional rights. The road to Hell is frequently paved by good intentions... and hysteria.
        So, what if COVID-Zero and the vaccine exit strategy is merely the global state-sanctioned equivalent of a drug dealer creating dependency among its customers to keep pushing more drugs?
        What if it was all just a way of convincing society of the need for subscription-based "immunity as a service"? The subscription-based business model (or some version of it) is all the rage these days in the corporate world to create loyal captive audiences that generate reliable money streams, forever. Subscriptions are not just for your cable TV and gym membership anymore. Everything has been redesignated as a "consumable".
        Netflix did it with movies.
        Spotify did it with music.
        Microsoft did it with its Office suite.
        Adobe did it with Photoshop editing suite.
        The smartphone industry did it with phones that need to be replaced every 3 to 5 years.
        The gaming industry did it with video games.
        Amazon is doing it with books (i.e. Kindle Unlimited).
        The food industry is doing it with meal delivery services (i.e. Hello Fresh).
        Uber is doing it with subscription-based ride sharing.
        Coursera is doing it with online education.
        Duolingo and Rosetta Stone are doing it with language learning.
        Zoom is doing it with online meetings.
        Monsanto and its peers did it to farmers with patented seed technology, which cannot legally be replanted, and is lobbying to try to legalize the use of terminator seed technology (GMO seeds that are sterile in the second generation to prevent replanting).
        The healthcare industry is doing it with concierge medical services, fitness tracking apps (Fitbit), sleep-tracking apps, and meditation apps.
        The investment industry is doing it with farmland, with investors owning the land and leasing it back to farmers in a kind of modern revival of the sharecropping system. (Bill Gates is the largest farmland owner in the USA - are you surprised?)
        Blackrock and other investment firms are currently trying to do it with homes to create a permanent class of renters.
        And public health authorities and vaccine makers have been trying to do it with flu vaccines for years, but we've been stubbornly uncooperative. Not anymore.
        Remember when the World Economic Forum predicted in 2016 that by 2030 all products would become services? And remember their infamous video in which they predicted that "You will own nothing. And you will be happy."? Well, the future is here. This is what it looks like. The subscription-based economy. And apparently it now also includes your immune system in a trade-off for access to your life.
        Original video on Facebook, World Economic Forum, December 9th, 2016.
        Let's revisit the Peter Daszak quote from earlier. A second read allows the message to really hit home: "Daszak reiterated that, until an infectious disease crisis is very real, present, and at an emergency threshold, it is often largely ignored. To sustain the funding base beyond the crisis, he said, we need to increase public understanding of the need for MCMs [medical counter measures] such as a pan-influenza or pan-coronavirus vaccine. A key driver is the media, and the economics follow the hype. We need to use that hype to our advantage to get to the real issues. Investors will respond if they see profit at the end of process, Daszak stated."
        Isn't it ironic that he didn't even care which vaccine was pushed? Influenza or coronavirus, it made no difference. It was always about funding. It was always about the money. It always was. It always is.
        The holy trinity of pharmaceutical companies, public health, and international health organizations, all egging each other on in their hunger for a reliable flow of cash: shareholder profits, larger budgets, and governmental donations. Their interests are perfectly aligned and the lines between them are blurred to such a degree that each benefits from reinforcing one another's best interests.
        And why would politicians and media bow to the holy trinity?
        Big Pharma spent an average of US$4.7 billion per year between 1999 and 2018 on lobbying and campaign contributions, just in the USA!
        Big Pharma also shells out $US20 billion each year to schmooze doctors and another US$6 billion on drug ads, just in the USA! So, it's no surprise why legacy media and Big Tech are tripping over themselves not to ruffle the party line — they live and die by the almighty advertising dollar. Never bite the hand that feeds you.
        So, they are all dancing to the same tune while your pocket gets picked and your arm gets pricked, and everyone wins... except you and me. We are the cow that gets milked. We are the serfs that fund their largesse in this neo-feudal society where a few big boys own the assets and everyone else is beholden to those above them in the hierarchy for access to, well, everything — land, resources, rights, individual autonomy, and even immune systems. My body, their choice.
        What if, in an atmosphere of runaway hysteria, a police state founded on medical tyranny is creating itself, fueled by a toxic brew of self-serving opportunists who have seized the moment to superimpose their own goals on a fortuitous virus, until one day you wake up to find yourself chained and milked, like a cow in a dairy barn, under the absolute custody of a modern-day Louis the Fourteenth and his royal court full of drug pushers, ideologues, and militant devotees? The modern face of feudalism, updated for the 21st century. Neo-feudalism, enforced by a mandatory subscription-based "immunity as a service".
        And what if a society that has lost its principles, a society that is eager to hand over individual responsibility to "experts," a society that is held hostage to cancel culture mobs, a society that no longer has transparency into the decisions made by its experts, a society led by a censorious political class full of immoral opportunists, a society that has fallen so in love with big government that red tape and cronyism have completely erased the self-limiting checks and balances of a free and open society, and a society that has elevated safety to a new sort of religious cult is a society that has no immunity to protect itself from predators who treat us like cattle?
        No period in history has ever lacked in snake-oil salesmen, ideologues, and social engineers eager to take society for a ride. Most of the time, they are ignored. So, what if the only real mystery is why society has grown so willing to accept the collar and yoke?
        What if all this really is just as simple as that?
        The Path Forward: Neutralizing the Threat and Bullet-Proofing Society to Prevent This Ever Happening Again.
        Now we know we've been played, how we've been played, and why we've been played. Again. Just like during the 2009 Swine Flu con. Only bigger, bolder, and better. They learned from their mistakes. We didn't.
        But now that you see the con, you can't unsee it. And now that you understand the threat and how the game is being played, there is a weight that comes off your shoulders.
        When you know there's a threat, but you don't know exactly what it is, every movement in the grass might be a tiger or a snake or a scorpion. It's paralysing and exhausting to defend yourself against an invisible unknown and they have used that fear masterfully against us to keep us frozen. But once you spot the tiger in the grass, you know where to direct your focus, your feet become unglued, your voice becomes bold, and you regain the clarity of thought to defend yourself.
        The con is clear. So, we can let go of all the worries about depopulation and bioweapons and all the gaslighting about variants and focus all our might on stopping this runaway train before it takes us over the cliff into a police state of no return. Rent-seeking snake-oil salesmen don't set out to kill their customers in a subscription-based economy. It's just that they are not that bothered if you're maimed or killed as collateral damage to their wild reckless con. They are the threat. They are the danger that deserves our undivided attention. Stand up. Speak out. Refuse to play along. Stopping this requires millions of voices with the courage to say NO — at work, at home, at school, at church, and out on the street.
        "Nonviolent direct action seeks to create such a crisis & foster such a tension that a community which has constantly refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored." — Martin Luther King Jr.
        Compliance is the glue that holds tyranny together. Non-compliance breaks it apart. One person alone cannot stop this. But if millions find the courage to raise their voices and the courage to refuse to participate in the system on these tyrannical medical terms, it will throw the system into such a crisis and create such a tension that the community will be forced to confront the issue. Without enough truckers, no-one eats. Without enough medical staff, hospitals close. Without enough workers, supply chains break. Without enough policemen, laws cannot be enforced. Without enough garbage collectors, cities grind to a halt. Without enough cashiers, box stores cannot stay open. Without enough administrators, institutions cease to function. Without enough staff, corporations lose profits. Without enough servers, restaurants cannot serve their customers. And without enough customers, businesses are brought to their knees.
        Tyranny is not sustainable if the system grinds to a halt. Make it grind by being a thorn in everyone's side until they give us back our freedoms and end this ridiculous charade. They are trying to impose vaccine passports and mandatory vaccinations. But we hold the cards... but only if we are bold enough to stand up even at the risk of finding ourselves standing alone. Courage begets courage. It was Martin Luther King's secret power. It must be ours.
        Now that you see the con, you also know the simple recipe to make this virus go away before their reckless policies turn it a monster virus for real. Remember 1918. End the war on the virus. Let the young folks come out of the trenches. Let people go back to their lives. Provide focused protection for the vulnerable. That is how this virus fades into the history books.
        It's time to be bold. It's time to call out the fraudsters. And it's time to reclaim the habits, values, and principles that are required to fix our democratic and scientific institutions to prevent this from ever happening again.
        Feudalism was one giant stinking cesspool of self-serving corruption. Individual rights, free markets, the democratic process, and limited government were the antidotes that freed humanity from that hierarchical servitude. It seems we have come full circle. The COVID con is a symptom, not the cause, of a broken system.
        Modern liberal democracy all around the world was inspired by the system of checks and balances that America's Founding Fathers built to prevent government from being co-opted by the special interests of its leaders, institutions, corporations, and most influential citizens. The ink was barely dry when those principles began to be ignored by those with ever greater enthusiasm for an all-powerful referee to manage even the most intimate details of how everyone lives their lives. After two and a half centuries of effort the admirers of big government have achieved their heart's desire. And what a glorious and rotten cesspool of self-serving corruption it is.
        But the principles laid out by America's Founding Fathers remain as true today as the day they were written and are waiting to be rediscovered. If there is one culprit who deserves to shoulder more blame than any other for the fiasco of the last 18 months, it is society itself for allowing itself to fall prey to the siren song of big government, the illusion that there can ever be a benevolent, virtuous, and incorruptible referee. He who creates the red tape, he who has the keys to the treasury, he who wields the power of the tax collector, and he who commands those sent to enforce the laws will always have an entourage of self-serving charlatans, rent seekers, and parasites following him wherever he goes. So, keep his powers on a very short leash to keep other people's hands off your money, your property, your freedom, and your body. You don't need better leaders. You need less powerful institutions. That's how you prevent this from ever happening again.
        Freedom of speech, individual rights, private property, individual ownership, competition, good faith debate, small government, minimal taxes, limited regulation, and free markets (the opposite of the crony capitalism we now suffer under), these are the checks and balances that bullet-proof a society against the soulless charlatans that fail upwards into positions of power in bloated government institutions and against the parasitic fraudsters that seek to attach themselves to the government's teat.
        Yes, we need a Great Reset. Just not the subscription-based version that the World Economic Forum imagined.
        "Just Say No to Drugs"
        ~
        “One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.” ― Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark #Commissions Earned
        ~
        If you enjoyed this Deep Dive, please consider donating to my Tip Jar to support my independent writing.
        Julius Ruechel's Tip Jar And I invite you to subscribe to my free email notifications to receive my latest articles in your inbox. I write about many things, but always with the goal of answering questions essential to science and democracy, and always in the hope of teasing a broader perspective from the mind-numbing noise.
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        COPYRIGHT 2021 JULIUS RUECHEL
      McDonald's Ice-Cream Machines Are Reportedly Subject Of FTC Probe : NPR
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        Sun, 05 Sep 2021 13:32
        A McDonald's sign in Houston on July 28. Brandon Bell/Getty Images hide caption
        toggle caption Brandon Bell/Getty Images A McDonald's sign in Houston on July 28.
        Brandon Bell/Getty Images I scream. You scream. We all scream ... out of sheer rage that the McDonald's ice-cream machine is busted again.
        By now it is well known among connoisseurs of the fast-food giant's frozen desserts that McDonald's ice-cream machines often break down. The technical problems that regularly befall the contraptions can make McFlurries, shakes and other treats unattainable.
        McDonald's has acknowledged the issue. But customers are not lovin' it.
        The problem has gotten so widespread there's even an online tool that lets you track malfunctioning machines across the United States.
        Now, the feds are reportedly on the case.
        According to a report in The Wall Street Journal, the Federal Trade Commission contacted McDonald's franchise owners over the summer looking for information about the broken ice-cream machines.
        McDonald's franchisees have long griped about the machines, the newspaper reported, which require a nightly cleaning cycle that can fail and require a technician to fix.
        The Biden administration is looking more closely at manufacturersThe move comes as the Biden administration looks broadly at whether manufacturers have been blocking owners from fixing broken products themselves, the newspaper said. Advocates of the "right to repair" movement say companies should not make it nearly impossible for users and independent technicians to repair modern products, particularly consumer electronics.
        The FTC declined to comment on the report.
        In July, the commission announced it would increase law enforcement efforts against manufacturers that imposed repair restrictions on businesses, government agencies, workers and consumers.
        McDonald's doesn't believe it's under investigationIn a statement, McDonald's USA said it had no reason to believe it was the focus of an FTC investigation.
        "Nothing is more important to us than delivering on our high standards for food quality and safety, which is why we work with fully vetted partners that can reliably provide safe solutions at scale," its statement said.
        McDonald's said it understood the frustrations surrounding the broken ice-cream machines and was instituting several solutions, including new training for workers and regular maintenance checks on the machines.
        Note: McDonald's is among NPR's financial supporters.
      Gender and the Law Blog
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        Archived Version
        Sun, 05 Sep 2021 13:20
        Thursday, September 2, 2021
        A Closer Look at the Text of the Texas Abortion Prohibition and Its Unusual Provisions The Texas abortion ban that went into effect 9/2/21 after the Supreme Court refused to stay the act in Whole Women's Health v. Jackson, has several unusual provisions not only for abortion rights, but for enforcement of constitutional rights generally. The full text is here.
        1. This is a fetal heartbeat law. (not exactly a "six-week ban").
        Sec.171.204.PROHIBITED ABORTION OF UNBORN CHILD WITH DETECTABLE FETAL HEARTBEAT; EFFECT. (a)Except as provided by Section 171.205, a physician may not knowingly perform or induce an abortion on a pregnant woman if the physician detected a fetal heartbeat for the unborn child as required by Section 171.203 or failed to perform a test to detect a fetal heartbeat.2. There is an exception for "medical emergency."
        Sec.171.205.EXCEPTION FOR MEDICAL EMERGENCY; RECORDS. (a)Sections 171.203 and 171.204 do not apply if a physician believes a medical emergency exists that prevents compliance with this subchapter.3. A woman cannot be sued or "prosecuted" for having the abortion.
        Sec. 171.206. (b) This subchapter may not be construed to: (1) authorize the initiation of a cause of action against or the prosecution of a woman on whom an abortion is performed or induced or attempted to be performed or induced in violation of this subchapter4. But those who "aid and abet" the woman or the physician are liable.
        knowingly engages in conduct that aids or abets the performance or inducement of an abortion, including paying for or reimbursing the costs of an abortion through insurance or otherwise, if the abortion is performed or induced in violation of this subchapter, regardless of whether the person knew or should have known that the abortion would be performed or induced in violation of this subchapter5. It provides solely for private enforcement by private civil action. No state or government actor can enforce the law.
        Sec.171.207.LIMITATIONS ON PUBLIC ENFORCEMENT. (a)Notwithstanding Section 171.005 or any other law, the requirements of this subchapter shall be enforced exclusively through the private civil actions described in Section 171.208. No enforcement of this subchapter, and no enforcement of Chapters 19 and 22, Penal Code, in response to violations of this subchapter, may be taken or threatened by this state, a political subdivision, a district or county attorney, or an executive or administrative officer or employee of this state or a political subdivision against any person, except as provided in Section 171.208.Sec.171.208.CIVIL LIABILITY FOR VIOLATION OR AIDING OR ABETTING VIOLATION. (a)Any person, other than an officer or employee of a state or local governmental entity in this state, may bring a civil actionExcept not a sexual perpetrator:
        a civil action under this section may not be brought by a person who impregnated the abortion patient through an act of rape, sexual assault, incest6. Remedies that may be awarded to the person suing to stop the abortion are an injunction, statutory damages, and attorneys' fees.
        If a claimant prevails in an action brought under this section, the court shall award: (1)injunctive relief sufficient to prevent the defendant from violating this subchapter or engaging in acts that aid or abet violations of this subchapter; (2)statutory damages in an amount of not less than $10,000 for each abortion that the defendant performed or induced in violation of this subchapter, and for each abortion performed or induced in violation of this subchapter that the defendant aided or abetted; and (3) costs and attorney's fees.7. Tries to limit the defendant's (provider or accomplice) ability and standing to assert the constitutional right of the woman.
        Notwithstanding any other law, the following are not a defense to an action brought under this section: (1) ignorance or mistake of law; (2)a defendant's belief that the requirements of this subchapter are unconstitutional or were unconstitutional;Sec.171.209.CIVIL LIABILITY: UNDUE BURDEN DEFENSE LIMITATIONS. (a)A defendant against whom an action is brought under Section 171.208 does not have standing to assert the rights of women seeking an abortion as a defense to liability under that section unless: (1)the United States Supreme Court holds that the courts of this state must confer standing on that defendant to assert the third-party rights of women seeking an abortion in state court as a matter of federal constitutional law; or (2)the defendant has standing to assert the rights of women seeking an abortion under the tests for third-party standing established by the United States Supreme Court.See also Wash Post, What to Know about the Texas Abortion Law
        Strict Scrutiny Podcast, Emergency Podcast on Texas Abortion Law
        https://lawprofessors.typepad.com/gender_law/2021/09/a-closer-look-at-the-text-of-the-texas-abortion-prohibition-that-just-went-into-effect.html
        Abortion, Legislation | Permalink
      India Could Sentence WHO Chief Scientist to Death for Misleading Over Ivermectin and Killing Indians | NextBigFuture.com
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        Sun, 05 Sep 2021 12:51
        The Indian Bar Association (IBA) sued WHO Chief Scientist Dr. Soumya Swaminathan on May 25, accusing her in a 71-point brief of causing the deaths of Indian citizens by misleading them about Ivermectin. There is also an updated legal notice on June 13, 2021.
        Point 56 states, ''That your misleading tweet on May 10, 2021, against the use of Ivermectin had the effect of the State of Tamil Nadu withdrawing Ivermectin from the protocol on May 11, 2021, just a day after the Tamil Nadu government had indicated the same for the treatment of COVID-19 patients.''
        If a trial in India finds WHO Chief Scientist Dr. Soumya Swaminathan guilty then the WHO Scientist could be sentenced to death or life in prison. Dr Soumya Swaminathan would have be charged with the threatened criminal prosecution and be found guilty on one of the those charges.
        The Government of Tamil Nadu has published new treatment protocols for COVID-19 patients that leaves out the use of ivermectin, which had been included in a previous version. The new protocols describe three categories of COVID-19 patients based on the level of care they need: home-based, primary care and pre-hospital care. It leaves hospital care out. The tests to determine the category to which a patient belongs are oxygen saturation (SpO2) and respiratory rate.
        Advocate Dipali Ojha, lead attorney for the Indian Bar Association, threatened criminal prosecution against Dr. Swaminathan ''for each death'' caused by her acts of commission and omission. The brief accused Swaminathan of misconduct by using her position as a health authority to further the agenda of special interests to maintain an EUA for the lucrative vaccine industry.
        Ivermectin is a cheap drug that is prescribed as an anti-parasitic. It has been gaining in popularity for preventing COVID-19. The WHO and FDA are not approving Ivermectin but many doctors and scientists believe Ivermectin is effective. There is the claim that the Indian States that used Ivermectin had far better outcomes and far fewer COVID deaths than the Indian states that did not use Ivermectin.
        Among the most prominent examples include the Ivermectin areas of Delhi, Uttar Pradesh, Uttarakhand, and Goa where cases dropped 98%, 97%, 94%, and 86%, respectively. By contrast, Tamil Nadu opted out of Ivermectin. As a result, their cases skyrocketed and rose to the highest in India. Tamil Nadu deaths increased ten-fold.
        In a test of over 4000 people in India (3000+ took Ivermectin) and over 1000 did not. The results were that 2% Ivermectin takers had PCR test confirmed COVID and 11.7% non-takers had PCR test confirmed COVID. The people were given two 21 mg doses of Ivermectin. This costs less than 1 penny per person.
        Advocate Dipali Ojha, lead attorney for the Indian Bar Association, threatened criminal prosecution against Dr. Swaminathan ''for each death'' caused by her acts of commission and omission. The brief accused Swaminathan of misconduct by using her position as a health authority to further the agenda of special interests to maintain an EUA for the lucrative vaccine industry.
        Specific charges included the running of a disinformation campaign against Ivermectin and issuing statements in social and mainstream media to wrongfully influence the public against the use of Ivermectin despite the existence of large amounts of clinical data showing its profound effectiveness in both prevention and treatment of COVID-19.
        In particular, the Indian Bar brief referenced the peer-reviewed publications and evidence compiled by the ten-member Front Line COVID-19 Critical Care Alliance (FLCCC) group and the 65-member British Ivermectin Recommendation Development (BIRD) panel headed by WHO consultant and meta-analysis expert Dr. Tess Lawrie.
        The brief cited US Attorney Ralph C. Lorigo's hospital cases in New York where court orders were required for dying COVID patients to receive the Ivermectin. In multiple instances of such comatose patients, following the court-ordered Ivermectin, the patients recovered. In addition, the Indian Bar Association cited previous articles published in this forum, The Desert Review.
        Advocate Ojha accused the WHO and Dr. Swaminathan in Points 60 and 61 as having misled and misguided the Indian people throughout the pandemic from mask wear to exonerating China as to the virus's origins.
        ''The Indian Bar Association has warned action under section 302 etc. of the Indian Penal Code against Dr. Soumya Swaminathan and others, for murder of each person dying due to obstruction in treatment of COVID-19 patient effectively by Ivermectin. Punishment under section 302 of the Indian Penal Code is death penalty or life imprisonment.''
        Ivermectin, used in Delhi beginning April 20, obliterated their COVID crisis. Cases dropped by 97% over 6 weeks. The fatal mistake would have been to NOT use Ivermectin. They used it and it saved Delhi. But tragically, Tamil Nadu did not, and their state was devastated. Their new cases rose from 10,986 to 36,184 '' a tripling. Their refusal to use Ivermectin harmed them. Not only did Tamil Nadu's cases rise to the highest in India, but their deaths skyrocketed from 48 on April 20 to 474 on May 27 '' a rise of ten-fold.
        SOURCES '' Indian Bar Association, The Desert Review, Dr Pierre Kory, Dr John Campbell, Brett Weinstein, Joe RoganWritten By Brian Wang, Nextbigfuture.com
        Brian Wang is a Futurist Thought Leader and a popular Science blogger with 1 million readers per month. His blog Nextbigfuture.com is ranked #1 Science News Blog. It covers many disruptive technology and trends including Space, Robotics, Artificial Intelligence, Medicine, Anti-aging Biotechnology, and Nanotechnology.
        Known for identifying cutting edge technologies, he is currently a Co-Founder of a startup and fundraiser for high potential early-stage companies. He is the Head of Research for Allocations for deep technology investments and an Angel Investor at Space Angels.
        A frequent speaker at corporations, he has been a TEDx speaker, a Singularity University speaker and guest at numerous interviews for radio and podcasts. He is open to public speaking and advising engagements.
      Cases of polio-like illness may increase among children, CDC warns
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        Archived Version
        Sun, 05 Sep 2021 12:48
        Cases of a polio-like condition in children, called acute flaccid myelitis, or AFM, may start to spike again starting this month, the Centers for Disease Control and Prevention warned Tuesday.
        But, because doctors believe AFM is caused by respiratory viruses, it's unclear whether recent measures to mitigate the spread of COVID-19 might have an impact on the outbreak of AFM predicted this fall.
        Full coverage of the coronavirus outbreak
        The coronavirus is not known to lead to AFM, but other viruses called enteroviruses, specifically D68 and A71, are strongly suspected. They spread the same way COVID-19 does: close contact with infected people, and by touching surfaces that have the virus on them, and then touching the mouth, nose or eyes.
        "With all of the social distancing measures, mask wearing and improved hand hygiene, I hope that that will really decrease enterovirus circulation," Dr. Janell Routh, the AFM team lead in the CDC's Division of Viral Diseases, said.
        AFM affects the nervous system and causes limb weakness, most often in young children. It is rare: 633 cases have been confirmed in the United States since the CDC started tracking them in 2014.
        Though cases have been reported every year since then, larger outbreaks of AFM have followed an every-other-year pattern, spiking in 2014, 2016 and 2018.
        That's why scientists are predicting another significant rise in cases in 2020.
        "We normally see cases between August and November. About 86 percent of our cases fall between those months," Routh told NBC News. "But this year is unprecedented. Anything can happen."
        What's more, enteroviruses "will be circulating at the same time as flu and other infectious diseases, including COVID-19," CDC Director Dr. Robert Redfield said during a call Tuesday with reporters.
        So far in 2020, 16 cases have been confirmed in the U.S. One of those patients, who was over age 18, died of the illness.
        AFM almost always starts with a mild head cold: cough, runny nose, fever. About a week later, the patient develops weakness in one or more limbs, and may have trouble walking. It's still unclear whether certain conditions may increase a child's risk, but cases are often reported in otherwise healthy children.
        "AFM can progress quickly, and patients can become paralyzed in the course of hours or days," Redfield said.
        Cases are confirmed with MRIs, which show lesions on the spinal cord. There is no specific treatment, other than supportive care and physical therapy to help patients regain strength.
        Patients can have a variety of outcomes. "We definitely see children recovery their limb function," Routh said. "But we also know that there are children who remain severely paralyzed and require ventilation and supportive nursing care around the clock."
        Download the NBC News app for full coverage of the coronavirus outbreak
        On Tuesday, the CDC released a report on the 238 AFM cases recorded in 2018. Most patients were around age 5. Half of those young patients needed treatment in the intensive care unit, and nearly a quarter were placed on a ventilator.
        There were a few significant symptoms just before the onset of weakness. Routh said kids tended to report a "striking headache, and neck and back pain." Those may be early warning signs to call a physician, she said, even during the ongoing coronavirus pandemic.
        "We have seen a decline in emergency room visits and even parents taking children to pediatric visits," she said. "With COVID on everyone's mind, it's particularly important to get this message out now."
        "Limb weakness, accompanied by neck or back pain, particularly after a viral illness, should all be triggers to seek medical care immediately."
        Follow NBC HEALTH on Twitter & Facebook.
      China will be our main partner, say Taliban
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 12:44
        ROME
        China will be the Taliban's ''main partner'' and help rebuild Afghanistan, according to a spokesman for the group.
        ''China will be our main partner and represents a great opportunity for us because it is ready to invest in our country and support reconstruction efforts,'' Zabihullah Mujahid said in an interview published by Italian newspaper La Repubblica on Wednesday.
        He said the Taliban value China's Belt and Road Initiative as the project will revive the ancient Silk Road.
        He said China will also help Afghanistan fully utilize its rich copper resources and give the country a path into global markets.
        The Taliban also view Russia as an important partner in the region and will maintain good relations with Moscow, he added.
        Speaking about the Kabul airport, Mujahid said the facility is fully under Taliban control but has been seriously damaged.
        Qatar and Turkey are leading efforts to resume operations at the airport, he told the Italian publication.
        ''The airport should be clean within the next three days and will be rebuilt in a short time. I hope it will be operational again in September,'' he said.
        On relations with Italy, Mujahid said the Taliban hope Italy will recognize their government and reopen its embassy in Kabul.
        The Taliban took control of Afghanistan on Aug. 15, forcing President Ashraf Ghani and other top officials to flee the country.
        The group has been working to form a government and an announcement is expected on Friday.
        * Writing by Zehra Nur Duz in Ankara.'‹'‹'‹'‹'‹'‹'‹
        Anadolu Agency website contains only a portion of the news stories offered to subscribers in the AA News Broadcasting System (HAS), and in summarized form. Please contact us for subscription options.
      Ivermectin for COVID-19: real-time analysis of all 113 studies
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 12:27
        Early, Late, PrEP, PEP Covid Analysis (Preprint) (meta analysis)meta-analysis v114Ivermectin for COVID-19: real-time meta analysis of 63 studies Details ' Meta analysis using the most serious outcome reported shows 72% [55'‘82%] and 86% [75'‘92%] improvement for early treatment and prophylaxis, with similar result.. Details Source PDF Early, Late, PrEP, PEP
        Early, Late, PrEP, PEP
        Covid Analysis (Preprint) (meta analysis)Ivermectin for COVID-19: real-time meta analysis of 63 studies' Meta analysis using the most serious outcome reported shows 72% [55'‘82%] and 86% [75'‘92%] improvement for early treatment and prophylaxis, with similar results after exclusion based sensitivity analysis and restriction to peer-reviewed studies or Randomized Controlled Trials.' Statistically significant improvements are seen for mortality, hospitalization, recovery, cases, and viral clearance. 27 studies show statistically significant improvements in isolation. The probability that an ineffective treatment generated results as positive as the 63 studies is estimated to be 1 in 1 trillion.' While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 29% of ivermectin studies show zero events in the treatment arm.' Elimination of COVID-19 is a race against viral evolution. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. All practical, effective, and safe means should be used. Those denying the efficacy of treatments share responsibility for the increased risk of COVID-19 becoming endemic; and the increased mortality, morbidity, and collateral damage.' The evidence base is much larger and has much lower conflict of interest than typically used to approve drugs.' All data to reproduce this paper and sources are in the appendix. See [Bryant, Hariyanto, Kory, Lawrie, Nardelli] for other meta analyses with similar results confirming efficacy. 00.250.50.7511.251.51.752+Kory et al.69%0.31 [0.20-0.47]Improvement, RR [CI]Bryant et al.62%0.38 [0.19-0.73]Lawrie et al.83%0.17 [0.08-0.35]Nardelli et al.79%0.21 [0.11-0.36]Hariyanto et al.69%0.31 [0.15-0.62]WHO (OR)81%0.19 [0.09-0.36]ivmmeta58%0.42 [0.30-0.59]Ivermectin meta analysis mortality resultsivmmeta.com Sep 5, 2021Lower RiskIncreased Risk
        Submit Corrections or CommentsIn Silico Gonzlez-Paz et al., Biophysical Chemistry, doi:10.1016/j.bpc.2021.106677 (Peer Reviewed)Comparative study of the interaction of ivermectin with proteins of interest associated with SARS-CoV-2: A computational and biophysical approach Details In SIlico analysis of the components of ivermectin (avermectin-B1a and'¯avermectin-B1b), suggesting different and complementary inhibitory activity of each component, with an affinity of avermectin-B1b for viral structures, and of avermect.. Details Source PDF In Silico
        In Silico
        Gonzlez-Paz et al., Biophysical Chemistry, doi:10.1016/j.bpc.2021.106677 (Peer Reviewed)Comparative study of the interaction of ivermectin with proteins of interest associated with SARS-CoV-2: A computational and biophysical approachIn SIlico analysis of the components of ivermectin (avermectin-B1a and'¯avermectin-B1b), suggesting different and complementary inhibitory activity of each component, with an affinity of avermectin-B1b for viral structures, and of avermectin-B1a for host structures.Gonzlez-Paz et al., 8/19/2021, peer-reviewed, 9 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsMeta Neil et al., Research Gate, doi:10.13140/RG.2.2.19703.75680 (Preprint) (meta analysis)meta-analysisBayesian hypothesis testing and hierarchical modelling of ivermectin effectiveness in treating Covid-19 Details Updated Bayesian analysis of a subset of ivermectin trials showing that there is strong evidence to support a causal link between ivermectin and COVID-19 severity and mortality, and that the result is robust in sensitivity analysis, inclu.. Details Source PDF Meta
        Meta
        Neil et al., Research Gate, doi:10.13140/RG.2.2.19703.75680 (Preprint) (meta analysis)Bayesian hypothesis testing and hierarchical modelling of ivermectin effectiveness in treating Covid-19Updated Bayesian analysis of a subset of ivermectin trials showing that there is strong evidence to support a causal link between ivermectin and COVID-19 severity and mortality, and that the result is robust in sensitivity analysis, including exclusion of Elgazzar et al.Neil et al., 8/18/2021, preprint, 2 authors.
        Submit Corrections or CommentsIn Silico Gonzlez-Paz et al., Journal of Molecular Liquids, doi:10.1016/j.molliq.2021.117284 (Peer Reviewed)Structural Deformability Induced in Proteins of Potential Interest Associated with COVID-19 by binding of Homologues present in Ivermectin: Comparative Study Based in Elastic Networks Models Details In Silico elastic network model analysis of ivermectin components (avermectin-B1a and'¯avermectin-B1b) providing a biophysical and computational perspective of proposed multi-target activity of ivermectin for COVID-19. Details Source PDF In Silico
        In Silico
        Gonzlez-Paz et al., Journal of Molecular Liquids, doi:10.1016/j.molliq.2021.117284 (Peer Reviewed)Structural Deformability Induced in Proteins of Potential Interest Associated with COVID-19 by binding of Homologues present in Ivermectin: Comparative Study Based in Elastic Networks ModelsIn Silico elastic network model analysis of ivermectin components (avermectin-B1a and'¯avermectin-B1b) providing a biophysical and computational perspective of proposed multi-target activity of ivermectin for COVID-19.Gonzlez-Paz et al., 8/17/2021, peer-reviewed, 9 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsLate Elavarasi et al., medRxiv, doi:10.1101/2021.08.10.21261855 (Preprint)death, '†'19.6% , p=0.12Clinical features, demography and predictors of outcomes of SARS-CoV-2 infection in a tertiary care hospital in India - a cohort study Details Retrospective 2017 hospitalized patients in India, showing lower mortality with ivermectin treatment in unadjusted results. No group details are provided and this result is subject to confounding by indication. Details Source PDF Late treatment study
        Late treatment study
        Elavarasi et al., medRxiv, doi:10.1101/2021.08.10.21261855 (Preprint)Clinical features, demography and predictors of outcomes of SARS-CoV-2 infection in a tertiary care hospital in India - a cohort studyRetrospective 2017 hospitalized patients in India, showing lower mortality with ivermectin treatment in unadjusted results. No group details are provided and this result is subject to confounding by indication. risk of death, 19.6% lower , RR 0.80, p = 0.12 , treatment 48 of 283 (17.0%), control 311 of 1475 (21.1%), unadjusted.
        Elavarasi et al., 8/12/2021, retrospective, India, South Asia, preprint, 26 authors, dosage not specified.
        Submit Corrections or CommentsN/A Pedroso et al., The Brazilian Journal of Infectious Diseases, doi:10.1016/j.bjid.2021.101603 (Peer Reviewed)Self-prescribed Ivermectin use is associated with a lower rate of seroconversion in health care workers diagnosed with COVID, in a dose-dependent response Details Retrospective 45 healthcare workes in Brazil, showing lower creation of antibodies with multiple doses of ivermectin, which may be expected due to the antiviral activity as demonstrated in multiple studies. Authors appear unaware of these.. Details Source PDF N/A
        N/A
        Pedroso et al., The Brazilian Journal of Infectious Diseases, doi:10.1016/j.bjid.2021.101603 (Peer Reviewed)Self-prescribed Ivermectin use is associated with a lower rate of seroconversion in health care workers diagnosed with COVID, in a dose-dependent responseRetrospective 45 healthcare workes in Brazil, showing lower creation of antibodies with multiple doses of ivermectin, which may be expected due to the antiviral activity as demonstrated in multiple studies. Authors appear unaware of these studies, citing only earlier in vitro research, which they misinterpret to suggest that therapeutic concentrations are not reached (for details on why this is incorrect see [1]). Authors combine no dose and one dose. Clinical outcomes and timing of treatment are not provided.Pedroso et al., 8/12/2021, peer-reviewed, 11 authors.
        Submit Corrections or CommentsNews La Pampa , Argentina (News)death, '†'27.4% La Pampa expondr a la comunidad cient­fica los resultados del Programa de Intervenci"n Monitoreado de Ivermectina Details News report on the use of ivermectin in La Pampa, Argentina, showing lower mortality with treatment. Details Source PDF News
        News
        La Pampa , Argentina (News)La Pampa expondr a la comunidad cient­fica los resultados del Programa de Intervenci"n Monitoreado de IvermectinaNews report on the use of ivermectin in La Pampa, Argentina, showing lower mortality with treatment. risk of death, 27.4% lower , RR 0.73 , treatment 3269, control 18149.
        risk of combined death/ICU, 38.0% lower , RR 0.62 , treatment 3269, control 18149.
        risk of death, 33.4% lower , RR 0.67 , treatment 3269, control 18149, >40yo.
        risk of death, 44.0% lower , RR 0.56 , treatment 3269, control 18149, >40yo including comorbidities.
        La Pampa et al., 8/10/2021, retrospective, Argentina, South America, preprint, 1 author, dosage 600Î¼g/kg days 1-5.
        Submit Corrections or CommentsReview Kow et al., American Journal of Therapeutics, doi:10.1097/MJT.0000000000001441 (Review) (Peer Reviewed)reviewPitfalls in Reporting Sample Size Calculation Across Randomized Controlled Trials Involving Ivermectin for the treatment of COVID-19 Details Review of sample size calculations in ivermectin RCTs, showing that existing RCTs are very underpowered. Details Source PDF Review
        Review
        Kow et al., American Journal of Therapeutics, doi:10.1097/MJT.0000000000001441 (Review) (Peer Reviewed)Pitfalls in Reporting Sample Size Calculation Across Randomized Controlled Trials Involving Ivermectin for the treatment of COVID-19Review of sample size calculations in ivermectin RCTs, showing that existing RCTs are very underpowered.Kow et al., 8/6/2021, peer-reviewed, 2 authors.
        Submit Corrections or CommentsEarly Together Trial (News)death, '†'18.0% , p=0.54Early Treatment of COVID-19 with Repurposed Therapies: The TOGETHER Adaptive Platform Trial Details Preliminary report from the Together Trial showing mortality RR 0.82 [0.44-1.52]. The trial randomization chart suggests major problems and does not match the protocol. Trial week 43, the first week for 3 dose ivermectin, shows ~3x pati.. Details Source PDF Early treatment study
        Early treatment study
        Together Trial (News)Early Treatment of COVID-19 with Repurposed Therapies: The TOGETHER Adaptive Platform TrialPreliminary report from the Together Trial showing mortality RR 0.82 [0.44-1.52]. The trial randomization chart suggests major problems and does not match the protocol. Trial week 43, the first week for 3 dose ivermectin, shows ~3x patients assigned to ivermectin vs. placebo [1]. Since overall treatment improves over time, and because the distribution of variants continually changes and shows significant differences in outcomes, this invalidates the randomization of the trial. (Confounding by time is common is COVID-19 studies and has often obscured efficacy because more treatment group patients were earlier when overall treatment protocols were significantly worse). Minas Gerais statistics show a period of declining CFR shortly after the time of excess assignment to ivermectin. The total numbers for the ivermectin and placebo groups also do not appear to match the totals in the presentation - reaching the number reported for ivermectin would require including some of the patients assigned to single dose ivermectin. Reaching the placebo number requires including placebo patients from the much earlier ivermectin single dose period, and from the early two week period when zero ivermectin patients were assigned.Treatment delay is currently unknown, however the protocol allows very late inclusion and a companion trial reported mostly late treatment. Overall mortality is high for 18+ outpatients. Results may be impacted by late treatment, poor SOC, and may be specific to local variants [2, 3]. Treatment was administered on an empty stomach, greatly reducing expected tissue concentration and making the effective dose about 1/5th of current clinical practice. The trial was conducted in Minas Gerais, Brazil which had substantial community use of ivermectin [4], and prior use of ivermectin is not listed in the excluson criteria.Time from symptom onset to randomization is specified as within 7 days. However the schedule of study activities specifies treatment administration only one day after randomization, suggesting that treatment was delayed an additional day for all patients.There is an unusual inclusion criteria: "patients with expected hospital stays of This trial uses a soft primary outcome, easily subject to bias and event inflation in both arms (e.g., observe >6 hours independent of indication).Trial design, analysis, and presentation, along with previous public and private statements suggest investigator bias. Design: including very late treatment, additional day before administration, including low-risk patients, operation in a region with high community use, specifying administration on an empty stomach, limiting treatment to 3 days, using soft inclusion criterion and a soft primary outcome, easily subject to bias. Analysis: authors perform analysis excluding events very shortly after randomization for fluvoxamine but not ivermectin, and report viral load results for fluvoxamine but not ivermectin. Presentation: falsely describing positive but not statistically significant effects as "no effect, what so ever" [5, 6]. Prior statements: [7].There are two published protocols, both are called "version 1", we refer to them as 1A (3/11/21 [8]) and 1B (8/5/21 [9]).1B deletes: - subgroup analysis by treatment delay.- "Amendments to the protocol, except when necessary to eliminate an immediate danger to participants, should be made only with the prior approval of the steering committee. Each applicable regulatory authority and EC must review and approve the amendments before they are implemented."1B adds: "we hypothesize that younger patients will benefit more than older patients"If you are a trial participant please contact us below. For other issues see: [10, 11]. risk of death, 18.0% lower , RR 0.82, p = 0.54 , treatment 18 of 677 (2.7%), control 22 of 678 (3.2%).
        extended ER observation or hospitalization, 9.0% lower , RR 0.91, p = 0.51 , treatment 86 of 677 (12.7%), control 95 of 678 (14.0%).
        Together Trial et al., 8/6/2021, Double Blind Randomized Controlled Trial, Brazil, South America, preprint, 1 author, dosage 400Î¼g/kg days 1-3.
        Submit Corrections or CommentsIn Silico Rana et al., Research Square, doi:10.21203/rs.3.rs-755838/v1 (Preprint)A Computational Study of Ivermectin and Doxycycline Combination Drug Against SARS-CoV-2 Infection Details In silico study showing strong binding affinity of ivermectin and doxycycline for SARS-CoV-2 main protease 3CLpro, and increased binding affinity for the combination of both. Details Source PDF In Silico
        In Silico
        Rana et al., Research Square, doi:10.21203/rs.3.rs-755838/v1 (Preprint)A Computational Study of Ivermectin and Doxycycline Combination Drug Against SARS-CoV-2 InfectionIn silico study showing strong binding affinity of ivermectin and doxycycline for SARS-CoV-2 main protease 3CLpro, and increased binding affinity for the combination of both.Rana et al., 8/5/2021, preprint, 3 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsReview Santin et al., New Microbes and New Infections, doi:10.1016/j.nmni.2021.100924 (Review) (Peer Reviewed)reviewIvermectin: a multifaceted drug of Nobel prize-honored distinction with indicated efficacy against a new global scourge, COVID-19 Details Review concluding that the evidence supports worldwide use of ivermectin for COVID-19, complementary to immunization. Authors note that it is likely non-epitope specific, possibly retaining efficacy with new viral strains. They note that .. Details Source PDF Review
        Review
        Santin et al., New Microbes and New Infections, doi:10.1016/j.nmni.2021.100924 (Review) (Peer Reviewed)Ivermectin: a multifaceted drug of Nobel prize-honored distinction with indicated efficacy against a new global scourge, COVID-19Review concluding that the evidence supports worldwide use of ivermectin for COVID-19, complementary to immunization. Authors note that it is likely non-epitope specific, possibly retaining efficacy with new viral strains. They note that ivermectin has been safely used with 3.7 billion doses since 1987, is well tolerated even at much greater than standard doses, and has been used without serious AEs in high-dose COVID-19 treatment studies.Santin et al., 8/3/2021, peer-reviewed, 5 authors.
        Submit Corrections or CommentsMeta Popp et al., Cochrane Database of Systematic Reviews, doi:10.1002/14651858.CD015017.pub2 (Preprint) (meta analysis)meta-analysisIvermectin for preventing and treating COVID'19 Details Outdated very biased retrospective meta analysis selecting a small subset of studies, with a majority of results based on only 1 or 2 studies, showing positive (non-statistically significant) results for 10 of 11 primary outcomes across a.. Details Source PDF Meta
        Meta
        Popp et al., Cochrane Database of Systematic Reviews, doi:10.1002/14651858.CD015017.pub2 (Preprint) (meta analysis)Ivermectin for preventing and treating COVID'19Outdated very biased retrospective meta analysis selecting a small subset of studies, with a majority of results based on only 1 or 2 studies, showing positive (non-statistically significant) results for 10 of 11 primary outcomes across a total of 13 studies.This analysis splits up studies in order to dilute the effects and avoid statistical significance. However, we can consider the probability of 10 of 11 positive effects occurring due to chance for an ineffective treatment, which is very unlikely (0.006), indicating efficacy.The study is entirely retrospective in the current version. The protocol is dated April 20, 2021, and the most recent study included is from March 9, 2021. The protocol was modified after publication in order to include a close to null result (Gonzalez et al. "patients discharged without respiratory deterioration or death at 28 days"), so the current protocol is dated July 28, 2021. The analysis may become partly prospective in the future if the authors do not continue to change the protocol.Authors excluded many studies by requiring results at a specific time, for example mortality, ventilation, etc. required results at exactly 28 days. Authors excluded all prophylaxis studies by requiring results at exactly 14 days.Studies comparing with other medications were excluded, however these studies confirm efficacy of ivermectin. The only case where they could overstate the efficacy of ivermectin is if the other medication was harmful. There is some evidence of this for excessive dosage/very late stage use, however that does not apply to any of the studies here.Studies using combined treatment were excluded, even when it is known that the other components have little or no effect. 3 of 4 RCTs with combined treatment use doxycycline in addition [1].Authors are inconsitent regarding active comparators. They state that hydroxychloroquine ''does not work'', yet excluded trials comparing ivermectin to a drug they hold to be inactive. Contrariwise, remdesivir was an acceptable comparator, though in some jurisdictions held to be an effective standard of care [2].Other studies were excluded by requiring PCR confirmation.Authors fail to recognize that Risk of Bias (RoB) domains such as blinding are far less important for the objective outcome of mortality.Bryant et al. note several other issues [3].Cochrane was reputable in the past, but is now controlled by pharmaceutical interests. For example, see the news related to the expulsion of founder Dr. G¸tzsche and the associated mass resignation of board members in protest [4]. For another example of Cochrane bias see [5].Authors report funding from the German Federal Ministry of Education and Research, which may be influenced by [6].Bias due to funding is ignored for both analyzed studies and Cochrane. For Cochrane funders see: [7, 8].The BiRD group gave the following early comment: "Yesterday's Cochrane review surprisingly doesn't take a pragmatic approach comparing ivermectin versus no ivermectin, like in the majority of other existing reviews. It uses a granular approach similar to WHO's and the flawed Roman et al paper, splitting studies up and thereby diluting effects. Consequently, the uncertain conclusions add nothing to the evidence base. A further obfuscation of the evidence on ivermectin and an example of research waste. Funding conflicts of interests of the authors and of the journal concerned should be examined."Popp et al., 7/28/2021, preprint, 8 authors.
        Submit Corrections or CommentsEarly Ontai et al., medRxiv, doi:10.1101/2021.07.21.21260223 (Preprint)Early multidrug treatment of SARS-CoV-2 (COVID-19) and decreased case fatality rates in Honduras Details Report on the nationwide implementation of multi-drug COVID-19 inpatient and outpatient treatment protocols in Honduras, showing a case fatality rate decrease from 9.33% to 2.97%. No decrease was seen in Mexico, a similar Latin American c.. Details Source PDF Early treatment study
        Early treatment study
        Ontai et al., medRxiv, doi:10.1101/2021.07.21.21260223 (Preprint)Early multidrug treatment of SARS-CoV-2 (COVID-19) and decreased case fatality rates in HondurasReport on the nationwide implementation of multi-drug COVID-19 inpatient and outpatient treatment protocols in Honduras, showing a case fatality rate decrease from 9.33% to 2.97%. No decrease was seen in Mexico, a similar Latin American country that did not introduce multi-drug treatment protocols at that time. Decreases in COVID-19 case fatality rates in Honduras were associated with both the initial publication of the protocol and a subsequent outreach program. Both inpatient and outpatient protocols include ivermectin as one component.Ontai et al., 7/25/2021, preprint, 6 authors.
        Submit Corrections or CommentsNews World Ivermectin Day (News)newsWorld Ivermectin Day Details Joint event by 22 worldwide organizations. Details Source PDF News
        News
        World Ivermectin Day (News)World Ivermectin DayJoint event by 22 worldwide organizations.World Ivermectin Day et al., 7/24/2021, preprint, 1 author.
        Submit Corrections or CommentsSafety Mansour et al., International Immunopharmacology, doi:10.1016/j.intimp.2021.108004 (Peer Reviewed)safety analysisSafety of inhaled ivermectin as a repurposed direct drug for treatment of COVID-19: A preclinical tolerance study Details Safety analysis of an inhaled lyophilized ivermectin formulation, showing 127-fold increase in drug solubility, and identifying safe dosage levels in rats. Details Source PDF Safety
        Safety
        Mansour et al., International Immunopharmacology, doi:10.1016/j.intimp.2021.108004 (Peer Reviewed)Safety of inhaled ivermectin as a repurposed direct drug for treatment of COVID-19: A preclinical tolerance studySafety analysis of an inhaled lyophilized ivermectin formulation, showing 127-fold increase in drug solubility, and identifying safe dosage levels in rats.Mansour et al., 7/23/2021, peer-reviewed, 7 authors.
        Submit Corrections or CommentsNews FLCCC Alliance and British Ivermectin Recommendation Development Group (News)newsJoint Statement of the FLCCC Alliance and British Ivermectin Recommendation Development Group on Retraction of Early Research on Ivermectin Details News release noting that ivermectin remains effective after excluding Elgazzar et al. Given the large magnitude effects and 61 studies, excluding one study with ~3% of patients does not significantly change the evidence base. Details Source PDF News
        News
        FLCCC Alliance and British Ivermectin Recommendation Development Group (News)Joint Statement of the FLCCC Alliance and British Ivermectin Recommendation Development Group on Retraction of Early Research on IvermectinNews release noting that ivermectin remains effective after excluding Elgazzar et al. Given the large magnitude effects and 61 studies, excluding one study with ~3% of patients does not significantly change the evidence base.FLCCC et al., 7/16/2021, preprint, 2 authors.
        Submit Corrections or CommentsMeta Neil et al., ResearchGate, doi:0.13140/RG.2.2.31800.88323 (Preprint) (meta analysis)meta-analysisBayesian Meta Analysis of Ivermectin Effectiveness in Treating Covid-19 Disease Details Bayesian analysis of a subset of ivermectin trial data concluding that there is overwhelming evidence to support a causal link between ivermectin, COVID-19 severity, and mortality. Details Source PDF Meta
        Meta
        Neil et al., ResearchGate, doi:0.13140/RG.2.2.31800.88323 (Preprint) (meta analysis)Bayesian Meta Analysis of Ivermectin Effectiveness in Treating Covid-19 DiseaseBayesian analysis of a subset of ivermectin trial data concluding that there is overwhelming evidence to support a causal link between ivermectin, COVID-19 severity, and mortality.Neil et al., 7/12/2021, preprint, 2 authors.
        Submit Corrections or CommentsIn Silico Muthusamy et al., Journal of Virology & Antiviral Research (Peer Reviewed)Virtual Screening Reveals Potential Anti-Parasitic Drugs Inhibiting the Receptor Binding Domain of SARS-CoV-2 Spike protein Details In Silico study identifying 32 anti-parisitic compounds effectively inhibiting the RBD of the SARS-CoV-2 spike protein, with ivermectin being one of the top compounds. Details Source PDF In Silico
        In Silico
        Muthusamy et al., Journal of Virology & Antiviral Research (Peer Reviewed)Virtual Screening Reveals Potential Anti-Parasitic Drugs Inhibiting the Receptor Binding Domain of SARS-CoV-2 Spike proteinIn Silico study identifying 32 anti-parisitic compounds effectively inhibiting the RBD of the SARS-CoV-2 spike protein, with ivermectin being one of the top compounds.Muthusamy et al., 7/8/2021, peer-reviewed, 5 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsNews Together Trial (News)newsTogether Trial removes mortality and adverse event outcomes, and sublingual administration mid-trial Details Together Trial removes mortality and adverse event outcomes, and sublingual administration mid-trial. Details Source PDF News
        News
        Together Trial (News)Together Trial removes mortality and adverse event outcomes, and sublingual administration mid-trialTogether Trial removes mortality and adverse event outcomes, and sublingual administration mid-trial.Together Trial et al., 7/8/2021, preprint, 1 author.
        Submit Corrections or CommentsLate Hazan et al., medRxiv, doi:10.1101/2021.07.06.21259924 (Preprint)death, '†'85.9% , p=0.04Effectiveness of Ivermectin-Based Multidrug Therapy in Severe Hypoxic Ambulatory COVID-19 Patients Details Small study of 24 consecutive patients in serious condition (9 days post symptoms, mean SpO2 87.4) using combined treatment with ivermectin, doxycycline, zinc, vitamin D, and vitamin C, showing no mortality or hospitalization with treatme.. Details Source PDF Late treatment study
        Late treatment study
        Hazan et al., medRxiv, doi:10.1101/2021.07.06.21259924 (Preprint)Effectiveness of Ivermectin-Based Multidrug Therapy in Severe Hypoxic Ambulatory COVID-19 PatientsSmall study of 24 consecutive patients in serious condition (9 days post symptoms, mean SpO2 87.4) using combined treatment with ivermectin, doxycycline, zinc, vitamin D, and vitamin C, showing no mortality or hospitalization with treatment. Two patients declined treatment and both died. This study uses a synthetic control arm. risk of death, 85.9% lower , RR 0.14, p = 0.04 , continuity correction due to zero event.
        risk of hospitalization, 93.3% lower , RR 0.07, p = 0.001 , continuity correction due to zero event.
        Hazan et al., 7/7/2021, retrospective, USA, North America, preprint, 7 authors, dosage 12mg days 1, 4, 8, this trial uses multiple treatments in the treatment arm (combined with doxycycline, zinc, vitamin D, vitamin C) - results of individual treatments may vary.
        Submit Corrections or CommentsNews Open Letter , Statement of Concern and Request for Retraction, re: Roman et al. (News)newsOpen Letter, Statement of Concern and Request for Retraction Details Open letter signed by 40 physicians detailing errors and flaws in the Roman et al. meta analysis, and requesting retraction. Details Source PDF News
        News
        Open Letter , Statement of Concern and Request for Retraction, re: Roman et al. (News)Open Letter, Statement of Concern and Request for RetractionOpen letter signed by 40 physicians detailing errors and flaws in the Roman et al. meta analysis, and requesting retraction.Open Letter et al., 7/3/2021, preprint, 40 authors.
        Submit Corrections or CommentsReview Adegboro et al., African Journal of Clinical and Experimental Microbiology, doi:10.4314/ajcem.v22i3.2 (Review) (Peer Reviewed)reviewA review of the anti-viral effects of ivermectin Details Review of the antiviral effects of ivermectin. Details Source PDF Review
        Review
        Adegboro et al., African Journal of Clinical and Experimental Microbiology, doi:10.4314/ajcem.v22i3.2 (Review) (Peer Reviewed)A review of the anti-viral effects of ivermectinReview of the antiviral effects of ivermectin.Adegboro et al., 7/2/2021, peer-reviewed, 4 authors.
        Submit Corrections or CommentsEarly Vallejos et al., BMC Infectious Diseases, doi:10.1186/s12879-021-06348-5 (Peer Reviewed)death, '†‘33.5% , p=0.70Ivermectin to prevent hospitalizations in patients with COVID-19 (IVERCOR-COVID19) a randomized, double-blind, placebo-controlled trial Details RCT with 501 relatively low-risk outpatients in Argentina showing hospitalization OR 0.65 [0.32-1.31]. With only 7% hospitalization, the trial is underpowered. The trial primarily includes low-risk patients that recover quickly without tr.. Details Source PDF Early treatment study
        Early treatment study
        Vallejos et al., BMC Infectious Diseases, doi:10.1186/s12879-021-06348-5 (Peer Reviewed)Ivermectin to prevent hospitalizations in patients with COVID-19 (IVERCOR-COVID19) a randomized, double-blind, placebo-controlled trialRCT with 501 relatively low-risk outpatients in Argentina showing hospitalization OR 0.65 [0.32-1.31]. With only 7% hospitalization, the trial is underpowered. The trial primarily includes low-risk patients that recover quickly without treatment, leaving minimal room for improvement with treatment. 74 patients had symptoms for >= 7 days and more than 25% of patients were hospitalized within 1 day (Figure S2). Among the 7 patients requiring ventilation, authors note that the earlier requirement in the ivermectin group may be due to those patients having higher severity at baseline. However, authors know the answer to this - it is unclear why it is not reported. There were more adverse events in the placebo group than the ivermectin group, suggesting a possible issue with dispensing or non-trial medication usage.Authors pre-specify multivariate analysis but do not present it, claiming "no significant differences in the univariate analysis", however multivariate analysis could significantly change the results. Consider for example if just a few extra patients in the ivermectin group were in severe condition based on baseline SpO2. The lower mean SpO2 in the ivermectin group, and the shorter time to ventilation, are consistent with this being the case. Additionally, there are 14% more male patients in the ivermectin group.An extremely large percentage of patients (55%) were excluded based on ivermectin use in the last 7 days. However, ivermectin may retain efficacy much longer (for example antiparasitic activity may persist for months [1]). A significant number of patients may also misrepresent their prior and future usage - the population is clearly aware of ivermectin, and patients with progressing disease may be motivated to take it, predicting that they are in the control group.There were no serious adverse events. NCT04529525. risk of death, 33.5% higher , RR 1.33, p = 0.70 , treatment 4 of 250 (1.6%), control 3 of 251 (1.2%), OR converted to RR.
        risk of mechanical ventilation, 33.5% higher , RR 1.33, p = 0.70 , treatment 4 of 250 (1.6%), control 3 of 251 (1.2%), OR converted to RR.
        risk of hospitalization, 33.0% lower , RR 0.67, p = 0.23 , treatment 14 of 250 (5.6%), control 21 of 251 (8.4%), OR converted to RR.
        risk of no virological cure, 5.0% higher , RR 1.05, p = 0.55 , treatment 137 of 250 (54.8%), control 131 of 251 (52.2%), OR converted to RR, day 3.
        risk of no virological cure, 26.8% higher , RR 1.27, p = 0.29 , treatment 38 of 250 (15.2%), control 30 of 251 (12.0%), OR converted to RR, day 12.
        Vallejos et al., 7/2/2021, Double Blind Randomized Controlled Trial, Argentina, South America, peer-reviewed, 29 authors, dosage 12mg days 1-2, 110kg 24mg.
        Submit Corrections or CommentsReview Turkia , M., ResearchGate, doi:10.13140/RG.2.2.16973.36326 (Review) (Preprint)reviewA Continuation of a Timeline of Ivermectin-Related Events in the COVID-19 Pandemic [June 30, 2021] Details An extension of the ivermectin timeline covering April - June 2021, including WHO's role and funding, Gavi, COVAX, Trusted News Initiative, International Fact-Checking Network, the role of private philantrophy, Frontiers, comparison to th.. Details Source PDF Review
        Review
        Turkia , M., ResearchGate, doi:10.13140/RG.2.2.16973.36326 (Review) (Preprint)A Continuation of a Timeline of Ivermectin-Related Events in the COVID-19 Pandemic [June 30, 2021]An extension of the ivermectin timeline covering April - June 2021, including WHO's role and funding, Gavi, COVAX, Trusted News Initiative, International Fact-Checking Network, the role of private philantrophy, Frontiers, comparison to the H1N1 pandemic, new treatment protocols, and causal modeling.Turkia et al., 6/30/2021, preprint, 1 author.
        Submit Corrections or CommentsN/A Roman et al., Clinical Infectious Diseases, doi:10.1093/cid/ciab591 (preprint 5/25/21) (Peer Reviewed) (meta analysis)meta-analysisIvermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials Details Severely flawed meta analysis. An open letter signed by 40 physicians detailing errors and flaws, and requesting retraction, can be found at [1]. See also [2].The authors state that they have no conflicts of interest on medRxiv, however.. Details Source PDF N/A
        N/A
        Roman et al., Clinical Infectious Diseases, doi:10.1093/cid/ciab591 (preprint 5/25/21) (Peer Reviewed) (meta analysis)Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trialsSeverely flawed meta analysis. An open letter signed by 40 physicians detailing errors and flaws, and requesting retraction, can be found at [1]. See also [2].The authors state that they have no conflicts of interest on medRxiv, however Dr. Pasupuleti's affiliation is Cello Health, whose website [3] says that they provide services such as ''brand and portfolio commercial strategy for biotech and pharma'', and that their clients are "24 of the top 25 pharmaceutical companies''.Authors cherry-pick to include only 4 studies reporting non-zero mortality and they claim a mortality RR of 1.11 [0.16-7.65]. However, they reported incorrect values for Niaee et al., claiming an RR of 6.51 [2.18-19.45]. The correct RR for Niaee et al. is 0.18 [0.06-0.55] (as below). After correction, their cherry-picked studies show >60% mortality reduction.Similarly, for viral clearance and NCT04392713, they report 20/41 treatment, 18/45 control, whereas the correct day 7 clearance numbers are 37/41 and 20/45 (sum of clearance @72hrs and @7 days), or 17/41 and 2/45 @72 hrs.The duration of hospital stay for Niaee et al. is also incorrectly reported, showing a lower duration for the control group.All of the errors are in one direction - incorrectly reporting lower than actual efficacy for ivermectin. Authors claim to include all RCTs excluding prophylaxis, however they only include 10 of the 24 non-prophylaxis RCTs (28 including prophylaxis). Authors actually reference meta analyses that do include the missing RCTs, so they should be aware of the missing RCTs.The PubMed search strategy provided is syntactically incorrect.For additional errors, see [4]. Also see [5].Only one of these errors has been partially fixed as of 5/29 - the Niaee RR was corrected, but the associated conclusion was not. Other errors have not been corrected. Comments on this article appear to be censored, with zero comments posted as of July 5.Roman et al., 6/28/2021, peer-reviewed, 6 authors.
        Submit Corrections or CommentsReview Jagiasi et al., The International Journal of Clinical Practice, doi:10.1111/ijcp.14574 (Review) (Peer Reviewed)reviewVariation in therapeutic strategies for the management of severe COVID-19 in India- A nationwide cross-sectional survey Details Survey of medication use for severe COVID-19 in India, showing 33% adoption of ivermectin as of January 2021. Details Source PDF Review
        Review
        Jagiasi et al., The International Journal of Clinical Practice, doi:10.1111/ijcp.14574 (Review) (Peer Reviewed)Variation in therapeutic strategies for the management of severe COVID-19 in India- A nationwide cross-sectional surveySurvey of medication use for severe COVID-19 in India, showing 33% adoption of ivermectin as of January 2021.Jagiasi et al., 6/25/2021, peer-reviewed, 19 authors.
        Submit Corrections or CommentsNews Misiones Ministry of Public Health (News)newsResults from ivermectin use from the Misiones Ministry of Public Health Details News report on ivermectin use in Misiones, Argentina, showing significantly lower hospitalization and mortality, and a dose-dependent effect with improved results for those taking 0.6mg/kg. Details Source PDF News
        News
        Misiones Ministry of Public Health (News)Results from ivermectin use from the Misiones Ministry of Public HealthNews report on ivermectin use in Misiones, Argentina, showing significantly lower hospitalization and mortality, and a dose-dependent effect with improved results for those taking 0.6mg/kg.Misiones Ministry of Public Health et al., 6/22/2021, preprint, 1 author.
        Submit Corrections or CommentsReview Lind et al., Journal of General Internal Medicine, doi:10.1007/s11606-021-06948-6 (Review) (Peer Reviewed)reviewIncrease in Outpatient Ivermectin Dispensing in the US During the COVID-19 Pandemic: A Cross-Sectional Analysis Details CDC analysis of ivermectin prescriptions in the US suggesting that, while national health authority recognition is delayed in that country, many physicians are aware of the efficacy demonstrated in clinical trials. Details Source PDF Review
        Review
        Lind et al., Journal of General Internal Medicine, doi:10.1007/s11606-021-06948-6 (Review) (Peer Reviewed)Increase in Outpatient Ivermectin Dispensing in the US During the COVID-19 Pandemic: A Cross-Sectional AnalysisCDC analysis of ivermectin prescriptions in the US suggesting that, while national health authority recognition is delayed in that country, many physicians are aware of the efficacy demonstrated in clinical trials.Lind et al., 6/18/2021, peer-reviewed, 6 authors.
        Submit Corrections or CommentsEarly Krolewiecki et al., EClinicalMedicine, doi:10.1016/j.eclinm.2021.100959 (Peer Reviewed)ventilation, '†‘151.9% , p=1.00Antiviral effect of high-dose ivermectin in adults with COVID-19: A proof-of-concept randomized trial Details Proof of concept RCT with 30 ivermectin patients and 15 control patients, showing a concentration dependent antiviral activity, but no significant difference in clinical outcomes. There was no significant difference in viral load reductio.. Details Source PDF Early treatment study
        Early treatment study
        Krolewiecki et al., EClinicalMedicine, doi:10.1016/j.eclinm.2021.100959 (Peer Reviewed)Antiviral effect of high-dose ivermectin in adults with COVID-19: A proof-of-concept randomized trialProof of concept RCT with 30 ivermectin patients and 15 control patients, showing a concentration dependent antiviral activity, but no significant difference in clinical outcomes. There was no significant difference in viral load reduction between groups overall, but a significant difference was found in patients with higher median plasma ivermectin levels (72% vs. 42%, p=0.004). Mean ivermectin plasma concentration levels correlated with viral decay rate (r=0.47, p=0.02). NCT004381884. Authors published a corrigendum: [1]. risk of mechanical ventilation, 151.9% higher , RR 2.52, p = 1.00 , treatment 1 of 27 (3.7%), control 0 of 14 (0.0%), continuity correction due to zero event.
        risk of disease progression, 3.7% higher , RR 1.04, p = 1.00 , treatment 2 of 27 (7.4%), control 1 of 14 (7.1%).
        Krolewiecki et al., 6/18/2021, Randomized Controlled Trial, Argentina, South America, peer-reviewed, 23 authors, dosage 600Î¼g/kg days 1-5.
        Submit Corrections or CommentsMeta Bryant et al., American Journal of Therapeutics, doi:10.1097/MJT.0000000000001402 (preprint 3/11/21) (Peer Reviewed) (meta analysis)death, '†'62.0% , p=0.005Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines Details Systematic review, meta analysis, and trial sequential analysis of 24 RCTs finding mortality RR 0.38 [0.19-0.73]. Details Source PDF Meta
        Meta
        Bryant et al., American Journal of Therapeutics, doi:10.1097/MJT.0000000000001402 (preprint 3/11/21) (Peer Reviewed) (meta analysis)Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical GuidelinesSystematic review, meta analysis, and trial sequential analysis of 24 RCTs finding mortality RR 0.38 [0.19-0.73]. risk of death, 62.0% lower , RR 0.38, p = 0.005 .
        Bryant et al., 6/17/2021, peer-reviewed, 7 authors.
        Submit Corrections or CommentsReview Zaidi et al., The Journal of Antibiotics, doi:10.1038/s41429-021-00430-5 (Review) (Peer Reviewed)reviewThe mechanisms of action of Ivermectin against SARS-CoV-2: An evidence-based clinical review article Details Extensive review of 20 mechanisms of action of ivermectin for SARS-CoV-2. Details Source PDF Review
        Review
        Zaidi et al., The Journal of Antibiotics, doi:10.1038/s41429-021-00430-5 (Review) (Peer Reviewed)The mechanisms of action of Ivermectin against SARS-CoV-2: An evidence-based clinical review articleExtensive review of 20 mechanisms of action of ivermectin for SARS-CoV-2.Zaidi et al., 6/15/2021, peer-reviewed, 2 authors.
        Submit Corrections or CommentsEarly Aref et al., International Journal of Nanomedicine, doi:10.2147/IJN.S313093 (Peer Reviewed)recov. time, '†'63.2% , p=0.0001Clinical, Biochemical and Molecular Evaluations of Ivermectin Mucoadhesive Nanosuspension Nasal Spray in Reducing Upper Respiratory Symptoms of Mild COVID-19 Details RCT 114 patients in Egypt, 57 treated with ivermectin mucoadhesive nanosuspension intranasal spray, showing faster recovery and viral clearance with treatment. NCT04716569. Details Source PDF Early treatment study
        Early treatment study
        Aref et al., International Journal of Nanomedicine, doi:10.2147/IJN.S313093 (Peer Reviewed)Clinical, Biochemical and Molecular Evaluations of Ivermectin Mucoadhesive Nanosuspension Nasal Spray in Reducing Upper Respiratory Symptoms of Mild COVID-19RCT 114 patients in Egypt, 57 treated with ivermectin mucoadhesive nanosuspension intranasal spray, showing faster recovery and viral clearance with treatment. NCT04716569. relative duration of fever, 63.2% lower , relative time 0.37, p , treatment 57, control 57.
        risk of no virological cure, 78.6% lower , RR 0.21, p = 0.004 , treatment 3 of 57 (5.3%), control 14 of 57 (24.6%).
        Aref et al., 6/15/2021, Randomized Controlled Trial, Egypt, Africa, peer-reviewed, 7 authors.
        Submit Corrections or CommentsN/A Hariyanto et al., Reviews In Medical Virology, doi:10.1002/rmv.2265 (Peer Reviewed) (meta analysis)death, '†'69.0% , p=0.001Ivermectin and outcomes from Covid-19 pneumonia: A systematic review and meta-analysis of randomized clinical trial studies Details Systematic review and meta analysis of 19 RCTs showing mortality RR 0.31 [0.15-0.62]. Details Source PDF N/A
        N/A
        Hariyanto et al., Reviews In Medical Virology, doi:10.1002/rmv.2265 (Peer Reviewed) (meta analysis)Ivermectin and outcomes from Covid-19 pneumonia: A systematic review and meta-analysis of randomized clinical trial studiesSystematic review and meta analysis of 19 RCTs showing mortality RR 0.31 [0.15-0.62]. risk of death, 69.0% lower , RR 0.31, p = 0.001 .
        Hariyanto et al., 6/6/2021, peer-reviewed, 5 authors.
        Submit Corrections or CommentsReview Wang et al., medRxiv, doi:10.1101/2021.06.01.21258147 (Review) (Preprint)reviewMinimum manufacturing costs, national prices and estimated global availability of new repurposed therapies for COVID-19 Details Analysis of the manufacturing cost of several COVID-19 medications, showing a cost of $0.55 per course of ivermectin, including excipients, formulation, tax, and profit. Details Source PDF Review
        Review
        Wang et al., medRxiv, doi:10.1101/2021.06.01.21258147 (Review) (Preprint)Minimum manufacturing costs, national prices and estimated global availability of new repurposed therapies for COVID-19Analysis of the manufacturing cost of several COVID-19 medications, showing a cost of $0.55 per course of ivermectin, including excipients, formulation, tax, and profit.Wang et al., 6/3/2021, preprint, 4 authors.
        Submit Corrections or CommentsLate Abd-Elsalam et al., Journal of Medical Virology, doi:10.1002/jmv.27122 (Peer Reviewed)death, '†'25.0% , p=0.70Clinical Study Evaluating the Efficacy of Ivermectin in COVID-19 Treatment: A Randomized Controlled Study Details RCT 164 hospitalized patients in Egypt showing lower mortality and shorter hospitalization, but without statistical significance. There were no serious adverse effects. Authors suggest the low dosage may have resulted in lower efficacy th.. Details Source PDF Late treatment study
        Late treatment study
        Abd-Elsalam et al., Journal of Medical Virology, doi:10.1002/jmv.27122 (Peer Reviewed)Clinical Study Evaluating the Efficacy of Ivermectin in COVID-19 Treatment: A Randomized Controlled StudyRCT 164 hospitalized patients in Egypt showing lower mortality and shorter hospitalization, but without statistical significance. There were no serious adverse effects. Authors suggest the low dosage may have resulted in lower efficacy than other trials, and recommend increased dosage in future trials. Time from symptom onset is not specified. risk of death, 25.0% lower , RR 0.75, p = 0.70 , treatment 3 of 82 (3.7%), control 4 of 82 (4.9%), OR converted to RR, logistic regression.
        risk of mechanical ventilation, no change , RR 1.00, p = 1.00 , treatment 3 of 82 (3.7%), control 3 of 82 (3.7%).
        hospitalization time, 19.6% lower , relative time 0.80, p = 0.09 , treatment 82, control 82.
        Abd-Elsalam et al., 6/2/2021, Randomized Controlled Trial, Egypt, Africa, peer-reviewed, 16 authors, dosage 12mg days 1-3.
        Submit Corrections or CommentsPrEPPEP Mondal et al., Journal of the Indian Medical Association, 119:5 (Peer Reviewed)symp. case, '†'87.9% , p=0.006Prevalence of COVID-19 Infection and Identification of Risk Factors among Asymptomatic Healthcare Workers: A Serosurvey Involving Multiple Hospitals in West Bengal Details Retrospective 1,470 healthcare workers in India, showing significantly lower risk of symptomatic COVID-19 with ivermectin prophylaxis. Details Source PDF Prophylaxis study
        Prophylaxis study
        Mondal et al., Journal of the Indian Medical Association, 119:5 (Peer Reviewed)Prevalence of COVID-19 Infection and Identification of Risk Factors among Asymptomatic Healthcare Workers: A Serosurvey Involving Multiple Hospitals in West BengalRetrospective 1,470 healthcare workers in India, showing significantly lower risk of symptomatic COVID-19 with ivermectin prophylaxis. risk of symptomatic case, 87.9% lower , RR 0.12, p = 0.006 , treatment 128, control 1342, OR converted to RR, multivariate logistic regression, control prevalence approximated with overall prevalence.
        Mondal et al., 5/31/2021, retrospective, India, South Asia, peer-reviewed, 11 authors, dosage not specified.
        Submit Corrections or CommentsIn Vitro Mountain Valley MD (Preprint) (In Vitro)in vitroMountain Valley MD Receives Successful Results From BSL-4 COVID-19 Clearance Trial on Three Variants Tested With Ivectosol' Details In Vitro and mouse study with human ACE2 cells, using solubilized ivermectin with Ivectosol', showing antiviral effect with B.1.1.7, B.1.351, and P.1 variants of SARS-CoV-2.The ability to inject ivermectin potentially reduces the onset .. Details Source PDF In Vitro
        In Vitro
        Mountain Valley MD (Preprint) (In Vitro)Mountain Valley MD Receives Successful Results From BSL-4 COVID-19 Clearance Trial on Three Variants Tested With Ivectosol'In Vitro and mouse study with human ACE2 cells, using solubilized ivermectin with Ivectosol', showing antiviral effect with B.1.1.7, B.1.351, and P.1 variants of SARS-CoV-2.The ability to inject ivermectin potentially reduces the onset of action from ~6 hours to ~15 minutes, with much lower variability.Mountain Valley MD et al., 5/18/2021, preprint, 1 author.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsNews FLCCC Public Statement (News)newsFLCCC Alliance Statement on the Irregular Actions of Public Health Agencies and the Widespread Disinformation Campaign Against Ivermectin Details Analysis of the ivermectin recommendations from WHO and others, and a call to action for all citizens, scientists, and media to counter false information. Whistleblowers can submit anonymous reports and images at the bottom of this page. Details Source PDF News
        News
        FLCCC Public Statement (News)FLCCC Alliance Statement on the Irregular Actions of Public Health Agencies and the Widespread Disinformation Campaign Against IvermectinAnalysis of the ivermectin recommendations from WHO and others, and a call to action for all citizens, scientists, and media to counter false information. Whistleblowers can submit anonymous reports and images at the bottom of this page.FLCCC et al., 5/12/2021, preprint, 9 authors.
        Submit Corrections or CommentsEarly Faisal et al., The Professional Medical Journal, doi:10.29309/TPMJ/2021.28.05.5867 (Peer Reviewed)no recov., '†'68.4% , p=0.005Potential use of azithromycin alone and in combination with ivermectin in fighting against the symptoms of COVID-19 Details RCT 100 outpatients in Pakistan, 50 treated with ivermectin, showing faster recovery with ivermectin. All patients received AZ, zinc, vitamin C, vitamin D, and paracetemol. Details of randomization were not provided. No mortality or hospi.. Details Source PDF Early treatment study
        Early treatment study
        Faisal et al., The Professional Medical Journal, doi:10.29309/TPMJ/2021.28.05.5867 (Peer Reviewed)Potential use of azithromycin alone and in combination with ivermectin in fighting against the symptoms of COVID-19RCT 100 outpatients in Pakistan, 50 treated with ivermectin, showing faster recovery with ivermectin. All patients received AZ, zinc, vitamin C, vitamin D, and paracetemol. Details of randomization were not provided. No mortality or hospitalization was reported. risk of no recovery, 68.4% lower , RR 0.32, p = 0.005 , treatment 6 of 50 (12.0%), control 19 of 50 (38.0%), 6-8 days, mid-recovery.
        risk of no recovery, 27.3% lower , RR 0.73, p = 0.11 , treatment 24 of 50 (48.0%), control 33 of 50 (66.0%), 3-5 days.
        risk of no recovery, 75.0% lower , RR 0.25, p = 0.09 , treatment 2 of 50 (4.0%), control 8 of 50 (16.0%), 9-10 days.
        Faisal et al., 5/10/2021, Randomized Controlled Trial, Pakistan, South Asia, peer-reviewed, 3 authors, dosage 12mg days 1-5.
        Submit Corrections or CommentsIn Vitro Zatloukal et al. (News) (In Vitro)newsNews report on In Vitro results from the research institute of Prof. Zatloukal Details News report on In Vitro results from the research institute of Prof. Zatloukal, showing that "ivermectin was able to reduce virus replication by a factor of 1,000 even at low concentrations". Details Source PDF In Vitro
        In Vitro
        Zatloukal et al. (News) (In Vitro)News report on In Vitro results from the research institute of Prof. ZatloukalNews report on In Vitro results from the research institute of Prof. Zatloukal, showing that "ivermectin was able to reduce virus replication by a factor of 1,000 even at low concentrations".Zatloukal et al., 5/5/2021, preprint, 1 author.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsIn Silico Qureshi et al., Journal of Biomolecular Structure and Dynamics, doi:10.1080/07391102.2021.1906750 (Peer Reviewed)Mechanistic insights into the inhibitory activity of FDA approved ivermectin against SARS-CoV-2: old drug with new implications Details In Silico study showing inhibition of importin-Î±1 by ivermectin, which disrupts SARS-CoV-2 replication. Details Source PDF In Silico
        In Silico
        Qureshi et al., Journal of Biomolecular Structure and Dynamics, doi:10.1080/07391102.2021.1906750 (Peer Reviewed)Mechanistic insights into the inhibitory activity of FDA approved ivermectin against SARS-CoV-2: old drug with new implicationsIn Silico study showing inhibition of importin-Î±1 by ivermectin, which disrupts SARS-CoV-2 replication.Qureshi et al., 5/5/2021, peer-reviewed, 6 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsMeta Karale et al., medRxiv, doi:10.1101/2021.04.30.21256415 (Preprint) (meta analysis)meta-analysisA Meta-analysis of Mortality, Need for ICU admission, Use of Mechanical Ventilation and Adverse Effects with Ivermectin Use in COVID-19 Patients Details Systematic review and meta analysis with 30 studies included in quantitative analysis, showing mortality OR 0.39 [0.22-0.70]. Subgroup analysis of trials with severity data showed mortality OR 0.10 [0.03-0.33] for mild/moderate cases. Details Source PDF Meta
        Meta
        Karale et al., medRxiv, doi:10.1101/2021.04.30.21256415 (Preprint) (meta analysis)A Meta-analysis of Mortality, Need for ICU admission, Use of Mechanical Ventilation and Adverse Effects with Ivermectin Use in COVID-19 PatientsSystematic review and meta analysis with 30 studies included in quantitative analysis, showing mortality OR 0.39 [0.22-0.70]. Subgroup analysis of trials with severity data showed mortality OR 0.10 [0.03-0.33] for mild/moderate cases.Karale et al., 5/4/2021, preprint, 12 authors.
        Submit Corrections or CommentsEarly Merino et al., SocArXiv Papers, doi:10.31235/osf.io/r93g4 (Preprint)hosp., '†'74.4% , pIvermectin and the odds of hospitalization due to COVID-19: evidence from a quasi-experimental analysis based on a public intervention in Mexico City Details Analysis of Mexico City's use of an ivermectin-based medical kit, showing significantly lower hospitalization with use. Authors use logistic-regression models with matched observations, including adjustments for age, sex, COVID severity, .. Details Source PDF Early treatment study
        Early treatment study
        Merino et al., SocArXiv Papers, doi:10.31235/osf.io/r93g4 (Preprint)Ivermectin and the odds of hospitalization due to COVID-19: evidence from a quasi-experimental analysis based on a public intervention in Mexico CityAnalysis of Mexico City's use of an ivermectin-based medical kit, showing significantly lower hospitalization with use. Authors use logistic-regression models with matched observations, including adjustments for age, sex, COVID severity, and comorbidities. risk of hospitalization, 74.4% lower , RR 0.26, p , model 7, same time period, patients receiving kit.
        risk of hospitalization, 68.4% lower , RR 0.32, p , model 1, different time periods, administrative rule.
        Merino et al., 5/3/2021, retrospective quasi-randomized (patients receiving kit), population-based cohort, Mexico, North America, preprint, 7 authors, dosage 6mg bid days 1-2.
        Submit Corrections or CommentsReview Kory et al., American Journal of Therapeutics, doi:10.1097/MJT.0000000000001377 (Review) (Peer Reviewed)reviewReview of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 Details Review of ivermectin trials and epidemiological data, concluding that ivermectin is effective for prophylaxis and treatment, and should be globally and systematically deployed in the prevention and treatment of COVID-19. Details Source PDF Review
        Review
        Kory et al., American Journal of Therapeutics, doi:10.1097/MJT.0000000000001377 (Review) (Peer Reviewed)Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19Review of ivermectin trials and epidemiological data, concluding that ivermectin is effective for prophylaxis and treatment, and should be globally and systematically deployed in the prevention and treatment of COVID-19.Kory et al., 4/30/2021, peer-reviewed, 5 authors.
        Submit Corrections or CommentsLate Ahsan et al., Cureus, doi:10.7759/cureus.14761 (Peer Reviewed)death, '†'50.0% , p=0.03Clinical Variants, Characteristics, and Outcomes Among COVID-19 Patients: A Case Series Analysis at a Tertiary Care Hospital in Karachi, Pakistan Details Retrospective 165 hospitalized patients in Pakistan showing unadjusted lower mortality with combined ivermectin and doxycycline treatment. Details of the ivermectin group compared to other patients are not provided, however ivermectin was.. Details Source PDF Late treatment study
        Late treatment study
        Ahsan et al., Cureus, doi:10.7759/cureus.14761 (Peer Reviewed)Clinical Variants, Characteristics, and Outcomes Among COVID-19 Patients: A Case Series Analysis at a Tertiary Care Hospital in Karachi, PakistanRetrospective 165 hospitalized patients in Pakistan showing unadjusted lower mortality with combined ivermectin and doxycycline treatment. Details of the ivermectin group compared to other patients are not provided, however ivermectin was given to a similar percentage of patients in the mild, moderate, and severe/critical groups (34.5%, 29.1%, and 36.4%), suggesting that ivermectin treatment was not based on severity. risk of death, 50.0% lower , RR 0.50, p = 0.03 , treatment 17 of 110 (15.5%), control 17 of 55 (30.9%).
        Ahsan et al., 4/29/2021, retrospective, Pakistan, South Asia, peer-reviewed, 10 authors, dosage 150Î¼g/kg days 1-2, 150-200µg/kg, this trial uses multiple treatments in the treatment arm (combined with doxycycline) - results of individual treatments may vary.
        Submit Corrections or CommentsReview DiNicolantonio et al., Open Heart, doi:10.1136/openhrt-2021-001655 (Review) (Peer Reviewed)reviewAnti-inflammatory activity of ivermectin in late-stage COVID-19 may reflect activation of systemic glycine receptors Details Review suggesting that the effectiveness of ivermectin in the cytokine storm phase of COVID-19 may be, at least in part, an anti-inflammatory effect mediated by increased activation of glycine receptors on leukocytes and possibly vascular.. Details Source PDF Review
        Review
        DiNicolantonio et al., Open Heart, doi:10.1136/openhrt-2021-001655 (Review) (Peer Reviewed)Anti-inflammatory activity of ivermectin in late-stage COVID-19 may reflect activation of systemic glycine receptorsReview suggesting that the effectiveness of ivermectin in the cytokine storm phase of COVID-19 may be, at least in part, an anti-inflammatory effect mediated by increased activation of glycine receptors on leukocytes and possibly vascular endothelium.DiNicolantonio et al., 4/19/2021, peer-reviewed, 3 authors.
        Submit Corrections or CommentsEarly Loue et al., J. Infectious Diseases and Epidemiology, doi:10.23937/2474-3658/1510202 (Peer Reviewed)death, '†'70.0% , p=0.34Ivermectin and COVID-19 in Care Home: Case Report Details Small quasi-randomized (patient choice) study with 25 PCR+ patients in a nursing home offered ivermectin, of which 10 chose to be treated. The mean age was 83.5 in the treatment group and 81.8 in the control group. There was lower mortali.. Details Source PDF Early treatment study
        Early treatment study
        Loue et al., J. Infectious Diseases and Epidemiology, doi:10.23937/2474-3658/1510202 (Peer Reviewed)Ivermectin and COVID-19 in Care Home: Case ReportSmall quasi-randomized (patient choice) study with 25 PCR+ patients in a nursing home offered ivermectin, of which 10 chose to be treated. The mean age was 83.5 in the treatment group and 81.8 in the control group. There was lower mortality and fewer serious cases with treatment. risk of death, 70.0% lower , RR 0.30, p = 0.34 , treatment 1 of 10 (10.0%), control 5 of 15 (33.3%).
        risk of COVID-19 severe case, 55.0% lower , RR 0.45, p = 0.11 , treatment 3 of 10 (30.0%), control 10 of 15 (66.7%).
        Loue et al., 4/17/2021, retrospective quasi-randomized (patient choice), France, Europe, peer-reviewed, 2 authors, dosage 200Î¼g/kg single dose.
        Submit Corrections or CommentsPrEPPEP Morgenstern et al., Cureus, doi:10.7759/cureus.17455 (preprint 4/16/2021) (Peer Reviewed)hosp., '†'80.0% , p=0.50Ivermectin as a SARS-CoV-2 Pre-Exposure Prophylaxis Method in Healthcare Workers: A Propensity Score-Matched Retrospective Cohort Study Details Propensity matched retrospective prophylaxis study of healthcare workers in the Dominican Republic showing significantly lower cases with treatment, and no hospitalization with treatment (versus 2 in the PSM matched control group). The ca.. Details Source PDF Prophylaxis study
        Prophylaxis study
        Morgenstern et al., Cureus, doi:10.7759/cureus.17455 (preprint 4/16/2021) (Peer Reviewed)Ivermectin as a SARS-CoV-2 Pre-Exposure Prophylaxis Method in Healthcare Workers: A Propensity Score-Matched Retrospective Cohort StudyPropensity matched retrospective prophylaxis study of healthcare workers in the Dominican Republic showing significantly lower cases with treatment, and no hospitalization with treatment (versus 2 in the PSM matched control group). The cases with treatment were mostly in the first week, with only one case in the second and third weeks, and none in the fourth week. There were no severe side effects. In post-hoc analysis, as the treatment group discontinued treatment over time, their protection also decreased. NCT04832945. risk of hospitalization, 80.0% lower , RR 0.20, p = 0.50 , treatment 0 of 271 (0.0%), control 2 of 271 (0.7%), continuity correction due to zero event, PSM.
        risk of COVID-19 case, 74.0% lower , RR 0.26, p = 0.008 , treatment 5 of 271 (1.8%), control 18 of 271 (6.6%), adjusted, PSM, multivariate Cox regression.
        Morgenstern et al., 4/16/2021, retrospective, propensity score matching, Dominican Republic, Caribbean, peer-reviewed, 16 authors, dosage 200Î¼g/kg weekly.
        Submit Corrections or CommentsPrEPPEP Seet et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2021.04.035 (Peer Reviewed)severe case, '†'49.8% , p=0.01Positive impact of oral hydroxychloroquine and povidone-iodine throat spray for COVID-19 prophylaxis: an open-label randomized trial Details Prophylaxis RCT in Singapore with 3,037 low risk patients, showing lower serious cases, lower symptomatic cases, and lower confirmed cases of COVID-19 with all treatments (ivermectin, HCQ, PVP-I, and Zinc + vitamin C) compared to vitamin .. Details Source PDF Prophylaxis study
        Prophylaxis study
        Seet et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2021.04.035 (Peer Reviewed)Positive impact of oral hydroxychloroquine and povidone-iodine throat spray for COVID-19 prophylaxis: an open-label randomized trialProphylaxis RCT in Singapore with 3,037 low risk patients, showing lower serious cases, lower symptomatic cases, and lower confirmed cases of COVID-19 with all treatments (ivermectin, HCQ, PVP-I, and Zinc + vitamin C) compared to vitamin C.The ivermectin dosage was low for 42 days prophylaxis - only a single dose of 200µg/kg, with a maximum of 12mg.Meta-analysis of vitamin C in 6 previous trials shows a benefit of 16%, so the actual benefit of ivermectin, HCQ, and PVP-I may be higher. Cluster RCT with 40 clusters.There were no hospitalizations and no deaths. NCT04446104. risk of COVID-19 severe case, 49.8% lower , RR 0.50, p = 0.01 , treatment 32 of 617 (5.2%), control 64 of 619 (10.3%).
        risk of COVID-19 case, 5.8% lower , RR 0.94, p = 0.61 , treatment 398 of 617 (64.5%), control 433 of 619 (70.0%), adjusted, OR converted to RR, model 6.
        Seet et al., 4/14/2021, Cluster Randomized Controlled Trial, Singapore, Asia, peer-reviewed, 15 authors, dosage 12mg single dose, 200µg/kg, maximum 12mg, this trial compares with another treatment - results may be better when compared to placebo.
        Submit Corrections or CommentsIn Silico Bello et al., Journal of Biomolecular Structure and Dynamics, doi:10.1080/07391102.2021.1911857 (Peer Reviewed)Elucidation of the inhibitory activity of ivermectin with host nuclear importin Î± and several SARS-CoV-2 targets Details In Silico analysis finding that the in vitro activity of ivermectin may explained by acting as an inhibitor of importin-Î±, dimeric 3CLpro, and Nsp9. Details Source PDF In Silico
        In Silico
        Bello et al., Journal of Biomolecular Structure and Dynamics, doi:10.1080/07391102.2021.1911857 (Peer Reviewed)Elucidation of the inhibitory activity of ivermectin with host nuclear importin Î± and several SARS-CoV-2 targetsIn Silico analysis finding that the in vitro activity of ivermectin may explained by acting as an inhibitor of importin-Î±, dimeric 3CLpro, and Nsp9.Bello et al., 4/10/2021, peer-reviewed, 1 author.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsReview Turkia , M., Research Gate (Review) (Preprint)reviewA timeline of ivermectin-related events in the COVID-19 pandemic Details An extensive timeline of ivermectin-related events from April 2020 to March 2021 including studies, news, health authority decisions, biased news coverage, and censorship.The author concludes that in a broader historical perspective, th.. Details Source PDF Review
        Review
        Turkia , M., Research Gate (Review) (Preprint)A timeline of ivermectin-related events in the COVID-19 pandemicAn extensive timeline of ivermectin-related events from April 2020 to March 2021 including studies, news, health authority decisions, biased news coverage, and censorship.The author concludes that in a broader historical perspective, the timeline depicts rather dysfunctional societies unable to properly communicate and organize themselves, leading to misallocation of resources and decisions that may have conflicted with elementary ethical considerations, with this behavior rationalized by claiming adherence to mental paradigms that may have poorly matched the situation.Turkia et al., 4/3/2021, preprint, 1 author.
        Submit Corrections or CommentsEarly Mourya et al., Int. J. Health and Clinical Research (Peer Reviewed)viral+, '†'89.4% , pComparative Analytical Study of Two Different Drug Regimens in Treatment of Covid 19 Positive Patients in Index Medical College Hospital and Research Center, Indore, India Details Retrospective 100 patients in India with 50 treated with ivermectin, and SOC for all patients including HCQ+AZ, showing much higher viral clearance with ivermectin. Baseline clinical status was worse in the control group. Time of testing .. Details Source PDF Early treatment study
        Early treatment study
        Mourya et al., Int. J. Health and Clinical Research (Peer Reviewed)Comparative Analytical Study of Two Different Drug Regimens in Treatment of Covid 19 Positive Patients in Index Medical College Hospital and Research Center, Indore, IndiaRetrospective 100 patients in India with 50 treated with ivermectin, and SOC for all patients including HCQ+AZ, showing much higher viral clearance with ivermectin. Baseline clinical status was worse in the control group. Time of testing after treatment initiation was longer in the control group (mean 7.24 days versus 5.22 days). risk of no virological cure, 89.4% lower , RR 0.11, p , treatment 5 of 50 (10.0%), control 47 of 50 (94.0%).
        Mourya et al., 4/1/2021, retrospective, India, South Asia, peer-reviewed, 5 authors, dosage 12mg days 1-7.
        Submit Corrections or CommentsReview Wehbe et al., Front. Immunol., doi:10.3389/fimmu.2021.663586 (Review) (Peer Reviewed)reviewRepurposing Ivermectin for COVID-19: Molecular Aspects and Therapeutic Possibilities Details Review of how ivermectin was identified for use in COVID-19, mechanisms of action, and selected clinical trials. Details Source PDF Review
        Review
        Wehbe et al., Front. Immunol., doi:10.3389/fimmu.2021.663586 (Review) (Peer Reviewed)Repurposing Ivermectin for COVID-19: Molecular Aspects and Therapeutic PossibilitiesReview of how ivermectin was identified for use in COVID-19, mechanisms of action, and selected clinical trials.Wehbe et al., 3/30/2021, peer-reviewed, 7 authors.
        Submit Corrections or CommentsEarly Chahla et al., Research Square, doi:10.21203/rs.3.rs-495945/v1 (original preprint 3/30) (Preprint)no disch., '†'86.9% , p=0.004Cluster Randomised Trials - Ivermectin Repurposing For COVID-19 Treatment Of Outpatients With Mild Disease In Primary Health Care Centers Details Cluster RCT outpatients in Argentina showing signficantly faster recovery with ivermectin. There were no deaths. Cluster RCT where outpatients in Tucumn were assigned to the ivermectin group and outpatients from San Miguel de Tucumn and.. Details Source PDF Early treatment study
        Early treatment study
        Chahla et al., Research Square, doi:10.21203/rs.3.rs-495945/v1 (original preprint 3/30) (Preprint)Cluster Randomised Trials - Ivermectin Repurposing For COVID-19 Treatment Of Outpatients With Mild Disease In Primary Health Care CentersCluster RCT outpatients in Argentina showing signficantly faster recovery with ivermectin. There were no deaths. Cluster RCT where outpatients in Tucumn were assigned to the ivermectin group and outpatients from San Miguel de Tucumn and Gran San Miguel de Tucumn were assigned to the control group. All comorbidities, percentage of male patients, and age were higher in the ivermectin group, favoring the control group. NCT04784481. risk of no discharge, 86.9% lower , RR 0.13, p = 0.004 , treatment 2 of 110 (1.8%), control 20 of 144 (13.9%), adjusted, OR converted to RR, logistic regression.
        Chahla et al., 3/30/2021, Cluster Randomized Controlled Trial, Argentina, South America, preprint, 9 authors, dosage 24mg days 1, 8, 15, 22.
        Submit Corrections or CommentsMeta Kow et al., Pharmacological Reports, doi:10.1007/s43440-021-00245-z (Peer Reviewed) (meta analysis)meta-analysisThe association between the use of ivermectin and mortality in patients with COVID-19: a meta-analysis Details Small meta analysis of 6 RCTs showing mortality OR 0.21 [0.11-0.42]. Authors do not include two more recent RCTs with mortality results, 10 other studies with mortality results, and a total of 42 other studies including other outcomes. Au.. Details Source PDF Meta
        Meta
        Kow et al., Pharmacological Reports, doi:10.1007/s43440-021-00245-z (Peer Reviewed) (meta analysis)The association between the use of ivermectin and mortality in patients with COVID-19: a meta-analysisSmall meta analysis of 6 RCTs showing mortality OR 0.21 [0.11-0.42]. Authors do not include two more recent RCTs with mortality results, 10 other studies with mortality results, and a total of 42 other studies including other outcomes. Authors do not distinguish between studies with very different treatment delays (earlier treatment is more successful).Kow et al., 3/29/2021, peer-reviewed, 4 authors.
        Submit Corrections or CommentsPrEPPEP Tanioka et al., medRxiv, doi:10.1101/2021.03.26.21254377 (Preprint)death, '†'88.2% , p=0.002Why COVID-19 is not so spread in Africa: How does Ivermectin affect it? Details Retrospective study of the 31 onchocerciasis-endemic countries using the community-directed treatment with ivermectin (CDTI) and the 22 non-endemic countries in Africa, showing significantly lower mortality per capita in the countries us.. Details Source PDF Prophylaxis study
        Prophylaxis study
        Tanioka et al., medRxiv, doi:10.1101/2021.03.26.21254377 (Preprint)Why COVID-19 is not so spread in Africa: How does Ivermectin affect it?Retrospective study of the 31 onchocerciasis-endemic countries using the community-directed treatment with ivermectin (CDTI) and the 22 non-endemic countries in Africa, showing significantly lower mortality per capita in the countries using ivermectin. risk of death, 88.2% lower , RR 0.12, p = 0.002 , relative mean mortality per million.
        Tanioka et al., 3/26/2021, retrospective, ecological study, multiple countries, multiple regions, preprint, 3 authors, dosage 200Î¼g/kg, dose varied, typically 150-200Î¼g/kg.
        Submit Corrections or CommentsIn Silico Udofia et al., Network Modeling Analysis in Health Informatics and Bioinformatics, doi:10.1007/s13721-021-00299-2 (Peer Reviewed)In silico studies of selected multi-drug targeting against 3CLpro and nsp12 RNA-dependent RNA-polymerase proteins of SARS-CoV-2 and SARS-CoV Details In Silico analysis finding that ivermectin had the highest binding energy against the 3CLpro of SARS-CoV-2 and RdRps of both SARS-CoV and SARS-CoV-2. Details Source PDF In Silico
        In Silico
        Udofia et al., Network Modeling Analysis in Health Informatics and Bioinformatics, doi:10.1007/s13721-021-00299-2 (Peer Reviewed)In silico studies of selected multi-drug targeting against 3CLpro and nsp12 RNA-dependent RNA-polymerase proteins of SARS-CoV-2 and SARS-CoVIn Silico analysis finding that ivermectin had the highest binding energy against the 3CLpro of SARS-CoV-2 and RdRps of both SARS-CoV and SARS-CoV-2.Udofia et al., 3/25/2021, peer-reviewed, 5 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsIn Silico Choudhury et al., Future Medicine, doi:10.2217/fvl-2020-0342 (Peer Reviewed)Exploring the binding efficacy of ivermectin against the key proteins of SARS-CoV-2 pathogenesis: an in silico approach Details In Silico analysis finding that ivermectin has high binding affinity for the SARS-CoV-2 viral spike protein, main protease, replicase, and human TMPRSS2 receptors. Details Source PDF In Silico
        In Silico
        Choudhury et al., Future Medicine, doi:10.2217/fvl-2020-0342 (Peer Reviewed)Exploring the binding efficacy of ivermectin against the key proteins of SARS-CoV-2 pathogenesis: an in silico approachIn Silico analysis finding that ivermectin has high binding affinity for the SARS-CoV-2 viral spike protein, main protease, replicase, and human TMPRSS2 receptors.Choudhury et al., 3/25/2021, peer-reviewed, 7 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsLate Huvemek Press Release (Preprint)no improv., '†'31.6% , p=0.28Kovid-19 - Huvemek® Phase 2 clinical trial Details Phase 2 results from a multicenter RCT of hospitalized patients in Bulgaria showing faster viral clearance, greater clinical improvement, and improved biomarkers with treatment. Ivermectin was taken on an empty stomach, potentially reduci.. Details Source PDF Late treatment study
        Late treatment study
        Huvemek Press Release (Preprint)Kovid-19 - Huvemek® Phase 2 clinical trialPhase 2 results from a multicenter RCT of hospitalized patients in Bulgaria showing faster viral clearance, greater clinical improvement, and improved biomarkers with treatment. Ivermectin was taken on an empty stomach, potentially reducing lung tissue concentration by ~2.5x [1]. Limited data has been reported currently. No serious adverse events were observed. EudraCT 2020-002091-12. risk of no improvement, 31.6% lower , RR 0.68, p = 0.28 , treatment 13 of 50 (26.0%), control 19 of 50 (38.0%), day 7, patients with improvement on WHO scale.
        risk of no improvement, 34.5% lower , RR 0.66, p = 0.07 , treatment 19 of 50 (38.0%), control 29 of 50 (58.0%), day 4, patients with improvement on WHO scale.
        Huvemek et al., 3/25/2021, Double Blind Randomized Controlled Trial, Bulgaria, Europe, preprint, 1 author, dosage 400Î¼g/kg days 1-3.
        Submit Corrections or CommentsReview Yagisawa et al., The Japanese Journal of Antibiotics, 74-1, Mar 2021 (Review) (Peer Reviewed)reviewGlobal trends in clinical studies of ivermectin in COVID-19 Details Review of ivermectin for COVID-19. Authors note that Kitasato University's project was expanded in response to the results of Caly et al. which had left questions regarding in vivo therapeutic levels, and the results of those studies were.. Details Source PDF Review
        Review
        Yagisawa et al., The Japanese Journal of Antibiotics, 74-1, Mar 2021 (Review) (Peer Reviewed)Global trends in clinical studies of ivermectin in COVID-19Review of ivermectin for COVID-19. Authors note that Kitasato University's project was expanded in response to the results of Caly et al. which had left questions regarding in vivo therapeutic levels, and the results of those studies were positive. Early in the pandemic, Kitasato University requested Merck to conduct clinical trials in Japan because they have priority for an expansion of ivermectin's indications, however Merck declined.Since large companies have declined to study ivermectin for COVID-19, trials have been mostly doctor-initiated with relatively little funding. Authors discuss these, noting that the physicians involved are enthusiastic about avoiding bias, and strive to treat and prevent COVID-19 witn non-profit motives.Authors discuss the trials, epidemiological data, and inaccurate statements made by certain authorities.Authors note that regulations make it challenging for doctor-initiated trials to enroll many participants in a timely manner.Authors conclude that ivermectin may turn out to be comparable to the benefits achieved from the discovery of penicillin - said to be one of the greatest discoveries of the twentieth century.Authors include the nobel prize winning biochemist who discovered ivermectin, Satoshi ÅŒmura [1].Yagisawa et al., 3/24/2021, peer-reviewed, 4 authors.
        Submit Corrections or CommentsEarly Emmerich et al., Int. J. Environ. Res. Public Health, doi:10.3390/ijerph18073371 (Preprint)Comparisons between the Neighboring States of Amazonas and Par in Brazil in the Second Wave of COVID-19 Outbreak and a Possible Role of Early Ambulatory Treatment Details Comparison between the two largest neighboring states in Brazil, Amazonas and Par, showing more than 5 times lower mortality in Par during the second wave when the Par government supported early treatment and Amazonas did not, compared.. Details Source PDF Early treatment study
        Early treatment study
        Emmerich et al., Int. J. Environ. Res. Public Health, doi:10.3390/ijerph18073371 (Preprint)Comparisons between the Neighboring States of Amazonas and Par in Brazil in the Second Wave of COVID-19 Outbreak and a Possible Role of Early Ambulatory TreatmentComparison between the two largest neighboring states in Brazil, Amazonas and Par, showing more than 5 times lower mortality in Par during the second wave when the Par government supported early treatment and Amazonas did not, compared to similar results in the first wave when treatment protocols were similar.Emmerich et al., 3/21/2021, preprint, 1 author.
        Submit Corrections or CommentsLate Del Franco et al., Journal of Biomedical Research and Clinical Investigation, doi:10.31546/2633-8653.1008 (Peer Reviewed)Ivermectin in Long-Covid Patients: A Retrospective Study Details Retrospective 856 patients previously admitted to hospital for COVID-19 in Argentina, finding that ivermectin improved recovery from "long covid" symptoms. Details Source PDF Late treatment study
        Late treatment study
        Del Franco et al., Journal of Biomedical Research and Clinical Investigation, doi:10.31546/2633-8653.1008 (Peer Reviewed)Ivermectin in Long-Covid Patients: A Retrospective StudyRetrospective 856 patients previously admitted to hospital for COVID-19 in Argentina, finding that ivermectin improved recovery from "long covid" symptoms.Del Franco et al., 3/18/2021, peer-reviewed, 3 authors.
        Submit Corrections or CommentsEarly Roy et al., medRxiv, doi:10.1101/2021.03.08.21252883 (Preprint)recov. time, '†'5.6% , p=0.87Outcome of Different Therapeutic Interventions in Mild COVID-19 Patients in a Single OPD Clinic of West Bengal: A Retrospective study Details Retrospective database analysis of 56 mild COVID-19 patients, all treated with vitamin C, vitamin D, and zinc, comparing ivermectin + doxycycline (n=14), AZ (n=13), HCQ (n=14), and SOC (n=15), finding that all groups recover quickly, and .. Details Source PDF Early treatment study
        Early treatment study
        Roy et al., medRxiv, doi:10.1101/2021.03.08.21252883 (Preprint)Outcome of Different Therapeutic Interventions in Mild COVID-19 Patients in a Single OPD Clinic of West Bengal: A Retrospective studyRetrospective database analysis of 56 mild COVID-19 patients, all treated with vitamin C, vitamin D, and zinc, comparing ivermectin + doxycycline (n=14), AZ (n=13), HCQ (n=14), and SOC (n=15), finding that all groups recover quickly, and there was no significant difference between the groups. Subject to the usual limitation of a database study, very small size, and limited evaluation of patients. relative time to clinical response of wellbeing, 5.6% lower , relative time 0.94, p = 0.87 , treatment 14, control 15.
        Roy et al., 3/12/2021, retrospective, database analysis, India, South Asia, preprint, 5 authors, dosage not specified, this trial uses multiple treatments in the treatment arm (combined with doxycycline) - results of individual treatments may vary.
        Submit Corrections or CommentsMeta Nardelli et al., Signa Vitae, doi:10.22514/sv.2021.043 (Peer Reviewed) (meta analysis)death, '†'79.5% , pCrying wolf in time of Corona: the strange case of ivermectin and hydroxychloroquine. Is the fear of failure withholding potential life-saving treatment from clinical use? Details Meta analysis of RCT mortality results showing RR 0.19, p Details Source PDF Meta
        Meta
        Nardelli et al., Signa Vitae, doi:10.22514/sv.2021.043 (Peer Reviewed) (meta analysis)Crying wolf in time of Corona: the strange case of ivermectin and hydroxychloroquine. Is the fear of failure withholding potential life-saving treatment from clinical use?Meta analysis of RCT mortality results showing RR 0.19, p risk of death, 79.5% lower , RR 0.21, p , treatment 14 of 703 (2.0%), control 57 of 620 (9.2%), OR converted to RR.
        Nardelli et al., 3/11/2021, peer-reviewed, 8 authors.
        Submit Corrections or CommentsMeta Scheim et al., OSF Preprints (Preprint) (meta analysis)meta-analysisIvermectin sales in Valle del Cauca, Colombia, patterns of AEs, and other background re L"pez-Medina et al. 2021 Details Analysis of several issues with L"pez-Medina et al. including the atypical adverse effects in the control arm and population use of ivermectin. Details Source PDF Meta
        Meta
        Scheim et al., OSF Preprints (Preprint) (meta analysis)Ivermectin sales in Valle del Cauca, Colombia, patterns of AEs, and other background re L"pez-Medina et al. 2021Analysis of several issues with L"pez-Medina et al. including the atypical adverse effects in the control arm and population use of ivermectin.Scheim et al., 3/11/2021, preprint, 1 author.
        Submit Corrections or CommentsMeta Scheim et al., OSF Preprints (Preprint) (meta analysis)meta-analysisProtocol violations in L"pez-Medina et al.: 38 switched ivermectin (IVM) and placebo doses, failure of blinding, widespread IVM sales OTC in Cali, and nearly identical AEs for the IVM and control groups Details Report on protocol violations in L"pez-Medina et al. Details Source PDF Meta
        Meta
        Scheim et al., OSF Preprints (Preprint) (meta analysis)Protocol violations in L"pez-Medina et al.: 38 switched ivermectin (IVM) and placebo doses, failure of blinding, widespread IVM sales OTC in Cali, and nearly identical AEs for the IVM and control groupsReport on protocol violations in L"pez-Medina et al.Scheim et al., 3/11/2021, preprint, 3 authors.
        Submit Corrections or CommentsIn Vitro Yesilbag et al., Virus Research, doi:10.1016/j.virusres.2021.198384 (Peer Reviewed) (In Vitro)in vitroIvermectin also inhibits the replication of bovine respiratory viruses (BRSV, BPIV-3, BoHV-1, BCoV and BVDV) in vitro Details In Vitro study showing that ivermectin can inhibit infection of bovine respiratory disease viral agents BCoV, BPIV-3, BVDV, BRSV and BoHV-1 at the concentrations of 2.5 and 5 Î¼M and in a dose-dependent manner. Details Source PDF In Vitro
        In Vitro
        Yesilbag et al., Virus Research, doi:10.1016/j.virusres.2021.198384 (Peer Reviewed) (In Vitro)Ivermectin also inhibits the replication of bovine respiratory viruses (BRSV, BPIV-3, BoHV-1, BCoV and BVDV) in vitroIn Vitro study showing that ivermectin can inhibit infection of bovine respiratory disease viral agents BCoV, BPIV-3, BVDV, BRSV and BoHV-1 at the concentrations of 2.5 and 5 Î¼M and in a dose-dependent manner.Yesilbag et al., 3/10/2021, peer-reviewed, 3 authors.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsLate Pott-Junior et al., Toxicology Reports, doi:10.1016/j.toxrep.2021.03.003 (Peer Reviewed)ventilation, '†'85.2% , p=0.25Use of ivermectin in the treatment of Covid-19: a pilot trial Details Very small RCT with 4 control patients and 28 ivermectin patients split across 3 different dosage levels, showing lower (non-statistically significant) ICU admission with treatment. Authors suggest that ivermectin for SARS-CoV-2 is safe a.. Details Source PDF Late treatment study
        Late treatment study
        Pott-Junior et al., Toxicology Reports, doi:10.1016/j.toxrep.2021.03.003 (Peer Reviewed)Use of ivermectin in the treatment of Covid-19: a pilot trialVery small RCT with 4 control patients and 28 ivermectin patients split across 3 different dosage levels, showing lower (non-statistically significant) ICU admission with treatment. Authors suggest that ivermectin for SARS-CoV-2 is safe and reduces symptoms and viral load, and that the antiviral effect appears to be dose-dependent. NCT04431466. risk of mechanical ventilation, 85.2% lower , RR 0.15, p = 0.25 , treatment 1 of 27 (3.7%), control 1 of 4 (25.0%).
        risk of ICU admission, 85.2% lower , RR 0.15, p = 0.25 , treatment 1 of 27 (3.7%), control 1 of 4 (25.0%).
        relative improvement in Ct value, 0.8% lower , RR 0.99, p = 1.00 , treatment 27, control 3.
        risk of no virological cure, 11.1% higher , RR 1.11, p = 1.00 , treatment 10 of 27 (37.0%), control 1 of 3 (33.3%).
        time to viral-, 16.7% lower , relative time 0.83 , treatment 27, control 3.
        Pott-Junior et al., 3/9/2021, Randomized Controlled Trial, Brazil, South America, peer-reviewed, 10 authors, dosage 200Î¼g/kg single dose, dose varies in three arms 100, 200, 400Î¼g/kg.
        Submit Corrections or CommentsEarly Chamie-Quintero et al., OSF Preprints (Preprint)Ivermectin for COVID-19 in Peru: 14-fold reduction in nationwide excess deaths, p=.002 for effect by state, then 13-fold increase after ivermectin use restricted Details Analysis of ivermectin use in Peru concluding that ivermectin most likely caused a 14 times reduction in excess deaths in Peru, prior to a 13 times increase after reversal of ivermectin use. Authors conclude that the results strongly sugg.. Details Source PDF Early treatment study
        Early treatment study
        Chamie-Quintero et al., OSF Preprints (Preprint)Ivermectin for COVID-19 in Peru: 14-fold reduction in nationwide excess deaths, p=.002 for effect by state, then 13-fold increase after ivermectin use restrictedAnalysis of ivermectin use in Peru concluding that ivermectin most likely caused a 14 times reduction in excess deaths in Peru, prior to a 13 times increase after reversal of ivermectin use. Authors conclude that the results strongly suggest that ivermectin can complement vaccination. They note that the potential mechanism of action, competitive binding with the SARS-CoV-2 spike protein, is likely to be non-epitope specific, possibly maintaining efficacy against emerging mutant strains.Chamie-Quintero et al., 3/8/2021, preprint, 3 authors.
        Submit Corrections or CommentsLate Guzman et al., medRxiv, doi:10.1101/2021.03.04.21252084 (Preprint)Factors associated with increased mortality in critically ill COVID-19 patients in a Mexican public hospital: the other faces of health system oversaturation Details Retrospective 196 critically ill patients in Mexico. Patients overlap with the existing RCT by Beltran-Gonzalez (NCT04391127). This preprint shows a larger treated population and greater (non-statistically significant) improvement with iv.. Details Source PDF Late treatment study
        Late treatment study
        Guzman et al., medRxiv, doi:10.1101/2021.03.04.21252084 (Preprint)Factors associated with increased mortality in critically ill COVID-19 patients in a Mexican public hospital: the other faces of health system oversaturationRetrospective 196 critically ill patients in Mexico. Patients overlap with the existing RCT by Beltran-Gonzalez (NCT04391127). This preprint shows a larger treated population and greater (non-statistically significant) improvement with ivermectin, RR 0.81 [0.53-1.24].Guzman et al., 3/8/2021, retrospective, Mexico, North America, preprint, 11 authors.
        Submit Corrections or CommentsLate Galan et al., Pathogens and Global Health, doi:10.1080/20477724.2021.1890887 (Peer Reviewed)Phase 2 randomized study on chloroquine, hydroxychloroquine or ivermectin in hospitalized patients with severe manifestations of SARS-CoV-2 infection Details RCT 168 very late stage severe condition hospitalized patients comparing CQ, HCQ, and ivermectin not showing significant differences. Authors were unable to add a control arm due to ethical issues.Authors claim that "the mortality .. Details Source PDF Late treatment study
        Late treatment study
        Galan et al., Pathogens and Global Health, doi:10.1080/20477724.2021.1890887 (Peer Reviewed)Phase 2 randomized study on chloroquine, hydroxychloroquine or ivermectin in hospitalized patients with severe manifestations of SARS-CoV-2 infectionRCT 168 very late stage severe condition hospitalized patients comparing CQ, HCQ, and ivermectin not showing significant differences. Authors were unable to add a control arm due to ethical issues.Authors claim that "the mortality rates of the three groups are very similar to historical reports of other studies that used placebo in hospitalized patients", without providing any reference. However [1] shows 43% hospital mortality in the northern region of Brazil, where the study was performed, from which we can estimate the mortality with ivermectin in this study is 47% lower, RR 0.53. Further, the study is restricted to more severe cases, hence the expected mortality may be higher.Galan et al., 3/8/2021, peer-reviewed, 19 authors.
        Submit Corrections or CommentsSafety Descotes , J., ImmunoSafe Consultance (Preprint)safety analysisMedical Safety of Ivermectin Details Safety analysis of >350 articles showing that ivermectin has an excellent safety profile. The author notes that "no severe adverse event has been reported in dozens of completed or ongoing studies involving thousands of participants.. Details Source PDF Safety
        Safety
        Descotes , J., ImmunoSafe Consultance (Preprint)Medical Safety of IvermectinSafety analysis of >350 articles showing that ivermectin has an excellent safety profile. The author notes that "no severe adverse event has been reported in dozens of completed or ongoing studies involving thousands of participants worldwide to evaluate the efficacy of ivermectin against COVID-19".Descotes et al., 3/5/2021, preprint.
        Submit Corrections or CommentsEarly L"pez-Medina et al., JAMA, doi:10.1001/jama.2021.3071 (Peer Reviewed)death, '†'66.8% , p=0.50Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19: A Randomized Clinical Trial Details An open letter, signed by >100 physicians, concluding this study is fatally flawed can be found at [1].Phone survey based RCT with low risk patients, 200 ivermectin and 198 control, showing lower mortality, lower disease progression, lo.. Details Source PDF Early treatment study
        Early treatment study
        L"pez-Medina et al., JAMA, doi:10.1001/jama.2021.3071 (Peer Reviewed)Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19: A Randomized Clinical TrialAn open letter, signed by >100 physicians, concluding this study is fatally flawed can be found at [1].Phone survey based RCT with low risk patients, 200 ivermectin and 198 control, showing lower mortality, lower disease progression, lower treatment escalation, and faster resolution of symptoms with treatment, without reaching statistical significance. Authors find the results of this trial alone do not support the use of ivermectin. However the effects are all positive, especially for serious outcomes which are unable to reach statistical significance with the very small number of events in the low risk population.With the low risk patient population, there is little room for improvement with an effective treatment - 59/57% (IVM/control) recovered within the first 2 days to either "no symptoms" or "not hospitalized and no limitation of activities"; 73/69% within 5 days. Less than 3% of all patients ever deteriorated.The primary outcome was changed mid-trial, it was originally clinical deterioration, which is more meaningful, and shows greater benefit. The new outcome of resolution of symptoms includes "not hospitalized and no limitation of activities" as a negative outcome and is not very meaningful in terms of assessing how much treatment reduces serious outcomes. Using this measure could completely invalidate results - for example a treatment that eliminates all COVID-19 symptoms but has a temporary minor adverse event could be seen as worse.Authors state that "preliminary reports of other randomized trials of ivermectin as treatment for COVID-19 with positive results have not yet been published in peer-reviewed journals", however there were actually 8 peer-reviewed RCTs with positive effects published prior to this paper (and 19 total peer-reviewed studies with positive effects).Authors advised taking ivermectin on an empty stomach, reducing lung tissue concentration by ~2.5x [2].76 patients were excluded due to control patients receiving ivermectin. However, there was a similar percentage of adverse events like diarrhea, nausea, and abdominal pain in both treatment and control groups. These are potential non-serious side effects of treatment and suggest that it is possible that many more control patients received some kind of treatment. Ivermectin was widely used in the population and available OTC at the time of the study. The study protocol only excluded patients with previous ivermectin use within 5 days, however other trials often monitor effects 10+ days after the last dose [3].This study reportedly has an ethical issue whereby participants were told the study drug was "D11AX22" [4]. The editor-in-chief of JAMA initially offered to help with this issue, but later indicated that "JAMA does not review consent forms", however the lead author reportedly confirmed the issue. Therefore this paper may be retracted (JAMA has not indicated their response yet) [5, 6, 7].The study protocol specifically allows "the use of other treatments outside of clinical trials". The paper provides no information on what other treatments were used, but other treatments were commonly used at the time, for example [8]. Additionally, the control group did about 5x better than anticipated for deterioration, also suggesting that the control patients used some kind of treatment. Patients which enroll in such a study may be more likely to learn about and use other treatments, especially since they do not know if they are receiving the study medication.Most data was collected via surveys, without physical examination.The trial protocol lists ''the duration of supplemental oxygen'' as an outcome but the results for this outcome are missing.The study protocol was amended 4 times. Amendments 2-4 are provided but amendment 1 is missing. Amendment 2 increased the inclusion criteria to within 7 days of onset, including more later stage patients and reducing the expected effectiveness.Grants and/or personal fees, including in some cases during the conduct of the study, were provided by Sanofi Pasteur, GlaxoSmithKline, Janssen, Merck, and Gilead. For more details see [9].Other issues can be found in the comments of the article [10].For other confounding issues see: [11].87% medication adherence. NCT04405843. risk of death, 66.8% lower , RR 0.33, p = 0.50 , treatment 0 of 200 (0.0%), control 1 of 198 (0.5%), continuity correction due to zero event.
        risk of escalation of care, 60.8% lower , RR 0.39, p = 0.10 , treatment 4 of 200 (2.0%), control 10 of 198 (5.1%), OR converted to RR.
        risk of escalation of care with post-hoc 34.3% lower , RR 0.66, p = 0.51, treatment 4 of 200 (2.0%), control 6 of 198 (3.0%), OR converted to RR.
        risk of deterioration by >= 2 points on an 8-point scale, 43.1% lower , RR 0.57, p = 0.35 , treatment 4 of 200 (2.0%), control 7 of 198 (3.5%), OR converted to RR.
        risk of fever post randomization, 24.8% lower , RR 0.75, p = 0.33 , treatment 16 of 200 (8.0%), control 21 of 198 (10.6%), OR converted to RR.
        risk of unresolved symptoms at day 21, 15.3% lower , RR 0.85, p = 0.53 , treatment 36 of 200 (18.0%), control 42 of 198 (21.2%), OR converted to RR, Cox proportional-hazard model.
        hazard ratio for lack of resolution of symptoms, 6.5% lower , RR 0.93, p = 0.53 , treatment 200, control 198.
        relative median time to resolution of symptoms, 16.7% lower , relative time 0.83 , treatment 200, control 198.
        L"pez-Medina et al., 3/4/2021, Double Blind Randomized Controlled Trial, Colombia, South America, peer-reviewed, median age 37.0, 19 authors, dosage 300Î¼g/kg days 1-5.
        Submit Corrections or CommentsIn Silico Saha et al., Structural Chemistry, doi:10.1007/s11224-021-01776-0 (preprint 3/1) (Preprint)The Binding mechanism of ivermectin and levosalbutamol with spike protein of SARS-CoV-2 Details In SIlico analysis predicting that ivermectin has a large binding affinity for the SARS-CoV-2 spike protein. Three different computer modeling techniques show that ivermectin can inhibit SARS-CoV-2 entrance via hACE2. Details Source PDF In Silico
        In Silico
        Saha et al., Structural Chemistry, doi:10.1007/s11224-021-01776-0 (preprint 3/1) (Preprint)The Binding mechanism of ivermectin and levosalbutamol with spike protein of SARS-CoV-2In SIlico analysis predicting that ivermectin has a large binding affinity for the SARS-CoV-2 spike protein. Three different computer modeling techniques show that ivermectin can inhibit SARS-CoV-2 entrance via hACE2.Saha et al., 3/1/2021, preprint, 2 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsLate Gonzalez et al., medRxiv, doi:10.1101/2021.02.18.21252037 (Preprint)death, '†'14.4% , p=1.00Efficacy and safety of Ivermectin and Hydroxychloroquine in patients with severe COVID-19. A randomized controlled trial Details RCT late stage severe condition (93% SOFA '‰¥ 2, 96% APACHE '‰¥ 8) high comorbidity hospitalized patients in Mexico with 36 low dose ivermectin and 37 control patients not finding significant differences. NCT04391127. Details Source PDF Late treatment study
        Late treatment study
        Gonzalez et al., medRxiv, doi:10.1101/2021.02.18.21252037 (Preprint)Efficacy and safety of Ivermectin and Hydroxychloroquine in patients with severe COVID-19. A randomized controlled trialRCT late stage severe condition (93% SOFA '‰¥ 2, 96% APACHE '‰¥ 8) high comorbidity hospitalized patients in Mexico with 36 low dose ivermectin and 37 control patients not finding significant differences. NCT04391127. risk of death, 14.4% lower , RR 0.86, p = 1.00 , treatment 5 of 36 (13.9%), control 6 of 37 (16.2%).
        risk of respiratory deterioration or death, 8.6% lower , RR 0.91, p = 1.00 , treatment 8 of 36 (22.2%), control 9 of 37 (24.3%).
        risk of no hospital discharge, 37.0% higher , RR 1.37, p = 0.71 , treatment 4 of 36 (11.1%), control 3 of 37 (8.1%).
        Gonzalez et al., 2/23/2021, Double Blind Randomized Controlled Trial, Mexico, North America, preprint, mean age 53.8, 13 authors, dosage 12mg single dose, 18mg for patients >80kg.
        Submit Corrections or CommentsNews BIRD Meeting 20th February 2021 (News)newsBIRD Meeting 20th February 2021 Details The British Ivermectin Recommendation Development (BIRD) panel, with dozens of multi-national scientists & doctors, issued sweeping recommendations for the immediate global use of ivermectin. Details Source PDF News
        News
        BIRD Meeting 20th February 2021 (News)BIRD Meeting 20th February 2021The British Ivermectin Recommendation Development (BIRD) panel, with dozens of multi-national scientists & doctors, issued sweeping recommendations for the immediate global use of ivermectin.BIRD et al., 2/20/2021, preprint, 1 author.
        Submit Corrections or CommentsEarly Elalfy et al., J. Med. Virol., doi:10.1002/jmv.26880 (Peer Reviewed)viral+, '†'86.9% , pEffect of a combination of Nitazoxanide, Ribavirin and Ivermectin plus zinc supplement (MANS.NRIZ study) on the clearance of mild COVID-1 Details Non-randomized controlled trial with 62 mild and early moderate patients with home treatment with ivermectin + nitazoxanide + ribavirin + zinc, showing significantly faster viral clearance. Details Source PDF Early treatment study
        Early treatment study
        Elalfy et al., J. Med. Virol., doi:10.1002/jmv.26880 (Peer Reviewed)Effect of a combination of Nitazoxanide, Ribavirin and Ivermectin plus zinc supplement (MANS.NRIZ study) on the clearance of mild COVID-1Non-randomized controlled trial with 62 mild and early moderate patients with home treatment with ivermectin + nitazoxanide + ribavirin + zinc, showing significantly faster viral clearance. risk of no virological cure, 86.9% lower , RR 0.13, p , treatment 7 of 62 (11.3%), control 44 of 51 (86.3%), day 15.
        risk of no virological cure, 58.1% lower , RR 0.42, p , treatment 26 of 62 (41.9%), control 51 of 51 (100.0%), day 7.
        Elalfy et al., 2/16/2021, retrospective, Egypt, Africa, peer-reviewed, 15 authors, dosage 18mg days 1, 4, 7, 10, 13, 120kg 30mg, this trial uses multiple treatments in the treatment arm (combined with nitazoxanide, ribavirin, and zinc) - results of individual treatments may vary.
        Submit Corrections or CommentsPrEPPEP Behera et al., Cureus 13:8, doi:10.7759/cureus.16897 (preprint 2/15/21) (Peer Reviewed)cases, '†'83.0% , pProphylactic Role of Ivermectin in Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Workers Details Prospective prophylaxis study with 3,532 healthcare workers, 2,199 receiving two-dose ivermectin prophylaxis, showing adjusted relative risk of confirmed COVID-19 with treatment 0.17 [0.12-0.23] p Details Source PDF Prophylaxis study
        Prophylaxis study
        Behera et al., Cureus 13:8, doi:10.7759/cureus.16897 (preprint 2/15/21) (Peer Reviewed)Prophylactic Role of Ivermectin in Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare WorkersProspective prophylaxis study with 3,532 healthcare workers, 2,199 receiving two-dose ivermectin prophylaxis, showing adjusted relative risk of confirmed COVID-19 with treatment 0.17 [0.12-0.23] p risk of COVID-19 case, 83.0% lower , RR 0.17, p , treatment 45 of 2199 (2.0%), control 133 of 1147 (11.6%), two doses.
        risk of COVID-19 case, 4.0% higher , RR 1.04, p = 0.85 , treatment 23 of 186 (12.4%), control 133 of 1147 (11.6%), patients only receiving the first dose.
        Behera et al., 2/15/2021, prospective, India, South Asia, peer-reviewed, 14 authors, dosage 300Î¼g/kg days 1, 4.
        Submit Corrections or CommentsEarly Biber et al., medRxiv, doi:10.1101/2021.05.31.21258081 (results 2/12/21) (Preprint)hosp., '†'70.2% , p=0.34Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19, A double-blind, randomized placebo-controlled trial Details Double blind RCT for mild-moderate COVID-19 outpatients in Israel showing significantly faster reduction in viral load with treatment, and lower hospitalization with treatment. The one treatment hospitalization was a few hours after treat.. Details Source PDF Early treatment study
        Early treatment study
        Biber et al., medRxiv, doi:10.1101/2021.05.31.21258081 (results 2/12/21) (Preprint)Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19, A double-blind, randomized placebo-controlled trialDouble blind RCT for mild-moderate COVID-19 outpatients in Israel showing significantly faster reduction in viral load with treatment, and lower hospitalization with treatment. The one treatment hospitalization was a few hours after treatment and the patient improved and was discharged quickly. Authors also examine culture viability on days 2-6, with 13% positive in the ivermectin group vs. 48% in the control group. There were no safety issues. Sheba IRB-7156/20. NCT04429711. risk of hospitalization, 70.2% lower , RR 0.30, p = 0.34 , treatment 1 of 47 (2.1%), control 3 of 42 (7.1%).
        risk of no virological cure, 44.8% lower , RR 0.55, p = 0.04 , treatment 13 of 47 (27.7%), control 21 of 42 (50.0%), adjusted, OR converted to RR, multivariable logistic regression, day 6, Ct>30.
        risk of no virological cure, 70.2% lower , RR 0.30, p = 0.14 , treatment 2 of 47 (4.3%), control 6 of 42 (14.3%), day 10, non-infectious samples (Ct>30 or non-viable culture).
        risk of no virological cure, 82.1% lower , RR 0.18, p = 0.01 , treatment 2 of 47 (4.3%), control 10 of 42 (23.8%), day 8, non-infectious samples (Ct>30 or non-viable culture).
        risk of no virological cure, 75.6% lower , RR 0.24, p = 0.02 , treatment 3 of 47 (6.4%), control 11 of 42 (26.2%), day 6, non-infectious samples (Ct>30 or non-viable culture).
        risk of no virological cure, 65.1% lower , RR 0.35, p = 0.05 , treatment 4 of 28 (14.3%), control 9 of 22 (40.9%), day 4, non-infectious samples (Ct>30 or non-viable culture).
        risk of no virological cure, 51.9% lower , RR 0.48, p = 0.08 , treatment 7 of 47 (14.9%), control 13 of 42 (31.0%), day 10, Ct>30.
        risk of no virological cure, 57.9% lower , RR 0.42, p = 0.02 , treatment 8 of 47 (17.0%), control 17 of 42 (40.5%), day 8, Ct>30.
        risk of no virological cure, 44.7% lower , RR 0.55, p = 0.05 , treatment 13 of 47 (27.7%), control 21 of 42 (50.0%), day 6, Ct>30.
        risk of no virological cure, 31.9% lower , RR 0.68, p = 0.16 , treatment 13 of 28 (46.4%), control 15 of 22 (68.2%), day 4, Ct>30.
        Biber et al., 2/12/2021, Double Blind Randomized Controlled Trial, Israel, Middle East, preprint, 10 authors, dosage 12mg days 1-3, 15mg for patients >= 70kg.
        Submit Corrections or CommentsLate Lima-Morales (Peer Reviewed)death, '†'77.7% , pEffectiveness of a multidrug therapy consisting of ivermectin, azithromycin, montelukast and acetylsalicylic acid to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico Details Prospective trial of 768 COVID-19 outpatients in Mexico, 481 treated with ivermectin, AZ, montelukast, and aspirin, and 287 control patients with various treatments, showing significantly lower mortality and hospitalization, and significa.. Details Source PDF Late treatment study
        Late treatment study
        Lima-Morales (Peer Reviewed)Effectiveness of a multidrug therapy consisting of ivermectin, azithromycin, montelukast and acetylsalicylic acid to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, MexicoProspective trial of 768 COVID-19 outpatients in Mexico, 481 treated with ivermectin, AZ, montelukast, and aspirin, and 287 control patients with various treatments, showing significantly lower mortality and hospitalization, and significantly higher recovery at 14 days with treatment. risk of death, 77.7% lower , RR 0.22, p , treatment 15 of 481 (3.1%), control 52 of 287 (18.1%), adjusted, OR converted to RR, multivariate.
        risk of hospitalization, 67.4% lower , RR 0.33, p , treatment 44 of 481 (9.1%), control 89 of 287 (31.0%), adjusted, OR converted to RR, multivariate.
        risk of no recovery, 58.6% lower , RR 0.41, p , treatment 75 of 481 (15.6%), control 118 of 287 (41.1%), adjusted, OR converted to RR, recovery at day 14 after symptoms, multivariate.
        Lima-Morales et al., 2/10/2021, prospective, Mexico, North America, peer-reviewed, 9 authors, dosage 12mg single dose, this trial uses multiple treatments in the treatment arm (combined with azithromycin, montelukast, and aspirin) - results of individual treatments may vary.
        Submit Corrections or CommentsEarly Mohan et al., Journal of Infection and Chemotherapy, doi:10.1016/j.jiac.2021.08.021 (preprint 2/2/2021) (Peer Reviewed)no recov., '†'62.5% , p=0.27Single-dose oral ivermectin in mild and moderate COVID-19 (RIVET-COV): a single-centre randomized, placebo-controlled trial Details RCT in India with low risk patients, comparing 24mg ivermectin, 12mg ivermectin, and placebo showing non-statistically significant improvements in recovery and PCR+ status (day 5 both arms, day 7 24mg only) with treatment, and showing gre.. Details Source PDF Early treatment study
        Early treatment study
        Mohan et al., Journal of Infection and Chemotherapy, doi:10.1016/j.jiac.2021.08.021 (preprint 2/2/2021) (Peer Reviewed)Single-dose oral ivermectin in mild and moderate COVID-19 (RIVET-COV): a single-centre randomized, placebo-controlled trialRCT in India with low risk patients, comparing 24mg ivermectin, 12mg ivermectin, and placebo showing non-statistically significant improvements in recovery and PCR+ status (day 5 both arms, day 7 24mg only) with treatment, and showing greater improvement for the higher dose arm. Viral load decline was similar in all arms. There were no deaths or use of mechanical ventilation. There were no serious adverse events. Note that our pre-specified protocol prioritizes clinical outcomes over PCR results. The supplementary appendix is not currently available. risk of no discharge at day 14, 62.5% lower , RR 0.38, p = 0.27 , treatment 2 of 40 (5.0%), control 6 of 45 (13.3%), ivermectin 24mg.
        risk of no discharge at day 14, 43.8% lower , RR 0.56, p = 0.49 , treatment 3 of 40 (7.5%), control 6 of 45 (13.3%), ivermectin 12mg.
        risk of clinical worsening, 32.5% lower , RR 0.68, p = 0.72 , treatment 3 of 40 (7.5%), control 5 of 45 (11.1%), ivermectin 24mg.
        risk of clinical worsening, 55.0% lower , RR 0.45, p = 0.44 , treatment 2 of 40 (5.0%), control 5 of 45 (11.1%), ivermectin 12mg.
        risk of no virological cure, 23.8% lower , RR 0.76, p = 0.18 , treatment 21 of 40 (52.5%), control 31 of 45 (68.9%), ivermectin 24mg, day 5.
        risk of no virological cure, 5.6% lower , RR 0.94, p = 0.82 , treatment 26 of 40 (65.0%), control 31 of 45 (68.9%), ivermectin 12mg, day 5.
        risk of no virological cure, 10.3% lower , RR 0.90, p = 0.65 , treatment 20 of 36 (55.6%), control 26 of 42 (61.9%), ivermectin 24mg, day 7.
        risk of no virological cure, 3.2% higher , RR 1.03, p = 1.00 , treatment 23 of 36 (63.9%), control 26 of 42 (61.9%), ivermectin 12mg, day 7.
        Mohan et al., 2/2/2021, Double Blind Randomized Controlled Trial, India, South Asia, peer-reviewed, 27 authors, dosage 400Î¼g/kg single dose, 200Î¼g/kg also tested.
        Submit Corrections or CommentsMeta Cobos-Campos et al., Clin. Res. Trials, 2021, doi:10.15761/CRT.1000333 (Peer Reviewed) (meta analysis)meta-analysisPotential use of ivermectin for the treatment and profilaxis of SARS-CoV-2 infection: Efficacy of ivermectin for SARS-CoV-2 Details Review finding that there appears to be sufficient evidence to recommend ivermectin for the treatment of COVID-19, especially in the early stages of the disease. Details Source PDF Meta
        Meta
        Cobos-Campos et al., Clin. Res. Trials, 2021, doi:10.15761/CRT.1000333 (Peer Reviewed) (meta analysis)Potential use of ivermectin for the treatment and profilaxis of SARS-CoV-2 infection: Efficacy of ivermectin for SARS-CoV-2Review finding that there appears to be sufficient evidence to recommend ivermectin for the treatment of COVID-19, especially in the early stages of the disease.Cobos-Campos et al., 1/29/2021, peer-reviewed, 9 authors.
        Submit Corrections or CommentsMeta Castaneda-Sabogal et al., medRxiv, doi:10.1101/2021.01.26.21250420 (Preprint) (meta analysis)meta-analysisOutcomes of Ivermectin in the treatment of COVID-19: a systematic review and meta-analysis Details Student-written meta analysis of a very small subset of studies exhibiting very high bias and significant flaws. Some of the problems:- As of the publication date, there are 35 studies, authors include only 4. (They list 5, but two are .. Details Source PDF Meta
        Meta
        Castaneda-Sabogal et al., medRxiv, doi:10.1101/2021.01.26.21250420 (Preprint) (meta analysis)Outcomes of Ivermectin in the treatment of COVID-19: a systematic review and meta-analysisStudent-written meta analysis of a very small subset of studies exhibiting very high bias and significant flaws. Some of the problems:- As of the publication date, there are 35 studies, authors include only 4. (They list 5, but two are the same study, preprint and published version).- From the 17 RCTs, authors include 0.- Authors include only late treatment studies, excluding all 10 early treatment studies and all 10 prophylaxis studies.- Authors did not locate 13 studies, despite this being trivial from existing meta analyses.- There is no logic in the exclusion reasons. For example, they include the most biased study to date, Soto-Becerra, and assign the highest weight to it.- Authors randomly exclude letters but include preprints (excluding letters to help avoid positive results, including preprints to include Soto-Becerra).- Soto-Becerra has clear evidence of extreme bias. The study presents 30 day results and extended KM curves up to day 43 for ivermectin. At 30 days the result is negative but reverts (as do all treatments in the study) and becomes positive before day 43. Authors of this meta analysis ignore the extended followup. Soto-Becerra is a database analysis that includes anyone with ICD-10 COVID-19 codes which includes asymptomatic PCR+ patients, therefore many patients in the control group are likely asymptomatic with regards to SARS-CoV-2, but in the hospital for another reason. For those that had symptomatic COVID-19, there is also likely significant confounding by indication. In this study all medications show higher mortality at day 30, which is consistent with asymptomatic (for COVID-19) or mild condition patients being more common in the control group. For ivermectin they show 30 day mortality aHR = 1.39 [0.88 - 2.22]. KM curves show that the treatment groups were in more serious condition, and also that after about day 35 survival became better with ivermectin. More than the total excess mortality happened on the first day. This is consistent with treated patients being in more serious condition, and with many of the control group patients being in hospital for something unrelated to COVID-19. Authors use a machine learning based propensity scoring system that appears over-parameterized and likely to result in significant overfitting and inaccurate results. Essentially they test for all interactions between two and three covariates. The nature and large number of covariates means many random correlations may be found. COVID-19 severity is not used. In summary, this is the lowest quality ivermectin study to date. This study also does not compare treatments with a control group not receiving the treatment - authors put patients receiving treatments after 48 hours in the control group. Authors also state that outcomes within 24 hours were excluded, however KM curves show significant mortality at day 1 (only for the treatment groups).- We checked the reported results for the mortality outcome and found they do not appear to match the actual papers.- Rajter: authors list mortality as 13/85 (treatment), 24/74 (control), the paper shows (for the matched cohort) 13/98 (treatment), 24/98 (control). The adjusted result in the paper is OR 0.27 [0.09-0.80] (multivariate) or OR 0.47 [0.22-0.99] (PSM). These correspond to RR 0.33 and 0.54 respectively, or logRR -1.1 and -0.62. However authors here show logRR 0.54 and 0.85 - they include the study twice (preprint and published). The preprint and published papers have the same multivariate result, the PSM result was added in the published paper. Neither of the two results the authors use match the actual results.- Khan: the paper shows RR 0.13, logRR -2.0. Authors show logRR 0.13.- Soto-Becerra at day 30 shows wHR 1.39 [0.88-2.22], and day 43 weighted KM 0.82 [0.76-0.88]. These correspond to logRR 0.33 and -0.19. Authors show logRR 1.75.- Gorial: there is zero mortality with treatment in this paper. Using the typical continuity correction, the paper shows RR 0.29 when accounting for the different group sizes, or 0.86 when using naive continuity correction that does not account for the very different group sizes. These correspond to logRR -1.24 or -0.15. Authors show logRR 0.60.- Authors did not locate and reference the existing widely known meta-analyses from well-known researchers - Kory et al., Hill et al., Lawrie et al.For more issues see: [1, 2]Authors on Twitter: [3, 4, 5, 6]Castaneda-Sabogal et al., 1/27/2021, preprint.
        Submit Corrections or CommentsIn Silico Eweas et al., Frontiers in Microbiology, doi:10.3389/fmicb.2020.592908 (Peer Reviewed)Molecular Docking Reveals Ivermectin and Remdesivir as Potential Repurposed Drugs Against SARS-CoV-2 Details Molecular docking analysis showing that ivermectin efficiently binds to the viral S protein as well as the human cell surface receptors ACE-2 and TMPRSS2; therefore, it might be involved in inhibiting the entry of the virus into the host .. Details Source PDF In Silico
        In Silico
        Eweas et al., Frontiers in Microbiology, doi:10.3389/fmicb.2020.592908 (Peer Reviewed)Molecular Docking Reveals Ivermectin and Remdesivir as Potential Repurposed Drugs Against SARS-CoV-2Molecular docking analysis showing that ivermectin efficiently binds to the viral S protein as well as the human cell surface receptors ACE-2 and TMPRSS2; therefore, it might be involved in inhibiting the entry of the virus into the host cell. It also binds to Mpro and PLpro of SARS-CoV-2; therefore, it might play a role in preventing the post-translational processing of viral polyproteins. The highly efficient binding of ivermectin to the viral N phosphoprotein and nsp14 is suggestive of its role in inhibiting viral replication and assembly.Eweas et al., 1/25/2021, peer-reviewed, 3 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsAnimal Errecalde et al., Journal of Pharmaceutical Sciences, doi:10.1016/j.xphs.2021.01.017 (Peer Reviewed)animal studySafety and Pharmacokinetic Assessments of a Novel Ivermectin Nasal Spray Formulation in a Pig Model Details Animal study of a novel spray formulation of ivermectin, showing an advantage of the spray formulation in terms of fast attainment of high and persistent ivermectin concentrations in nasopharyngeal tissue. Details Source PDF Animal study
        Animal study
        Errecalde et al., Journal of Pharmaceutical Sciences, doi:10.1016/j.xphs.2021.01.017 (Peer Reviewed)Safety and Pharmacokinetic Assessments of a Novel Ivermectin Nasal Spray Formulation in a Pig ModelAnimal study of a novel spray formulation of ivermectin, showing an advantage of the spray formulation in terms of fast attainment of high and persistent ivermectin concentrations in nasopharyngeal tissue.Errecalde et al., 1/23/2021, peer-reviewed, 15 authors.
        Submit Corrections or CommentsEarly Chamie-Quintero et al., Preprint, doi:10.2139/ssrn.3765018 (Preprint)Sharp Reductions in COVID-19 Case Fatalities and Excess Deaths in Peru in Close Time Conjunction, State-By-State, with Ivermectin Treatments Details Analysis of ivermectin usage within states in Peru showing sharp reductions in COVID-19 deaths corresponding to the usage of ivermectin treatment. Details Source PDF Early treatment study
        Early treatment study
        Chamie-Quintero et al., Preprint, doi:10.2139/ssrn.3765018 (Preprint)Sharp Reductions in COVID-19 Case Fatalities and Excess Deaths in Peru in Close Time Conjunction, State-By-State, with Ivermectin TreatmentsAnalysis of ivermectin usage within states in Peru showing sharp reductions in COVID-19 deaths corresponding to the usage of ivermectin treatment.Chamie-Quintero et al., 1/21/2021, preprint, 3 authors.
        Submit Corrections or CommentsIn Vitro Mody et al., Communications Biology, doi:10.1038/s42003-020-01577-x (Peer Reviewed) (In Vitro)in vitroIdentification of 3-chymotrypsin like protease (3CLPro) inhibitors as potential anti-SARS-CoV-2 agents Details Computational molecular modeling screening and in vitro analysis for inhibitory effects on SARS-CoV-2 specific 3CLpro enzyme, showing that ivermectin blocked more than 85% of 3CLpro activity of SARS-CoV-2. Antiviral activity of ivermectin.. Details Source PDF In Vitro
        In Vitro
        Mody et al., Communications Biology, doi:10.1038/s42003-020-01577-x (Peer Reviewed) (In Vitro)Identification of 3-chymotrypsin like protease (3CLPro) inhibitors as potential anti-SARS-CoV-2 agentsComputational molecular modeling screening and in vitro analysis for inhibitory effects on SARS-CoV-2 specific 3CLpro enzyme, showing that ivermectin blocked more than 85% of 3CLpro activity of SARS-CoV-2. Antiviral activity of ivermectin mediated through the blocking of Î±/Î²1 importin has been previously established, this analysis suggests an additional antiviral mechanism of ivermectin for SARS-CoV-2 via inhibitory effects on 3CLpro.Mody et al., 1/20/2021, peer-reviewed, 9 authors.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsLate Shahbaznejad et al., Clinical Therapeutics, doi:10.1016/j.clinthera.2021.04.007 (partial results available 1/19) (Peer Reviewed)death, '†‘197.1% , p=1.00Effect of ivermectin on COVID-19: A multicenter double-blind randomized controlled clinical trial Details RCT in Iran showing shorter time to recovery and shorter hospitalization time with ivermectin. There were no adverse effects. There was one death in the treatment group, the patient was in critical condition at baseline and died within 24.. Details Source PDF Late treatment study
        Late treatment study
        Shahbaznejad et al., Clinical Therapeutics, doi:10.1016/j.clinthera.2021.04.007 (partial results available 1/19) (Peer Reviewed)Effect of ivermectin on COVID-19: A multicenter double-blind randomized controlled clinical trialRCT in Iran showing shorter time to recovery and shorter hospitalization time with ivermectin. There were no adverse effects. There was one death in the treatment group, the patient was in critical condition at baseline and died within 24 hours of admission. IRCT20111224008507N3. Also see [1] and the author response [2]. risk of death, 197.1% higher , RR 2.97, p = 1.00 , treatment 1 of 35 (2.9%), control 0 of 34 (0.0%), continuity correction due to zero event, patient died within 24 hours of admission.
        risk of mechanical ventilation, 94.3% higher , RR 1.94, p = 1.00 , treatment 2 of 35 (5.7%), control 1 of 34 (2.9%).
        recovery time, 31.6% lower , relative time 0.68, p = 0.05 , treatment 35, control 34, duration of dsypnea.
        recovery time, 19.2% lower , relative time 0.81, p = 0.02 , treatment 35, control 34, duration of all symptoms.
        hospitalization time, 15.5% lower , relative time 0.85, p = 0.02 , treatment 35, control 34.
        Shahbaznejad et al., 1/19/2021, Double Blind Randomized Controlled Trial, Iran, Middle East, peer-reviewed, 8 authors, dosage 200Î¼g/kg single dose.
        Submit Corrections or CommentsMeta Hill et al., Research Square, doi:10.21203/rs.3.rs-148845/v1 (Preprint) (meta analysis)death, '†'75.0% , p=0.0002Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection Details Meta analysis of 18 ivermectin RCTs with 2,282 patients showing faster viral clearance (dose and duration dependent), improved clinical recovery, and lower hospitalization and mortality. In six RCTs of moderate or severe infection, there .. Details Source PDF Meta
        Meta
        Hill et al., Research Square, doi:10.21203/rs.3.rs-148845/v1 (Preprint) (meta analysis)Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infectionMeta analysis of 18 ivermectin RCTs with 2,282 patients showing faster viral clearance (dose and duration dependent), improved clinical recovery, and lower hospitalization and mortality. In six RCTs of moderate or severe infection, there was a 75% reduction in mortality, RR 0.25 [0.12-0.52], p = 0.0002.A sponsor reportedly required the conclusion of this paper to be changed against the wishes of the authors (to suggest that more trials should be done as opposed to the existing evidence being sufficient) [1, 2, 3]. risk of death, 75.0% lower , RR 0.25, p .
        Hill et al., 1/19/2021, preprint, 40 authors.
        Submit Corrections or CommentsEarly Samaha et al., Viruses, doi:10.3390/v13060989 (results 1/16) (Peer Reviewed)hosp., '†'85.7% , p=0.24Effects of a Single Dose of Ivermectin on Viral and Clinical Outcomes in Asymptomatic SARS-CoV-2 Infected Subjects: A Pilot Clinical Trial in Lebanon Details RCT 100 patients in Lebanon, showing significantly lower viral load at day 3, and lower hospitalization. All patients also took zinc and vitamin C. ChiCTR2000033627. Details Source PDF Early treatment study
        Early treatment study
        Samaha et al., Viruses, doi:10.3390/v13060989 (results 1/16) (Peer Reviewed)Effects of a Single Dose of Ivermectin on Viral and Clinical Outcomes in Asymptomatic SARS-CoV-2 Infected Subjects: A Pilot Clinical Trial in LebanonRCT 100 patients in Lebanon, showing significantly lower viral load at day 3, and lower hospitalization. All patients also took zinc and vitamin C. ChiCTR2000033627. risk of hospitalization, 85.7% lower , RR 0.14, p = 0.24 , treatment 0 of 50 (0.0%), control 3 of 50 (6.0%), continuity correction due to zero event.
        risk of fever at day 3, 90.9% lower , RR 0.09, p = 0.004 , treatment 1 of 50 (2.0%), control 11 of 50 (22.0%).
        Samaha et al., 1/16/2021, Randomized Controlled Trial, Lebanon, Middle East, peer-reviewed, 16 authors, dosage 12mg single dose, 45''64kg, 65''84kg, and >85kg patients received 9mg, 12mg, or 150µg/kg respectively.
        Submit Corrections or CommentsEarly Bukhari et al., medRxiv, doi:10.1101/2021.02.02.21250840 (results 1/16) (Preprint)viral+, '†'82.4% , pEfficacy of Ivermectin in COVID-19 Patients with Mild to Moderate Disease Details RCT of relatively low risk hospitalized patients with 50 ivermectin and 50 control patients showing significantly faster viral clearance with treatment. 9 patients in the treatment arm were lost to followup compared with 5 in the control .. Details Source PDF Early treatment study
        Early treatment study
        Bukhari et al., medRxiv, doi:10.1101/2021.02.02.21250840 (results 1/16) (Preprint)Efficacy of Ivermectin in COVID-19 Patients with Mild to Moderate DiseaseRCT of relatively low risk hospitalized patients with 50 ivermectin and 50 control patients showing significantly faster viral clearance with treatment. 9 patients in the treatment arm were lost to followup compared with 5 in the control arm, which could be in part due to faster recovery with treatment. There were no safety concerns. No mortality was reported. The numbers in Table 3 are the number of patients that became negative on that day, i.e., non-cumulative. NCT04392713. risk of no virological cure, 82.4% lower , RR 0.18, p , treatment 4 of 41 (9.8%), control 25 of 45 (55.6%), day 7.
        risk of no virological cure, 38.7% lower , RR 0.61, p , treatment 24 of 41 (58.5%), control 43 of 45 (95.6%), day 3.
        Bukhari et al., 1/16/2021, Randomized Controlled Trial, Pakistan, South Asia, preprint, 10 authors, dosage 12mg single dose.
        Submit Corrections or CommentsReview Kory et al., Frontiers in Pharmacology, doi:10.3389/fphar.2021.643369 (Review) (Peer Reviewed)reviewReview of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 Details Meta analysis of ivermectin clinical studies and natural experiments where ivermectin has been widely used, showing efficacy of ivermectin in prophylaxis and treatment of COVID-19. This paper was censored by the journal after acceptance [.. Details Source PDF Review
        Review
        Kory et al., Frontiers in Pharmacology, doi:10.3389/fphar.2021.643369 (Review) (Peer Reviewed)Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19Meta analysis of ivermectin clinical studies and natural experiments where ivermectin has been widely used, showing efficacy of ivermectin in prophylaxis and treatment of COVID-19. This paper was censored by the journal after acceptance [1].Kory et al., 1/13/2021, peer-reviewed, 10 authors.
        Submit Corrections or CommentsLate OkumuÅŸ et al., BMC Infectious Diseases, doi:10.1186/s12879-021-06104-9 (preprint 1/12) (Peer Reviewed)death, '†'33.3% , p=0.55Evaluation of the Effectiveness and Safety of Adding Ivermectin to Treatment in Severe COVID-19 Patients Details Small RCT for severe COVID-19 comparing the addition of ivermectin to SOC (low dose HCQ+AZ+favipiravir), with 30 treatment and 30 control patients in Turkey, showing lower mortality and faster clinical recovery. Authors also investigate t.. Details Source PDF Late treatment study
        Late treatment study
        OkumuÅŸ et al., BMC Infectious Diseases, doi:10.1186/s12879-021-06104-9 (preprint 1/12) (Peer Reviewed)Evaluation of the Effectiveness and Safety of Adding Ivermectin to Treatment in Severe COVID-19 PatientsSmall RCT for severe COVID-19 comparing the addition of ivermectin to SOC (low dose HCQ+AZ+favipiravir), with 30 treatment and 30 control patients in Turkey, showing lower mortality and faster clinical recovery. Authors also investigate the presence of gene mutations that alter ivermectin metabolism, predicting that ivermectin can be used safely without serious side effects in patients without MDR-1/ABCB1 and/or CYP3A4 gene mutation, and recommending monitoring and appropriate treatment if necessary when sequencing is unavailable. risk of death, 33.3% lower , RR 0.67, p = 0.55 , treatment 6 of 30 (20.0%), control 9 of 30 (30.0%).
        risk of no improvement at day 10, 42.9% lower , RR 0.57, p = 0.18 , treatment 8 of 30 (26.7%), control 14 of 30 (46.7%).
        risk of no improvement at day 5, 15.8% lower , RR 0.84, p = 0.60 , treatment 16 of 30 (53.3%), control 19 of 30 (63.3%).
        risk of no virological cure, 80.0% lower , RR 0.20, p = 0.02 , treatment 2 of 16 (12.5%), control 5 of 8 (62.5%), day 10.
        OkumuÅŸ et al., 1/12/2021, Double Blind Randomized Controlled Trial, Turkey, Europe, peer-reviewed, 15 authors, dosage 200Î¼g/kg days 1-5, 36-50kg - 9mg, 51-65kg - 12mg, 66-79kg - 15mg, >80kg 200Î¼g/kg.
        Submit Corrections or CommentsPrEPPEP Chahla et al., medRxiv, doi:10.1101/2021.03.26.21254398 (Preprint)m/s case, '†'95.2% , p=0.002A randomized trial - intensive treatment based in ivermectin and iota-carrageenan as pre-exposure prophylaxis for COVID-19 in healthcare agents Details Prophylaxis RCT for ivermectin and iota-carrageenan in Argentina, 117 healthcare workers treated with ivermectin and iota-carrageenan, and 117 controls, showing significantly lower cases with treatment. There were no moderate/severe cases.. Details Source PDF Prophylaxis study
        Prophylaxis study
        Chahla et al., medRxiv, doi:10.1101/2021.03.26.21254398 (Preprint)A randomized trial - intensive treatment based in ivermectin and iota-carrageenan as pre-exposure prophylaxis for COVID-19 in healthcare agentsProphylaxis RCT for ivermectin and iota-carrageenan in Argentina, 117 healthcare workers treated with ivermectin and iota-carrageenan, and 117 controls, showing significantly lower cases with treatment. There were no moderate/severe cases with treatment vs. 10 in the control group. There were 4 cases with treatment (all mild) vs. 25 for the control group. NCT04701710. risk of moderate/severe case, 95.2% lower , RR 0.05, p = 0.002 , treatment 0 of 117 (0.0%), control 10 of 117 (8.5%), continuity correction due to zero event, moderate/severe COVID-19.
        risk of COVID-19 case, 84.0% lower , RR 0.16, p , treatment 4 of 117 (3.4%), control 25 of 117 (21.4%), adjusted, OR converted to RR, all cases.
        risk of COVID-19 case, 84.0% lower , RR 0.16, p , treatment 4 of 117 (3.4%), control 25 of 117 (21.4%), all cases.
        Chahla et al., 1/11/2021, Randomized Controlled Trial, Argentina, South America, preprint, 1 author, dosage 12mg weekly, this trial uses multiple treatments in the treatment arm (combined with iota-carrageenan) - results of individual treatments may vary.
        Submit Corrections or CommentsN/A Bousquet-Melou et al., Preprint, doi:10.22541/au.161047848.80388481/v1 (Preprint)dosing studyLarge Impact of obesity on the disposition of ivermectin, moxidectin and eprinomectin in a canine model: relevance for COVID-19 patients Details Animal dosing study with an obese dog model concluding that ivermectin maintenance doses should be based on lean body weight and not the total body weight in obese subjects, while the loading dose should be based on the total body weight. Details Source PDF N/A
        N/A
        Bousquet-Melou et al., Preprint, doi:10.22541/au.161047848.80388481/v1 (Preprint)Large Impact of obesity on the disposition of ivermectin, moxidectin and eprinomectin in a canine model: relevance for COVID-19 patientsAnimal dosing study with an obese dog model concluding that ivermectin maintenance doses should be based on lean body weight and not the total body weight in obese subjects, while the loading dose should be based on the total body weight.Bousquet-Melou et al., 1/11/2021, preprint, 5 authors.
        Submit Corrections or CommentsReview Formiga et al., J. Control Release, doi:10.1016/j.jconrel.2020.10.009 (Review) (Peer Reviewed)reviewIvermectin: an award-winning drug with expected antiviral activity against COVID-19 Details Review hypothesizing that micro- and nanotechnology-based formulations of ivermectin for the pulmonary delivery of ivermectin may be beneficial for use with COVID-19. Details Source PDF Review
        Review
        Formiga et al., J. Control Release, doi:10.1016/j.jconrel.2020.10.009 (Review) (Peer Reviewed)Ivermectin: an award-winning drug with expected antiviral activity against COVID-19Review hypothesizing that micro- and nanotechnology-based formulations of ivermectin for the pulmonary delivery of ivermectin may be beneficial for use with COVID-19.Formiga et al., 1/10/2021, peer-reviewed, 6 authors.
        Submit Corrections or CommentsEarly Ravikirti et al., Journal of Pharmacy & Pharmaceutical Sciences, doi:10.18433/jpps32105 (Peer Reviewed)death, '†'88.7% , p=0.12Ivermectin as a potential treatment for mild to moderate COVID-19: A double blind randomized placebo-controlled trial Details RCT with 112 mild and moderate COVID-19 patients in India, showing lower mortality, ventilation, and ICU admission, although not statistically significant due to the small number of events. There was no mortality in the treatment arm (55 .. Details Source PDF Early treatment study
        Early treatment study
        Ravikirti et al., Journal of Pharmacy & Pharmaceutical Sciences, doi:10.18433/jpps32105 (Peer Reviewed)Ivermectin as a potential treatment for mild to moderate COVID-19: A double blind randomized placebo-controlled trialRCT with 112 mild and moderate COVID-19 patients in India, showing lower mortality, ventilation, and ICU admission, although not statistically significant due to the small number of events. There was no mortality in the treatment arm (55 patients) versus 7% (4 of 57) in the control arm. The PCR result is subject to confounding by biased loss of followup, with 23 lost in the treatment group and 13 in the control group, and 8 more people in the treatment group discharged before day 6. risk of death, 88.7% lower , RR 0.11, p = 0.12 , treatment 0 of 55 (0.0%), control 4 of 57 (7.0%), continuity correction due to zero event.
        risk of mechanical ventilation, 79.3% lower , RR 0.21, p = 0.10 , treatment 1 of 55 (1.8%), control 5 of 57 (8.8%).
        risk of ICU admission, 13.6% lower , RR 0.86, p = 0.80 , treatment 5 of 55 (9.1%), control 6 of 57 (10.5%).
        risk of no virological cure, 11.6% higher , RR 1.12, p = 0.35 , treatment 42 of 55 (76.4%), control 39 of 57 (68.4%).
        Ravikirti et al., 1/9/2021, Double Blind Randomized Controlled Trial, India, South Asia, peer-reviewed, 11 authors, dosage 12mg days 1, 2.
        Submit Corrections or CommentsEarly Chamie , J. (News)newsCOVID-19 in Mexico Details Comparison of COVID-19 death rates in Mexico showing that the only state using ivermectin has a dramatically lower rate. Details Source PDF Early treatment study
        Early treatment study
        Chamie , J. (News)COVID-19 in MexicoComparison of COVID-19 death rates in Mexico showing that the only state using ivermectin has a dramatically lower rate.Chamie et al., 1/8/2021, preprint, 1 author.
        Submit Corrections or CommentsEarly Babalola et al., QJM: An International Journal of Medicine, doi:10.1093/qjmed/hcab035 (preprint 1/6) (Peer Reviewed)viral+, '†'63.9% , p=0.11Ivermectin shows clinical benefits in mild to moderate COVID19: A randomised controlled double-blind, dose-response study in Lagos Details Small RCT comparing ivermectin 6mg & 12mg q84hr with lopinavir/ritonavir, showing a statistically significant and dose dependent effect of ivermectin on reducing the time to PCR-.A twitter personality well known for negative attacks on .. Details Source PDF Early treatment study
        Early treatment study
        Babalola et al., QJM: An International Journal of Medicine, doi:10.1093/qjmed/hcab035 (preprint 1/6) (Peer Reviewed)Ivermectin shows clinical benefits in mild to moderate COVID19: A randomised controlled double-blind, dose-response study in LagosSmall RCT comparing ivermectin 6mg & 12mg q84hr with lopinavir/ritonavir, showing a statistically significant and dose dependent effect of ivermectin on reducing the time to PCR-.A twitter personality well known for negative attacks on ivermectin suggests that there are clinical results which should be prioritized here. The paper does not report mortality, hospitalization, progression, recovery, etc. The paper does report change in SpO2 (Figure 3, '†SpO2), where a similar improvement with a smaller p value is seen with ivermectin, however this result is unadjusted and there are large differences between groups. Specifically, baseline SpO2 is lower in the control group, giving the control group more room to improve, therefore the actual benefit of ivermectin is likely to be even larger than the benefit in '†SpO2 shown. The twitter personality would like to cherry pick an unadjusted individual symptom like cough, for which baseline values differ by ~2x. adjusted risk of viral+ at day 5, 63.9% lower , RR 0.36, p = 0.11 , treatment 40, control 20, adjusted.
        risk of no virological cure, 58.0% lower , RR 0.42, p = 0.01 , treatment 20, control 20, 12mg - Cox proportional hazard model.
        risk of no virological cure, 40.5% lower , RR 0.60, p = 0.12 , treatment 20, control 20, 6mg - Cox proportional hazard model.
        time to viral-, 49.2% lower , relative time 0.51 , treatment 20, control 20, 12mg.
        time to viral-, 34.4% lower , relative time 0.66 , treatment 20, control 20, 6mg.
        Babalola et al., 1/6/2021, Double Blind Randomized Controlled Trial, Nigeria, Africa, peer-reviewed, baseline oxygen requirements 8.3%, 10 authors, dosage 12mg or 6mg q84h for two weeks, this trial compares with another treatment - results may be better when compared to placebo.
        Submit Corrections or CommentsPrEPPEP Hirsch et al., Microbiology & Infectious Diseases (Peer Reviewed)Ivermectin as Prophylaxis Against COVID-19 Retrospective Cases Evaluation Details Report on ivermectin prophylaxis for healthcare workers in a hospital in Argentina, showing 0 cases in the 162 participants. Dosage was 0.2mg/kg weekly for eight weeks, followed by 4 months rest. Details Source PDF Prophylaxis study
        Prophylaxis study
        Hirsch et al., Microbiology & Infectious Diseases (Peer Reviewed)Ivermectin as Prophylaxis Against COVID-19 Retrospective Cases EvaluationReport on ivermectin prophylaxis for healthcare workers in a hospital in Argentina, showing 0 cases in the 162 participants. Dosage was 0.2mg/kg weekly for eight weeks, followed by 4 months rest.Hirsch et al., 1/6/2021, peer-reviewed, 2 authors.
        Submit Corrections or CommentsEarly, Late, PrEP, PEP Lawrie et al., Preprint (Preprint) (meta analysis)death, '†'83.0% , pIvermectin reduces the risk of death from COVID-19 '' a rapid review and meta-analysis in support of the recommendation of the Front Line COVID-19 Critical Care Alliance Details Meta analysis confirming the effectiveness of ivermectin for COVID-19, showing ivermectin treatment mortality relative risk RR 0.17 [0.18-0.35] and prophylaxis cases RR 0.12 [0.08-0.18]. Details Source PDF Early, Late, PrEP, PEP
        Early, Late, PrEP, PEP
        Lawrie et al., Preprint (Preprint) (meta analysis)Ivermectin reduces the risk of death from COVID-19 '' a rapid review and meta-analysis in support of the recommendation of the Front Line COVID-19 Critical Care AllianceMeta analysis confirming the effectiveness of ivermectin for COVID-19, showing ivermectin treatment mortality relative risk RR 0.17 [0.18-0.35] and prophylaxis cases RR 0.12 [0.08-0.18]. risk of death, 83.0% lower , RR 0.17, p , treatment 8 of 585 (1.4%), control 44 of 522 (8.4%).
        Lawrie et al., 1/3/2021, preprint, 1 author.
        Submit Corrections or CommentsLate Wijaya et al., Cermin Dunia Kedokteran, 47:7 (Peer Reviewed)Ivermectin as a Potential Therapeutic Agent for COVID-19 '' case studies Details Case report on 3 confirmed cases of COVID-19 with significant clinical and radiological improvement after a single dose of ivermectin. Details Source PDF Late treatment study
        Late treatment study
        Wijaya et al., Cermin Dunia Kedokteran, 47:7 (Peer Reviewed)Ivermectin as a Potential Therapeutic Agent for COVID-19 '' case studiesCase report on 3 confirmed cases of COVID-19 with significant clinical and radiological improvement after a single dose of ivermectin.Wijaya et al., 12/31/2020, peer-reviewed, 2 authors.
        Submit Corrections or CommentsAnimal Madrid et al., Heliyon, doi:10.1016/j.heliyon.2020.e05820 (Peer Reviewed)animal studySafety of oral administration of high doses of ivermectin by means of biocompatible polyelectrolytes formulation Details In vivo analysis of the safety of high dose ivermectin with a Corydoras fish animal model. Details Source PDF Animal study
        Animal study
        Madrid et al., Heliyon, doi:10.1016/j.heliyon.2020.e05820 (Peer Reviewed)Safety of oral administration of high doses of ivermectin by means of biocompatible polyelectrolytes formulationIn vivo analysis of the safety of high dose ivermectin with a Corydoras fish animal model.Madrid et al., 12/31/2020, peer-reviewed, 8 authors.
        Submit Corrections or CommentsReview McCullough et al., Reviews in Cardiovascular Medicine, doi:10.31083/j.rcm.2020.04.264 (Review) (Peer Reviewed)reviewMultifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) Details Review urging early treatment of COVID-19 with sequential multidrug treatment that has been shown to be safe and effective. Proposed treatment includes zinc, vitamin D & C, quercetin, and depending on age, comorbidities, and symptoms may .. Details Source PDF Review
        Review
        McCullough et al., Reviews in Cardiovascular Medicine, doi:10.31083/j.rcm.2020.04.264 (Review) (Peer Reviewed)Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)Review urging early treatment of COVID-19 with sequential multidrug treatment that has been shown to be safe and effective. Proposed treatment includes zinc, vitamin D & C, quercetin, and depending on age, comorbidities, and symptoms may include >=2 of HCQ, ivermectin, favipiravir; AZM/DOXY; corticosteroids; colchicine; bamlanivimab; aspirin; LMWH; and supplemental oxygen.McCullough et al., 12/30/2020, peer-reviewed, 58 authors.
        Submit Corrections or CommentsEarly Procter et al., Reviews in Cardiovascular Medicine, doi:10.31083/j.rcm.2020.04.260 (Peer Reviewed)Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection Details Retrospective 922 outpatients, with 320 treated early due to age>50 or comorbidities, showing 2.2% hospitalization and 0.3% death, which authors note is considerably lower than reported in other studies in their region.At least two of z.. Details Source PDF Early treatment study
        Early treatment study
        Procter et al., Reviews in Cardiovascular Medicine, doi:10.31083/j.rcm.2020.04.260 (Peer Reviewed)Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infectionRetrospective 922 outpatients, with 320 treated early due to age>50 or comorbidities, showing 2.2% hospitalization and 0.3% death, which authors note is considerably lower than reported in other studies in their region.At least two of zinc, HCQ, and ivermectin were used, along with one antibiotic, and budesonide and/or dexamethasone.Procter et al., 12/30/2020, peer-reviewed, 6 authors.
        Submit Corrections or CommentsMeta Hill , A., Preprint (Preprint) (meta analysis)meta-analysisMeta-analysis of clinical trials of ivermectin to treat COVID-19 infection Details WHO-funded meta analysis showing ivermectin treatment mortality relative risk RR 0.17 [0.08-0.35] for RCTs and RR 0.28 [0.13-0.62] for RCTs and observational studies, and confirming a dose-response effect. Details Source PDF Meta
        Meta
        Hill , A., Preprint (Preprint) (meta analysis)Meta-analysis of clinical trials of ivermectin to treat COVID-19 infectionWHO-funded meta analysis showing ivermectin treatment mortality relative risk RR 0.17 [0.08-0.35] for RCTs and RR 0.28 [0.13-0.62] for RCTs and observational studies, and confirming a dose-response effect.Hill et al., 12/27/2020, preprint, 1 author.
        Submit Corrections or CommentsIn Vitro Jeffreys et al., bioRxiv, doi:10.1101/2020.12.23.424232 (Preprint) (In Vitro)in vitroRemdesivir-Ivermectin combination displays synergistic interaction with improved in vitro antiviral activity against SARS-CoV-2 Details In Vitro study showing enhanced antiviral activity of ivermectin and remdesivir in combination. Details Source PDF In Vitro
        In Vitro
        Jeffreys et al., bioRxiv, doi:10.1101/2020.12.23.424232 (Preprint) (In Vitro)Remdesivir-Ivermectin combination displays synergistic interaction with improved in vitro antiviral activity against SARS-CoV-2In Vitro study showing enhanced antiviral activity of ivermectin and remdesivir in combination.Jeffreys et al., 12/24/2020, preprint, 15 authors.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsPrEPPEP Vallejos et al., Preliminary Results (Preprint)cases, '†'73.4% , pIvermectina en agentes de salud e IVERCOR COVID19 Details Report on ivermectin prophylaxis in a hospital in Argentina showing lower cases for healthcare workers taking ivermectin. Preliminary results from: [1]. Details Source PDF Prophylaxis study
        Prophylaxis study
        Vallejos et al., Preliminary Results (Preprint)Ivermectina en agentes de salud e IVERCOR COVID19Report on ivermectin prophylaxis in a hospital in Argentina showing lower cases for healthcare workers taking ivermectin. Preliminary results from: [1]. risk of COVID-19 case, 73.4% lower , RR 0.27, p , treatment 13 of 389 (3.3%), control 61 of 486 (12.6%).
        Vallejos et al., 12/20/2020, retrospective, Argentina, South America, preprint, 1 author, dosage 12mg weekly.
        Submit Corrections or CommentsEarly, Late, PrEP, PEP Kory et al., FLCCC Alliance (Preprint) (meta analysis)death, '†'69.0% , pReview of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 Details Meta analysis of ivermectin clinical studies and natural experiments where ivermectin has been widely used, showing efficacy of ivermectin in prophylaxis and treatment of COVID-19. Details Source PDF Early, Late, PrEP, PEP
        Early, Late, PrEP, PEP
        Kory et al., FLCCC Alliance (Preprint) (meta analysis)Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19Meta analysis of ivermectin clinical studies and natural experiments where ivermectin has been widely used, showing efficacy of ivermectin in prophylaxis and treatment of COVID-19. risk of death, 69.0% lower , RR 0.31, p , treatment 35 of 1551 (2.3%), control 191 of 1957 (9.8%), OR converted to RR.
        Kory et al., 12/18/2020, preprint, 10 authors.
        Submit Corrections or CommentsPrEPPEP Alam et al., European Journal ofMedical and Health Sciences, doi:10.24018/ejmed.2020.2.6.599 (Peer Reviewed)cases, '†'90.6% , pIvermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka '' An Observational Study Details 91% reduction in COVID-19 cases with ivermectin prophylaxis. 118 healthcare workers in Bangladesh, 58 receiving ivermectin 12mg monthly, showing RR 0.094, p Details Source PDF Prophylaxis study
        Prophylaxis study
        Alam et al., European Journal ofMedical and Health Sciences, doi:10.24018/ejmed.2020.2.6.599 (Peer Reviewed)Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka '' An Observational Study91% reduction in COVID-19 cases with ivermectin prophylaxis. 118 healthcare workers in Bangladesh, 58 receiving ivermectin 12mg monthly, showing RR 0.094, p risk of COVID-19 case, 90.6% lower , RR 0.09, p , treatment 4 of 58 (6.9%), control 44 of 60 (73.3%).
        Alam et al., 12/15/2020, prospective, Bangladesh, South Asia, peer-reviewed, 13 authors, dosage 12mg monthly.
        Submit Corrections or CommentsEarly Afsar et al., SSRN (Preprint)symptoms, '†'92.2% , p=0.04Ivermectin Use Associated with Reduced Duration of COVID-19 Febrile Illness in a Community Setting Details Small 95 patient study in Pakistan adding ivermectin to standard of care (HCQ+AZ) for outpatients with mild/moderate suspected COVID-19, showing faster resolution of fever with ivermectin.The low dose HCQ used in this study may not reac.. Details Source PDF Early treatment study
        Early treatment study
        Afsar et al., SSRN (Preprint)Ivermectin Use Associated with Reduced Duration of COVID-19 Febrile Illness in a Community SettingSmall 95 patient study in Pakistan adding ivermectin to standard of care (HCQ+AZ) for outpatients with mild/moderate suspected COVID-19, showing faster resolution of fever with ivermectin.The low dose HCQ used in this study may not reach therapeutic levels fast enough to make a significant impact. risk of fever at day 14, 92.2% lower , RR 0.08, p = 0.04 , treatment 0 of 37 (0.0%), control 7 of 53 (13.2%), continuity correction due to zero event.
        Afsar et al., 12/15/2020, retrospective, Pakistan, South Asia, preprint, 6 authors, dosage 12mg days 1-6.
        Submit Corrections or CommentsEarly Hussain et al., International Journal of Molecular and Immuno Oncology, doi:10.25259/IJMIO_30_2020 (Preprint)Outcome of ivermectin and doxycycline in cancer patients with COVID-19: A positive experience in Bangladesh Details Small case study of ivermectin + doxycycline with 8 cancer patients, with all patients becoming PCR- by day 6 when tested again. Details Source PDF Early treatment study
        Early treatment study
        Hussain et al., International Journal of Molecular and Immuno Oncology, doi:10.25259/IJMIO_30_2020 (Preprint)Outcome of ivermectin and doxycycline in cancer patients with COVID-19: A positive experience in BangladeshSmall case study of ivermectin + doxycycline with 8 cancer patients, with all patients becoming PCR- by day 6 when tested again.Hussain et al., 12/11/2020, preprint, 3 authors.
        Submit Corrections or CommentsEarly Chaccour et al., EClinicalMedicine, doi:10.1016/j.eclinm.2020.100720 (preprint 12/7) (Peer Reviewed)symp. prob., '†'52.9% , pThe effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe COVID-19: A pilot, double-blind, placebo-controlled, randomized clinical trial Details Tiny RCT for early treatment of mild COVID-19 in low risk patients, with 12 400mcg/kg single dose ivermectin patients and 12 control patients, showing significantly faster viral load reduction and symptom improvement with ivermectin.Ave.. Details Source PDF Early treatment study
        Early treatment study
        Chaccour et al., EClinicalMedicine, doi:10.1016/j.eclinm.2020.100720 (preprint 12/7) (Peer Reviewed)The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe COVID-19: A pilot, double-blind, placebo-controlled, randomized clinical trialTiny RCT for early treatment of mild COVID-19 in low risk patients, with 12 400mcg/kg single dose ivermectin patients and 12 control patients, showing significantly faster viral load reduction and symptom improvement with ivermectin.Average median viral load for gene E and gene N mid-viral recovery at day 7:Ivermectin: 1637control: 30175Probability of symptoms at day 28, adjusted for the time since onset and day of followup:Ivermectin: = 0.26 [0.10-0.42]control: 0.55 [0.33-0.77](details are in the supplementary appendix) symptom probability, 52.9% lower , RR 0.47, p , treatment 12, control 12, relative probability of symptoms at day 28, mixed effects logistic regression, data in supplementary appendix.
        viral load, 94.6% lower , relative load 0.05 , treatment 12, control 12, day 7 mid-recovery, data in supplementary appendix.
        Chaccour et al., 12/7/2020, Double Blind Randomized Controlled Trial, Spain, Europe, peer-reviewed, 23 authors, dosage 400Î¼g/kg single dose.
        Submit Corrections or CommentsMeta Kalfas et al., medRxiv, doi:10.1101/2020.11.30.20236570 (Preprint) (meta analysis)meta-analysisThe therapeutic potential of ivermectin for COVID-19: a systematic review of mechanisms and evidence Details Review of ivermectin mechanisms and 8 trials, showing positive mortality benefit, reduced time to clinical recovery, reduced incidence of disease progression, and decreased duration of hospital admission in patients across all stages of c.. Details Source PDF Meta
        Meta
        Kalfas et al., medRxiv, doi:10.1101/2020.11.30.20236570 (Preprint) (meta analysis)The therapeutic potential of ivermectin for COVID-19: a systematic review of mechanisms and evidenceReview of ivermectin mechanisms and 8 trials, showing positive mortality benefit, reduced time to clinical recovery, reduced incidence of disease progression, and decreased duration of hospital admission in patients across all stages of clinical severity.Kalfas et al., 12/4/2020, preprint, 4 authors.
        Submit Corrections or CommentsIn Vitro Surnar et al., ACS Pharmacol. Transl. Sci., doi:10.1021/acsptsci.0c00179 (Peer Reviewed) (In Vitro)in vitroClinically Approved Antiviral Drug in an Orally Administrable Nanoparticle for COVID-19 Details In Vitro analysis of ivermectin with orally administrable nanoparticles showing efficacy for decreasing expression of the viral spike protein and ACE2. Inhibition of nuclear transport activities mediated through proteins such as importin .. Details Source PDF In Vitro
        In Vitro
        Surnar et al., ACS Pharmacol. Transl. Sci., doi:10.1021/acsptsci.0c00179 (Peer Reviewed) (In Vitro)Clinically Approved Antiviral Drug in an Orally Administrable Nanoparticle for COVID-19In Vitro analysis of ivermectin with orally administrable nanoparticles showing efficacy for decreasing expression of the viral spike protein and ACE2. Inhibition of nuclear transport activities mediated through proteins such as importin Î±/Î²1 heterodimer are also considered as a possible mechanism of action. The technology may work for other coronaviruses as well.Surnar et al., 12/4/2020, peer-reviewed, 4 authors.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsEarly Ahmed et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.11.191 (Peer Reviewed)symptoms, '†'85.0% , p=0.09A five day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness Details Small 72 patient RCT of ivermectin and ivermectin + doxycycline showing faster recovery with ivermectin.Ivermectin group: 12mg daily for 5 daysIvermectin + doxycycline: 12mg ivermectin single dose, 200mg doxycycline + 100mg bid 4 days Details Source PDF Early treatment study
        Early treatment study
        Ahmed et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.11.191 (Peer Reviewed)A five day course of ivermectin for the treatment of COVID-19 may reduce the duration of illnessSmall 72 patient RCT of ivermectin and ivermectin + doxycycline showing faster recovery with ivermectin.Ivermectin group: 12mg daily for 5 daysIvermectin + doxycycline: 12mg ivermectin single dose, 200mg doxycycline + 100mg bid 4 days risk of unresolved symptoms, 85.0% lower , RR 0.15, p = 0.09 , treatment 0 of 17 (0.0%), control 3 of 19 (15.8%), continuity correction due to zero event, day 7 fever ivermectin.
        risk of unresolved symptoms, 62.7% lower , RR 0.37, p = 0.35 , treatment 1 of 17 (5.9%), control 3 of 19 (15.8%), day 7 fever ivermectin + doxycycline.
        risk of no virological cure, 42.5% lower , RR 0.58, p = 0.01 , treatment 11 of 22 (50.0%), control 20 of 23 (87.0%), day 7 ivermectin.
        risk of no virological cure, 20.0% lower , RR 0.80, p = 0.28 , treatment 16 of 23 (69.6%), control 20 of 23 (87.0%), day 7 ivermectin + doxycycline.
        risk of no virological cure, 62.7% lower , RR 0.37, p = 0.02 , treatment 5 of 22 (22.7%), control 14 of 23 (60.9%), day 14 ivermectin.
        risk of no virological cure, 35.7% lower , RR 0.64, p = 0.24 , treatment 9 of 23 (39.1%), control 14 of 23 (60.9%), day 14 ivermectin + doxycycline.
        time to viral-, 23.6% lower , relative time 0.76, p = 0.02 , treatment 22, control 23, ivermectin.
        time to viral-, 9.4% lower , relative time 0.91, p = 0.27 , treatment 23, control 23, ivermectin + doxycycline.
        hospitalization time, 1.0% lower , relative time 0.99 , ivermectin.
        hospitalization time, 4.1% higher , relative time 1.04 , ivermectin + doxycycline.
        Ahmed et al., 12/2/2020, Double Blind Randomized Controlled Trial, Bangladesh, South Asia, peer-reviewed, mean age 42.0, 15 authors, dosage 12mg days 1-5, ivermectin + doxycycline group took only a single dose of ivermectin.
        Submit Corrections or CommentsEarly Chamie , J. (News)newsThe effect of using ivermectin to control COVID-19 in Chiapas Details After starting to distribute ivermectin in drug kits in July, the Mexican state of Chiapas has seen a dramatic divergence from other states with much lower mortality [1, 2]. Details Source PDF Early treatment study
        Early treatment study
        Chamie , J. (News)The effect of using ivermectin to control COVID-19 in ChiapasAfter starting to distribute ivermectin in drug kits in July, the Mexican state of Chiapas has seen a dramatic divergence from other states with much lower mortality [1, 2].Chamie et al., 12/2/2020, preprint, 1 author.
        Submit Corrections or CommentsEarly Alonso et al., (Preprint)death, '†'91.8% , p=0.009COVID-19: Uso de ivermectina Details Observational study in Argentina showing significantly lower mortality in the 60 days after adopting ivermectin compared to the 60 days before, relative risk RR 0.082, p=0.003. Details Source PDF Early treatment study
        Early treatment study
        Alonso et al., (Preprint)COVID-19: Uso de ivermectinaObservational study in Argentina showing significantly lower mortality in the 60 days after adopting ivermectin compared to the 60 days before, relative risk RR 0.082, p=0.003. risk of death, 91.8% lower , RR 0.08, p = 0.009 , treatment 1 of 311 (0.3%), control 5 of 128 (3.9%).
        Alonso et al., 12/1/2020, retrospective, Argentina, South America, preprint, 1 author, dosage not specified.
        Submit Corrections or CommentsPrEPPEP Bernigaud et al., Annals of Dermatology and Venereology, doi:10.1016/j.annder.2020.09.231 (Peer Reviewed)death, '†'99.4% , p=0.08Ivermectin benefit: from scabies to COVID-19, an example of serendipity Details 69 residents of a French care home, median age 90, were treated with ivermectin for a scabies outbreak. 3,062 residents in 45 nearby comparable homes were used as controls.7 of 69 treated patients had probable or certain COVID-19, with .. Details Source PDF Prophylaxis study
        Prophylaxis study
        Bernigaud et al., Annals of Dermatology and Venereology, doi:10.1016/j.annder.2020.09.231 (Peer Reviewed)Ivermectin benefit: from scabies to COVID-19, an example of serendipity69 residents of a French care home, median age 90, were treated with ivermectin for a scabies outbreak. 3,062 residents in 45 nearby comparable homes were used as controls.7 of 69 treated patients had probable or certain COVID-19, with no serious cases and no deaths. In comparable care homes in the same district, matched by age and socio-economic level, there was 22.6% COVID-19 and 5% death. risk of death, 99.4% lower , RR 0.006, p = 0.08 , treatment 0 of 69 (0.0%), control 150 of 3062 (4.9%), continuity correction due to zero event.
        risk of COVID-19 case, 55.1% lower , RR 0.45, p = 0.01 , treatment 7 of 69 (10.1%), control 692 of 3062 (22.6%).
        Bernigaud et al., 11/28/2020, retrospective, France, Europe, peer-reviewed, 12 authors, dosage 200Î¼g/kg days 1, 8, 15, 400Î¼g/kg days 1, 8, 15, two different dosages.
        Submit Corrections or CommentsPrEPPEP Hellwig et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106248 (Peer Reviewed)cases, '†'78.0% , pA COVID-19 Prophylaxis? Lower incidence associated with prophylactic administration of Ivermectin Details Analysis of COVID-19 cases vs. widespread prophylactic use of ivermectin for parasitic infections showing significantly lower incidence of COVID-19 cases. Details Source PDF Prophylaxis study
        Prophylaxis study
        Hellwig et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106248 (Peer Reviewed)A COVID-19 Prophylaxis? Lower incidence associated with prophylactic administration of IvermectinAnalysis of COVID-19 cases vs. widespread prophylactic use of ivermectin for parasitic infections showing significantly lower incidence of COVID-19 cases. risk of COVID-19 case, 78.0% lower , RR 0.22, p , African countries, PCTI vs. no PCT, relative cases per capita.
        risk of COVID-19 case, 80.0% lower , RR 0.20, p , worldwide, PCTI vs. no PCT, relative cases per capita.
        Hellwig et al., 11/28/2020, retrospective, ecological study, multiple countries, multiple regions, peer-reviewed, 2 authors, dosage 200Î¼g/kg, dose varied, typically 150-200Î¼g/kg.
        Submit Corrections or CommentsLate Niaee et al., Asian Pacific Journal of Tropical Medicine, doi:10.4103/1995-7645.318304 (preprint 11/24/20) (Peer Reviewed)death, '†'81.8% , p=0.001Ivermectin as an adjunct treatment for hospitalized adult COVID-19 patients: A randomized multi-center clinical trial Details 82% lower mortality with ivermectin. RCT with 180 hospitalized patients showing reduced mortality and hospital stay with ivermectin, with a wide margin of safety. All patients received SOC including low dose HCQ. Details Source PDF Late treatment study
        Late treatment study
        Niaee et al., Asian Pacific Journal of Tropical Medicine, doi:10.4103/1995-7645.318304 (preprint 11/24/20) (Peer Reviewed)Ivermectin as an adjunct treatment for hospitalized adult COVID-19 patients: A randomized multi-center clinical trial82% lower mortality with ivermectin. RCT with 180 hospitalized patients showing reduced mortality and hospital stay with ivermectin, with a wide margin of safety. All patients received SOC including low dose HCQ. risk of death, 81.8% lower , RR 0.18, p = 0.001 , treatment 4 of 120 (3.3%), control 11 of 60 (18.3%), All IVM vs. all control.
        risk of death, 94.3% lower , RR 0.06, p = 0.01 , treatment 0 of 30 (0.0%), control 11 of 60 (18.3%), continuity correction due to zero event, IVM single dose 200mcg/kg vs. all control.
        risk of death, 45.5% lower , RR 0.55, p = 0.37 , treatment 3 of 30 (10.0%), control 11 of 60 (18.3%), IVM three dose 200mcg/kg vs. all control.
        risk of death, 94.3% lower , RR 0.06, p = 0.01 , treatment 0 of 30 (0.0%), control 11 of 60 (18.3%), continuity correction due to zero event, IVM single dose 400mcg/kg vs. all control.
        risk of death, 81.8% lower , RR 0.18, p = 0.06 , treatment 1 of 30 (3.3%), control 11 of 60 (18.3%), IVM three dose 400/200/200mcg/kg vs. all control.
        Niaee et al., 11/24/2020, Double Blind Randomized Controlled Trial, Iran, Middle East, peer-reviewed, mean age 56.0, 14 authors, dosage 400Î¼g/kg single dose, dose varies in different groups.
        Submit Corrections or CommentsAnimal de Melo et al., EMBO Mol. Med., doi:10.15252/emmm.202114122 (preprint 11/22/20) (Peer Reviewed)animal studyAttenuation of clinical and immunological outcomes during SARS-CoV-2 infection by ivermectin Details Animal study showing that standard doses of ivermectin prevented clinical deterioration, reduced olfactory deficit, and limited the inflammation of the upper and lower respiratory tracts in SARS-CoV-2-infected hamsters. Details Source PDF Animal study
        Animal study
        de Melo et al., EMBO Mol. Med., doi:10.15252/emmm.202114122 (preprint 11/22/20) (Peer Reviewed)Attenuation of clinical and immunological outcomes during SARS-CoV-2 infection by ivermectinAnimal study showing that standard doses of ivermectin prevented clinical deterioration, reduced olfactory deficit, and limited the inflammation of the upper and lower respiratory tracts in SARS-CoV-2-infected hamsters.de Melo et al., 11/22/2020, peer-reviewed, 11 authors.
        Submit Corrections or CommentsLate Budhiraja et al., medRxiv, doi:10.1101/2020.11.16.20232223 (Preprint)death, '†'99.1% , p=0.04Clinical Profile of First 1000 COVID-19 Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian Experience Details Retrospective 976 hospitalized patients with 34 treated with ivermectin showing ivermectin mortality relative risk RR 0.13, p = 0.04. Details Source PDF Late treatment study
        Late treatment study
        Budhiraja et al., medRxiv, doi:10.1101/2020.11.16.20232223 (Preprint)Clinical Profile of First 1000 COVID-19 Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian ExperienceRetrospective 976 hospitalized patients with 34 treated with ivermectin showing ivermectin mortality relative risk RR 0.13, p = 0.04. risk of death, 99.1% lower , RR 0.009, p = 0.04 , treatment 0 of 34 (0.0%), control 103 of 942 (10.9%), continuity correction due to zero event.
        Budhiraja et al., 11/18/2020, retrospective, India, South Asia, preprint, 12 authors, dosage not specified.
        Submit Corrections or CommentsPrEPPEP Carvallo et al., Journal of Biomedical Research and Clinical Investigation, doi:10.31546/2633-8653.1007 (Peer Reviewed)cases, '†'99.9% , pStudy of the Efficacy and Safety of Topical Ivermectin + Iota-Carrageenan in the Prophylaxis against COVID-19 in Health Personnel Details Prophylaxis study using ivermectin and iota-carrageenan showing 0 of 788 cases from treated healthcare workers, compared to 237 of 407 control.The authors later reported that carrageenan is not necessary in this protocol [1]. Details Source PDF Prophylaxis study
        Prophylaxis study
        Carvallo et al., Journal of Biomedical Research and Clinical Investigation, doi:10.31546/2633-8653.1007 (Peer Reviewed)Study of the Efficacy and Safety of Topical Ivermectin + Iota-Carrageenan in the Prophylaxis against COVID-19 in Health PersonnelProphylaxis study using ivermectin and iota-carrageenan showing 0 of 788 cases from treated healthcare workers, compared to 237 of 407 control.The authors later reported that carrageenan is not necessary in this protocol [1]. risk of COVID-19 case, 99.9% lower , RR 0.001, p , treatment 0 of 788 (0.0%), control 237 of 407 (58.2%), continuity correction due to zero event.
        Carvallo et al., 11/17/2020, prospective, Argentina, South America, peer-reviewed, 4 authors, dosage 12mg weekly, this trial uses multiple treatments in the treatment arm (combined with iota-carrageenan) - results of individual treatments may vary.
        Submit Corrections or CommentsLate Spoorthi et al., IAIM, 2020, 7:10, 177-182 (Peer Reviewed)recov. time, '†'21.1% , p=0.03Utility of Ivermectin and Doxycycline combination for the treatment of SARSCoV-2 Details 100 patient prospective trial of ivermectin + doxycycline showing reduced time to symptom resolution and shorter hospital stay with treatment. Details Source PDF Late treatment study
        Late treatment study
        Spoorthi et al., IAIM, 2020, 7:10, 177-182 (Peer Reviewed)Utility of Ivermectin and Doxycycline combination for the treatment of SARSCoV-2100 patient prospective trial of ivermectin + doxycycline showing reduced time to symptom resolution and shorter hospital stay with treatment. recovery time, 21.1% lower , relative time 0.79, p = 0.03 , treatment 50, control 50.
        hospitalization time, 15.5% lower , relative time 0.84, p = 0.01 , treatment 50, control 50.
        Spoorthi et al., 11/14/2020, prospective, India, South Asia, peer-reviewed, 2 authors, dosage not specified, this trial uses multiple treatments in the treatment arm (combined with doxycycline) - results of individual treatments may vary.
        Submit Corrections or CommentsLate Elgazzar et al., Research Square, doi:10.21203/rs.3.rs-100956/v2 (Preprint)Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic Details This study was withdrawn. Details Source PDF Late treatment study
        Late treatment study
        Elgazzar et al., Research Square, doi:10.21203/rs.3.rs-100956/v2 (Preprint)Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 PandemicThis study was withdrawn.Elgazzar et al., 11/13/2020, preprint, 6 authors.
        Submit Corrections or CommentsLate Camprub­ et al., PLoS ONE, 15:11, doi:10.1371/journal.pone.0242184 (Peer Reviewed)ventilation, '†'40.0% , p=0.67Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients Details Tiny 26 patients retrospective study of ivermectin 200 Î¼g/kg, median 12 days after symptoms, not showing significant differences. Authors suggest the dose is too low and recommend evaluation of higher doses.All patients received HCQ whi.. Details Source PDF Late treatment study
        Late treatment study
        Camprub­ et al., PLoS ONE, 15:11, doi:10.1371/journal.pone.0242184 (Peer Reviewed)Lack of efficacy of standard doses of ivermectin in severe COVID-19 patientsTiny 26 patients retrospective study of ivermectin 200 Î¼g/kg, median 12 days after symptoms, not showing significant differences. Authors suggest the dose is too low and recommend evaluation of higher doses.All patients received HCQ which may reduce the potential benefit for adding ivermectin. risk of mechanical ventilation, 40.0% lower , RR 0.60, p = 0.67 , treatment 3 of 13 (23.1%), control 5 of 13 (38.5%).
        risk of ICU admission, 33.3% lower , RR 0.67, p = 1.00 , treatment 2 of 13 (15.4%), control 3 of 13 (23.1%), ICU at day 8.
        risk of no improvement at day 8, 33.3% higher , RR 1.33, p = 1.00 , treatment 4 of 13 (30.8%), control 3 of 13 (23.1%).
        Camprub­ et al., 11/11/2020, retrospective, Spain, Europe, peer-reviewed, 9 authors, dosage 200Î¼g/kg single dose.
        Submit Corrections or CommentsReview Turkia , M., ResearchGate (Review) (Preprint)reviewFLCCC Alliance MATH+ ascorbic acid and I-MASK+ ivermectin protocols for COVID-19 '-- a brief review Details Review suggesting that ivermectin should be used based on existing data suggesting significant benefits, and that waiting for additional data may result in significant harm. Details Source PDF Review
        Review
        Turkia , M., ResearchGate (Review) (Preprint)FLCCC Alliance MATH+ ascorbic acid and I-MASK+ ivermectin protocols for COVID-19 '-- a brief reviewReview suggesting that ivermectin should be used based on existing data suggesting significant benefits, and that waiting for additional data may result in significant harm.Turkia et al., 11/10/2020, preprint, 1 author.
        Submit Corrections or CommentsEarly Cadegiani et al., New Microbes and New Infections, doi:10.1016/j.nmni.2021.100915 (preprint 11/4/2020) (Peer Reviewed)death, '†'78.3% , p=0.50Early COVID-19 Therapy with azithromycin plus nitazoxanide, ivermectin or hydroxychloroquine in Outpatient Settings Significantly Improved COVID-19 outcomes compared to Known outcomes in untreated patients Details Comparison of HCQ, nitazoxanide, and ivermectin showing similar effectiveness for overall clinical outcomes in COVID-19 when used before seven days of symptoms, and overwhelmingly superior compared to the untreated COVID-19 population, ev.. Details Source PDF Early treatment study
        Early treatment study
        Cadegiani et al., New Microbes and New Infections, doi:10.1016/j.nmni.2021.100915 (preprint 11/4/2020) (Peer Reviewed)Early COVID-19 Therapy with azithromycin plus nitazoxanide, ivermectin or hydroxychloroquine in Outpatient Settings Significantly Improved COVID-19 outcomes compared to Known outcomes in untreated patientsComparison of HCQ, nitazoxanide, and ivermectin showing similar effectiveness for overall clinical outcomes in COVID-19 when used before seven days of symptoms, and overwhelmingly superior compared to the untreated COVID-19 population, even for those outcomes not influenced by placebo effect, at least when combined with azithromycin, and vitamin C, D and zinc in the majority of the cases. 585 patients with mean treatment delay 2.9 days. There was no hospitalization, mechanical ventilation, or mortality with treatment. Control group 1 was a retrospectively obtained group of untreated patients of the same population. risk of death, 78.3% lower , RR 0.22, p = 0.50 , treatment 0 of 110 (0.0%), control 2 of 137 (1.5%), continuity correction due to zero event, control group 1.
        risk of mechanical ventilation, 94.2% lower , RR 0.06, p = 0.005 , treatment 0 of 110 (0.0%), control 9 of 137 (6.6%), continuity correction due to zero event, control group 1.
        risk of hospitalization, 98.0% lower , RR 0.02, p , treatment 0 of 110 (0.0%), control 27 of 137 (19.7%), continuity correction due to zero event, control group 1.
        Cadegiani et al., 11/4/2020, prospective, Brazil, South America, peer-reviewed, 4 authors, dosage 200Î¼g/kg days 1-3, this trial uses multiple treatments in the treatment arm (combined with AZ, nitazoxanide (82), HCQ (22), spironolactone (66), dutasteride (4)) - results of individual treatments may vary.
        Submit Corrections or CommentsEarly, Late Morgenstern et al., J. Clinical Trials (preprint 11/3) (Peer Reviewed)The Use of Compassionate Ivermectin in the Management of SymptomaticOutpatients and Hospitalized Patients with Clinical Diagnosis of Covid-19 at theCentro Medico Bournigal and at the Centro Medico Punta Cana, GrupoRescue, Dominican Republic, from May 1 to August 10, 2020 Details Retrospective 3,099 outpatients treated with ivermectin in an ER. Of 2,706 treated on an outpatient basis, 18 were subsequently hospitalized, 2 in the ICU, and there was one death (0.04%).The average treatment delay for patients treated.. Details Source PDF Early, Late
        Early, Late
        Morgenstern et al., J. Clinical Trials (preprint 11/3) (Peer Reviewed)The Use of Compassionate Ivermectin in the Management of SymptomaticOutpatients and Hospitalized Patients with Clinical Diagnosis of Covid-19 at theCentro Medico Bournigal and at the Centro Medico Punta Cana, GrupoRescue, Dominican Republic, from May 1 to August 10, 2020Retrospective 3,099 outpatients treated with ivermectin in an ER. Of 2,706 treated on an outpatient basis, 18 were subsequently hospitalized, 2 in the ICU, and there was one death (0.04%).The average treatment delay for patients treated on an outpatient basis was 3.6 days, compared to 6.9 days for hospitalized patients, and 7.8 days for ICU patients.For the 300 late treatment hospitalized patients there was 3 deaths. For the 111 very late treatment ICU patients there was 34 deaths.Morgenstern et al., 11/3/2020, peer-reviewed, 14 authors.
        Submit Corrections or CommentsPrEPPEP Behera et al., PLoS ONE, doi:10.1371/journal.pone.0247163 (preprint 11/3) (Peer Reviewed)cases, '†'53.8% , pRole of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control study Details Retrospective matched case-control prophylaxis study for HCQ, ivermectin, and vitamin C with 372 healthcare workers, showing lower COVID-19 incidence for all treatments, with statistical significance reached for ivermectin.HCQ OR 0.56, .. Details Source PDF Prophylaxis study
        Prophylaxis study
        Behera et al., PLoS ONE, doi:10.1371/journal.pone.0247163 (preprint 11/3) (Peer Reviewed)Role of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control studyRetrospective matched case-control prophylaxis study for HCQ, ivermectin, and vitamin C with 372 healthcare workers, showing lower COVID-19 incidence for all treatments, with statistical significance reached for ivermectin.HCQ OR 0.56, p = 0.29Ivermectin OR 0.27, p Vitamin C OR 0.82, p = 0.58 risk of COVID-19 case, 53.8% lower , RR 0.46, p , treatment 41 of 117 (35.0%), control 145 of 255 (56.9%), adjusted, OR converted to RR, model 2 2+ doses conditional logistic regression.
        risk of COVID-19 case, 44.5% lower , RR 0.56, p , treatment 41 of 117 (35.0%), control 145 of 255 (56.9%), OR converted to RR, matched pair analysis.
        Behera et al., 11/3/2020, retrospective, India, South Asia, peer-reviewed, 13 authors, dosage 300Î¼g/kg days 1, 4.
        Submit Corrections or CommentsAnimal Ar(C)valo et al., Scientific Reports, doi:10.1038/s41598-021-86679-0 (preprint 11/2/20) (Peer Reviewed)animal studyIvermectin reduces in vivo coronavirus infection in a mouse experimental model Details Mouse study showing ivermectin reducing MHV viral load and disease. MHV is a type 2 family RNA coronavirus similar to SARS-CoV2. Details Source PDF Animal study
        Animal study
        Ar(C)valo et al., Scientific Reports, doi:10.1038/s41598-021-86679-0 (preprint 11/2/20) (Peer Reviewed)Ivermectin reduces in vivo coronavirus infection in a mouse experimental modelMouse study showing ivermectin reducing MHV viral load and disease. MHV is a type 2 family RNA coronavirus similar to SARS-CoV2.Ar(C)valo et al., 11/2/2020, peer-reviewed, 12 authors.
        Submit Corrections or CommentsPrEPPEP Chang et al., ResearchGate (Preprint)COVID-19: Effectiveness of pre-exposure prophylaxis with ivermectin in exposed persons Details Pre-exposure prophylaxis study with 129 people split into high/low exposure groups, with each group split into different dosing regimens, showing higher effectivess with more frequent doses.High-exposure group:every 7 days dosing: 0 o.. Details Source PDF Prophylaxis study
        Prophylaxis study
        Chang et al., ResearchGate (Preprint)COVID-19: Effectiveness of pre-exposure prophylaxis with ivermectin in exposed personsPre-exposure prophylaxis study with 129 people split into high/low exposure groups, with each group split into different dosing regimens, showing higher effectivess with more frequent doses.High-exposure group:every 7 days dosing: 0 of 20 cases, 100% effectiveevery 14 days dosing: 1 of 47 cases, 98% effectiveevery 30 days dosing: 2 of 20 cases, 90% effectiveLow-exposure group:every 14 days dosing: 0 of 21 cases, 100% effectiveevery 30 days dosing: 1 of 20 cases, 95% effectiveChang et al., 10/31/2020, preprint, 2 authors.
        Submit Corrections or CommentsEarly Szente Fonseca et al., Travel Medicine and Infectious Disease, doi:10.1016/j.tmaid.2020.101906 (Peer Reviewed)hosp., '†‘13.9% , p=0.45Risk of Hospitalization for Covid-19 Outpatients Treated with Various Drug Regimens in Brazil: Comparative Analysis Details Retrospective 717 patients in Brazil showing OR 1.17 [0.72-1.90] for ivermectin. This paper focuses on HCQ, event counts for ivermectin are not provided. With significant correlation between the variables used, including overlap in the pr.. Details Source PDF Early treatment study
        Early treatment study
        Szente Fonseca et al., Travel Medicine and Infectious Disease, doi:10.1016/j.tmaid.2020.101906 (Peer Reviewed)Risk of Hospitalization for Covid-19 Outpatients Treated with Various Drug Regimens in Brazil: Comparative AnalysisRetrospective 717 patients in Brazil showing OR 1.17 [0.72-1.90] for ivermectin. This paper focuses on HCQ, event counts for ivermectin are not provided. With significant correlation between the variables used, including overlap in the prescription of multiple treatments that show efficacy alone, and limited data for the model size, the model used here may be inaccurate due to multicollinearity [1]. risk of hospitalization, 13.9% higher , RR 1.14, p = 0.45 , treatment 340, control 377, adjusted, OR converted to RR, control prevalence approximated with overall prevalence.
        Szente Fonseca et al., 10/31/2020, retrospective, Brazil, South America, peer-reviewed, mean age 50.6, 10 authors, dosage 12mg days 1-2.
        Submit Corrections or CommentsLate Hashim et al., Iraqi Journal of Medical Science, 19:1 (Peer Reviewed)death, '†'91.7% , p=0.03Controlled randomized clinical trial on using Ivermectin with doxycycline for treating COVID-19 patients in Baghdad, Iraq Details RCT 70 ivermectin+doxycycline patients and 70 control patients showing reduced time to recovery and reduced mortality with treatment. Earlier treatment was more successful. For ethical reasons, critical patients were all in the treatment .. Details Source PDF Late treatment study
        Late treatment study
        Hashim et al., Iraqi Journal of Medical Science, 19:1 (Peer Reviewed)Controlled randomized clinical trial on using Ivermectin with doxycycline for treating COVID-19 patients in Baghdad, IraqRCT 70 ivermectin+doxycycline patients and 70 control patients showing reduced time to recovery and reduced mortality with treatment. Earlier treatment was more successful. For ethical reasons, critical patients were all in the treatment group. risk of death, 91.7% lower , RR 0.08, p = 0.03 , treatment 0 of 59 (0.0%), control 6 of 70 (8.6%), continuity correction due to zero event, excluding non-randomized critical patients.
        risk of death, 67.1% lower , RR 0.33, p = 0.16 , treatment 2 of 70 (2.9%), control 6 of 70 (8.6%), OR converted to RR, including critical patients which were always allocated to treatment.
        risk of disease progression, 83.1% lower , RR 0.17, p = 0.07 , treatment 1 of 59 (1.7%), control 7 of 70 (10.0%), excluding non-randomized critical patients.
        risk of disease progression, 57.4% lower , RR 0.43, p = 0.20 , treatment 3 of 70 (4.3%), control 7 of 70 (10.0%), OR converted to RR, including critical patients which were always allocated to treatment.
        recovery time, 40.7% lower , relative time 0.59, p , treatment 70, control 70.
        Hashim et al., 10/26/2020, Single Blind Randomized Controlled Trial, Iraq, Middle East, peer-reviewed, 7 authors, dosage 200Î¼g/kg days 1-2, some patients received a third dose on day 8, this trial uses multiple treatments in the treatment arm (combined with doxycycline) - results of individual treatments may vary.
        Submit Corrections or CommentsPrEPPEP Guerrero et al., Colombia M(C)dica, doi:10.25100/cm.v51i4.4613 (Peer Reviewed)COVID-19: The Ivermectin African Enigma Details Study of African Programme for Onchocerciasis Control (APOC) countries, which used ivermectin, with non-APOC countries in Africa, showing 28% lower mortality for APOC countries, relative risk RR = 0.72 [0.67-0.78]. See also [1] and the au.. Details Source PDF Prophylaxis study
        Prophylaxis study
        Guerrero et al., Colombia M(C)dica, doi:10.25100/cm.v51i4.4613 (Peer Reviewed)COVID-19: The Ivermectin African EnigmaStudy of African Programme for Onchocerciasis Control (APOC) countries, which used ivermectin, with non-APOC countries in Africa, showing 28% lower mortality for APOC countries, relative risk RR = 0.72 [0.67-0.78]. See also [1] and the author's response [2].Guerrero et al., 10/22/2020, peer-reviewed, 5 authors.
        Submit Corrections or CommentsPrEPPEP Carvallo et al., NCT04425850 (Preprint)cases, '†'96.3% , pUsefulness of Topic Ivermectin and Carrageenan to Prevent Contagion of Covid 19 (IVERCAR) Details Prophylaxis study using ivermectin and carrageenan showing 0 of 131 cases from treated healthcare workers, compared to 11 of 98 control.The effect is likely to be primarily due to ivermectin - the author has later reported that carragee.. Details Source PDF Prophylaxis study
        Prophylaxis study
        Carvallo et al., NCT04425850 (Preprint)Usefulness of Topic Ivermectin and Carrageenan to Prevent Contagion of Covid 19 (IVERCAR)Prophylaxis study using ivermectin and carrageenan showing 0 of 131 cases from treated healthcare workers, compared to 11 of 98 control.The effect is likely to be primarily due to ivermectin - the author has later reported that carrageenan is not necessary [1]. risk of COVID-19 case, 96.3% lower , RR 0.04, p , treatment 0 of 131 (0.0%), control 11 of 98 (11.2%), continuity correction due to zero event.
        Carvallo et al., 10/19/2020, prospective, Argentina, South America, preprint, 1 author, dosage 1mg days 1-14, this trial uses multiple treatments in the treatment arm (combined with iota-carrageenan) - results of individual treatments may vary.
        Submit Corrections or CommentsAnimal Chaccour et al., Scientific Reports, doi:10.1038/s41598-020-74084-y (Peer Reviewed)animal studyNebulized ivermectin for COVID-19 and other respiratory diseases, a proof of concept, dose-ranging study in rats Details Study showing that nebulized ivermectin can reach pharmacodynamic concentrations in the lung tissue of rats. Authors note that additional experiments are required to assess the safety of this formulation in larger animals. Details Source PDF Animal study
        Animal study
        Chaccour et al., Scientific Reports, doi:10.1038/s41598-020-74084-y (Peer Reviewed)Nebulized ivermectin for COVID-19 and other respiratory diseases, a proof of concept, dose-ranging study in ratsStudy showing that nebulized ivermectin can reach pharmacodynamic concentrations in the lung tissue of rats. Authors note that additional experiments are required to assess the safety of this formulation in larger animals.Chaccour et al., 10/13/2020, peer-reviewed, 8 authors.
        Submit Corrections or CommentsLate Rajter et al., Chest, doi:10.1016/j.chest.2020.10.009 (Peer Reviewed)death, '†'46.0% , p=0.04Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID-19 (ICON study) Details Retrospective 280 hospitalized patients showing lower mortality with ivermectin (13.3% vs 24.5%), propensity matched odds ratio OR 0.47 [0.22-0.99], p=0.045. Details Source PDF Late treatment study
        Late treatment study
        Rajter et al., Chest, doi:10.1016/j.chest.2020.10.009 (Peer Reviewed)Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID-19 (ICON study)Retrospective 280 hospitalized patients showing lower mortality with ivermectin (13.3% vs 24.5%), propensity matched odds ratio OR 0.47 [0.22-0.99], p=0.045. risk of death, 46.0% lower , RR 0.54, p = 0.04 , treatment 13 of 98 (13.3%), control 24 of 98 (24.5%), adjusted, OR converted to RR, PSM.
        risk of death, 66.9% lower , RR 0.33, p = 0.03 , treatment 26 of 173 (15.0%), control 27 of 107 (25.2%), adjusted, OR converted to RR, multivariate.
        risk of mechanical ventilation, 63.6% lower , RR 0.36, p = 0.10 , treatment 4 of 98 (4.1%), control 11 of 98 (11.2%), matched cohort excluding intubated at baseline.
        Rajter et al., 10/13/2020, retrospective, propensity score matching, USA, North America, peer-reviewed, 6 authors, dosage 200Î¼g/kg single dose.
        Submit Corrections or CommentsEarly Mahmud et al., Journal of International Medical Research, doi:10.5061/dryad.qjq2bvqf6 (preprint 10/9/20) (Peer Reviewed)death, '†'85.7% , p=0.25Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial Details RCT for ivermectin+doxycycline showing improvements in mortality, recovery, progression, and virological cure. 183 treatment and 183 control patients with no deaths in the treatment arm vs. 3 in the control arm (the 3 control deaths are n.. Details Source PDF Early treatment study
        Early treatment study
        Mahmud et al., Journal of International Medical Research, doi:10.5061/dryad.qjq2bvqf6 (preprint 10/9/20) (Peer Reviewed)Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trialRCT for ivermectin+doxycycline showing improvements in mortality, recovery, progression, and virological cure. 183 treatment and 183 control patients with no deaths in the treatment arm vs. 3 in the control arm (the 3 control deaths are not included in the analysis of other outcomes). NCT04523831. risk of death, 85.7% lower , RR 0.14, p = 0.25 , treatment 0 of 183 (0.0%), control 3 of 183 (1.6%), continuity correction due to zero event.
        risk of disease progression, 57.0% lower , RR 0.43, p , treatment 16 of 183 (8.7%), control 32 of 180 (17.8%), adjusted, Cox regression.
        risk of no recovery, 94.0% lower , RR 0.06, p , treatment 72 of 183 (39.3%), control 100 of 180 (55.6%), adjusted, day 7, Cox regression.
        risk of no recovery, 38.5% lower , RR 0.61, p = 0.005 , treatment 40 of 183 (21.9%), control 64 of 180 (35.6%), day 11.
        risk of no recovery, 96.0% lower , RR 0.04, p , treatment 42 of 183 (23.0%), control 67 of 180 (37.2%), adjusted, day 12, Cox regression.
        time to recovery, 27.0% lower , RR 0.73, p = 0.003 , treatment 183, control 180, Cox regression.
        risk of no virological cure, 39.0% lower , RR 0.61, p = 0.002 , treatment 14 of 183 (7.7%), control 36 of 180 (20.0%), adjusted, Cox regression.
        Mahmud et al., 10/9/2020, Double Blind Randomized Controlled Trial, Bangladesh, South Asia, peer-reviewed, 15 authors, dosage 12mg single dose, this trial uses multiple treatments in the treatment arm (combined with doxycycline) - results of individual treatments may vary.
        Submit Corrections or CommentsIn Silico Franc(C)s-Monerris et al., ChemRxiv, doi:10.26434/chemrxiv.12782258.v1 (Preprint)Has Ivermectin Virus-Directed Effects against SARS-CoV-2? Rationalizing the Action of a Potential Multitarget Antiviral Agent Details In silico study showing that ivermectin is capable of interfering in different key steps of the SARS-CoV-2 replication cycle. Details Source PDF In Silico
        In Silico
        Franc(C)s-Monerris et al., ChemRxiv, doi:10.26434/chemrxiv.12782258.v1 (Preprint)Has Ivermectin Virus-Directed Effects against SARS-CoV-2? Rationalizing the Action of a Potential Multitarget Antiviral AgentIn silico study showing that ivermectin is capable of interfering in different key steps of the SARS-CoV-2 replication cycle.Franc(C)s-Monerris et al., 10/8/2020, preprint, 8 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsLate Soto-Becerra et al., medRxiv, doi:10.1101/2020.10.06.20208066 (Preprint)death, '†'17.1% , p=0.01Real-World Effectiveness of hydroxychloroquine, azithromycin, and ivermectin among hospitalized COVID-19 patients: Results of a target trial emulation using observational data from a nationwide Healthcare System in Peru Details Retrospective database study of 5683 patients, 692 received HCQ/CQ+AZ, 200 received HCQ/CQ, 203 received ivermectin, 1600 received AZ, 358 received ivermectin+AZ, and 2630 received standard of care.This study includes anyone with ICD-10.. Details Source PDF Late treatment study
        Late treatment study
        Soto-Becerra et al., medRxiv, doi:10.1101/2020.10.06.20208066 (Preprint)Real-World Effectiveness of hydroxychloroquine, azithromycin, and ivermectin among hospitalized COVID-19 patients: Results of a target trial emulation using observational data from a nationwide Healthcare System in PeruRetrospective database study of 5683 patients, 692 received HCQ/CQ+AZ, 200 received HCQ/CQ, 203 received ivermectin, 1600 received AZ, 358 received ivermectin+AZ, and 2630 received standard of care.This study includes anyone with ICD-10 COVID-19 codes which includes asymptomatic PCR+ patients, therefore many patients in the control group are likely asymptomatic with regards to SARS-CoV-2, but in the hospital for another reason. For those that had symptomatic COVID-19, there is also likely significant confounding by indication.In this study all medications show higher mortality at day 30, which is consistent with asymptomatic (for COVID-19) or mild condition patients being more common in the control group.For ivermectin they show 30 day mortality aHR = 1.39 [0.88 - 2.22]. KM curves show that the treatment groups were in more serious condition, and also that after about day 35 survival became better with ivermectin. The last day available for ivermectin shows RR 0.83, p = 0.01. More than the total excess mortality happened on the first day. This is consistent with treated patients being in more serious condition, and with many of the control group patients being in hospital for something unrelated to COVID-19.Authors use a machine learning based propensity scoring system that appears over-parameterized and likely to result in significant overfitting and inaccurate results. Essentially they test for all interactions between two and three covariates. The nature and large number of covariates means many random correlations may be found. COVID-19 severity is not used.This study also does not compare treatments with a control group not receiving the treatment - authors put patients receiving treatments after 48 hours in the control group.Authors state that outcomes within 24 hours were excluded, however KM curves show significant mortality at day 1 (only for the treatment groups).Several protocol violations and missing data have also been reported in this study: [1, 2].See also: [3].Ivermectin dosage details: [4] risk of death, 17.1% lower , RR 0.83, p = 0.01 , treatment 92 of 203 (45.3%), control 1438 of 2630 (54.7%), IVM vs. control day 43 (last day available) weighted KM from figure 3, per the pre-specified rules, the last available day mortality results have priority.
        risk of death, 39.0% higher , RR 1.39, p = 0.16 , treatment 47 of 203 (23.2%), control 401 of 2630 (15.2%), adjusted, day 30, Table 2, IVM wHR.
        Soto-Becerra et al., 10/8/2020, retrospective, database analysis, Peru, South America, preprint, median age 59.4, 4 authors, dosage 200Î¼g/kg single dose.
        Submit Corrections or CommentsLate Chachar et al., International Journal of Sciences, 9:31-35, doi:10.18483/ijSci.2378 (Peer Reviewed)no recov., '†'10.0% , p=0.50Effectiveness of Ivermectin in SARS-CoV-2/COVID-19 Patients Details Small RCT with 25 ivermectin and 25 control patients, not finding a significant difference in recovery at day 7. Details Source PDF Late treatment study
        Late treatment study
        Chachar et al., International Journal of Sciences, 9:31-35, doi:10.18483/ijSci.2378 (Peer Reviewed)Effectiveness of Ivermectin in SARS-CoV-2/COVID-19 PatientsSmall RCT with 25 ivermectin and 25 control patients, not finding a significant difference in recovery at day 7. risk of no recovery at day 7, 10.0% lower , RR 0.90, p = 0.50 , treatment 9 of 25 (36.0%), control 10 of 25 (40.0%).
        Chachar et al., 9/30/2020, Randomized Controlled Trial, India, South Asia, peer-reviewed, 6 authors, dosage 36mg, 12mg stat, 12mg after 12 hours, 12mg after 24 hours.
        Submit Corrections or CommentsLate Khan et al., Archivos de Bronconeumolog­a, doi:10.1016/j.arbres.2020.08.007 (Letter)death, '†'87.0% , pIvermectin treatment may improve the prognosis of patients with COVID-19 Details Retrospective 115 ivermectin patients and 133 control patients showing significantly lower death and faster viral clearance.Some potential issues and the authors' response can be found in [1, 2]. Details Source PDF Late treatment study
        Late treatment study
        Khan et al., Archivos de Bronconeumolog­a, doi:10.1016/j.arbres.2020.08.007 (Letter)Ivermectin treatment may improve the prognosis of patients with COVID-19Retrospective 115 ivermectin patients and 133 control patients showing significantly lower death and faster viral clearance.Some potential issues and the authors' response can be found in [1, 2]. risk of death, 87.0% lower , RR 0.13, p , treatment 1 of 115 (0.9%), control 9 of 133 (6.8%).
        risk of ICU admission, 89.5% lower , RR 0.11, p = 0.007 , treatment 1 of 115 (0.9%), control 11 of 133 (8.3%).
        time to viral-, 73.3% lower , relative time 0.27, p , treatment 115, control 133.
        Khan et al., 9/24/2020, retrospective, Bangladesh, South Asia, preprint, median age 35.0, 8 authors, dosage 12mg single dose.
        Submit Corrections or CommentsIn Vitro Li et al., J. Cellular Physiology, doi:10.1002/jcp.30055 (Peer Reviewed) (In Vitro)in vitroQuantitative proteomics reveals a broad'spectrum antiviral property of ivermectin, benefiting for COVID'19 treatment Details In Vitro study showing Ivermectin is a safe wide-spectrum antiviral against SARS-CoV-2, human papillomavirus (HPV), Epstein''Barr virus (EBV), and HIV.Authors note that the combination of ivermectin and other drugs might result in more f.. Details Source PDF In Vitro
        In Vitro
        Li et al., J. Cellular Physiology, doi:10.1002/jcp.30055 (Peer Reviewed) (In Vitro)Quantitative proteomics reveals a broad'spectrum antiviral property of ivermectin, benefiting for COVID'19 treatmentIn Vitro study showing Ivermectin is a safe wide-spectrum antiviral against SARS-CoV-2, human papillomavirus (HPV), Epstein''Barr virus (EBV), and HIV.Authors note that the combination of ivermectin and other drugs might result in more favorable prognoses for patients with COVID'19, for example ivermerctin and HCQ.Li et al., 9/22/2020, peer-reviewed, 3 authors.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsEarly Carvallo et al., Journal of Clinical Trials, 11:459 (preprint 9/15/20) (Peer Reviewed)death, '†'85.4% , p=0.08Safety and Efficacy of the Combined Use of Ivermectin, Dexamethasone, Enoxaparin and Aspirina against COVID-19 the I.D.E.A. Protocol Details Prospective trial of ivermectin, dexamethasone, enoxaparin, and aspirin, showing no hospitalization for mild cases, and lower mortality for moderate/severe patients. Details Source PDF Early treatment study
        Early treatment study
        Carvallo et al., Journal of Clinical Trials, 11:459 (preprint 9/15/20) (Peer Reviewed)Safety and Efficacy of the Combined Use of Ivermectin, Dexamethasone, Enoxaparin and Aspirina against COVID-19 the I.D.E.A. ProtocolProspective trial of ivermectin, dexamethasone, enoxaparin, and aspirin, showing no hospitalization for mild cases, and lower mortality for moderate/severe patients. moderate/severe patients, 85.4% lower , RR 0.15, p = 0.08 , treatment 1 of 32 (3.1%), control 3 of 14 (21.4%), the only treatment death was a patient already in the ICU before treatment.
        Carvallo et al., 9/15/2020, prospective, Argentina, South America, peer-reviewed, mean age 55.7, 3 authors, dosage 36mg days 1, 8, dose varied depending on patient condition - mild 24mg, moderate 36mg, severe 48mg, this trial uses multiple treatments in the treatment arm (combined with dexamethasone, enoxaparin, and aspirin) - results of individual treatments may vary.
        Submit Corrections or CommentsReview Jans et al., Cells 2020, 9:9, 2100, doi:10.3390/cells9092100 (Review) (Letter)reviewIvermectin as a Broad-Spectrum Host-Directed Antiviral: The Real Deal? Details Review of ivermectin as a host-directed broad-spectrum antiviral agent for a range of viruses, including SARS-CoV-2.Cell culture experiments show robust antiviral action towards HIV-1, dengue virus (DENV), Zika virus, West Nile virus, V.. Details Source PDF Review
        Review
        Jans et al., Cells 2020, 9:9, 2100, doi:10.3390/cells9092100 (Review) (Letter)Ivermectin as a Broad-Spectrum Host-Directed Antiviral: The Real Deal?Review of ivermectin as a host-directed broad-spectrum antiviral agent for a range of viruses, including SARS-CoV-2.Cell culture experiments show robust antiviral action towards HIV-1, dengue virus (DENV), Zika virus, West Nile virus, Venezuelan equine encephalitis virus, Chikungunya virus, Pseudorabies virus, adenovirus, and SARS-CoV-2 (COVID-19).Jans et al., 9/15/2020, preprint, 2 authors.
        Submit Corrections or CommentsIn SIlico Swargiary , A., Research Square, doi:10.21203/rs.3.rs-73308/v1 (Preprint)Ivermectin as a promising RNA-dependent RNA polymerase inhibitor and a therapeutic drug against SARS-CoV2: Evidence from in silico studies Details In Silico study showing high binding affinity of ivermectin with SARS-CoV-2 RNA-dependent RNA polymerase, suggesting ivermectin as an inhibitor of RdRp. Details Source PDF In SIlico
        In SIlico
        Swargiary , A., Research Square, doi:10.21203/rs.3.rs-73308/v1 (Preprint)Ivermectin as a promising RNA-dependent RNA polymerase inhibitor and a therapeutic drug against SARS-CoV2: Evidence from in silico studiesIn Silico study showing high binding affinity of ivermectin with SARS-CoV-2 RNA-dependent RNA polymerase, suggesting ivermectin as an inhibitor of RdRp.Swargiary et al., 9/9/2020, preprint, 1 author.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsReview DiNicolantonio et al., Open Heart, doi:10.1136/openhrt-2020-001350 (Review) (Peer Reviewed)reviewIvermectin may be a clinically useful anti-inflammatory agent for late-stage COVID-19 Details Review suggesting that ivermectin may be useful for late stage COVID-19. Authors note that ivermectin, in doses at or modestly above the standard clinical dose, may have important clinical potential for managing disorders associated with .. Details Source PDF Review
        Review
        DiNicolantonio et al., Open Heart, doi:10.1136/openhrt-2020-001350 (Review) (Peer Reviewed)Ivermectin may be a clinically useful anti-inflammatory agent for late-stage COVID-19Review suggesting that ivermectin may be useful for late stage COVID-19. Authors note that ivermectin, in doses at or modestly above the standard clinical dose, may have important clinical potential for managing disorders associated with life-threatening respiratory distress and cytokine storm, such as advanced COVID-19.DiNicolantonio et al., 9/6/2020, peer-reviewed, 3 authors.
        Submit Corrections or CommentsLate Podder et al., IMC J. Med. Science, 14:2, July 2020 (Peer Reviewed)recov. time, '†'16.1% , p=0.34Outcome of ivermectin treated mild to moderate COVID-19 cases: a single-centre, open-label, randomised controlled study Details Small RCT with 32 ivermectin patients and 30 control patients.The mean recovery time after enrolment in the intervention arm was 5.31 ± 2.48 days vs. 6.33 ± 4.23 days in the control arm, p > 0.05.Negative PCR results were not signific.. Details Source PDF Late treatment study
        Late treatment study
        Podder et al., IMC J. Med. Science, 14:2, July 2020 (Peer Reviewed)Outcome of ivermectin treated mild to moderate COVID-19 cases: a single-centre, open-label, randomised controlled studySmall RCT with 32 ivermectin patients and 30 control patients.The mean recovery time after enrolment in the intervention arm was 5.31 ± 2.48 days vs. 6.33 ± 4.23 days in the control arm, p > 0.05.Negative PCR results were not significantly different between control and intervention arms, p>0.05. We are not sure what the results were because the abstract and Table 5 have switched the results. recovery time from enrollment, 16.1% lower , relative time 0.84, p = 0.34 , treatment 32, control 30.
        Podder et al., 9/3/2020, Randomized Controlled Trial, Bangladesh, South Asia, peer-reviewed, 4 authors, dosage 200Î¼g/kg single dose.
        Submit Corrections or CommentsLate Kishoria et al., Paripex - Indian Journal of Research, doi:10.36106/paripex/4801859 (Peer Reviewed)no disch., '†‘7.5% , p=1.00Ivermectin as adjuvant to hydroxychloroquine in patients resistant to standard treatment for SARS-CoV-2: results of an open-label randomized clinical study Details Small RCT of hospitalized patients in India with 19 ivermectin patients and 13 control patients, with all receiving SOC including HCQ, showing no significant differences. The patient population is biased because the study recruited patien.. Details Source PDF Late treatment study
        Late treatment study
        Kishoria et al., Paripex - Indian Journal of Research, doi:10.36106/paripex/4801859 (Peer Reviewed)Ivermectin as adjuvant to hydroxychloroquine in patients resistant to standard treatment for SARS-CoV-2: results of an open-label randomized clinical studySmall RCT of hospitalized patients in India with 19 ivermectin patients and 13 control patients, with all receiving SOC including HCQ, showing no significant differences. The patient population is biased because the study recruited patients that did not respond to standard treatment. Authors do not specify the treatment delay but it is likely relatively late because the patients had already undergone standard treatment. Criteria for discharge are not provided. The time of discharge status is not specified and may not have been an equal time since treatment initiation for all patients.Authors indicate 19 treatment and 16 control patients, but the results only show 13 control patients. Authors do not indicate why the other 3 are missing.Randomization in this small sample resulted in very large differences in the groups, with over twice as many in the ivermectin group with age >40, and the only 2 patients with age >60 both in the ivermectin group. Authors did not adjust for these differences. risk of no hospital discharge, 7.5% higher , RR 1.08, p = 1.00 , treatment 11 of 19 (57.9%), control 7 of 13 (53.8%).
        risk of no virological cure, 7.5% higher , RR 1.08, p = 1.00 , treatment 11 of 19 (57.9%), control 7 of 13 (53.8%), day 3.
        risk of no virological cure, 220.0% higher , RR 3.20, p = 0.45 , treatment 1 of 5 (20.0%), control 0 of 6 (0.0%), continuity correction due to zero event, day 5.
        Kishoria et al., 8/31/2020, Randomized Controlled Trial, India, South Asia, peer-reviewed, 7 authors, dosage 12mg single dose.
        Submit Corrections or CommentsPrEPPEP Shouman et al., Journal of Clinical and Diagnostic Research, doi:10.7860/JCDR/2020/46795.0000 (Peer Reviewed)symp. case, '†'91.3% , pUse of Ivermectin as a Potential Chemoprophylaxis for COVID-19 in Egypt: A Randomised Clinical Trial Details PEP trial for asymptomatic close contacts of COVID-19 patients, 203 ivermectin patients and 101 control patients. 7.4% of contacts developed COVID-19 in the ivermectin group vs. 58.4% in the control group, adjusted odds ratio OR 0.087, p .. Details Source PDF Prophylaxis study
        Prophylaxis study
        Shouman et al., Journal of Clinical and Diagnostic Research, doi:10.7860/JCDR/2020/46795.0000 (Peer Reviewed)Use of Ivermectin as a Potential Chemoprophylaxis for COVID-19 in Egypt: A Randomised Clinical TrialPEP trial for asymptomatic close contacts of COVID-19 patients, 203 ivermectin patients and 101 control patients. 7.4% of contacts developed COVID-19 in the ivermectin group vs. 58.4% in the control group, adjusted odds ratio OR 0.087, p NCT04422561. See also [1]. risk of symptomatic case, 91.3% lower , RR 0.09, p , treatment 15 of 203 (7.4%), control 59 of 101 (58.4%), adjusted, multivariate.
        risk of COVID-19 severe case, 92.9% lower , RR 0.07, p = 0.002 , treatment 1 of 203 (0.5%), control 7 of 101 (6.9%), unadjusted.
        Shouman et al., 8/28/2020, Randomized Controlled Trial, Egypt, Africa, peer-reviewed, 8 authors, dosage 18mg days 1, 3, dose varies depending on weight - 40-60kg: 15mg, 60-80kg: 18mg, >80kg: 24mg.
        Submit Corrections or CommentsEarly Espitia-Hernandez et al., Biomedical Research, 31:5 (Peer Reviewed)viral+, '†'97.2% , pEffects of Ivermectin-azithromycin-cholecalciferol combined therapy on COVID-19 infected patients: A proof of concept study Details Small study with 28 patients treated with ivermectin + AZ + cholecalciferol and 7 control patients.All treated patients were PCR- at day 10 while all control patients remained PCR+. The mean duration of symptoms was 3 days in the treatm.. Details Source PDF Early treatment study
        Early treatment study
        Espitia-Hernandez et al., Biomedical Research, 31:5 (Peer Reviewed)Effects of Ivermectin-azithromycin-cholecalciferol combined therapy on COVID-19 infected patients: A proof of concept studySmall study with 28 patients treated with ivermectin + AZ + cholecalciferol and 7 control patients.All treated patients were PCR- at day 10 while all control patients remained PCR+. The mean duration of symptoms was 3 days in the treatment group and 10 days in the control group. risk of viral+ at day 10, 97.2% lower , RR 0.03, p , treatment 0 of 28 (0.0%), control 7 of 7 (100.0%), continuity correction due to zero event.
        Espitia-Hernandez et al., 8/15/2020, retrospective, Mexico, North America, peer-reviewed, mean age 45.1, 5 authors, dosage 6mg days 1-2, 8-9, this trial uses multiple treatments in the treatment arm (combined with azithromycin and cholecalciferol) - results of individual treatments may vary.
        Submit Corrections or CommentsLate Bhattacharya et al., Int. J. Scientific Research, doi:10.36106/ijsr/7232245 (Peer Reviewed)Observational Study on Clinical Features, Treatment and Outcome of COVID 19 in a tertiary care Centre in India- a retrospective case series Details Retrospective 148 hospitalized patients showing triple therapy with ivermectin + atorvastatin + N-acetylcysteine resulted in a 1.35% case fatality rate which was well below the national average. Details Source PDF Late treatment study
        Late treatment study
        Bhattacharya et al., Int. J. Scientific Research, doi:10.36106/ijsr/7232245 (Peer Reviewed)Observational Study on Clinical Features, Treatment and Outcome of COVID 19 in a tertiary care Centre in India- a retrospective case seriesRetrospective 148 hospitalized patients showing triple therapy with ivermectin + atorvastatin + N-acetylcysteine resulted in a 1.35% case fatality rate which was well below the national average.Bhattacharya et al., 8/14/2020, peer-reviewed, mean age 57.6, 6 authors.
        Submit Corrections or CommentsReview Vora et al., Indian Journal of Tuberculosis, doi:10.1016/j.ijtb.2020.07.031 (Review) (Peer Reviewed)reviewWhite paper on Ivermectin as a potential therapy for COVID-19 Details Panel review of ivermectin reporting that "ivermectin in the dose of 12mg BD alone or in combination with other therapy for 5''7 days may be considered as safe therapeutic option for mild moderate or severe cases of Covid-19 infection.. Details Source PDF Review
        Review
        Vora et al., Indian Journal of Tuberculosis, doi:10.1016/j.ijtb.2020.07.031 (Review) (Peer Reviewed)White paper on Ivermectin as a potential therapy for COVID-19Panel review of ivermectin reporting that "ivermectin in the dose of 12mg BD alone or in combination with other therapy for 5''7 days may be considered as safe therapeutic option for mild moderate or severe cases of Covid-19 infection. It is cost effective especially when the other drugs are very costly & not easily available".Vora et al., 7/31/2020, peer-reviewed, 4 authors.
        Submit Corrections or CommentsLate Chang et al., ResearchGate (Preprint)Post-acute or prolonged COVID-19: ivermectin treatment for patients with persistent symptoms or post-acute symptoms Details Report on 33 patients with persistent or post-acute symptoms treated with ivermectin, showing a high rate of clinical improvement. Details Source PDF Late treatment study
        Late treatment study
        Chang et al., ResearchGate (Preprint)Post-acute or prolonged COVID-19: ivermectin treatment for patients with persistent symptoms or post-acute symptomsReport on 33 patients with persistent or post-acute symptoms treated with ivermectin, showing a high rate of clinical improvement.Chang et al., 7/31/2020, preprint, 4 authors.
        Submit Corrections or CommentsTheory Chang et al., ResearchGate, doi:10.13140/RG.2.2.34561.48483/2 (Preprint) (Theory)theoryCOVID-19: Post-exposure prophylaxis with ivermectin in contacts. At Homes, Places of Work, Nursing Homes, Prisons, and Others Details Proposed PEP protocol based on ivermectin. Details Source PDF Theory
        Theory
        Chang et al., ResearchGate, doi:10.13140/RG.2.2.34561.48483/2 (Preprint) (Theory)COVID-19: Post-exposure prophylaxis with ivermectin in contacts. At Homes, Places of Work, Nursing Homes, Prisons, and OthersProposed PEP protocol based on ivermectin.Chang et al., 7/31/2020, preprint, 2 authors.
        Submit Corrections or CommentsLate Alam et al., Journal of Bangladesh College of Physicians and Surgeons, doi:10.3329/jbcps.v38i0.47512 (Preprint)A Case Series of 100 COVID-19 Positive Patients Treated with Combination of Ivermectin and Doxycycline Details Case study of 100 patients treated with ivermectin and doxycycline, with no ICU admission, deaths, or serious side effects reported. Details Source PDF Late treatment study
        Late treatment study
        Alam et al., Journal of Bangladesh College of Physicians and Surgeons, doi:10.3329/jbcps.v38i0.47512 (Preprint)A Case Series of 100 COVID-19 Positive Patients Treated with Combination of Ivermectin and DoxycyclineCase study of 100 patients treated with ivermectin and doxycycline, with no ICU admission, deaths, or serious side effects reported.Alam et al., 7/31/2020, preprint, 4 authors.
        Submit Corrections or CommentsLate Rahman et al., J. Bangladesh Coll. Phys. Surg. 38, 5-9, doi:10.3329/jbcps.v38i0 (Peer Reviewed)Comparison of Viral Clearance between Ivermectin with Doxycycline and Hydroxychloroquine with Azithromycin in COVID-19 Patients Details Comparison of 200 patients treated with ivermectin + doxycycline and 200 treated with HCQ + AZ. The HCQ + AZ group had more severe cases at baseline. Viral clearance was faster with ivermectin + doxycycline. Ivermectin dose is given all o.. Details Source PDF Late treatment study
        Late treatment study
        Rahman et al., J. Bangladesh Coll. Phys. Surg. 38, 5-9, doi:10.3329/jbcps.v38i0 (Peer Reviewed)Comparison of Viral Clearance between Ivermectin with Doxycycline and Hydroxychloroquine with Azithromycin in COVID-19 PatientsComparison of 200 patients treated with ivermectin + doxycycline and 200 treated with HCQ + AZ. The HCQ + AZ group had more severe cases at baseline. Viral clearance was faster with ivermectin + doxycycline. Ivermectin dose is given all on one day, whereas HCQ is given over 10 days and therapeutic levels may not be reached for several days.Rahman et al., 7/31/2020, peer-reviewed, 6 authors.
        Submit Corrections or CommentsEarly Chowdhury et al., Eurasian Journal of Medicine and Oncology, doi:10.14744/ejmo.2021.16263 (Peer Reviewed)hosp., '†'80.6% , p=0.23A Comparative Study on Ivermectin-Doxycycline and Hydroxychloroquine-Azithromycin Therapy on COVID-19 Patients Details Small 116 patient RCT with low-risk patients comparing ivermectin+doxycycline and HCQ+AZ, showing lower hospitalization, higher viral clearance, and faster symptom resolution and viral clearance with ivermectin+doxycycline. Mid-recovery r.. Details Source PDF Early treatment study
        Early treatment study
        Chowdhury et al., Eurasian Journal of Medicine and Oncology, doi:10.14744/ejmo.2021.16263 (Peer Reviewed)A Comparative Study on Ivermectin-Doxycycline and Hydroxychloroquine-Azithromycin Therapy on COVID-19 PatientsSmall 116 patient RCT with low-risk patients comparing ivermectin+doxycycline and HCQ+AZ, showing lower hospitalization, higher viral clearance, and faster symptom resolution and viral clearance with ivermectin+doxycycline. Mid-recovery resolution of symptoms is statistically significantly better with treatment, while other measures do not reach statistical significance. Instructions were to take ivermectin on an empty stomach, reducing lung tissue concentration. risk of hospitalization, 80.6% lower , RR 0.19, p = 0.23 , treatment 0 of 60 (0.0%), control 2 of 56 (3.6%), continuity correction due to zero event.
        risk of no recovery, 46.4% lower , RR 0.54, p , treatment 27 of 60 (45.0%), control 47 of 56 (83.9%), mid-recovery day 5.
        recovery time, 15.2% lower , relative time 0.85, p = 0.07 , treatment 60, control 56.
        risk of no virological cure, 80.6% lower , RR 0.19, p = 0.23 , treatment 0 of 60 (0.0%), control 2 of 56 (3.6%), continuity correction due to zero event.
        time to viral-, 4.3% lower , relative time 0.96, p = 0.23 , treatment 60, control 56.
        Chowdhury et al., 7/14/2020, Randomized Controlled Trial, Bangladesh, South Asia, peer-reviewed, 6 authors, dosage 200Î¼g/kg single dose, this trial compares with another treatment - results may be better when compared to placebo, this trial uses multiple treatments in the treatment arm (combined with doxycycline) - results of individual treatments may vary.
        Submit Corrections or CommentsLate Gorial et al., medRxiv, doi:10.1101/2020.07.07.20145979 (Preprint)death, '†'71.0% , p=1.00Effectiveness of Ivermectin as add-on Therapy in COVID-19 Management (Pilot Trial) Details Small trial of hospitalized patients with 16 of 87 patients being treated with ivermectin showing a significantly lower mean hospital stay with ivermectin: 7.62 vs. 13.22 days, p=0.00005.0 of 16 ivermectin patients died vs. 2 of 71 cont.. Details Source PDF Late treatment study
        Late treatment study
        Gorial et al., medRxiv, doi:10.1101/2020.07.07.20145979 (Preprint)Effectiveness of Ivermectin as add-on Therapy in COVID-19 Management (Pilot Trial)Small trial of hospitalized patients with 16 of 87 patients being treated with ivermectin showing a significantly lower mean hospital stay with ivermectin: 7.62 vs. 13.22 days, p=0.00005.0 of 16 ivermectin patients died vs. 2 of 71 control patients. risk of death, 71.0% lower , RR 0.29, p = 1.00 , treatment 0 of 16 (0.0%), control 2 of 71 (2.8%), continuity correction due to zero event.
        hospitalization time, 42.0% lower , relative time 0.58, p , treatment 16, control 71.
        Gorial et al., 7/8/2020, retrospective, Iraq, Middle East, preprint, 9 authors, dosage 200Î¼g/kg single dose.
        Submit Corrections or CommentsIn Silico Lehrer et al., In Vivo, 34:5, 3023-3026, doi:10.21873/invivo.12134Ivermectin Docks to the SARS-CoV-2 Spike Receptor-binding Domain Attached to ACE2 Details In silico analysis showing ivermectin docking which may interfere with the attachment of the spike to the human cell membrane. Details Source PDF In Silico
        In Silico
        Lehrer et al., In Vivo, 34:5, 3023-3026, doi:10.21873/invivo.12134Ivermectin Docks to the SARS-CoV-2 Spike Receptor-binding Domain Attached to ACE2In silico analysis showing ivermectin docking which may interfere with the attachment of the spike to the human cell membrane.Lehrer et al., 6/19/2020, preprint, 2 authors.
        In Silico studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsEarly Ramos et al., Preprint (Preprint)Intervenci"n de la Ivermectina Pre-Hospitalaria para la Modificaci"n de la Evoluci"n del Covid19. Estudio realizado en Perº Details Prospective study of 63 outpatients in Peru treated with ivermectin, reporting significant improvement within 24 hours. Details Source PDF Early treatment study
        Early treatment study
        Ramos et al., Preprint (Preprint)Intervenci"n de la Ivermectina Pre-Hospitalaria para la Modificaci"n de la Evoluci"n del Covid19. Estudio realizado en PerºProspective study of 63 outpatients in Peru treated with ivermectin, reporting significant improvement within 24 hours.Ramos et al., 6/16/2020, preprint, 9 authors.
        Submit Corrections or CommentsReview Heidary et al., The Journal of Antibiotics, 73, 593''602, doi:10.1038/s41429-020-0336-z (Review) (Peer Reviewed)reviewIvermectin: a systematic review from antiviral effects to COVID-19 complementary regimen Details Review of the antimicrobial, antiviral, and anti-cancer properties of ivermectin.Antiviral effects have been reported for Zika, dengue, yellow fever, West Nile, Hendra, Newcastle, Venezuelan equine encephalitis, chikungunya, Semliki For.. Details Source PDF Review
        Review
        Heidary et al., The Journal of Antibiotics, 73, 593''602, doi:10.1038/s41429-020-0336-z (Review) (Peer Reviewed)Ivermectin: a systematic review from antiviral effects to COVID-19 complementary regimenReview of the antimicrobial, antiviral, and anti-cancer properties of ivermectin.Antiviral effects have been reported for Zika, dengue, yellow fever, West Nile, Hendra, Newcastle, Venezuelan equine encephalitis, chikungunya, Semliki Forest, Sindbis, Avian influenza A, Porcine Reproductive and Respiratory Syndrome, Human immunodeficiency virus type 1, and severe acute respiratory syndrome coronavirus 2. Ivermectin plays a role in several biological mechanisms, therefore it could serve as a potential candidate in the treatment of a wide range of viruses including COVID-19 as well as other types of positive-sense single-stranded RNA viruses. In vivo studies of animal models revealed a broad range of antiviral effects of ivermectin, however, clinical trials are necessary to appraise the potential efficacy of ivermectin in clinical setting.Heidary et al., 6/12/2020, peer-reviewed, 2 authors.
        Submit Corrections or CommentsDosing Arshad et al., Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.1909 (Peer Reviewed) (Dosing)dosing studyPrioritization of Anti-SARS-Cov-2 Drug Repurposing Opportunities Based on Plasma and Target Site Concentrations Derived from their Established Human Pharmacokinetics Details Pharmacokinetic analysis predicting that ivermectin will achieve lung concentration over 10 times higher than the reported EC50. Details Source PDF Dosing
        Dosing
        Arshad et al., Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.1909 (Peer Reviewed) (Dosing)Prioritization of Anti-SARS-Cov-2 Drug Repurposing Opportunities Based on Plasma and Target Site Concentrations Derived from their Established Human PharmacokineticsPharmacokinetic analysis predicting that ivermectin will achieve lung concentration over 10 times higher than the reported EC50.Arshad et al., 5/20/2020, peer-reviewed, 22 authors.
        Submit Corrections or CommentsEarly Chang , G., Research Gate, doi:10.13140/RG.2.2.34689.48482/7 (Preprint)Inclusi"n de la ivermectina en la primera l­nea de acci"n terap(C)utica para COVID-19 Details Peru observational case study of 7 patients treated with ivermectin, showing improvement and resolution of fever within 48 hours, and 100% recovery. Details Source PDF Early treatment study
        Early treatment study
        Chang , G., Research Gate, doi:10.13140/RG.2.2.34689.48482/7 (Preprint)Inclusi"n de la ivermectina en la primera l­nea de acci"n terap(C)utica para COVID-19Peru observational case study of 7 patients treated with ivermectin, showing improvement and resolution of fever within 48 hours, and 100% recovery.Chang et al., 5/2/2020, preprint, 1 author.
        Submit Corrections or CommentsReview Bray et al., Antiviral Res., doi:10.1016/j.antiviral.2020.104805 (Review) (Preprint)reviewIvermectin and COVID-19: A report in Antiviral Research, widespread interest, an FDA warning, two letters to the editor and the authors' responses Details Responses to Caly et al., and the author's reply. The original authors note that "ivermectin's key direct target in mammalian cells is a not a viral component, but a host protein important in intracellular transport; the fact that it.. Details Source PDF Review
        Review
        Bray et al., Antiviral Res., doi:10.1016/j.antiviral.2020.104805 (Review) (Preprint)Ivermectin and COVID-19: A report in Antiviral Research, widespread interest, an FDA warning, two letters to the editor and the authors' responsesResponses to Caly et al., and the author's reply. The original authors note that "ivermectin's key direct target in mammalian cells is a not a viral component, but a host protein important in intracellular transport; the fact that it is a host-directed agent (HDA) is almost certainly the basis of its broad-spectrum activity against a number of different RNA viruses in vitro. The way a HDA can reduce viral load is by inhibiting a key cellular process that the virus hijacks to enhance infection by suppressing the host antiviral response. Reducing viral load by even a modest amount by using a HDA at low dose early in infection can be the key to enabling the body's immune system to begin to mount the full antiviral response before the infection takes control."Bray et al., 4/21/2020, preprint, 5 authors.
        Submit Corrections or CommentsIn Vitro Caly et al., Antiviral Research, doi:10.1016/j.antiviral.2020.104787 (Peer Reviewed) (In Vitro)in vitroThe FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro Details In Vitro study showing that ivermectin is an inhibitor of SARS-CoV-2, with a single addition to Vero-hSLAM cells 2h post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48h.Some people claim this study show.. Details Source PDF In Vitro
        In Vitro
        Caly et al., Antiviral Research, doi:10.1016/j.antiviral.2020.104787 (Peer Reviewed) (In Vitro)The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitroIn Vitro study showing that ivermectin is an inhibitor of SARS-CoV-2, with a single addition to Vero-hSLAM cells 2h post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48h.Some people claim this study shows that therapeutic concentrations cannot be reached in humans, however this is incorrect. The authors explain why using this in vitro study to determine the effective dose in vivo is a fallacy in this presentation [1]. Authors indicate that the concentration required is very unlikely to be an issue. The study used monkey kidney cells (the only choice at the time of the experiments), which they note lack adaptive immune responses and do not produce interferon. Authors also note that ivermectin accumulates in lung and other tissues, and that the average lung concentration shown in modeling studies exceeds the effective level in their study. Authors have also repeated experiments with human lung cells showing 6-8 times improved IC50.Author's have also responded noting that "ivermectin's key direct target in mammalian cells is a not a viral component, but a host protein important in intracellular transport; the fact that it is a host-directed agent (HDA) is almost certainly the basis of its broad-spectrum activity against a number of different RNA viruses in vitro. The way a HDA can reduce viral load is by inhibiting a key cellular process that the virus hijacks to enhance infection by suppressing the host antiviral response. Reducing viral load by even a modest amount by using a HDA at low dose early in infection can be the key to enabling the body's immune system to begin to mount the full antiviral response before the infection takes control." Authors note that ivermectin works with the immune system and a 1:1 ratio of drug to virus is unlikely to be required [2].In further research, authors note that they find efficacy for prophylactic use, and that smaller repeated doses is more efffective than a single larger dose [3].Rajter et al. summarize the author, noting that ''the antiviral activities of ivermectin have been derived from laboratory experiments that largely involve high, generally non physiologic, multiplicities of infection, and cell mono layer cultures, often of cell lines such as Vero cells that are not clinically relevant. The EC50 values should not be interpreted beyond the fact that they reveal robust, dose dependent antiviral activity in the cell model system used, and it would be naive to strive for Î¼M concentrations of ivermectin in the clinic based on them.'' [4].Caly et al., 4/3/2020, peer-reviewed, 5 authors.
        In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
        Submit Corrections or CommentsN/A Guzzo et al., J. Clinical Pharmacology, doi:10.1177/009127002237994 (Peer Reviewed)safety analysisSafety, Tolerability, and Pharmacokinetics of Escalating High Doses of Ivermectin in Healthy Adult Subjects Details Safety study concluding that ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose. Adverse effects were similar between ivermectin and placebo and di.. Details Source PDF N/A
        N/A
        Guzzo et al., J. Clinical Pharmacology, doi:10.1177/009127002237994 (Peer Reviewed)Safety, Tolerability, and Pharmacokinetics of Escalating High Doses of Ivermectin in Healthy Adult SubjectsSafety study concluding that ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose. Adverse effects were similar between ivermectin and placebo and did not increase with dose. Authors also show that the plasma concentration is much higher when taken with food (geometric mean AUC 2.6 times higher).Guzzo et al., 1/1/2013, peer-reviewed, 9 authors.
        Submit Corrections or Comments
      Dems Eye National Plastic Tax | Americans for Tax Reform
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 12:17
        Posted by Mike Palicz on Friday, September 3rd, 2021, 6:33 PM PERMALINK Follow @Mike_Palicz
        Democrats may impose a national plastic tax to finance their $3.5 trillion ($3,500,000,000,000) tax and spending spree, according to a leaked Senate Finance Committee document.
        The document lists a "Plastics Excise Tax" which will "impose a $.20 per pound fee on the sale of virgin plastic." Virgin plastic is a vital material in medical devices and products, clothing, toys, and thousands of household products. The authenticity of the document was confirmed by NBC News.
        "The Democrats' tax on plastics is a tax on every middle income American 50 times a day," said Grover Norquist, president of Americans for Tax Reform. "For Dustin Hoffman in The Graduate, the answer was 'plastics.' The question was, 'What will Democrats tax next?'"
        The proposed tax hike appears to be modeled off of legislation introduced in early August by Sen. Sheldon Whitehouse (D-Beach Club), one of the most progressive members of the Senate.
        The burden of the tax would be borne by consumers in the form of higher prices for everyday household goods.
        Violates President Biden's $400,000 Tax Pledge
        The national plastic tax would violate President Biden's pledge not to raise any form of tax on anyone making less than $400,000 per year. Even the White House has raised this concern. A recent Reuters story detailing Democrats proposed carbon border tax claimed, ''the White House is concerned the Democrats' proposal will raise prices on a host of consumer goods, from cars to appliances, and conflict with Biden's pledge not to tax any American earning less than $400,000 per year.'' The same logic applies to the plastic tax now under consideration.
        Additional Taxes Democrats Plan to Impose:
        Trillions in new tax increases on working families and small businesses. The recently-passed budget resolution is the first step toward the Biden plan to raise taxes by $3 trillion over the next decade. Some of these tax increases include:
        At least 2 million small businesses will get hit by Biden's tax hikes. This includes over 1.4 million small businesses organized as c-corporations, family-owned farms impacted by the repeal of step-up in basis, and pass-through organizations which would be hit by the increase of the top marginal income tax rate to 39.6 percent. Increasing the corporate tax rate from 21 percent to 28 percent, which will be passed along to working families in the form of higher prices, fewer jobs, and lower wages. This will give the U.S. a combined state-federal rate of 32 percent, higher than our foreign competitors including China, which has a 25 percent corporate tax rate. Raising the corporate income tax rate will hit Americans with higher utility bills as the country tries to recover from the pandemic. Customers directly bear the cost of corporate income taxes imposed on utility companies. Investor-owned electric, gas, and water companies must get their billing rates approved by the respective state utility commissions. Therefore, if Democrats raise the corporate tax rate, they will have voted to raise utility bills. [Americans for Tax Reform has compiled 300 examples of utilities passing tax savings along to customers.] Doubling the capital gains tax to 43.4 percent, a rate more than double China's capital gains tax. Taking away step-up in basis and imposing a second death tax by taxing unrealized capital gains at death. This will disproportionately fall on family-owned businesses. Taking away step-up in basis has already been tried and failed. In 1976, Congress eliminated stepped-up basis, but it was so complicated and unworkable that it was restored in 1980. Imposing a 15 percent minimum tax on ''book income'' that will disallow the use of important deductions and credits that help promote job creation and economic growth. Increasing the top income tax rate to 39.6%, a tax increase that will fall on small businesses. As noted in a recent Senate Finance Committee report, "... in 2016, only 42 percent of net business income in the United States was earned by corporations, down from 78.3 percent in 1980." New taxes on American energy including a tax on manufacturers based on their methane production and a carbon border tax. These tax increases will be passed along to families and businesses in the form of higher prices. Creating a 21 percent global minimum tax, higher than the 15 percent global minimum tax the Biden admin is pushing other countries to enact. Because existing law denies foreign tax credits, this could see businesses pay a top rate of 26.25 percent. Repealing the deduction for foreign-derived intangible income, a tax cut that encourages businesses to house their intellectual property in the United States. $80 billion in new IRS funding to hire 87,000 new agents. This would allow the IRS to audit and harass small businesses and American families for an additional $787 billion. It would hire enough new IRS agents to fill Nationals Park twice.
        It would help implement the Biden plan to create a new comprehensive financial account information reporting regime which would force the disclosure of any business or personal account that exceeds $600.
        Not only would this include the bank, loan, and investment accounts of virtually every individual and business, but it would also include third-party providers like Venmo, CashApp, and PayPal.
        New IRS funding will also be a boon to the union that represents IRS employees. This union, the National Treasury Employees Union (NTEU), shovels 97 percent of their money into Democrat campaign coffers.
        IRS employees also regularly perform union work on the taxpayer's dime. In 2019, 1,421 IRS and other Treasury Department employees spent 353,820 hours of taxpayer-funded union time (TFUT), costing the federal government $17.27 million.
        Socialist healthcare policies such as H.R. 3, the Pelosi plan to impose new taxes and government price controls on American medical innovation. This legislation creates a 95 percent excise tax on manufacturers and imposes an international reference pricing scheme that directly imports foreign price controls into the U.S.
        This proposal will reduce access to new, lifesaving and life-preserving medicines. According to research by the Galen Institute, the U.S. had access to 90 percent of new cures launched between 2011 and 2018, a rate far greater than comparable foreign countries. For instance, The United Kingdom had access to 60 percent of medicines, Japan had 50 percent, and Canada had just 44 percent.
        It will also threaten high-paying manufacturing jobs across the country at a time when we are just emerging from the economic wreckage from the pandemic. Pharmaceutical manufacturers invest $100 billion in the U.S. economy every year, directly supporting 800,000 jobs including jobs in every state.
        Trillions in new welfare spending that will allow the federal government to promote woke policies. This includes:
        Hundreds of billions in funding for ''free'' pre-K and community college to ''close the equity gap.'' Part of this funding will ensure classroom environments that are ''inclusive for all students.'' $10 billion to create a Civilian Climate Corps. The program will help set the stage for the Green New Deal and give progressive activists free government housing, transportation, and salaries to ''advance environmental justice.'' New spending to make childcare ''affordable,'' and to promote ''culturally and linguistically responsive environments.'' New federal subsidies to improve ''housing affordability and equity'' and to encourage green and sustainable housing. Lowers the Medicare eligibility age and expands coverage to Dental, Vision, and Hearing. This $3.5 trillion spending package is a reckless proposal that will lead to increased taxes on working families and small businesses and trillions in new spending on welfare programs and woke policies.
        Americans for Tax Reform urges all Members of Congress to oppose all of the above tax increases.
        Photo Credit: Third Way
        More from Americans for Tax Reform There are no related posts.
        Dems Eye National Plastic Tax Posted by Mike Palicz on Friday, September 3rd, 2021, 6:33 PM PERMALINK Follow @Mike_Palicz
        Democrats may impose a national plastic tax to finance their $3.5 trillion ($3,500,000,000,000) tax and spending spree, according to a leaked Senate Finance Committee document.
        The document lists a "Plastics Excise Tax" which will "impose a $.20 per pound fee on the sale of virgin plastic." Virgin plastic is a vital material in medical devices and products, clothing, toys, and thousands of household products. The authenticity of the document was confirmed by NBC News.
        "The Democrats' tax on plastics is a tax on every middle income American 50 times a day," said Grover Norquist, president of Americans for Tax Reform. "For Dustin Hoffman in The Graduate, the answer was 'plastics.' The question was, 'What will Democrats tax next?'"
        The proposed tax hike appears to be modeled off of legislation introduced in early August by Sen. Sheldon Whitehouse (D-Beach Club), one of the most progressive members of the Senate.
        The burden of the tax would be borne by consumers in the form of higher prices for everyday household goods.
        Violates President Biden's $400,000 Tax Pledge
        The national plastic tax would violate President Biden's pledge not to raise any form of tax on anyone making less than $400,000 per year. Even the White House has raised this concern. A recent Reuters story detailing Democrats proposed carbon border tax claimed, ''the White House is concerned the Democrats' proposal will raise prices on a host of consumer goods, from cars to appliances, and conflict with Biden's pledge not to tax any American earning less than $400,000 per year.'' The same logic applies to the plastic tax now under consideration.
        Additional Taxes Democrats Plan to Impose:
        Trillions in new tax increases on working families and small businesses. The recently-passed budget resolution is the first step toward the Biden plan to raise taxes by $3 trillion over the next decade. Some of these tax increases include:
        At least 2 million small businesses will get hit by Biden's tax hikes. This includes over 1.4 million small businesses organized as c-corporations, family-owned farms impacted by the repeal of step-up in basis, and pass-through organizations which would be hit by the increase of the top marginal income tax rate to 39.6 percent. Increasing the corporate tax rate from 21 percent to 28 percent, which will be passed along to working families in the form of higher prices, fewer jobs, and lower wages. This will give the U.S. a combined state-federal rate of 32 percent, higher than our foreign competitors including China, which has a 25 percent corporate tax rate. Raising the corporate income tax rate will hit Americans with higher utility bills as the country tries to recover from the pandemic. Customers directly bear the cost of corporate income taxes imposed on utility companies. Investor-owned electric, gas, and water companies must get their billing rates approved by the respective state utility commissions. Therefore, if Democrats raise the corporate tax rate, they will have voted to raise utility bills. [Americans for Tax Reform has compiled 300 examples of utilities passing tax savings along to customers.] Doubling the capital gains tax to 43.4 percent, a rate more than double China's capital gains tax. Taking away step-up in basis and imposing a second death tax by taxing unrealized capital gains at death. This will disproportionately fall on family-owned businesses. Taking away step-up in basis has already been tried and failed. In 1976, Congress eliminated stepped-up basis, but it was so complicated and unworkable that it was restored in 1980. Imposing a 15 percent minimum tax on ''book income'' that will disallow the use of important deductions and credits that help promote job creation and economic growth. Increasing the top income tax rate to 39.6%, a tax increase that will fall on small businesses. As noted in a recent Senate Finance Committee report, "... in 2016, only 42 percent of net business income in the United States was earned by corporations, down from 78.3 percent in 1980." New taxes on American energy including a tax on manufacturers based on their methane production and a carbon border tax. These tax increases will be passed along to families and businesses in the form of higher prices. Creating a 21 percent global minimum tax, higher than the 15 percent global minimum tax the Biden admin is pushing other countries to enact. Because existing law denies foreign tax credits, this could see businesses pay a top rate of 26.25 percent. Repealing the deduction for foreign-derived intangible income, a tax cut that encourages businesses to house their intellectual property in the United States. $80 billion in new IRS funding to hire 87,000 new agents. This would allow the IRS to audit and harass small businesses and American families for an additional $787 billion. It would hire enough new IRS agents to fill Nationals Park twice.
        It would help implement the Biden plan to create a new comprehensive financial account information reporting regime which would force the disclosure of any business or personal account that exceeds $600.
        Not only would this include the bank, loan, and investment accounts of virtually every individual and business, but it would also include third-party providers like Venmo, CashApp, and PayPal.
        New IRS funding will also be a boon to the union that represents IRS employees. This union, the National Treasury Employees Union (NTEU), shovels 97 percent of their money into Democrat campaign coffers.
        IRS employees also regularly perform union work on the taxpayer's dime. In 2019, 1,421 IRS and other Treasury Department employees spent 353,820 hours of taxpayer-funded union time (TFUT), costing the federal government $17.27 million.
        Socialist healthcare policies such as H.R. 3, the Pelosi plan to impose new taxes and government price controls on American medical innovation. This legislation creates a 95 percent excise tax on manufacturers and imposes an international reference pricing scheme that directly imports foreign price controls into the U.S.
        This proposal will reduce access to new, lifesaving and life-preserving medicines. According to research by the Galen Institute, the U.S. had access to 90 percent of new cures launched between 2011 and 2018, a rate far greater than comparable foreign countries. For instance, The United Kingdom had access to 60 percent of medicines, Japan had 50 percent, and Canada had just 44 percent.
        It will also threaten high-paying manufacturing jobs across the country at a time when we are just emerging from the economic wreckage from the pandemic. Pharmaceutical manufacturers invest $100 billion in the U.S. economy every year, directly supporting 800,000 jobs including jobs in every state.
        Trillions in new welfare spending that will allow the federal government to promote woke policies. This includes:
        Hundreds of billions in funding for ''free'' pre-K and community college to ''close the equity gap.'' Part of this funding will ensure classroom environments that are ''inclusive for all students.'' $10 billion to create a Civilian Climate Corps. The program will help set the stage for the Green New Deal and give progressive activists free government housing, transportation, and salaries to ''advance environmental justice.'' New spending to make childcare ''affordable,'' and to promote ''culturally and linguistically responsive environments.'' New federal subsidies to improve ''housing affordability and equity'' and to encourage green and sustainable housing. Lowers the Medicare eligibility age and expands coverage to Dental, Vision, and Hearing. This $3.5 trillion spending package is a reckless proposal that will lead to increased taxes on working families and small businesses and trillions in new spending on welfare programs and woke policies.
        Americans for Tax Reform urges all Members of Congress to oppose all of the above tax increases.
        Photo Credit: Third Way
        More from Americans for Tax Reform There are no related posts.
        Terrible Jobs Report Shows Now is the Wrong Time to Raise Taxes Posted by Isabelle Morales on Friday, September 3rd, 2021, 10:20 AM PERMALINK Follow @IsabelleAliciaa
        The U.S. economy added just 235,000 jobs in August. This is a far cry from estimates which predicted the economy would add 720,000 jobs. The US is still 5.2 million jobs short from its pre-pandemic employment.
        8.4 million Americans are still out of work and millions of Americans are still underemployed. About 4.5 million workers are employed part-time for economic reasons, meaning they would prefer to work full-time, but cannot gain the hours needed to do so.
        Not only has job growth been disappointing under the Biden administration, but inflation has been surging as well. Consumer prices increased by 5.4 percent on an annualized basis in July, according to the Bureau of Labor Statistics (BLS). In January 2021, before Joe Biden took over the presidency, annual inflation was at a stable 1.4 percent. If wages cannot keep up with inflation, purchasing power will continue to erode.
        Given the economy remains weak, now is not the right time to impose Biden's multi-trillion tax hike on small businesses, working families, and investment.
        Biden's tax hikes would eliminate one million jobs in the first two years and would eliminate 600,000 jobs per year over the first decade, according to a study by economists John W. Diamond and George R. Zodrow. President Biden and congressional Democrats want to raise the corporate rate to 28 percent, higher than communist China's 25 percent rate. A corporate tax hike would be borne by workers and consumers. As noted by Stephen Entin of the Tax Foundation, workers bear nearly 70 percent of the cost of a corporate tax through lower wages and fewer jobs. Further, a 2020 study by the National Bureau of Economic Research found that 31% of the corporate tax falls on consumers. This tax hike would hit many small businesses as well. Over one million C-corporations are classified as small businesses, defined by the Small Business Administration as any independent business with fewer than 500 employees. President Biden and congressional Democrats want to double the capital gains rate, making the average top capital gains rate 48.8 percent after state taxes. This tax hike will threaten business creation, business expansion, entrepreneurship, retirement savings, and jobs and wages. Democrats are also proposing the creation of a second Death Tax by repealing step-up in basis. This will impose the capital gains tax (which Biden has proposed raising to 43.4 percent) on the unrealized gains of every asset owned by a taxpayer when they die and will be imposed in addition to the existing 40 percent Death Tax. It will force predominantly family-owned businesses to downsize and liquidate assets, leading to fewer jobs, lower wages, and reduced GDP. In fact, 78 percent of small business owners say that Democrats' repeal of step-up in basis would have crippling consequences for small businesses. Democrats have pushed for increasing the top income tax rate to 39.6 percent. This tax increase will hit small business that are organized as sole proprietorships, LLCs, partnerships and S-corporations. These ''pass-through'' entities pay taxes through the individual side of the tax code. Of the 26 million businesses in 2014, 95 percent were pass-throughs. Pass-through businesses also account for 55.2 percent, or 65.7 million of all private sector workers. More than half of all pass-through income would be taxed at this new, higher rate. Today's disappointing jobs report shows that we still have a long way to go to fully recover from the economic damage the pandemic caused. With the U.S. economy still 5.2 million jobs short from pre-pandemic level, now is an especially bad time to impose $3.5 trillion in job-killing, growth-killing tax hikes.
        Photo Credit: Andreas Klinke Johannsen
        More from Americans for Tax Reform Wyden's Derivatives Tax Harms Retail Investors Posted by Bryan Bashur on Thursday, September 2nd, 2021, 5:58 PM PERMALINK
        Last month, Senate Finance Chairman Ron Wyden (D-Ore.) introduced legislation that would severely increase the tax burden on the multi-trillion-dollar derivatives market. There is a chance that the looming $3.5 trillion budget reconciliation bill could include this tax hike on derivatives contracts, which would harm everyday investors trading on platforms such as Robinhood, SoFi, FTX, and CME Group.
        Individuals who trade derivatives on brokerage apps will be negatively affected by this tax change. This is especially concerning since retail investing in equity options is on the rise. According to data from the Options Clearing Corporation, and reported by Reuters, in January U.S. equity options increased by 70%. Additionally, Robinhood alone has 18 million user accounts. In the second quarter of 2021, Robinhood made $180 million in order flow revenue. Out of that, $111 million was from options trading. That is over 60% of revenue from options.
        It is safe to say that derivatives trading is not just for the rich. Anyone with a smart phone can buy or sell derivatives contracts. This is just another example of how technological advances are allowing retail investors to breach the traditionally closed off world of finance.
        Senator Wyden's legislation, the Modernization of Derivatives Tax Act of 2021 (S. 2621), imposes a tax burden that is two-fold.
        First, the bill taxes derivatives transactions at ordinary income rates and applies the tax to unrealized gains for derivative transactions prior to completion of the contract. Thus, taxes will be required to be paid annually even if the derivatives contract has not been settled. This is incredibly alarming. Individuals will be required to pay taxes even when there has been no real gain from the derivative. What incentive do individuals have to invest in derivatives if they will constantly have to pay taxes for holding the asset even when no actual gains are being made? There will be very little incentive to invest at all.
        Second, the bill could require investors who execute derivatives with respect to a stock position they hold, to recognize built-in gain on the stock, and potentially pay tax annually on the current market value (mark-to-market) of the stock position in perpetuity. Again, another provision that will certainly stymie private investment.
        The provisions of this bill will only add to investors' compliance burden.
        The derivatives impacted by Wyden's bill include certain futures contracts, swaps, and options.
        Certain derivatives are currently taxed at a top rate of 23.8%. But changing statute to tax these transactions as ordinary income opens the tax burden to increase to upwards of 43.4% if the budget reconciliation bill raises the top rate to 39.6%. Not to mention additional state taxes.
        Specifically, passage of Sen. Wyden's bill could severely hamper any growth for the nascent cryptocurrency derivatives market in the United States. Overburdensome government regulation across the globe has already stymied Binance's crypto derivatives services. The last thing the U.S. should do is follow suit and implement a tax regime that will raise taxes on individuals who participate in the derivatives markets through free online brokerage accounts.
        Democrats falsely claim this measure will close tax loopholes for the super-rich. But make no mistake, this tax-grab will harm all individuals who trade futures, options, and swaps.
        The Joint Committee on Taxation estimated that this bill would raise $16.5 billion over 10 years. However, raising $1.65 billion in revenue annually pales in comparison to the subsequent decline of derivatives trading overall that will likely occur in the $15.8 trillion derivatives market because of the increased tax burden. Enactment of Wyden's bill will chill derivatives trading activity and may lower revenue for the federal government.
        Members of Congress should oppose this tax increase and its potential inclusion in the budget reconciliation bill. ''Closing loopholes'' and cracking down on ''tax avoidance'' have become a recent clarion call of the Democratic party to raise taxes on middle-class Americans. But all retail investors should be aware that this new tax regime is not only going to affect the wealthy, it will affect you too.
        Photo Credit: Tech Daily
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        State of State Governments: How they compare in size, which are growing, and which are shrinking Posted by Drew Carlson on Thursday, September 2nd, 2021, 1:50 PM PERMALINK
        Today Americans for Tax Reform released an updated list of the 50 states ranked by the size of their state government, using state spending as a percentage of state GDP as the metric for comparison. The state spending data comes from the National Association of State Budget Officers' annual state spending surveys and the state GDP figures come from the U.S. Bureau of Economic Analysis.
        In addition to looking at the size of all 50 state governments today, ATR examined how the sizes of all 50 state governments have changed over the past decade.
        Size of State Governments Today (2019)
        West Virginia (24.81%) Arkansas (21.83%) Alaska (20.93%) New Mexico (19.89%) Vermont (19.58%) Hawaii (18.94%) Oregon (18.93%) Mississippi (18.67%) Kentucky (18.26%) Rhode Island (18.14%) Delaware (17.61%) Wisconsin (16.31%) Maine (14.99%) Montana (14.97%) Alabama (14.36%) Connecticut (13.7%) Iowa (13.51%) Louisiana (13.44%) Michigan (12.64%) Pennsylvania (12.25%) South Carolina (12.13%) Maryland (12.06%) Oklahoma (12.04%) Colorado (12.01%) Wyoming (12.01%) Minnesota (11.98%) Arizona (11.96%) North Dakota (11.85%) Ohio (11.54%) New Jersey (11.53%) Massachusetts (11.5%) New York (11.46%) Virginia (11.3%) Idaho (11.24%) California (10.73%) Kansas (10.58%) Nevada (10.46%) Nebraska (10.31%) Tennessee (10.3%) Indiana (10.1%) Georgia (9.85%) Utah (9.84%) North Carolina (9.61%) South Dakota (9.44%) Illinois (9.29%) Washington (9.21%) Missouri (9.18%) Florida (8.57%) New Hampshire (8.1%) Texas (6.86%) Fastest Growing State Governments of the Last 5 years:
        Nevada (43.7%) Pennsylvania (19.81%) Kentucky (18%) Delaware (17.51%) Indiana (16.23%) Connecticut (15.68%) California (15.37%) Louisiana (14.73%) Iowa (14.57%) New Jersey (13.71%) Fastest Shrinking State Governments of the Last 5 years:
        Wyoming (-38.41%) Arizona (-8.73%) Massachusetts (-7.3%) Texas (-7.19%) Tennessee (-2.15%) Alaska (-1.8%) Maine (-0.95%) Mississippi (0.57%) Oklahoma (0.61%) Idaho (0.95%) Fastest Growing State Governments of the Last 10 Years:
        Connecticut (76.44%) Nevada (40.01%) Virginia (30.26%) Alabama (30.13%) Oregon (28.54%) Kentucky (25.43%) New Jersey (24.51%) Rhode Island (23.88%) Arkansas (23%) Delaware (22.57%) Fastest Shrinking State Governments of the Last 10 years:
        Wyoming (-25.09%) West Virginia (-17.93%) North Carolina (-13.17%) Oklahoma (-11.29%) Alaska (-6.98%) Tennessee (-6.88%) Texas (-5.53%) Massachusetts (-3.49%) South Carolina (-2.48%) Maine (-1.68%) Photo Credit: Martin Falbisoner
        More from Americans for Tax Reform Bloomberg Exposed for Foreign Meddling in Tobacco and Vaping Policy in the Philippines Posted by Karl Abramson on Wednesday, September 1st, 2021, 8:21 PM PERMALINK Follow @karlabramson
        The philanthropic wing of American billionaire Mike Bloomberg, Bloomberg Philanthropies, has been exposed for effectively buying off the Food and Drug Administration (FDA) of the Philippines in exchange for the implementation of unpopular, anti-science policies related to tobacco and nicotine products. In a report approved by a committee of the Filipino legislature, lawmakers expressed outrage and demanded an investigation into the scheme, a signal that there may be more evidence yet to be presented regarding Bloomberg's money-driven influence over Philippines' FDA.
        The report, which was overwhelmingly approved by the House Committee on Good Government and Public Accountability, outlined how FDA and Bloomberg Philanthropies colluded, using regulatory methods, to discriminate against the legal tobacco industry. In the process, Bloomberg Philanthropies and their associates at FDA violated Philippine law. There is now an opportunity for Philippine authorities to hold Bloomberg and his allies legally accountable for their infringements.
        It has long been public knowledge that Mike Bloomberg holds radical anti-tobacco views. Unfortunately, his opinions extend to non-combustible nicotine products like e-cigarettes, Swedish snus, heated tobacco products (HTP's), and pouches. E-cigarettes have been shown to be at least 95% less harmful than cigarettes, and an incredibly effective method of getting people who smoke to quit. Swedish snus is a clean tobacco product that exposes users to significantly less toxins than cigarettes and is the reason why Sweden has one of the lowest lung cancer rates in the world. Similarly, HTP's reduce the user's exposure to harmful chemicals by heating, rather than burning, tobacco to create a vapor.
        Mike Bloomberg, however, could care less about the lifesaving impacts that reduced harm alternatives have. His policy proposals make it clear thar he would prefer smokers die from their addiction than make the switch to a safer product. His actions in the Philippines are proof that he will stop at nothing to use his money to purchase influence over the policies of sovereign countries. As some have put it, Bloomberg utilizes a unique method of ''philanthro-colonialism'' to gain control over a country's political system under the guise of ''philanthropy'' intended to improve the lives of their citizens.
        Key findings from the report can be read below, while the full report can be accessed here.
        The Committee determined that the decision by FDA to partner with Bloomberg Philanthropies was questionable due to Bloomberg's ''avowed policy to ban or restrict the use of tobacco and novel tobacco products''.
        FDA failed to disclose, in detail, its receipt of foreign donation. This is a potential violation of Philippine law and the report calls on the State Auditor General to investigate the validity of FDA's receipt.
        In response to Bloomberg's scheme, the Committee recommended the Filipino Congress pass a bill prohibiting foreign donors from engaging in donation-for-policy conspiracies with government offices.
        Bloomberg Philanthropies violated Philippine law by not obtaining the necessary registration permits to lobby the government as a foreign agent. This is direct breach of the Foreign Agents Registration Act.
        The report recommends mandating FDA and Ministry of Health to disclose all foreign donations with detailed receipts.
        The report sends a strong warning to FDA that they must now act with full transparency. They cannot accept monetary grants from anti-tobacco groups, or any groups, in exchange for implementing predetermined policies. The decision to release the report now is timely as the Philippine Senate is currently considering a bill that would remove FDA's ability to regulate e-cigarettes, vaping products, and HTP's.
        Supporters of government transparency are pushing for this bill to pass, as it would force Philippine authorities to consider the overwhelming science and data in support of these products. Should FDA be allowed to determine such regulations, that data would almost surely be pushed aside in favor of Bloomberg's extremist ideology. The public health ramifications of that would be catastrophic.
        Sadly, Bloomberg's philanthro-colonialism is not unique to the Philippines. Bloomberg Philanthropies has donated more than three billion dollars to the World Health Organization, a significant portion of that going towards a ''Bloomberg Initiative to reduce tobacco''.
        In Armenia, where more than half of all men smoke cigarettes, restrictive vaping laws have begun to emerge. According to Armenia's Health Minister, their funding for tobacco control comes from the World Health Organization, Bloomberg Philanthropies, and Campaign for Tobacco Free Kids (CTFK). CTFK receives nearly all their funding from Bloomberg Philanthropies.
        In Vietnam, Bloomberg's ''deep collaboration with government and local organizations'' resulted in a plan, currently under consideration, to completely prohibit all e-cigarettes. As a result, millions of Armenians and Vietnamese will unnecessarily die from cigarette smoking as they are actively being discouraged from making the lifesaving switch to vaping.
        It is near certain that the same tactics Bloomberg utilized in the Philippines are being used by groups funded by him in dozens of other countries around the world. Those nations would be well served by enacting the same stringent policies protecting against pay-for-play schemes related to tobacco products, or any industry for that matter, as are currently under consideration in the Philippine Congress. As is evident in the Philippines, Vietnam, and Armenia, millions of lives depend on legislators taking a stand against the undue influence of foreign wealth over a nation's domestic policies.
        Photo Credit: Center for American Progress
        More from Americans for Tax Reform EU to Tax US Tech Companies Despite Biden's Global Tax Capitulation Posted by Rowan Saydlowski on Wednesday, September 1st, 2021, 4:28 PM PERMALINK Follow @rsaydlowski
        The European Union recently announced that it will be imposing a digital services tax (DST) in the bloc's long-term budget under a new label of a ''digital levy''.
        The announcement was revealed this week by EU Budget Commissioner Johannes Hahn, who said the DST along with several other new taxes will be implemented to help Europe cover the cost of its massive government spending, effectively trying to make the United States pay for Europe's COVID relief in addition to our own. Digital services taxes are discriminatory taxes that unfairly target large American technology companies that do business abroad and transfer American wealth to foreign governments.
        The Trump Administration had opened an investigation into the European Union's plans to implement a DST last year, but President Biden's U.S. Trade Representative Katherine Tai ended the investigation shortly after she was appointed as trade chief in March. All other investigations into similar digital taxes concluded that they are discriminatory. In place of the investigation, the Biden Administration entered into negotiations at the Organization for Economic Cooperation and Development (OECD) that they claimed could eliminate DSTs from other countries while implementing a global minimum corporate tax rate instead.
        The United States agreed to this global minimum tax''''which would ban countries around the world from lowering their corporate tax rates below 15%''''with no enforcement mechanism set in place to ensure that DSTs would not arise. Sure enough, Europe appears to already be reneging on their pledge to eliminate their digital tax plans in return for a global tax agreement. In a further attempt at obfuscation, European officials changed the term ''digital tax'' to their new term ''digital levy'' in order to argue that their DST is not actually a violation of the global agreement.
        Brussels isn't the only trading partner implementing DSTs now that the U.S. is wrapped up in the OECD's global tax agreement. Tanzania also recently decided to implement a DST of their own, which will hurt U.S. companies operating in the African country. The dominoes certainly won't end with Europe and Tanzania; more digital services taxes are likely to be crafted in countries around the world as American jobs and wealth are shipped abroad unimpeded by the Biden Administration.
        It was a tremendous mistake for President Biden to enter into the destructive global minimum tax agreement that harms Americans without an enforceable method of preventing digital services taxes from arising or any clear benefit to the United States. The Biden Administration and Congress should reject the global tax agreement and OECD deal and renew their fight against DSTs to ensure that this mistake does not endure.
        Photo Credit: Thijs ter Haar
        Heitkamp Warns Dems Not to Impose Second Death Tax Posted by John Kartch on Wednesday, September 1st, 2021, 1:37 PM PERMALINK Follow @johnkartch
        "I'm trying to sound the alarm both economically and politically for Democrats."
        Today on CNBC's SquawkBox, Democratic former North Dakota Sen. Heidi Heitkamp sent a warning to Democrats who are thinking about killing stepped-up basis. Taking away stepped-up basis -- as President Biden has proposed -- would impose a second Death Tax on the American people:
        "I'm trying to sound the alarm both economically and politically for Democrats, that this is not a path to walk, which is taxing unrealized gain.
        You can look at different strategies for stepped-up basis, for realizing some income tax when that asset is eventually sold, but the disruption that this would create for small family businesses and for farmers and for family assets is just not worth the pain. In fact, ironically when it's polled, 70% of democrats agree with me that death should not be the taxable event."
        Click here or below to view the video clip:
        Needed Property Tax Relief In Texas Clears Key Committee Hurdle Posted by Dennis Hull on Wednesday, September 1st, 2021, 12:37 PM PERMALINK
        A bill to slash property taxes by at least $2 billion was passed unanimously by the Texas Senate Finance Committee this week on August 30, clearing the way for final approval by the Senate. This bipartisan tax relief plan, Senate Bill 91, takes aim at the state's onerous school district Maintenance and Operations (M&O) taxes. Known as the ''Robinhood Tax,'' M&O property taxes are imposed by Texas municipalities and account for nearly half of the total annual property tax burden, totaling $56 billion last year.
        SB 91 would allocate at least $2 billion and up to $4 billion in state dollars to pay down local M&O taxes, creating substantial tax relief for Texans. For the owner of a median $300,000 home, tax savings under the new bill will come out to about $200 next year, according to Senator Paul Bettencourt, the author and primary sponsor of the tax plan.
        ''Texans will see a reduction of at least 6.6 pennies on their school district tax rate in the 2022 property tax year,'' said Bettencourt at Monday's Finance Committee hearing. ''Each billion available for compression will lower the M&O tax rate for all property owners in Texas.''
        This new round of tax relief is contingent upon a revenue trigger being met. The total amount of tax savings under the new bill will depend on a key revenue estimate for the 2022-23 fiscal year, to be provided by the Texas Comptroller on June 1, 2022. If the Texas economy continues to grow at its current pace, school district M&O taxes could be lowered by as much as $4 billion as surplus state tax revenue subsidizes local property taxes.
        Vance Ginn, chief economist at the Texas Public Policy Foundation, testified in favor of SB 91 at Monday's hearing. Ginn points out that property taxes are inefficient, as they rely on subjective valuations by appraisal review boards, and can often force people out of their homes if not paid, meaning no one truly owns their property in Texas. Moreover, Ginn argues, property taxes tend to hurt low- and fixed-income earners the most. Booming housing markets, of which Texas has many, lead to rising home valuations and higher property taxes, regardless of the homeowner's ability to afford the additional tax burden.
        Not only is property tax relief clearly needed, Texans are demanding it. Recent polls show that 82% of Texans consider property taxes to be a ''serious issue,'' while more than two-thirds would be upset if no legislative action is taken to lower property taxes this year. Their concerns are valid; over the last 20 years, local property taxes have grown faster than the average taxpayer's ability to pay for them, helping make Texas the state with the 7th worst property tax burden on homeowners.
        By passing SB 91, Texas legislators can heed the advice of Americans for Tax Reform and its coalition partners to ease a crushing tax burden on Texas families. ''Texans cannot afford to wait until 2023 for the Legislature to address these issues,'' noted a joint statement released on Monday by the Texas Public Policy Foundation, the Texas Conservative Coalition Research Institute, and Americans for Tax Reform. ''Not only is the burden too high, but the system is designed to allow insatiable local governments to keep squeezing every last dime out of taxpayers.''
        SB 91 now awaits a full vote in the Texas Senate and subsequent votes in the House before it can go to Governor Greg Abbott's desk. ATR will be following this legislation closely.
        Photo Credit: LoneStarMike
        More from Americans for Tax Reform Letter to New Jersey Congressional Delegation Shows Breadth of Opposition to Biden Tax Hikes Posted by Michael Mirsky on Tuesday, August 31st, 2021, 4:00 PM PERMALINK
        A broad coalition of New Jersey business groups including the African American Chamber of Commerce and the Statewide Hispanic Chamber of Commerce wrote a letter to the New Jersey Congressional delegation voicing opposition to President Biden's proposed tax increases.
        The letter, signed by 96 groups, laid out the economic pitfalls of raising the corporate tax rate and taxation of Global Intangible Low-Tax Income (GILTI).
        As noted in the letter:
        New Jersey already has the highest state corporate tax in the nation, and the contemplated federal increase would be additionally destructive to New Jersey's economy, subjecting our corporations to among the highest tax rates in the world.
        Similarly, this increase in the corporate rate will make New Jersey businesses uncompetitive with the rest of the world:
        New Jersey's combined rate, with the discussed federal increase to 25%, would be 33.6%. The worldwide average corporate tax rate is estimated at about 24%, so New Jersey could surpass that by about 40%.
        The coalition also voiced their concerns over the proposed increase in the taxation of GILTI:
        A GILTI increase will push multi-national businesses to leave New Jersey and seek out states with lower GILTI rates, because we are already a GILTI outlier in how harshly we treat it at the state level.
        A less competitive corporate tax rate would exacerbate substantial affordability issues faced by New Jersey residents, including:
        Having the highest property taxes in the nation, some of the highest personal income tax rates and the general high cost of living and doing business.
        If these tax increases go into effect, it would be detrimental to the investments that New Jersey businesses so badly need:
        Spending on innovation and infrastructure would be curtailed, and needed advancements in broadband, R&D and manufacturing capital would be stymied.
        The letter concludes with a plea to the administration to consider the consequences of their near-sighted actions:
        New Jersey businesses are at a critical juncture as we attempt to survive and recover from the impacts of COVID-19, and we ask you to help move our economy in the right direction '' the opposite of this disastrous tax increase proposal.
        A link to the full letter can be found here.
        [See also: Biden Tax Hikes Largest Since 1968]
        More from Americans for Tax Reform Montanans Will Get Stuck with Higher Utility Bills Due to Biden Corporate Tax Rate Hike Posted by John Kartch and Michael Mirsky on Tuesday, August 31st, 2021, 3:03 PM PERMALINK Follow @JohnKartch
        If Tester enacts a corporate income tax rate increase, he will have to explain why he just increased your utility bills
        If President Biden and Senator Jon Tester hike the corporate income tax rate, Montana households and businesses will get stuck with higher utility bills as the country tries to recover from the pandemic.
        Democrats plan to impose a corporate income tax rate increase to 28%, even higher than communist China's 25%. This does not even include state corporate income taxes, which average 4 - 5% nationwide.
        Customers bear the cost of corporate income taxes imposed on utility companies. Corporate income tax cuts drive utility rates down, corporate income tax hikes drive utility rates up.
        Electric, gas, and water companies must get their billing rates approved by the respective state utility commissions. When the 2017 Tax Cuts and Jobs Act cut the corporate income tax rate from 35% to 21%, utility companies worked with state officials to pass along the tax savings to customers, including at least two Montana utilities.
        The savings typically come in the form of a rate reduction, a bill credit, or a reduction to an existing or planned rate increase.
        According to a report published in the trade publication Utility Dive, customers nationwide were to receive a $90 billion utility benefit from the Tax Cuts and Jobs Act:
        Estimates derived from 2017 annual SEC 10-K filings indicate that the 14-percentage-point reduction in the corporate tax rate enacted under the 2017 Tax Cuts and Jobs Act (TCJA) resulted in investor-owned utilities establishing significant regulatory liability balances, totaling approximately $90 billion to be refunded back to customers.
        Americans for Tax Reform has compiled a 90-second nationwide utility savings video from local news reports which may be viewed here.
        If Democrats now impose a corporate income tax rate increase, they will have to reckon with local news coverage noting utility bills are going up. A vote for a corporate income tax hike is a vote for higher utility bills as households try to recover from the pandemic.
        Tax Cuts and Jobs Act Impact: Working with the Montana Public Service Commission, Montana-Dakota Utilities and NorthWestern Energy passed along tax savings to customers.
        Montana-Dakota Utilities: As noted in a 2018 Montana Public Service Commission release:
        The Montana Public Service Commission voted unanimously to approve an agreement for Montana-Dakota Utilities' electric business to refund to consumers the benefits they received from the Tax Cuts and Jobs Act. The agreement, or Stipulation, calls for a $1.5 million consumer refund as a result of the TCJA.
        NorthWestern Energy: As noted in this April 3, 2018 Billings Gazette article excerpt:
        The tax savings stem from the Republican Tax Cuts and Jobs Act, which Congress passed in December and was signed into law by President Donald Trump. Federal corporate tax rates fell from 35 percent to 21 percent.
        Regulated utilities like NorthWestern cannot pocket the savings, which must be shared with ratepayers, who also pay the utilities' taxes. NorthWestern has about 345,000 customers in Montana.
        NorthWestern is proposing that its natural gas customers receive direct refunds for the entire $3.154 million in tax breaks associated with the utility's natural gas business. The company's electric customers would receive half of the $10.8 million in tax breaks associated with NorthWestern's electric business. Half the money would be spent removing hazard trees that pose a fire or outage risk.
        ''With what we proposed, for a natural gas customer, it would be about $1.18 a month. An electricity customer would be 67 cents per month,'' said Butch Larcombe, NorthWestern spokesman.
        Conversely, if Biden and Democrats raise the corporate tax rate, they will add to the burden faced by working families. And any small businesses operate on tight margins and can't afford higher heating, cooling, gas, and refrigeration costs.
        President Biden should withdraw his tax increases.
      Top defense firms spend $1B on lobbying during Afghan war, see $2T return '' Responsible Statecraft
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        Archived Version
        Sun, 05 Sep 2021 12:16
        With the final withdrawal of U.S. troops from Afghanistan and the Taliban's return to power, the unwinnable nature of the U.S. war in Afghanistan is increasingly obvious to Americans across the political spectrum. That's probably one reason why over half of Americans support Biden's decision to withdraw from Afghanistan even while disapproving of the handling of the withdrawal, according to a Pew Research poll released on Tuesday.There will be inevitable finger-pointing for why three successive U.S. presidents continued the war in Afghanistan despite public reports and the congressional testimony from the Special Inspector General for Afghan Reconstruction, or SIGAR, casting serious doubts on the viability of efforts to nation-build in Afghanistan.
        Indeed, the United States paid a high price for these mistakes '-- the Cost of War Project at Brown University estimates that the war in Afghanistan cost U.S. taxpayers $2.3 trillion to date and resulted in the deaths of 2,324 U.S. military personnel, 4,007 U.S. contractors and 46,319 Afghan civilians '-- but those costs weren't shared by everyone.
        While the American people financed the war with their tax dollars, and in some cases their lives, the top five Pentagon contractors enjoyed a boom in growth in federal contracts over the course of the war in Afghanistan. Stephen Semler, co-founder of the Security Policy Reform Institute, found that Congress gave $2.02 trillion to the top five weapons companies '-- Raytheon, Lockheed Martin, General Dynamics, Boeing and Northrop Grumman '-- between 2001 and 2021.
        And between 2002 and 2020, federal funding for those five weapons companies grew by 188 percent.
        In fairness, the weapons companies invested heavily to lobby members of Congress about a variety of matters, including budget and appropriations issues impacting their bottom-lines.
        That wasn't cheap. A compilation of data from lobbying disclosures archived at OpenSecrets shows that those five firms spent over $1.1 billion on lobbying between 2001 and 2021. That number seems like a staggering sum to spend on influencing policymakers but it may have been the most financially prudent decision these companies have made in the past 20 years.
        Taken as a form of investment in procuring lucrative Pentagon contracts, the top five weapons firms earned $1,813 in Pentagon contracts for every dollar spent on lobbying.
        Of course, the weapons firms made other investments in influencing policymakers. They sent $120 million in campaign contributions to federal candidates between 2002 and 2020, hired former government officials to sit on their boards while simultaneously advising U.S. policymakers to extend the withdrawal timeline from Afghanistan, and bankrolled think tanks that opposed the withdrawal and supported ongoing U.S. military engagement in the Middle East.
        But those investments dwarf in comparison to the over $1 billion explicitly spent to influence policymakers via legal, registered, and documented lobbying, leading to enormous federal contracts and outsized gains for owners of weapons stocks.
        ''$10,000 of stock evenly divided among America's top five defense contractors on September 18, 2001 '-- the day President George W. Bush signed the Authorization for Use of Military Force in response to the 9/11 terrorist attacks '-- and faithfully reinvested all dividends, it would now be worth $97,295,'' according to The Intercept's Jon Schwarz.
        The exact same investment in an S&P 500 index fund would be worth only $61,613.
        The Global War On Terror was very good for a select group of companies that invested over $1 billion in lobbying Congress and securing over $2 trillion in taxpayer funds. While the American public takes a hard look at how and why an unwinnable war was fought at a staggering financial and human cost for two decades, the war's biggest profiteers appear to be facing little accountability or scrutiny, especially from the policymakers who were the target of a billion dollar lobbying blitz.
      Australia COVID: NSW considers vaccination measures for truckies
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        Archived Version
        Sun, 05 Sep 2021 12:09
        ''You couldn't put an arbitrary date in without acknowledging there would be supply issues when you're talking about statewide vaccination '' you've got to make it realistic,'' he said.
        ''Our view is, let's incentivise drivers in freight by way of bonuses, gift cards and a range of things.''
        The discussions follow five truck drivers from NSW testing positive to coronavirus this week after entering South Australia and one who drove to Queensland testing positive on Wednesday.
        'Serious concerns'A statewide vaccine mandate is not explicitly on the agenda but is a possibility in light of jab requirements for hundreds of thousands of authorised workers in western Sydney hotspots, which cover major logistic and supply chain hubs and kick in from Monday.
        Any mandate could prove controversial after some truckies this week protested a Queensland requirement that drivers, and other essential workers, be vaccinated to cross the border.
        Transport Workers Union NSW secretary Richard Olsen said: ''The TWU supports vaccination and encourages everyone able to get vaccinated to get the jab, but we have serious concerns about a blanket mandate while so many truck drivers still haven't been able to get vaccinated.
        ''Truck drivers face unique challenges in accessing COVID vaccines '' including irregular work hours, difficulty getting paid time off and not being prioritised in the vaccine rollout,'' he said.
        ''The government needs to be looking at additional measures, such as rapid antigen testing, to strengthen COVID protection for transport workers and the communities they service.''
        Australian Logistics Council chief executive Brad Williams said it was ''supportive of any practical and pragmatic measure that supports the health, safety and wellbeing of the workforce and the broader community''.
        ''ALC encourages the government to ensure adequate industry consultation to ensure any measures are workable and the industry has an appropriate time to respond.''
        A Transport for NSW spokeswoman said it was ''seeking the views of industry about vaccination of freight workers''.
        ''The feedback received from this forum will inform the whole of government response to freight workers and the continued safe operation of the supply chain.''
        Last week, the NSW government backflipped on allowing rapid antigen testing as an alternative to vaccination for Sydney hotspot workers, scrapping it seven days after announcing it.
        Mr O'Hara said one of his members, a medium to large transport company, had ordered rapid tests costing $50,000 at 4pm last Friday, only to find they were no longer needed when the requirement was removed at 8.30pm that night.
        ''If NSW Health needs more rapid antigen tests we have some we're prepared to sell them,'' Mr O'Hara said.
        Clyde & Co workplace safety lawyer Michael Tooma said any vaccination mandate needed ''to cater to the minority of workforces where vaccination is not a viable option'', citing the vaccine hesitant, and said rapid antigen testing was a necessary alternative.
        ''There are concerns it will be difficult to redeploy or replace the small proportion of the workforce that might be affected and that might cause business continuity issues for some organisations,'' he said.
        ''Rapid antigen testing allows that portion of the workforce to be accommodated and for safety issues to be addressed and really provides businesses with an option to keep a proportion of the workforce gainfully employed and servicing the employer.''
      Parents sue California over mandated 'chants to Aztec gods' in ethnic studies classes - Washington Times
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        Archived Version
        Sun, 05 Sep 2021 12:04
        A group of parents in California sued the State Board of Education Friday over a proposed new ''Ethnic Studies Model Curriculum'' (ESMC) that would have public school students chanting affirmations to Aztec gods and invoking an ancient Nigerian Yoruba religious prayer.
        Other critics have slammed the ESMC for allegedly indoctrinating students in Marxism and for promoting an antisemitic viewpoint. The state education board unanimously adopted the curriculum for the state's 6 million-plus public school students in March, media reports indicate.
        The lawsuit includes the text of the ''Nahui Ollin,'' described as a chant ''founded on traditional Aztec beliefs, focusing especially on the four deities Tezkatlipoka, Quetzalkoatl, Huitzilopochtli, and Xipe Totek'' as well as a reference to Hunab Ku, ''an older Mayan creator deity.''
        Also included in the curriculum is another ''affirmation'' dedicated to the Yoruba ''divine force'' known as Ashe. After sentences such as ''Who is going to have a positive day?'' or ''Who will represent their people, this day?'', students are told to say, ''Ashe!'''
        The Thomas More Society and special counsel Paul Jonna of LiMandri & Jonna LLP filed the complaint with the Superior Court of California in San Diego on behalf of Californians for Equal Rights and San Diego county residents Eric Gonzales, Steve Houbeck, and Jose Velazquez, each parents of school-age children. The action came after the state board did not respond to a letter seeking the removal of the offensive items.
        ''The curriculum's unequivocal promotion of five Aztec gods or deities through repetitive chanting and affirmation of their symbolic principles constitutes an unlawful government preference toward a particular religious practice,'' Frank Xu, Californians for Equal Rights Foundation president, said in a statement. ''This public endorsement of the Aztec religion fundamentally erodes equal education rights and irresponsibly glorifies anthropomorphic, male deities whose religious rituals involved gruesome human sacrifice and human dismemberment,'' he added.
        The ESMC lawsuit includes a section of ''Affirmation, Chants, and Energizers.'' One invocation ''addresses the deities both by name and by their traditional titles, recognizes them as sources of power and knowledge, invokes their assistance, and gives thanks to them.''
        According to the complaint, ''In short '... it is a prayer.''
        Mr. Jonna, the lawyer, noted in a statement that ''both the California and the United States constitutions prohibit prayer in public schools '' particularly prayers drafted by public officials.''
        ''Can you imagine if elements of the Christian faith were proposed to be included in the public school curriculum?'' he added. ''What if a class incorporated praying to the Blessed Virgin Mary, or even reciting the Lord's Prayer?''
        Other parts of the proposed new curriculum have already proved controversial.
        The Jewish Journal, a Los Angeles-based publication, in an Aug. 16 commentary argued that said the curriculum's authors ''define Zionism as 'a nationalist, colonial ideology,' claim that there is a 'current apartheid in Israel' and that Israel's 'settler colonialism' has 'pedagogical importance' and therefore must be included in California's ethnic studies curriculum.''
        Legislation mandating the ESMC in California schools is pending in the state Senate. A spokesperson for the State Board of Education told The Washington Times via email they could not comment on the lawsuit since the board has not seen it yet.
        Sign up for Daily NewslettersCopyright (C) 2021 The Washington Times, LLC. Click here for reprint permission.
        New and improved commenting system coming soon.
      'This is life from now on': Israel's coronavirus czar warns people to prepare for a 'fourth injection' of Covid vaccine '-- RT World News
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        Archived Version
        Sun, 05 Sep 2021 12:00
        With over 2.5 million Israelis already inoculated with three Covid-19 vaccine doses, the national coronavirus czar, Salman Zarka, has said preparations need to begin for an eventual fourth jab due to the virus' growing variants.
        Yet another round of booster shots will be needed for the vaccinated in order to keep up with coronavirus variants, said Zarka, the head of the special task force set up to coordinate Israel's fight against Covid-19, in an interview with Kan public radio on Saturday. Despite two-thirds of the Israeli population already being vaccinated with two doses, health officials expect that the more spreadable Delta will continue to lead to a rise in cases and hospitalizations in the fall months.
        Given that the virus is here and is here to stay, we must also ready ourselves for the fourth jab.
        Also on rt.com Israel reports record daily Covid cases over 10,900 for 1st time since pandemic outbreak as schools set to open ''This is our life from now on, in waves,'' Zarka added. He believes booster shots that deal with new variants of the virus more effectively could be ready by late 2021 or early 2022.
        The health official previously stated that vaccine booster shots could need to be taken ''once a year or five or six months.''
        Israel was among the first countries to offer a third dose of the vaccine, which over 2.5 million people have already received. A 'Green Pass' issued to vaccinated citizens '' which grants access to places like restaurants and bars '' expires six months after an individual is given their second or third dose, leading speculations that more future doses could be on the way. Also on rt.com Americans will 'likely' need 3rd Covid shot to qualify as 'fully vaccinated,' Fauci says as booster battle rages at FDA Think your friends would be interested? Share this story!
      Bitcoin miners, oil and gas execs talk about natural gas mining
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        Archived Version
        Sun, 05 Sep 2021 11:28
        Bitcoin enthusiasts, miners, and oil & gas execs gathered at a meetup in Houston to talk about the future of bitcoin mining.
        HOUSTON '' On a residential back street of Houston, in a 150,000 square-foot warehouse safeguarding high-end vintage cars, 200 oil and gas execs and bitcoin miners mingled, drank beer, and talked shop on a recent Wednesday night in August.
        These two groups of people may seem as though they are at opposite ends of the professional and social spectrums, but their worlds are colliding '' fast. As it turns out, the industries make for compatible bedfellows.
        Just take Hayden Griffin Haby III, an oilman turned bitcoiner. The Texas native and father of three has spent 14 years in oil and gas, and he epitomizes what this monthly meetup is all about.
        Haby started as a surface landman where he brokered land contracts, and later, ran his own oil company. But for the last nine months, he's exclusively been in the business of mining bitcoin.
        As Haby describes it, he was "orange pilled" in November 2020 '' a term used to describe the process of convincing a fiat-minded person that they are missing out by not investing in bitcoin. A month later, he co-founded Limpia Creek Technologies, which powers bitcoin mining rigs with flared, vented, and stranded natural gas assets.
        "When I heard that you could make this much money per MCF (a metric used to measure natural gas), instead of just burning it up into the atmosphere, thanks to the whole 'bitcoin mining thing,' I couldn't look away," Haby said. "You can't unsee that."
        When China kicked out all its crypto miners this spring '' an exodus which Haby calls the "Chexit" '' that poured kerosene on the flames. "This is an opportunity we didn't think was coming," he said.
        Haby tells CNBC they are already seeing demand rushing to Texas, and he is convinced that the state is poised to capture most of the Chinese hashrate looking for a new home on friendlier shores.
        Bitcoin miners care most about finding cheap sources of electricity, so Texas '' with its crypto-friendly politicians, deregulated power grid, and crucially, abundance of inexpensive power sources '' is a virtually perfect fit. The union becomes even more harmonious when miners connect their rigs to otherwise stranded energy, like natural gas going to waste on oil fields across Texas.
        "This is Texas, boys. We got what you need, so come on down," said Haby. "We are sitting on the energy capital of the world."
        "I think Kevin Costner said it best: 'If you build it, they will come,'" said Haby.
        An underground meetup of bitcoin miners and oil & gas execs was held at a 150,000 square-foot warehouse safeguarding high-end vintage cars.
        Mobilizing a movementParker Lewis is one of Texas' de facto bitcoin ambassadors. Everyone knows him. Everyone likes him. And virtually any bitcoiner you ask refers to him as the future mayor of Austin.
        Lewis is an executive at Unchained Capital, a bitcoin-native financial services firm. He isn't in politics '' yet '-- but he is hustling across the state of Texas to spread the good word on the world's biggest cryptocurrency. In May, the Houston Bitcoin Meetup consisted of only 20 people in a fluorescent-lit conference room in an office. Then Lewis decided to get involved.
        "I just knew Houston would be prime to explode because of the energy connection to mining '' if we organized a good meetup," Lewis told CNBC. "It's also key to Texas being the bitcoin capital of the world."
        His efforts are paying off. Wednesday's meetup drew more than 200 attendees from across the state of Texas, as well as California, Colorado, Louisiana, Pennsylvania, New York, Australia and the UK.
        The buzz was electric on Wednesday night. You had to shout to be heard. And no one in the room mentioned any cryptocurrency beside bitcoin. There was also an unmistakable air of stealth '' and FOMO. The people who showed up to this event did so, at least in part, because they didn't want to get left behind.
        Capturing excess and otherwise wasted natural gas from drilling sites and then using that energy to mine bitcoin is still firmly in the category of avant-garde tech.
        Haby, who's affable and an open book on most things, clams up when it comes to sharing the location of his company's mining sites. "West Texas" is as much as Haby would give CNBC, though if the name "Limpia Creek" is any indication, that would place them 100 miles due north of Big Bend National Park.
        His secrecy was par for the course that evening.
        Oilmen, turned bitcoin miners, Griffin Haby with Conner Murphree and Jordan Kuntz at one of their bitcoin mining sites in Texas.
        Bitcoin miner Alejandro de la Torre was born in Spain, but he's spent years minting bitcoin all over the world, most recently in China. When Beijing cracked down on all things crypto, De La Torre got a call from his boss at 3 A.M. telling him he had to go to Texas. He was in Austin the next day.
        Since then, he's been shipping his new-generation mining gear to the U.S. in bulk.
        "It's all through ships and from the Pacific side," De La Torre told CNBC. "The port depends on the location of where the rigs will end up."
        That was as much as De La Torre would divulge, because, as he explains it, any further details about the destination, or the gear itself, could give his competitors an edge.
        Bitcoin believers care a lot about privacy, as do the oil and gas guys. Some cited non-disclosure agreements as a reason to speak to CNBC in vague platitudes about business deals. Others were only willing to share their thoughts on the condition of anonymity. And some attendees worried about their job security should their employer find out they were there.
        These weren't tycoons -- they were mostly up-and-coming young execs, hungry to get ahead and make a name by taking a gamble on bitcoin mining.
        Oil and gas meets bitcoin For years, oil and gas companies have struggled with the problem of what to do when they accidentally hit a natural gas formation while drilling for oil. Whereas oil can easily be trucked out to a remote destination, gas delivery requires a pipeline.
        If a drilling site is right next door to a pipeline, they chuck the gas in and take whatever cash the buyer on the other end is willing to pay that day. "There's no choice. There's no middle finger. Whatever gas comes out that day has to be sold," explained Haby.
        But if it's 20 miles from a pipeline, things start to get more complicated.
        More often than not, the gas well won't be big enough to warrant the time and expense of building an entirely new pipeline. If a driller can't immediately find a way to sell the stash of natural gas, most look to dispose of it on site.
        One method is to vent it, which releases methane directly into the air '' a poor choice for the environment, as its greenhouse effects are shown to be much stronger than carbon dioxide. A more environmentally friendly option is to flare it, which means actually lighting the gas on fire.
        "Chemistry is amazing," explained Adam Ortolf, who heads up business development in the U.S. for Upstream Data, a company that manufactures and supplies portable mining solutions for oil and gas facilities.
        "When CH4, or methane, combusts, the only exhaust is CO2 and H2O vapor. That's literally the same thing that comes out of my mouth when I exhale," continued Ortolf.
        But Ortolf points out, flares are only 75 to 90% efficient. "Even with a flare, some of the methane is being vented without being combusted," he said.
        This is when on-site bitcoin mining can prove to be especially impactful.
        When the methane is run into an engine or generator, 100% of the methane is combusted and none of it leaks or vents into the air, according to Ortolf.
        "But nobody will run it through a generator unless they can make money, because generators cost money to acquire and maintain," he said. "So unless it's economically sustainable, producers won't internally combust the gas."
        A panel of bitcoin miners and oil & gas execs share what it's like to mine bitcoin in Texas.
        Bitcoin makes it economically sustainable for oil and gas companies to combust their methane rather than externally combust it with a flare.
        "There is no such thing as stranded gas anymore," said Haby.
        But Ortolf has taken years to convince people that parking a trailer full of ASICs on an oil and gas field is a smart and financially sound idea.
        "In 2018, I got laughed out of the room when I talked about mining bitcoin on flared gas," said Ortolf. "The concept of bringing hydrocarbons to market without a counterparty was laughable."
        Fast forward three years, and business at Upstream, a company founded by lead engineer Steve Barbour, is booming. It now works with 140 bitcoin mines across North America.
        "This is the best gift the oil and gas industry could've gotten," said Ortolf. "They were leaving a lot of hydrocarbons on the table, but now, they're no longer limited by geography to sell energy."
        It is also helping to curtail the overall carbon footprint of some of these oil and gas sites. Recent production stats show that in the U.S. alone about 1.5 billion cubic feet of natural gas is wasted on a daily basis. And these are just the reported numbers, so the actual figures are likely higher.
        Meanwhile, bitcoin miners get what they want most: cheap electricity.
        Voting out the hatersThe thing about all these grand visions for bitcoin mining '' to stay the course, it requires some manpower on Capitol Hill to safeguard its plan to scale. And right now, politicians in Washington are scrambling to figure out what and how to regulate cryptocurrencies and all the ancillary services that make up the wider ecosystem for digital currencies.
        That's why another big topic of conversation at the Houston Bitcoin Meeting was political activism.
        "Who knows a staffer or a representative?" one member of the crowd posed to the group. At least half a dozen people raised their hands and one stepped up to confirm they would reach out to their contact in Senator Cruz's office.
        There was a sense of momentum in the audience. Several people made the point that the bitcoin contingent across the country had paralyzed a $1 trillion rubber-stamped, bipartisan bill, no small feat for a voting bloc which hitherto hadn't been viewed as much of a threat on the Hill.
        But it's not just about being on the defensive for these tens of millions of voters and bitcoin faithful. They're going on the offensive by working to install like-minded people into office so that they can do something "before they do it to us," as one member of the audience said to the group. They're also teaching veteran lawmakers about bitcoin, as many representatives don't understand it.
        "We need to target anyone who is anti-bitcoin. There are 45 million of us in America, and we are not silent," said this same attendee.
      Crypto's Rapid Move Into Banking Elicits Alarm in Washington - The New York Times
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        Archived Version
        Sun, 05 Sep 2021 11:14
        BlockFi, a fast-growing financial start-up whose headquarters in Jersey City are across the Hudson River from Wall Street, aspires to be the JPMorgan Chase of cryptocurrency.
        It offers credit cards, loans and interest-generating accounts. But rather than dealing primarily in dollars, BlockFi operates in the rapidly expanding world of digital currencies, one of a new generation of institutions effectively creating an alternative banking system on the frontiers of technology.
        ''We are just at the beginning of this story,'' said Flori Marquez, 30, a founder of BlockFi, which was created in 2017 and claims to have more than $10 billion in assets, 850 employees and more than 450,000 retail clients who can obtain loans in minutes, without credit checks.
        But to state and federal regulators and some members of Congress, the entry of crypto into banking is cause for alarm. The technology is disrupting the world of financial services so quickly and unpredictably that regulators are far behind, potentially leaving consumers and financial markets vulnerable.
        In recent months, top officials from the Federal Reserve and other banking regulators have urgently begun what they are calling a ''crypto sprint'' to try to catch up with the rapid changes and figure out how to curb the potential dangers from an emerging industry whose short history has been marked as much by high-stakes speculation as by technological advances.
        In interviews and public statements, federal officials and state authorities are warning that the crypto financial services industry is in some cases vulnerable to hackers and fraud and reliant on risky innovations. Last month, the crypto platform PolyNetwork briefly lost $600 million of its customers' assets to hackers, much of which was returned only after the site's founders begged the thieves to relent.
        Image An ad for BlockFi at Union Station in Washington. Unlike a bank, BlockFi does not check credit scores, relying instead on the value of customers' cryptocurrency collateral. Credit... Samuel Corum for The New York Times ''We need additional authorities to prevent transactions, products and platforms from falling between regulatory cracks,'' Gary Gensler, the chairman of the Securities and Exchange Commission, wrote in August in a letter to Senator Elizabeth Warren, Democrat of Massachusetts, about the dangers of cryptocurrency products. ''We also need more resources to protect investors in this growing and volatile sector.''
        The S.E.C. has created a stand-alone office to coordinate investigations into cryptocurrency and other digital assets, and it has recruited academics with related expertise to help it track the fast-moving changes. Acknowledging that it could take at least a year to write rules or get legislation passed in Congress, regulators may issue interim guidance to set some expectations to exert control over the industry.
        BlockFi has already been targeted by regulators in five states that have accused it of violating local securities laws.
        Regulators' worries reach to even more experimental offerings by outfits like PancakeSwap, whose ''syrup pools'' boast that users can earn up to 91 percent annual return on crypto deposits.
        Treasury Secretary Janet L. Yellen and Jerome H. Powell, the chair of the Federal Reserve, have also voiced concerns, even as the Fed and other central banks study whether to issue digital currencies of their own.
        Mr. Powell has pointed to the proliferation of so-called stablecoins, digital currencies whose value is typically pegged to the dollar and are frequently used in digital money transfers and other transactions like lending.
        Image Jerome H. Powell, the chair of the Federal Reserve, has voiced concerns about innovations like stablecoins, even as the Fed and other central banks study whether to issue digital currencies of their own. Credit... Sarahbeth Maney/The New York Times ''We have a tradition in this country where, you know, where the public's money is held in what is supposed to be a very safe asset,'' Mr. Powell said during congressional testimony in July, adding, ''That doesn't exist really for stablecoins.''
        The cryptocurrency banking frontier features a wide range of companies. At one end are those that operate on models similar to those of traditional consumer-oriented banks, like BlockFi or Kraken Bank, which has secured a special charter in Wyoming and hopes by the end of this year to take consumers' cryptocurrency deposits '-- but without traditional Federal Deposit Insurance Corporation insurance.
        On the more radical end is decentralized finance, or DeFi, which is more akin to Wall Street for cryptocurrency. Players include Compound, a company in San Francisco that operates completely outside the regulatory system. DeFi eliminates human intermediaries like brokers, bank clerks and traders, and instead uses algorithms to execute financial transactions, such as lending and borrowing.
        ''Crypto is the new shadow bank,'' Ms. Warren said in an interview. ''It provides many of the same services, but without the consumer protections or financial stability that back up the traditional system.''
        ''It's like spinning straw into gold,'' she added.
        Lawmakers and regulators are worried that consumers are not always fully aware of the potential dangers of the new banklike crypto services and decentralized finance platforms. Crypto deposit accounts are not federally insured and holdings may not be guaranteed if markets go haywire.
        People who borrow against their crypto could face liquidation of their holdings, sometimes in entirely automated markets that are unregulated.
        From Pawnbroker to BankBlockFi's extraordinary growth '-- and the recent crackdown by state regulators '-- illustrates the fraught path of cryptocurrency financial services companies amid confusion about what they do.
        BlockFi's business is not dissimilar to that of a regular bank. It takes deposits of cryptocurrencies and pays interest on them. It makes loans in dollars to people who put up cryptocurrency as collateral. And it lends crypto to institutions that need it.
        For consumers, the main allure of BlockFi is the chance to take loans in dollars up to half of the value of their crypto collateral, allowing customers to get cash without the tax hit of selling their digital assets, or to leverage the value of holdings to buy more cryptocurrency. The company also offers interest of up to 8 percent per year on crypto deposits, compared with a national average of 0.06 percent for savings deposits at banks in August.
        How can BlockFi offer such a high rate? In addition to charging interest on the loans it makes to consumers, it lends cryptocurrency to institutions like Fidelity Investments or Susquehanna International Group that use those assets for quick and sometimes lucrative cryptocurrency arbitrage transactions, passing on high returns to customers. And because BlockFi is not officially a bank, it does not have the large costs associated with maintaining required capital reserves and following other banking regulations.
        Also unlike a bank, BlockFi does not check credit scores, relying instead on the value of customers' underlying crypto collateral. The company's executives argue that the approach democratizes financial services, opening them to people without the traditional hallmarks of reliability '-- like good credit '-- but with digital assets.
        The model has worked for BlockFi. It is hiring employees from London to Singapore, while prominent investors '-- like Bain Capital, Winklevoss Capital and Coinbase Ventures '-- have jumped in to fund its expansion. The company has raised at least $450 million in capital.
        But to regulators, BlockFi's offerings are worrying and perplexing '-- so much so that in California, where BlockFi first sought a lender's license, officials initially advised it to instead apply for a pawnbroker license. Their reasoning was that customers seeking a loan from BlockFi hand over cryptocurrency holdings as collateral in the same way that a customer might give a pawnshop a watch in exchange for cash.
        Ms. Marquez of BlockFi called the sheriff's office in San Francisco about a pawnbroker license, only to be redirected again. ''No, pawnbrokers' licenses are only for physical goods,'' she recounted being told. ''And because crypto is a virtual asset, this license actually does not apply to you.''
        Image Flori Marquez, right, is a founder of BlockFi, which says it has $15 billion in assets, 700 employees and more than 450,000 retail clients who can obtain loans in minutes, without credit checks. Credit... Desiree Rios for The New York Times Undeterred, she returned to the state's banking regulators and persuaded them BlockFi qualified as a lender, albeit of a new variety. The company now has licenses in at least 28 states, which it uses for cryptocurrency deposits from its more than 450,000 clients '-- many of whom are outside the United States. In the first three months of this year, the value of crypto held in BlockFi interest-bearing accounts more than tripled to $14.7 billion from $4.4 billion, a jump driven in part by the rise in the price of Bitcoin and other cryptocurrencies.
        As the company has expanded, regulators have become increasingly concerned. New Jersey's attorney general sent it a ''cease and desist'' letter in July, saying it sells a financial product that requires a securities license, with all the associated obligations, including mandated disclosures.
        ''No one gets a free pass simply because they're operating in the fast-evolving cryptocurrency market,'' the acting attorney general, Andrew J. Bruck, said.
        BlockFi does not adequately notify customers of risks associated with its use of their cryptocurrency deposits for borrowing pools, including the ''creditworthiness of borrowers, the type and nature of transactions,'' officials in Texas added in their own complaint, echoing allegations made by state officials in Alabama, Kentucky and Vermont.
        Zac Prince, BlockFi's chief executive, said that the company was complying with the law but that regulators did not fully understand its offerings. ''Ultimately, we see this as an opportunity for BlockFi to help define the regulatory environment for our ecosystem,'' he wrote in a note to customers.
        Breaking the Banking MoldThe regulatory challenge is even greater when it comes to other emerging crypto finance developers in the world of DeFi, such as Compound, SushiSwap and Aave as well as PancakeSwap.
        They are all essentially automated markets run by computer programs facilitating transactions without human intervention '-- the crypto-era version of trading floors. The idea is to eliminate intermediaries and bring together buyers and sellers on the blockchain, the technology behind cryptocurrency. The sites do not even collect users' personal information.
        Founders of those kinds of platforms argue that they are just building a ''protocol'' ultimately led by a community of users, with the computer code effectively running the show.
        Robert Leshner, 37, started Compound in 2018 after spending a year in a tiny attic office sublet in the Mission district in San Francisco with five colleagues, experimenting with a computer program that would become part of the foundation of the DeFi movement.
        Compound '-- backed by prominent crypto venture capitalists like Andreessen Horowitz and Coinbase Ventures '-- now has more than $20 billion in assets. Each of the nearly 300,000 ''customers'' is represented by a unique 42-character list of letters and numbers. But Compound does not know their names or even what country they are from.
        Mr. Leshner and others who helped set up Compound own a large share of its self-issued cryptocurrency token '-- known as COMP '-- which has surged in value, making him worth, at least on paper, tens of millions of dollars.
        Mr. Leshner has been startled by the rapid growth. ''At every juncture, the speed at which decentralized finance has just, like, started to work, has caught myself and everybody off guard,'' he said.
        Industry executives say concerns about the safety and stability of digital assets are overblown, but federal financial regulators are still working to get a handle on the latest developments.
        Image A Bitcoin mining factory in Florence, Italy. The cryptocurrency banking frontier features a wide range of companies. Credit... Alessandro Bianchi/Reuters DeFi protocols largely rely upon stablecoins, cryptocurrencies that are ostensibly pegged to the United States dollar for a steady value but without guarantees that their value is adequately backed.
        The overall market of stablecoins has ballooned to $117 billion as of early September from $3.3 billion in January 2019. That has regulators worried.
        ''These things are effectively treated by users as bank deposits,'' said Lee Reiners, a former supervisor at the Federal Reserve Bank of New York. ''But unlike actual deposits, they are not insured by F.D.I.C., and if account holders begin to have concerns that they cannot get money out, they might try and trigger a bank run.''
        One option worth considering, Ms. Warren said, is to ban banks in the United States from holding cash deposits backing up stablecoins, which could effectively end the surging market. Another possibility that some say could undermine the entire crypto ecosystem is the creation of a government-issued digital dollar.
        ''You wouldn't need stablecoins, you wouldn't need cryptocurrencies if you had a digital U.S. currency,'' Mr. Powell, the Fed chairman, said in July. ''I think that's one of the stronger arguments in its favor.''
      Anti-Abortion Whistleblowing Site Gets New Home With Provider Known for Hosting Extremists
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        Archived Version
        Sun, 05 Sep 2021 11:12
        An online whistleblower portal created to punish anyone providing abortion services in Texas has suffered another defeat in its quest to enforce the state's new six-week abortion ban as it was forced to disable the function allowing it to collect anonymous tips.
        The site, created by the evangelical group Texas Right to Life, had gotten the boot from hosting provider GoDaddy on Friday, but it had found a new home alongside neo-Nazis and white supremacists on Saturday. That's when Epik, a provider known for hosting right-wing extremist groups, welcomed ProLifeWhistleblower.com to its client roster, according to domain registration data cited by Ars Technica.
        By Saturday night, however, even Epik apparently saw the need to impose limits on what ProLifeWhistlerblower.com was doing.
        ''We received complaints about the site,'' a representative said in a statement late Saturday, noting that the site had ''violated Epik's Terms of Use.'' The specific violation was reportedly the collection of information on third-parties without their consent.
        ''We contacted the owner of the domain, who agreed to disable the collection of user submissions on this domain,'' the statement said.
        It was not immediately clear if the anti-abortion site could still solicit anonymous tips via email or other means.
        The move is just the latest fallout from the state's draconian ''Texas Heartbeat Act'' that took effect on Sept. 1, banning abortions outright after the sixth week of pregnancy'--before most women realize they are pregnant. Also known as SB 8, it was signed into law by Gov. Greg Abbott, a Republican, in May. And while there are loopholes for a mother whose life is in danger, the act does not include exceptions for rape or incest. In addition to targeting doctors who provide abortions, SB 8 also opens the door to lawsuits against insurance companies and even transportation services that might be involved at some point along the way.
        To facilitate enforcement of the law, Texas Right to Life set up a digital tip line that lets Texans file anonymous reports about suspected violations.
        ''The Texas Heartbeat Act is unique because it calls upon private citizens to hold abortion providers and their enablers accountable,'' the site explains (emphasis theirs). ''Any person can sue any abortion provider who kills an unborn child after six weeks of gestation'--and any person can sue anyone who aids or abets these illegal abortions. All of these individuals must pay damages to the person who sued them of at least $10,000 for each illegal abortion that they perform or assist.''
        Texas Right to Life says it ''will ensure that these lawbreakers are held accountable for their actions,'' the site continues. ''Use the links below to report anyone who is violating the Texas Heartbeat Act by aiding or abetting a post-heartbeat abortion. And report any person or entity that aids or abets (or that intends to aid or abet) an illegal abortion in Texas.''
        When a user clicks on the site's ''Send an anonymous tip'' button, a brief questionnaire appears asking for details. Users can also upload photos and video of any evidence that supports their claims. ''We will not follow up with or contact you,'' the site states.
        This week, the site was overwhelmed with obviously bogus tips about people like Gov. Abbott seeking abortions, Shrek porn, and countless copies of the screenplay for 2007's ''Bee Movie.'' Texas Right to Life reportedly had trouble keeping the site online due to the crush of traffic, an issue that appears to persist. Those attempting to access the site on Saturday from within Texas, as well as points further afield, were regularly met with an error message. When the site did occasionally work, trying to get past the homepage was often impossible.
        GoDaddy had informed Texas Right to Life late Thursday that it would no longer be hosted, and to find another provider within 24 hours.
        Texas Right to Life communications director Kim Schwartz on Friday wrote a blog post denouncing GoDaddy's decision to drop the site, complaining that ''keyboard warriors harassed GoDaddy'' to cut ties with the group.
        ''We will not be silenced,'' Texas Right to Life communications director Kimberlyn Schwartz told The Daily Beast in an email. ''If anti-Lifers want to take our website down, we'll put it back up. No one can keep us from telling the truth. No one can stop us from saving lives. We are not afraid of the mob. Anti-Life activists hate us because we're winning. Hundreds of babies are being saved from abortion right now because of Texas Right to Life, and these attacks don't change that.''
        According to Schwartz, GoDaddy ''neglected to specify'' which rules the site had broken. But GoDaddy told Ars Technica that ''the site violated multiple provisions,'' including one that forbids using GoDaddy to ''collect or harvest... non-public or personally identifiable information'' without ''prior written consent.''
        The site had then quickly moved to Epik, a hosting provider that has in the past worked with other entities no one else would touch, including alt-right Twitter clone Parler, internet hate speech haven 8Chan, and Gab, the social network favored by Pittsburgh synagogue shooter Robert Bowers.
        Epik's CEO is a Dutch-American businessman in his 50s named Robert Monster'--which is indeed his real name. After earning his MBA at Cornell University, Monster, who describes himself as a ''Christian Libertarian,'' went to work for Procter & Gamble as global product development manager for Pampers baby diapers.
        In 2007, he found religion.
        ''I came to the deeply-researched conclusion that the God of the Bible is in fact the Creator of the Universe, and that the decision to accept the free gift of salvation through the Lord Jesus Christ is the path to eternal life,'' Monster said in a 2016 interview cited by HuffPost that has now been taken down.
        Monster, who did not respond to multiple requests for comment, founded Epik two years later. One of Epik's selling points was that it would work with anyone who could pay, such as Alex Jones, the Sandy Hook truther behind conspiracy site Infowars. (Monster apparently draws the line at The Daily Stormer, a virulently anti-Semitic website he sent packing in 2019.)
        For now, Epik is among Texas Right to Life's only choices. But Schwartz said the group is still ''exploring various long-term plans for hosting.''
        Texas Right to Life will be celebrating the new law with a ''Celebration of Life'' on Sept. 18 at the Hilton Americas hotel in downtown Houston. It is selling corporate sponsorships for up to $50,000, according to a flyer for the event.
      Rolling Stone 'Horse Dewormer' Hit-Piece Debunked After Hospital Says No Ivermectin Overdoses | ZeroHedge
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 11:03
        After Joe Rogan announced that he'd kicked Covid in just a few days using a cocktail of drugs, including Ivermectin - an anti-parasitic prescribed for humans for over 35 years, with over 4 billion doses administered (and most recently as a Covid-19 treatment), the left quickly started mocking Rogan for having taken a 'horse dewormer' due to its dual use in livestock.
        Rolling Stone's Jon Blistein led the charge:
        On Friday, Rolling Stone's Peter Wade took another stab - publishing a hit piece claiming that Oklahoma ERs were overflowing with people 'overdosing on horse dewormer.'
        It was suspect from the beginning.
        The report, sourced to local Oaklahoma outlet KFOR's Katelyn Ogle, cites Oklahoma ER doctor Dr. Jason McElyea - claimed that people overdosing on ivermectin horse dewormer are causing emergency rooms to be "so backed up that gunshot victims were having hard times getting" access to health facilities.
        As people take the drug, McElyea said patients have arrived at hospitals with negative reactions like nausea, vomiting, muscle aches, and cramping '-- or even loss of sight.
        ''The scariest one that I've heard of and seen is people coming in with vision loss,'' the doctor said. -Rolling Stone
        Except, the article provided zero evidence for McElyea's claims, causing people to start asking questions.
        Good stock photo though: gun shot victims standing in line at the hospital while wearing winter coates in August. Total horse shit.
        '-- Dave Collum (@DavidBCollum) September 4, 2021And while neither KFOR or Rolling Stone mention the hospital McElyea worked for, NHS Sequoyah, located in Sallisaw, Oklahoma - just issued a statement disavowing McElyea's claims, which pops up when you visit their website.
        It reads:
        Although Dr. Jason McElyea is not an employee of NHS Sequoyah, he is affiliated with a medical staffing group that provides coverage for our emergency room.
        With that said, Dr. McElyea has not worked at our Sallisaw location in over 2 months.
        NHS Sequoyah has not treated any patients due to complications related to taking ivermectin. This includes not treating any patients for ivermectin overdose.
        All patients who have visited our emergency room have received medical attention as appropriate. Our hospital has not had to turn away any patients seeking emergency care.
        We want to reassure our community that our staff is working hard to provide quality healthcare to all patients. We appreciate the opportunity to clarify this issue and as always, we value our community's support.
        What about the rest of the state?
        According to Scott Schaeffer, managing director of the Oklahoma Center for Poison and Drug Information, "Since the beginning of May, we've received reports of 11 people being exposed to ivermectin," he told the NY Daily News (which still pushed the 'ivermectin overdoses' story despite this fact).
        Meanwhile, this horseshit story has also been picked up by the far-left Business Insider and The Independent, as well as The Guardian, among other notable outlets.
        Nobody even bothered to call the hospital where this guy claims to work. https://t.co/rCbgcvOoOa pic.twitter.com/wXjncinhQX
        '-- jimtreacher.substack.com (@jtLOL) September 4, 2021If Rolling Stone had only called the hospital to verify. Shocking.
        '-- R. W. Evans (@RealAngelof) September 5, 2021And of course, the story was breathlessly parroted:
        McElyea is also listed as working at Integris Grove Hospital in Grove, OK as a general family practitioner - not in the ER. A phone call to them provided no insight as to any ivermectin overdoses, however the gentleman who answered the phone sounded quite amused. What's more, Grove, OK - with a population of 7,129, had just 14 aggravated assaults in all of 2019 according to the FBI's latest data. We somehow doubt that 'gunshot victims were lining up outside the ER,' while just 11 ivermectin related hospital cases have been reported in the entire state since the beginning of May.
      Editorial: Nicotine and SARS-CoV-2: COVID-19 may be a disease of the nicotinic cholinergic system
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 04:20
        Journal List Toxicol Rep v.7; 2020 PMC7192087 Toxicol Rep. 2020; 7: 658''663.
        Konstantinos Farsalinosa,b,*aLaboratory of Mol. Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece
        bSchool of Public Health, Department of Public and Community Health, University of West Attica, 11521, Greece
        Konstantinos FarsalinosaLaboratory of Mol. Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece
        bSchool of Public Health, Department of Public and Community Health, University of West Attica, 11521, Greece
        Raymond NiauraDepartments of Social and Behavioral Science and Epidemiology, College of Global Public Health, New York University, USA
        Jacques Le HouezecLaboratory of Mol. Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece
        Anastasia BarbouniSchool of Public Health, Department of Public and Community Health, University of West Attica, 11521, Greece
        Dimitrios KouretasDepartment of Biochemistry and Biotechnology, University of Thessaly, Larisa, 41500, Greece
        Konstantinos PoulasLaboratory of Mol. Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece
        This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
        This article has been
        cited by other articles in PMC.
        1.'ƒIntroductionAs of 20 April, almost 1.7 million people globally have been diagnosed with Corona Virus Disease 2019 (COVID-19), a pandemic that has evolved from the emergence of a new coronavirus strain, acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in China. More than 170,000 deaths have been reported, while there are certainly many more cases of milder disease that have not been diagnosed and officially confirmed due to limited testing capacity in most countries. The pandemic is a global emergency due to the rapid transmission of the disease and the potential to overwhelm the healthcare systems, and is expected to have considerable economic and health impacts. Contributing factors and their possible role in the relatively high infection, death rates between countries and origin have recently been studied [1,2]. This new outbreak has been additionally evaluated for current knowledge on coronaviruses based on a short history to epidemiology, pathogenesis, clinical manifestation of the disease, as well as treatment and prevention strategies [3]. The search for potential protective and therapeutic antiviral strategies is of particular and urgent concern [4].
        While in most cases, especially in young people without any comorbidities, the disease is expected to be relatively mild, there is a substantial proportion of patients who develop complications and need intensive care-unit support and mechanical ventilation. In one case series of 1099 patients in China [5], 6.1 % of cases suffered from the primary composite end-point of admission to an intensive care unit, use of mechanical ventilation, or death. Patients with severe disease typically present with dyspnea and hypoxemia shortly after disease initiation, and may quickly progress to respiratory failure, acute respiratory distress syndrome (ARDS) and multi-organ failure [6]. Predictors of adverse outcomes include elevated levels of inflammatory markers and pro-inflammatory cytokines. A study of 150 COVID-19 cases reported that elevated levels of C-reactive protein (CRP), ferritin and IL-6 were associated with death [7]. IL-6, an important pro-inflammatory cytokine, was elevated in fatal cases of COVID-19 in another study of 191 patients [8]. Another study of 452 patients reported that those with severe disease showed lymphocytopenia, neutrophilia, low levels of monocytes, eosinophils and basophils, and elevated levels of infection-related biomarkers and inflammatory cytokines [9]. Pathological examination of a case in China revealed bilateral diffuse alveolar damage, desquamation of pneumocytes, hyaline membrane formation and interstitial mononuclear inflammatory infiltrates [10]. Flow cytometry of peripheral blood revealed reduced levels of CD4+ and CD8'‰+'‰T cells, which however were hyper-activated, and elevated concentration of pro-inflammatory CCR6+ Th17 in CD4'‰+'‰T cells. Such findings are hallmarks of ARDS and resemble features observed in SARS and Middle Eastern Respiratory Syndrome [11,12]. Systemic vasculitis was also observed [10]. Therefore, it seems that immune dysregulation may be implicated in the pathophysiology of severe COVID-19.
        2.'ƒCytokine stormWhile for decades common thinking suggested that every immune response to antigenic invasion was always beneficial in averting potential damage, studies in the 1980s identified that immune cells produce proteins with pleiotropic properties, having the potential to be either beneficial or harmful [13]. The proteins, called cytokines, were found to cause clinical manifestations similar to sepsis such as hemodynamic instability, fever, and localized inflammation [14,15]. Cytokines are important in mediating both immune cell recruitment and complex intracellular signaling control mechanisms that characterize inflammation and infection control. They are expressed by numerous cells, including macrophages, monocytes, B cells and T cells, promote differentiation of T-helper cells and stimulate CD4+ cells [16]. While activation of the immune system is important in fighting pathogens, dysregulation of cytokine production may lead to uncontrolled effects that can ultimately be detrimental to health [16,17].
        Cytokine storm (also called macrophage activation syndrome) is a systemic inflammatory response that can be triggered by a variety of factors such as infections and drugs [18]. It represents a failure of the inflammatory response to return to homeostasis. The resulting unregulated immune activity can potentially lead to catastrophic tissue damage. The term first appeared in 1993 in an article relevant to graft-versus-host disease [19]. Subsequently, cytokine storm was a phenomenon recognized in both viral and bacterial infections. It has been particularly studied in viral infections such as cytomegalovirus pneumonitis, influenza virus and SARS-CoV [[20], [21], [22], [23]]. Bermejo-Martin et al. [21] recruited both inpatients and outpatients during the first wave of the pandemic flu in 2009 (nvH1N1) and examined the effects of immune host responses to the evolution of mild or severe disease by measuring serum levels of several chemokines and cytokines. They found a dramatic increase of mediators that stimulate Th-1 and Th-17 responses (which are responsible for attacking intracellular pathogens and clearing pathogens during host defence reactions) among severe hospitalized patients compared to milder cases of nvH1N1 infection. The cytokine storm can result in acute lung injury and further progress to ARDS. This is characterized by local infiltration of inflammatory cells, increased vascular permeability and systemic spillover of inflammatory mediators that can cause systemic sepsis-like symptoms [23]. While focus on cytokine storm detection relies mostly on measuring cytokines in the systemic circulation, it has been suggested that measuring systemic inflammatory mediators may underestimate the extent of the immunological cascade that takes place locally in deep tissues such as the respiratory tract [23]. Considering the above, controlling the inflammatory response may be an effective way of preventing collateral damage caused by the excessive activation of the immune system to clear pathogens.
        3.'ƒCholinergic anti-inflammatory pathwaySince the early 2000s, the cholinergic nervous system has been identified as an important pathway that modifies and controls the inflammatory response. Surgical dissection of the vagus nerve in mice led to enhanced TNF production and excessive response to endotoxin administration, while vagus nerve electrical stimulation inhibits the synthesis of TNF and prevents the acute inflammatory response [[24], [25], [26]]. Several animal experimental models inducing pro-inflammatory cytokines, such as sepsis, ischemia-reperfusion and pancreatitis have shown that vagus stimulation improves outcomes. This effect is mediated by the nicotinic acetylcholine receptor (nAChR) Î±7 subunit on macrophages [27]. Mice deficient of the Î±7 subunit exhibited increased endotoxin-induced TNF production, and electrical vagus innervation failed to reduce serum TNF levels [27]. B-lymphocytes also express Î±7 nAChRs. Macrophages appear to be very sensitive to acetylcholine, which suggests that any source of acetylcholine, even from non-neuronal sources such as epithelial and endothelial cells, could also modulate the activity of adjacent macrophages [25]. Besides TNF, other pro-inflammatory cytokines are inhibited by acetylcholine, such as high mobility group B1 (HMGB1), IL-1, and IL-6 [28].
        Modulation of inflammatory and immune response by the central nervous system (CNS) through the vagus nerve is based on bi-directional communication between the immune and nervous systems. Afferent vagus nerve fibers, located in nucleus tractus solitarius, provide sensory input to the CNS about the inflammatory status that can result in the transmission of efferent signals, originating from the dorsal motor nucleus, to control the inflammatory response [29]. Such a response is rapid and localized, unlike the diffusible anti-inflammatory network, which is slow, distributed, non-integrated and dependent on concentration gradients [25].
        4.'ƒNicotine, nicotinic cholinergic system and COVID-19Smoking is known to increase the risk for respiratory infection susceptibility and severity [30,31]. Considering that COVID-19 was declared by the World Health Organization as a pandemic, a substantial disease burden would be expected among the estimated 1.1 billion smokers, especially in countries with high smoking prevalence. Therefore, there were understandable concerns about this population subgroup [32]. Additionally, smoking-related disease conditions such as cardiovascular disease and COPD are also established risk factors for adverse outcomes in COVID-19 [33]. China was the first country to be affected by the pandemic and has a high smoking prevalence. In 2018, the population smoking prevalence was 26.6 % with a much higher prevalence in men (50.5 %) than in women (2.1 %) [34]. Therefore, a high smoking prevalence among patients with COVID-19 would be expected, even if smoking did not adversely affect disease susceptibility and severity.
        On 23 March, a preliminary analysis by some members of our group examined data from 5 case series of hospitalized COVID-19 patients from China, and calculated a smoking prevalence of 10.2 % (95 % CI: 8.7''11.8 %) while the estimated expected prevalence was 31.3 % (95 % CI: 8.7''11.8 %) [35]. The analysis was further expanded on 3 April by examining 13 Chinese studies and 5960 hospitalized COVID-19 patients, with a pooled smoking prevalence of 6.5 % (95 % CI: 4.9''8.2 %) [36]. On that date, we presented for the first time a hypothesis about the potential beneficial effects of nicotine, which was subsequently expanded [37]. While there were limitations in the study analysis, mainly due to the inability to adjust for confounding factors, the findings of low smoking prevalence among hospitalized COVID-19 patients in China were consistent across all studies and in agreement with case series from USA [38,39]. The original hypothesis was based on the anti-inflammatory properties of nicotine through the cholinergic anti-inflammatory system, acknowledging that the disease appeared to involve a dysregulation of the immune response to viral invasion.
        It is obviously inappropriate to suggest that anyone should initiate smoking or continue to smoke, due to the well-established smoking-related morbidities and the large number of toxic chemicals in cigarette smoke. Furthermore, it is unlikely that any other compound in tobacco cigarette smoke, besides nicotine, would be implicated to the potential benefits observed in smokers. Moreover, due to the adverse effects of smoking and the fact that many smokers would suffer from co-morbidities (such as cardiovascular disease, COPD etc.), it is expected that the potential benefits of nicotine would be masked by the adverse effects of smoking.
        Nicotine is a cholinergic agonist. Therefore, it is an important inhibitor of pro-inflammatory cytokines acting through the cholinergic anti-inflammatory pathway via Î±7-nAChRs. Nicotine inhibits TNF, IL-1, IL-6 and HMGB1 while it does not inhibit anti-inflammatory cytokines such as IL-10 [28]. In vivo animal models have found nicotine to be protective against lipopolysaccharide-induced ARDS by reducing leukocyte infiltration and pro-inflammatory mediators in bronchoalveolar lavage fluid [40]. Such effects are relevant to COVID-19 since cytokine storm appears to be the hallmark in severe cases [41,42]. Several pro-inflammatory cytokines, such as IL-1Î², IL-2, IL-6, IL-17, IL-8, TNF and CCL2 are elevated in COVID-19 patients [43]. Treatment with anti-IL-6 anti-TNF medications has been proposed and clinical trials are already underway [44,45]. However, it may be more effective to inhibit several instead of selectively one cytokine, while some cytokine inhibitors are associated with elevated risk of opportunistic infections [46]. Also, it is possible that measuring blood levels of inflammatory cytokines does not accurately reflect the extent of the immune imbalance that exists locally in the lungs. In any case, the cholinergic anti-inflammatory system could provide better control and modulation of the cytokine response compared to blocking a single agent, and nicotine could effectively contribute to maintaining a balanced immune response against viral infection. Therefore, it is possible that the clinical manifestations of cytokine storm in COVID-19 patients are the result of dysfunction of the cholinergic anti-inflammatory pathway.
        SARS-CoV-2 is known to use the angiotensin converting enzyme 2 (ACE2) as a receptor for cell entry [47]. ACE2 has well-established vasodilatory, anti-inflammatory and antioxidant properties. Studies on smoking and ACE2 have reported contradictory findings. Studies published before the COVID-19 pandemic reported that smoking and nicotine down-regulate ACE2 [48,49]. However, more recent studies suggest that they up-regulate ACE2 [[50], [51], [52]]. There is currently no evidence to suggest that up-regulation of ACE2 is associated with increased COVID-19 susceptibility or severity. In fact, up-regulation of ACE2 appears to be protective against tissue damage caused by SARS-CoV-2. ACE2 has been found to protect mice from developing ARDS [[53], [54], [55]]. Data from SARS experimental studies suggest that continuous SARS-CoV-2 infection and replication induces immediate down-regulation of ACE2 that may be implicated in organ damage and disease severity [56]. Further support for the beneficial role of ACE2 comes from data that estrogens appear to up-regulate ACE2 while children and younger adults have higher ACE2 levels compared to older people [57,58]. At the same time, women, children and young people have milder COVID-19 symptoms. If accurate and verified, the recently-observed ACE2 up-regulation in smokers is probably induced as a defence mechanism to counteract the effects of angiotensin II. There is probably a dynamic balance between ACE and ACE2, which is continuously changing, depending on stressors and stimuli. Thus, there is uncertainty on whether nicotine affects COVID-19 progression through the renin-angiotensin-aldosterone axis and there is no known interaction between ACE2 and nAChR receptors.
        Importantly, ACE2 is expressed in several regions in the brain. The regions where vagal afferent fibers terminate and vagal efferent fibers originate exhibit ACE2 expression [59,60]. Neuroinvasion is a common feature of coronaviruses [61]. Anosmia and ageusia have been reported by COVID-19 patients [62]. SARS-CoV-2 may enter the CNS either through the blood stream or via the olfactory nerve across the cribriform plate [63,64]. A case series of 214 patients reported that 36.4 % had neurological manifestations [65]. Thus, it is possible that the virus might infect the terminal areas of vagus afferent fibers or the origin of vagus efferent fiber causing down-regulation of ACE2 and resulting in local inflammation that could disrupt the cholinergic anti-inflammatory pathway and dysregulate the inflammatory response. Nicotine could have protective properties against possible brain inflammation caused by SARS-CoV-2, mediated through Î±7-AChRs [66].
        A noteworthy parameter relative to anosmia and ageusia observed among COVID-19 patients is that these are characteristic and prodromal non-motor manifestations of Parkinson's disease [67,68]. While ageusia has not been extensively studied, olfactory disturbance is a very common feature, observed in up to 95 % of Parkinson's disease patients [68], and may appear several years before the onset of motor symptoms. There is no olfactory improvement with dopamine agonists [69,70]. Unlike the general population where smoking is associated with impaired olfactory function, smokers with Parkinson's disease experience less decline in olfactory sense compared to non-smokers, suggesting a protective effect of smoking [71]. This maybe explained by the fact olfactory loss has been linked to impairment of cholinergic transmission [72] while nicotine improved the olfactory impairment in a mouse model of Parkinson's disease [73]. The olfactory bulb has a rich network of nAChRs, but Î±7 nAChRs may also be expressed on the axon terminals of the olfactory receptor neurons [74]. While this may suggest facilitated brain infection through anterograde transport along the olfactory nerve, it is possible that olfactory receptor neurons may act as first-line viral sensors and initiate a rapid immune response [75]. This would explain the mild symptoms in COVID-19 patients with olfactory loss. In any case, anosmia may represent another sign of dysfunction of the nicotinic cholinergic system in COVID-19.
        A prominent feature of COVID-19 is coagulopathy that results in thromboembolic complications. Venous thromboembolism was reported in 25 % of patients who were not under thromboprophylaxis, and was associated with higher mortality rate [76]. Abnormal coagulation parameters were also associated with poor survival [77]. Although venous thromboembolism is a well-known complication of any serious infection, additional mechanisms such as endothelial damage, increased vascular permeability and microvascular occlusion may be implicated in COVID-19 [78]. It is important to note that platelets express functional Î±7-AChRs [79] while hematopoietic Î±7 nAChR deficiency increases inflammation and platelet activity [80]. Recently, acetylcholine was found to be an endogenous inhibitor of platelet activation [81]. Therefore, dysfunction of the nicotinic cholinergic system could be implicated in the thrombotic and vascular complications of COVID-19.
        5.'ƒCOVID-19 could be a disease of the nicotinic cholinergic systemThe observation of a low prevalence of hospitalized COVID-19 patients in China led to the development of a hypothesis that nicotine could have protective effects by enhancing the cholinergic anti-inflammatory pathway [36]. As more studies presented the clinical manifestations, laboratory findings and disease progression in COVID-19 patients, it became apparent that the nicotinic cholinergic system could explain most (if not all) of the disease characteristics. It would be unlikely for a single ''defence system'' to ameliorate all the diverse and complex manifestations of COVID-19, unless that ''defence mechanism'' was the target of the viral host. Could that be possible?
        SARS-CoV-2 appears to have originated from a bat coronavirus. Ji et al. [82] carried out comprehensive sequence analysis in conjunction with relative synonymous codon usage bias and reported that the virus may have been a recombinant virus between the bat coronavirus and an unknown-origin coronavirus [83]. One possible intermediate host could have been a snake. Taking into consideration that snake venom toxins are competitive antagonists of acetylcholine on Î±7-nACh receptor with high affinity, we decided to explore the hypothesis that SARS-CoV-2 may have acquired sequences by any of the potential, and not defined yet, intermediates through genomic recombination. We compared the protein sequences between SARS-CoV-2 and snake venom neurotoxins. We were able to identify regions with four or five amino acids identity between the coronavirus and several neurotoxin molecules (e.g. SARS-CoV-2 compared with Muscarinic toxin like protein, Fig. 1 A; SARS-CoV-2 and Cobrotoxin - Naja siamensis, Fig. 1 B).
        BLAST-P alignment of the SARS-CoV-2 protein against Muscarinic toxin like protein (A) and Cobratoxin (Naja siamensis) (B) indicating regions with relatively high identity.
        Therefore, we hypothesize that these, or other, sequences on the SARS-CoV-2 proteins, being similar to the active sites of a neurotoxin, can result in binding to nAChRs and may adversely affect their function by preventing the action of acetylcholine.
        6.'ƒNicotine as a potential treatment for COVID-19Nicotine could act as a competitive agonist for the nAChRs that could restore the compromised function of the nicotinic cholinergic system. This may be feasible through repurposing already approved (for other indications) pharmaceutical nicotine products such as nicotine patches for use by non-smokers, or even by using these products as already indicated (i.e. as smoking substitutes) among current smokers. These products are available over-the-counter in most countries. They have been administered therapeutically in non-smokers for neurological conditions and inflammatory bowel disease for larger periods than would be needed for COVID-19 [[83], [84], [85]]. No abuse liability was observed in non-smokers despite being administerd for several weeks [84,85]. Besides gums and patches, nicotine can be administered though inhalation, with the use of a nebulizer or other aerosol systems, if necessary. Nicotine administration could be added on top of antiviral or other therapeutic options for COVID-19. By restoring and re-activating the cholinergic anti-inflammatory pathway, a more universal suppression of the cytokine storm could probably be achieved compared to administering inhibitors of a single cytokine. The potential need to provide pharmaceutical nicotine products to smokers and users of other nicotine products who experience abrupt nicotine cessation when hospitalized for COVID-19 or aim to follow medical advice to quit smoking, should also be examined. If the hypothesis about the beneficial effects of nicotine is valid, smokers who quit nicotine use when hospitalized will be deprived from these benefits. In France, the Addiction Prevention Network (RESPADD) officially recommends the use of nicotine replacement therapies for smokers when hospitalized for any illness [86]. Clinical trials will dictate future approaches and the role of nicotine in COVID-19, while further experimental studies should examine the affinity of the virus to nAChRs.
        7.'ƒConclusionsIn conclusion, we noticed that most of the clinical characteristics of severe COVID-19 could be explained by dysregulation of the cholinergic anti-inflammatory pathway. The observation that patients eventually develop cytokine storm which results in rapid clinical deterioration, led to the development of a hypothesis about the series of events associated with adverse outcomes in COVID-19 ( Fig. 2 ).
        Progression of COVID-19 after SARS-CoV-2 infection.
        Once someone is infected with SARS-CoV-2, the immune system is mobilized. As the virus replicates, cell and viral debris or virions may interact with the nAChRs blocking the action of the cholinergic anti-inflammatory pathway. If the initial immune response is not enough to combat the viral invasion at an early stage, the extensive and prolonged replication of the virus will eventually disrupt the cholinergic anti-inflammatory pathway seriously compromising its ability to control and regulate the immune response. The uncontrolled action of pro-inflammatory cytokines will result in the development of cytokine storm, with acute lung injury leading to ARDS, coagulation disturbances and multiorgan failure. Based on this hypothesis, COVID-19 appears to eventually become a disease of the nicotinic cholinergic system. Nicotine could maintain or restore the function of the cholinergic anti-inflammatory system and thus control the release and activity of pro-inflammatory cytokines. This could prevent or suppress the cytokine storm. This hypothesis needs to be examined in the laboratory and the clinical setting.
        Ethics approval and consent to participateNot applicable.
        Consent for publicationNot applicable.
        FundingNo funding was provided for this study.
        Declaration of Competing InterestThe authors declare no conflict of interest.
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      Rural Oklahoma hospitals overwhelmed by people overdosing on ivermectin | Daily Mail Online
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 04:11
        Overdoses from anti-parasite drug ivermectin overwhelm rural Oklahoma hospitals - leaving gunshot victims waiting for emergency roomsHospitals in rural southeast Oklahoma are struggling with a surge of ivermectin overdose patientsSo many patients are coming in with overdoses of the horse-grade medicine that other serious injuries - like gunshot wounds - have to waitIvermectin is FDA approved for human use fighting some parasite-related conditions, but has not demonstrated that it can fight viruses in humansMany are purchasing versions of the drug meant for horses and other large animals, where doses are dangerous for humans By Mansur Shaheen For Dailymail.Com
        Published: 15:57 EDT, 3 September 2021 | Updated: 16:03 EDT, 3 September 2021
        So many rural Oklahomans are overdosing on horse medication that it is overwhelming local hospitals.
        Dr Jason McElyea, a physician from Sallisaw, Oklahoma in the Southeast of the state, told Oklahoma City's KFOR that hospitals in his region are being clogged with patients overdosing on ivermectin after using the drug to treat COVID-19.
        Many people are using ivermectin, which is FDA approved for human use in some situations, in doses meant for large animals like horses and overdosing.
        The volume of overdoses has become a problem for the whole community, as people needing treatment for other issues, like gunshot victims, are left waiting in peril for emergency room space.
        Dr Jason McElyea (pictured) told Oklahoma City's KFOR that so many people in his rural Oklahoma community are overdosing on ivermectin it is overwhelming some local hospitals
        'There's a reason you have to have a doctor to get a prescription for this stuff, because it can be dangerous,' McElyea told KFOR about the drug.
        '...the ERs are so backed up that gunshot victims were having hard times getting to facilities where they can get definitive care and be treated.'
        The surge in overdoses has led to ambulances being backed up with calls as well.
        'All of their ambulances are stuck at the hospital waiting for a bed to open so they can take the patient in and they don't have any, that's it,' the doctor told KFOR.
        'If there's no ambulance to take the call, there's no ambulance to come to the call.'
        Ivermectin is safe to use in doses of around 200 micrograms, and is often prescribed to people at those levels for conditions like onchocerciasis and lymphatic filariasis.
        It is not a treatment for viruses like Covid, though, and has never demonstrated an ability to fight viral infections in humans.
        The anti-parasite drug has been incorrectly deemed by some to be a potential treatment for COVID-19 after some misinterpreted a March 2020 study conducted in Australia.
        Ivermectin is FDA approved for human use in fighting some parasite-related conditions. It has no known ability to fight viruses in the human body
        Dr Timothy Geary, one of the world's foremost experts on the drug, explained to DailyMail.com that the concentrations of the drug used in the study, which did show ivermectin could inhibit virus replication, was so high it could not be used in a person.
        The drug can be dangerous is large doses and cause many potentially devastating side effects like blindness, nervous system damage or even death.
        McElyea reports that many in his community are using the drug at dangerously high doses.
        Many have failed to acquire the drug via prescription, and instead purchase veterinary versions of it over the counter at feed stores.
        A standard dose for a horse is much larger than a dose for a human, though, causing people to overdose when using versions of the drug made for livestock.
        'Some people taking inappropriate doses have actually put themselves in worse conditions than if they'd caught COVID,' McElyea said.
        He told KFOR that he has seen patients suffering from cramps, muscle aches, nausea and vomiting.
        The worst cases has has seen are people coming in with vision loss after taking the drug.
        McElyea reports that tractor store in his area have sold out of the drug, and he implores others in his community not to self-medicate using the potentially dangerous drug.
        'You have to ask yourself, 'If I take this medicine, what am I going to do if something bad happens?' What's your next step, what's your backup plan?' he said.
        'If you're going to take a medicine that could affect your health, do it with a doctor on board.
        '...It's not just something you look on the internet for and decide if it's the right dose.'
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      Long Island company shifts COVID-19 vaccine trial focus from cats to mink | Newsday
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        Archived Version
        Sat, 04 Sep 2021 19:09
        A Stony Brook company whose human COVID-19 vaccine was repurposed to treat cats has pivoted to a more promising animal market: mink farms.
        Applied DNA Sciences Inc. expects to begin the new animal trials in upstate Brewster this month, a company spokesman said.
        Mink, however, will not be used to test the vaccine. Instead, the trials will use ferrets because uninfected mink are scarce.
        "Ferrets are in the same family as mink," said James A. Hayward, chairman and chief executive of Applied DNA. "It's kind of hard to find mink that don't have it. So we're using ferrets as a surrogate for mink."
        The mink vaccine initiative comes as Applied DNA rolls out testing programs for Suffolk County Community College and the City University of New York:
        On Thursday, Applied DNA announced that its clinical labs subsidiary was awarded an initial one-year contract to monitor cases of COVID-19 among SCCC's unvaccinated staff and faculty. SCCC is a unit of the State University of New York, which requires all on-campus students to be fully vaccinated by Sept. 27. SCCC has about 2,000 full-time and adjunct faculty at its Selden, Brentwood and Riverhead campuses and about 25,000 full- and part-time students.
        In August, the company announced it had won a 12-month contract to carry out testing at the City University of New York. That contract, covering CUNY's 25 colleges, could be worth as much as $35 million.
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        "COVID testing and monitoring of populations is still extremely relevant," said Hayward. "We don't really know the penetration rates, especially in academic environments," of the Delta variant.
        After the pandemic struck, Applied DNA began developing a COVID-19 vaccine for humans with its Rome-based Italian partner, Takis Biotech. That effort was soon eclipsed by efforts of giant global pharmaceutical companies.
        In the fall of 2020, Applied DNA announced a plan to launch the feline vaccine trial with Evvivax S.R.L., a spinout of Takis Biotech.
        Hayward said the company remains interested in the feline market though coronavirus transmission has only been documented from human to cat and not cat to human.
        Those feline trials provided encouraging indications of the vaccine's efficacy, he said. "The work we've done with felines demonstrates our vaccine works very well."
        Results from the mink vaccine trial's first phase are expected to be complete around the end of the year and a second phase of the trial would be conducted in 2022. If the vaccine passes muster, the companies would apply to the U.S. Department of Agriculture for emergency use authorization.
        The ferret studies, run by Cornell University's College of Veterinary Medicine, will be so-called "challenge trials" in which healthy ferrets are vaccinated and then exposed to the coronavirus.
        Such challenge trials '-- whether for animals or humans '-- provide a shortcut to evaluating vaccines' effectiveness.
        In non-challenge trials, researchers vaccinate a group and track whether members of that group come down with the specified disease. They can then compare infection rates among that vaccinated group against the general population. Challenge trials, by contrast, provide direct evidence of a vaccine's protection.
        An Applied DNA spokesman said that if the vaccine is approved by the Department of Agriculture, the company would seek partners to market the drug to the roughly 275 mink farms in the United States and others in Europe.
        "The mink population in the U.S. and Europe has been devastated by the virus," he said.
        Mink production in the United States totaled 1.4 million pelts in 2020, a 49% decline from the previous year, according to the Agriculture Department's National Agricultural Statistics Service. The average price per pelt in 2020 was $33.70 versus $21.30 in 2019.
        An August report by the federal Centers for Disease Control & Prevention said that mink-to-human spread of the virus had been reported in Denmark, Poland, the Netherlands and possibly Michigan.
        Shares of Applied DNA shed 0.17% to close Wednesday at $5.87.
        Ken Schachter covers corporate news, including technology and aerospace, and other business topics for Newsday. He has also worked at The Miami Herald and The Jerusalem Post.
      South Australia drops vaccine requirement for truckers in wake of protests, freight delays
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        Archived Version
        Sat, 04 Sep 2021 18:57
        The state of South Australia has dropped the upcoming vaccine requirement for truckers in the wake of protests and freight delays.
        The regulation was set to go into effect on September 24th, and would have required truck drivers entering the state of South Australia to have received at least one COVID vaccine shot. Now, the regulation has been scrapped, but it is still unclear how much effect the planned trucker protests had on the sudden change of plans.
        According to XYZ News, ''yesterday's protests [in Australia] have taken a serious toll on people. There were mass arrests, mass fines, and completely unnecessary police brutality against people who were simply standing still in silence,'' as people stood together to support truckers and their medical freedom. Some of the demonstrations were even described as ''complete and utter chaos.''
        #BREAKING: Truck drivers are right now protesting over mandatory vaccination on the Gold Coast. @JessMillward9 #9News pic.twitter.com/EjU61I8Shu
        '-- 9News Queensland (@9NewsQueensland) August 29, 2021 Peaceful protest at Noosa.#IStandWithTruckies #COVID19 #COVID19Aus pic.twitter.com/zyhJb5yHYK
        '-- XYZ (@itsyourxyz) August 31, 2021@thedisrespectedtrucker3, a major promoter and apparent leader of the proposed American trucker protest for August 31st, has been banned on Tik Tok since the movement's rise in popularity, but that didn't stop some Americans from joining in the week of planned protests. Check out how these demonstrations went here.
        pic.twitter.com/ZWVj2z9V4C
        '-- The Disrespected Trucker (@DisrespectedThe) August 28, 2021Although the South Australia COVID vaccine requirement had not yet gone into effect, a Victoria regulation requiring truckers to have received a negative COVID test within 72 hours had drivers waiting in large queues at the border, and some were even turned away. These hurdles have already caused freight delays and labor shortages, which may have been a factor in the decision to eliminate the upcoming requirement.
        It is not yet clear if more Australian States will follow South Australia's decision to scrap the vaccine requirement for truckers.
      White House proposes removing penalties for fentanyl trafficking-related offenses | Fox News
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 18:54
        The White House on Thursday proposed removing certain penalties associated with trafficking of fentanyl-related substances (FRS), prompting criticism that it would weaken illicit drug enforcement.
        President Biden and former President Trump temporarily placed FRS under schedule I of the Controlled Substances Act. Thursday's proposal would make that change permanent while removing certain quantity-based mandatory minimums.
        In a letter to Senate leaders reviewed by Fox News, the Office of National Drug Control Policy (ONDCP) described the plan as the result of collaboration with the Justice Department (DOJ) and Department of Health and Human Services (HHS).
        "We are pleased to present to Congress a long-term, consensus approach that advances efforts to reduce the supply and availability of illicitly manufactured FRS, while protecting civil rights, and reducing barriers to scientific research for all schedule I substances," said ONDCP acting Director Regina LaBelle.
        CRUZ, ROY SLAM BIDEN ADMIN OVER 'MAN-MADE' BORDER CRISIS AS FENTANYL DEATHS SKYROCKET
        LaBelle added that "the proposal would exclude those FRS that are scheduled by class from certain quantity-based mandatory minimum penalties normally associated with domestic trafficking, and import and export offenses of CSA schedule I compounds."
        "It would further ensure that a federal court can vacate or reduce the sentence of an individual convicted of an offense involving an individual FRS that is subsequently removed or rescheduled from schedule I."
        Not all mandatory minimums would be excluded under the proposal. It notes that it wouldn't exempt "FRS offenses from existing mandatory minimums for cases where death or serious bodily injury can be directly linked to the FRS that was trafficked, as is the case for any other Schedule I or II controlled substance under 21 U.S.C. 841(b)(1)(C)."
        "The Justice Department reported only eight cases with FRS charges from the time temporary class scheduling was adopted in 2018 through December 2020, of which only a handful even included charges of quantity-driven mandatory minimums."
        Sen. Rob Portman, R-Ohio, applauded the Biden administration in a statement Thursday.
        He said: "It is time for Congress to permanently ban fentanyl-related substances, and I'm pleased that the Biden administration has put forward a proposal that is consistent with bipartisan legislation I have introduced '... Not only is a permanent solution critical in our battle against addiction in this country, but it is also vital in ensuring law enforcement can continue to protect our communities by bringing criminal actions against individuals who manufacture, distribute, or handle these deadly drugs."
        The White House's letter came amid a spike in fentanyl deaths, which some Republicans have blamed on the administration's border enforcement.
        April of this year alone saw a 233% increase in fentanyl seizures at the southern border, according to data released by U.S. Customs and Border Protection. Fentanyl, a dangerous opioid, is significantly stronger than heroin and the related opioid carfentanyl is even stronger than fentanyl.
        Sen. Tom Cotton, R-Ark., slammed the Biden administration's proposal for being soft on criminals who are pushing fentanyl and killing Americans.
        "Fentanyl analogues kill thousands of Americans each year. To protect our communities from the dealers pushing this poison, President Biden needs to keep them off the streets, not let them off the hook," said Cotton in a statement to Fox News.
        Sen. Chuck Grassley, R-Iowa, was similarly critical: "For months, I've been calling on the Biden administration to get serious about combatting fentanyl knockoffs, which led to a record number of overdose deaths in the United States last year," he said.
        "The plan, released mere weeks before a temporary scheduling authority expires, sets us up for a rushed process that doesn't allow for the methodical review that this issues demands. While the plan provides some greater certainty on how deadly fentanyl-like substances will be controlled, it appears that the Biden Administration cares more about avoiding new penalties than holding drug traffickers accountable for fueling an opioid epidemic that continues to destroy families and erode communities across the country."
        BORDER CRISIS: 233% INCREASE IN FENTANYL SEIZURES AT SOUTHERN BORDER
        A Senate aide also told Fox News the proposal wasn't serious and would encourage illicit drug labs. "This is not a serious proposal. It's nothing more than a compromise between mainstream Democrats and pro-crime Democrats, and would only encourage illicit Chinese drug labs to get creative again with new fentanyl variants," the aide said.
        The White House did not immediately respond to Fox News' request for comment.
        Thursday's proposal raises questions about how the Biden administration will continue the previous president's fight against an opioid epidemic that has ravaged communities across the U.S.
        In May, Biden extended a rule from Trump's DOJ by signing the Extending Temporary Emergency Scheduling of Fentanyl Analogues Act, which lasts until Oct. 22.
        LaBelle added that Congress should approve $41 billion in spending for national drug program agencies, as well as continue working on legislation designed to counter overdoses.
        CLICK HERE TO GET THE FOX NEWS APP
        "Expanding the nation's public health approach to substance use disorders and strengthening our public safety efforts to reduce the drug supply are essential parts of our strategy to bringing down the rates of overdose death," said LaBelle.
        "Acting to permanently schedule FRS, combined with historic investments in the addiction infrastructure, as well as efforts to tackle illicit finance and disrupt drug trafficking, will stand as the most comprehensive effort to address substance use and its consequences in our nation's history. In all these efforts, we look forward to working with Congress to support safe and healthy communities. Please do not hesitate to reach out if you have any questions."
        Fox News' Kelly Laco contributed to this report.
      Virus czar calls to begin readying for eventual 4th vaccine dose | The Times of Israel
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 18:41
        Israel's national coronavirus czar on Saturday called for the country to begin making preparations to eventually administer fourth doses of the coronavirus vaccine.
        ''Given that that the virus is here and will continue to be here, we also need to prepare for a fourth injection,'' Salman Zarka told Kan public radio.
        He did not specify when fourth vaccine shots could eventually be administered.
        Zarka also said that the next booster shot may be modified to better protect against new variants of the SARS-CoV-2 virus that causes COVID-19, such as the highly infectious Delta strain.
        ''This is our life from now on, in waves,'' he said.
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        termsZarka made similar comments in an interview with The Times of Israel last month.
        ''It seems that if we learn the lessons from the fourth wave, we must consider the [possibility of subsequent] waves with the new variants, such as the new one from South America,'' he said at the time.
        ''And thinking about this and the waning of the vaccines and the antibodies, it seems every few months '-- it could be once a year or five or six months '-- we'll need another shot.''
        Zarka said that he expects that by late 2021 or early 2022, Israel will be giving shots that are especially adapted to cope better with variants.
        Israel '-- the first country to officially offer a third dose '-- began its COVID booster campaign on August 1, rolling it out to all those over the age of 60. It then gradually dropped the eligibility age, expanding it last week to everyone age 12 and up who received the second shot at least five months ago.
        As of Friday, over 2.5 million Israelis had received the third dose.
        Israelis receive their third dose of the COVID-19 vaccine at a Clalit clinic, on September 1, 2021, in Jerusalem. (Olivier Fitoussi/Flash90)
        The Health Ministry last week also announced that the ''Green Pass'' system '-- a document that allows entry into certain gatherings and public places for those who are vaccinated or have recovered from the coronavirus '-- will expire six months after the holder received their second or third dose, hinting that a fourth dose may be administered in six-months time.
        On Friday, the Health Ministry reported 11,269 new coronavirus infections the day before. Thursday's figure was slightly below the daily record of 11,274 infections confirmed on Wednesday.
        Despite surging infections, serious cases have begun falling since peaking at 753 on Sunday, with the Health Ministry reporting that 654 people were in serious condition from COVID-19 complications as of Friday afternoon.
        The positive test rate on Thursday was 8.43 percent, the highest it has been during the current wave of morbidity.
        The death toll stood at 7,129.
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      Tim Cook gets letter from Apple employees demanding changes | Fox Business
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 18:14
        Published September 03, 2021
        Apple workers voiced concerns over diversity and privacy issues at the workplaceFOX Business' Susan Li and Constellation Research CEO Ray Wang discuss Apple's business model.
        A group of Apple employees sent an open letter to CEO Tim Cook and the rest of the company's senior leadership team on Friday, presenting a litany of grievances along with demands for addressing the issues.
        "Apple prides itself on its commitment to diversity, equity, and an environment where every person is able to do their best work; however, in practice, this is far from the case," the letter begins. "Our experiences with the People team in dealing with harassment and discrimination have left many of us more vulnerable."
        Ticker Security Last Change Change % AAPL APPLE, INC. 154.30 +0.65 +0.42% Tim Cook Apple Keynote (Photo courtesy of Apple)
        WHAT DATA APPLE AND GOOGLE COLLECT ON YOU
        The letter was published on the website #AppleToo, which was formed by Apple employees just a few weeks ago for the purpose of collecting accounts of workplace discrimination and harassment at the tech behemoth. But the demands spelled out in the letter extended beyond those topics.
        The workers began by protesting Apple's purported policy of encouraging employees to link their personal iClouds to work devices, calling it "an unacceptable violation" of their privacy. "Workers who require devices should have a dedicated number and be allowed a personal device unlinked from Apple's corporate ecosystem, including not publishing personal phone numbers in Apple Directory," the petition argues, saying that "employees have been harassed on their personal phone numbers as a result of this policy."
        The second demand calls for the company to "provide transparent livable, equitable, and fair compensation across all of Apple," in part by auditing "all promotions and performance reviews for gender, racial, disability, and heteronormative biases that may lead to wage gaps and a lack of opportunity and compensation within the company in each part of it." The workers further asked that Apple "provide a transparent feedback loop into how these issues will be addressed long-term within the scope of Inclusion & Diversity."
        Another demand was for Apple to audit all its third-party relationships. The employees declared that "Apple contract workers often feel like second-class citizens, and are afforded fewer worker protections than full-time, salaried workers." As a remedy, the letter called for "more in-depth supplier responsibility reports, especially for agencies in administrative and corporate roles, and that Apple ensure all contract providers are paying above the living wage calculated for their geographic location, and providing benefits such as healthcare, paid leave, and other wellness benefits designed to ensure the physical and mental wellbeing of all workers."
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        It went on to call for "an unbiased third-party audit of Apple's reporting structure, People and Employee Relations teams, Business Conduct, and all executive leadership," along with asking for the company to "provide a process for group concerns to be heard with a transparent feedback loop."
        Meanwhile, the U.S. National Labor Relations Board (NLRB) is investigating two complaints made by Apple employees against the company recently for alleged harassment, stopping employee discussions about wages, and other charges.
        Apple did not immediately respond to FOX Business' request for comment on the letter, but in reaction to the investigation from the NLRB the firm told Reuters last month, "We take all concerns seriously and we thoroughly investigate whenever a concern is raised."
      Text of H.R. 5123: American Freedom and Internet Access Act of 2021 (Introduced version) - GovTrack.us
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        Archived Version
        Sat, 04 Sep 2021 17:56
        I
        117th CONGRESS
        1st Session
        H. R. 5123
        IN THE HOUSE OF REPRESENTATIVES
        A BILL
        To direct the Secretary of the Air Force to develop and begin implementation of Operation Starfall.
        1.This Act may be cited as the American Freedom and Internet Access Act of 2021 .
        2.Not later than 45 days after the date of the enactment of this Act, the Secretary of the Air Force, in consultation with the Chief of Space Operations, shall develop and begin implementation of Operation Starfall, a strategic plan to deploy stratospheric balloons, aerostats, or satellite technology capable of rapidly delivering wireless internet anywhere on the planet from the stratosphere or higher.
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      Americans will 'likely' need 3rd Covid shot to qualify as 'fully vaccinated,' Fauci says as booster battle rages at FDA '-- RT USA News
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        Archived Version
        Sat, 04 Sep 2021 17:48
        What it means to be ''fully vaccinated'' is set to change, Covid adviser Anthony Fauci said, suggesting the standard regimen will soon include three doses, amid reports that FDA staff voiced concerns over a rushed booster roll-out.
        While Fauci noted that the decision will ultimately be left up to federal health agencies, he told reporters at a Thursday press briefing that he believes an additional dose will ''likely'' be needed for Americans to be considered ''fully vaccinated'' in the near future, citing recent data out of Israel.
        ''From my own experience as an immunologist, I would not at all be surprised if the adequate, full regimen for vaccination will likely be three doses,'' he said, adding that the booster data from Israel showed a ''very clear'' and ''dramatic'' improvement in protection.
        Israel has seen a significant decline in vaccine effectiveness over time, reporting a major spike in serious illness among the fully-vaccinated (under the previous two-dose definition) beginning in July. However, Fauci pointed to a study based on data from about 1 million Israelis aged 60 and older that suggested a third dose of the Pfizer jab had ''substantial positive impact,'' resulting in a ten-fold reduction in severe illness.
        While Fauci stressed that the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) have yet to reach a final verdict on boosters, he said there is ''good reason to believe'' that third doses will not only produce a ''strong'' immune response in recipients, but a ''durable'' one.
        ''And if it is durable, then you're going to have very likely a three-dose regimen being the routine regimen. But we'll just have to wait to make sure that's the case when the data gets presented to the FDA,'' he said.
        Also on rt.com Top FDA vaccine regulators rush for the exits, resign posts as Biden jumps the gun on booster jabs However, though the Joe Biden administration has already begun promoting boosters '' with the president himself telling all American adults to receive their third shot within eight months of their last dose '' the move has stirred controversy among federal regulators and concerns the White House is moving too quickly on its booster campaign.
        Earlier this week, two top executives involved in vaccine research and testing at the FDA resigned, reportedly in protest over a number of blunders made by regulatory agencies, with Biden's rushed booster announcement being a last straw. He made the address ahead of official approval from the FDA, though the agency had previously backed boosters for those with compromised immune systems and has since acknowledged declining vaccine-induced immunity in the US.
        Fauci himself was previously hesitant about additional vaccine doses, saying in July that it was far too soon to discuss boosters, and even stating that Pfizer CEO Albert Bourla had apologized to him for publicizing the company's work on a third shot at such an early stage.
        By mid-August, however, the health adviser changed his stance significantly, instead arguing that Americans would ''inevitably'' need boosters. ''No vaccine, at least not within this category, is going to have an indefinite amount of protection,'' he said at the time.
        According to the CDC, nearly 175 million Americans, or just over 52% of the population, have been 'fully' vaccinated under the current two-dose regimen (or one-dose for Johnson & Johnson's formula). 'Full' vaccinations among the most vulnerable age group, those 65 and older, is now just shy of 82%.
        Also on rt.com 'Political disaster for Biden': Fauci's prediction that Covid won't be beaten until 'Spring 2022' met with horror, even at CNN Think your friends would be interested? Share this story!
      'Isis-inspired lone wolf' shot dead after stabbing six innocent shoppers, man was 'known threat'
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        Sat, 04 Sep 2021 17:46
        The man who stabbed six innocent supermarket shoppers today in a terrorist attack - before being shot dead by police - was an "Isis-inspired known threat" who was under "constant police surveillance", Prime Minister Jacinda Ardern says.
        The man was a known threat risk since 2016 and had been previously arrested for allegedly planning a "lone wolf" knife attack.
        He cannot currently be identified because of court suppression orders - but the work is already under way tonight to unmask the man.
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        STORY CONTINUES
        "The Crown is seeking the courts' urgent lifting of the suppression orders, which will be filed this evening," a spokesperson for the Prime Minister said tonight.
        Police were following the man after he left home and walked into the New Lynn Countdown this afternoon - before he took a knife from a shelf, and carried out the attack.
        Three of the six shoppers are in a critical condition in hospital.
        "This was a violent attack on innocent New Zealanders, it was senseless," said Ardern. "It was undertaken by an individual who was a known threat."
        The man was under watch because of his extremist views and sympathies with Isis.
        "The terrorist is a Sri Lankan national who arrived in 2011," Ardern said.
        Police Commissioner Andrew Coster said the man was "closely watched by surveillance teams and a strategic tactical team" as he travelled from his home in Glen Eden to Countdown in New Lynn this afternoon.
        He took a knife from a shelf in the supermarket before carrying out the attack. He was shot and killed by police within 60 seconds.
        The reality is when you are surveilling someone on a 24 hour basis it is not possible to be immediately next to them," Coster said.
        "I want to acknowledge the six New Zealanders injured," Ardern said. Three were in a serious condition.
        "The terrorist is a Sri Lankan national who arrived in 2011," said Ardern
        Ardern said there was information about him is covered by court suppression orders, she said.
        But the Herald has previously reported the case of the man - a known Isis sympathiser whom the police had previously arrested for allegedly planning a "lone wolf" knife attack.
        "We have utilised every legal and surveillance power available to us to keep people safe from this individual," Ardern said, adding the man became a person of interest in 2016.
        There would be multiple inquiries following today's terror attack, Ardern said, those by the IPCA and coroner.
        "What happened today was despicable, it was hateful it was wrong. It was carried out by an individual, not a faith, not a culture, not an ethnicity, but an individual person who is gripped by an ideology that is not supported here by anyone."
        Ardern said she intended to wait for the reports to release any information she could.
        "He alone carries the responsibility for these acts. Let that be where the judgment falls," Ardern said.
        The man was fatally shot by police officers while three of the six shoppers are understood to have suffered life-threatening injuries in the horrific scenes.
        The three critical patients, and another in a serious condition, have been taken to Auckland City Hospital. One person is in a moderate condition is at WaitÄkere Hospital, and another is in a moderate condition at Middlemore Hospital.
        "As the commissioner has said there was nothing to indicate that what he did today was going to happen today," Ardern said.
        Ardern said she had been advised that she could not share the timeline of the man's interaction with the state - including whether he had recently been released from prison.
        Asked why six people were able to be injured before he was shot - when he was under surveillance - Coster said the man was very "surveillance conscious" and police had to keep some distance from him to make surveillance effective.
        A brave bystander at the mall helped a wounded woman who had been stabbed in her right hip.
        Asked again why somebody who was deemed a threat to national security was allowed in the community, Coster said police had done as much as they were able to under the law.
        Ardern said the man held a 'violent, Isis-inspired' ideology but said she did not expect a backlash in the community.
        "That would be wrong, that would be absolutely wrong - the community here has been nothing but supportive," Ardern.
        Ardern was not sure when the suppression orders would be able to get lifted.
        Ardern said it was "speculative" that today's actions could have been prevented by anti-terror law changes that are currently before Parliament but not yet passed.
        Ardern was confident he was a lone wolf.
        As people scrambled to evacuate others yelled "he's got a gun" and the injured woman got up and fled the scene.
        A witness told the Herald their adrenaline was still pumping after the horrific attack.
        Auckland City Hospital has multiple operating theatres running to treat the injured - who have suffered chest and neck wounds. Two major abdominal cavity surgeries are under way, the Herald has been told.
        Ardern said the terror alert level would remain at medium.
        There were "very few" people in the same category as the man.
        "I can tell you that agencies were using every single possible means available to them to protect the New Zealand public form this individual - every single possible means" Ardern said.
        Ardern would not say whether he was a citizen, or what his immigration status was. She said she would reveal as much as she could when she was able to.
        "I was absolutely gutted," Ardern said. "The reason he was in the community was because of his inability through the law to have him anywhere else."
        "We used every element and lever in the law that was available, and when he was in the community there was constant monitoring," Ardern said.
        Coster said the surveillance was being undertaken as a "public safety operation".
        Ardern said: "If we had reached a threshold for him to be in prison, he would have been in prison."
        SIS reportThe 2020 annual report of the SIS said: "During the past year, between 30 and 50 individuals have been under active investigation by the NZSIS in relation to violent extremism at any one time."
        The number was higher than in recent years, the report said, due to investigations into politically-motivated violent extremism, including white identity extremism.
        "That said, faith-motivated violent extremism continues to appeal to a minority of individuals in New Zealand.
        "Over the last year we observed individuals in New Zealand with probable intent and almost certainly the capability to engage in acts of politically-motivated violent extremism and faith-motivated violent extremism.
        "Terrorist violence is most likely to come from lone actors, including those who may mobilise to violence rapidly with little or no warning. Our active investigations include a small number of New Zealanders who are believed to remain in Syria or Iraq with ISIL or other extremist groups."
        Terror expert Dr John Battersby said the Government had been "pedestrian" in dealing with the Terrorism Suppression Act.
        "It doesn't surprise me. We have lulled ourselves into a false sense of security that Christchurch was an abhorrent action," he told Newstalk ZB's Heather Du Plessis-Allan.
        "We need to look at the powers and resources that our intelligence agencies have."
        Countdown won't open until 10am SaturdayEvery Countdown supermarket in New Zealand will not open until 10am tomorrow.
        "We are devastated by this violent attack in our Lynn Mall store today," a spokeswoman said.
        "Our whole team will be deeply affected by what has happened, and we want them to have a chance to talk and to get the support they need."
        Auckland Mayor Phil Goff vents frustrationAuckland Mayor Phil Goff says it's frustrating not all the details of the attacker can be revealed because of a court order.
        He knew nothing about the individual beforehand. But he said from his experience in government, the amount of people like this individual being monitored are extremely few.
        "What's frustrating for all of us who have just listened to the Prime Minister and the police commissioner, is that they were constrained from sharing all of the information that they know about this individual, because of a court order, and I understand that the Prime Minister of all people have to live under the law, and cannot go outside the law.
        "But what is clear about it is that this person is an ideologically motivated terrorist... It's appalling that he could cause so much hurt in the space of a minute, just with a knife. But I guess the police interceded as quickly as they were able and ultimately, he has paid the price of his actions."
      The COVID-19 Tyranny of the Anointed '' Brendan Patrick Purdy
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        Archived Version
        Sat, 04 Sep 2021 17:31
        Dr. Anthony Fauci, Director of the National Institute of... moreA vision is a pre-analytic, cognitive act that is a human's sense of how the world works. While visions themselves are subjective, the theories that spring from them can be evaluated objectively. Thomas Sowell's informal trilogy of A Conflict of Visions, The Vision of the Anointed, and The Quest for Cosmic Justice discuss two conflicting social visions. The unconstrained (or anointed) vision is when someone believes that an individual can overcome self-interest through reason, and that knowledge and expertise are limitless; or at least they are among the anointed themselves. The constrained (or tragic) vision believes the opposite, viz. reason cannot defeat self-interest and there are limits to human knowledge and expertise. Throughout his brilliantly prophetic trilogy, Sowell uses several case studies to illustrate the failures of the anointed and draws the following pattern.
        In Stage 1, the anointed declare a negative societal situation a crisis while with Stage 2 there is an unconstrained solution that purports to solve the crisis. Those who have the tragic vision criticize the proposed solution, warning that instead of giving a solution to the so-called crisis, it will instead cause unintended and detrimental consequences. The inevitable Stage 3 comes after the policies of the anointed go into effect, and the tragic results occur. When the anointed are confronted with the detrimental results, their response in Stage 4 is two-fold: First, the benighted are accused by the anointed as being simplistic and ignoring the complexities involved, thus placing the burden of proof on the benighted critics to demonstrate with certainty that these policies alone caused a worsening of the crisis. Second, the anointed claim that the situation would have been worse if not for their bold and wonderful actions. While Sowell's own examples in the trio of books fit this pattern, it is worth considering if this pattern holds for the current Crise du Jour, viz. COVID-19. Not only will this allow us to test Sowell's theory as he believes all social theories should be, but it also allows us to understand why governments have responded the way they have to this pandemic. We'll primarily focus on the responses by different levels of the American government.
        Four Stages: A COVID-19 Case Study
        Stage 1: The Crisis. In December of 2019, a coronavirus disease was discovered in Wuhan, China. With COVID-19 being both contagious and novel, it spread around the world causing uncertainty and concern. While COVID-19 is undoubtedly dangerous to the elderly and those with certain underlying health conditions, there was a pronounced panic about the number of cases of the virus among many governments.
        Stage 2: The Solution. To flatten the curve in mid-March of 2020, there would be mandatory and universal lockdowns of society, and if one was able to participate in society at all, then a mask would be required. During that time, there were many skeptics, particularly as the two weeks stretched to months and the anti-COVID policies became more draconian and Byzantine. These COVID-response skeptics all share the constrained vision to some extent, even if they disagree on any number of political and social issues. Here is a but a sample from Spring 2020: Bethany S. Mandel warned on Twitter of the dangers to the economic, medical, and social health of people. Tucker Carlson worried about the one-size-fits-all COVID response from the government. David Harsanyi argued against the Coronavirus authoritarianism, especially on the state level. Betsy McCaughey discussed who is in danger from COVID-19, and who is not.
        Stage 3: The Results. As the benighted pundits predicted, the lockdowns and masking led to unintended detrimental consequences. Most significantly, the lockdowns were double-barrel shotgun blasts'--they failed to stop the spread and destroyed parts of civil society. By late 2020, enough time had passed since mid-March to carefully evaluate the lockdowns and to declare them a failure. Sowell notes that one of the differences between the unconstrained and constrained visions is that the former considers solutions while the latter considers tradeoffs. John Tierney in City Journal and I in these pages made this very point by arguing that the legacy of the lockdowns after six months is that there are tradeoffs between safety and freedom. However, the anointed does not countenance tradeoffs since those necessitate compromise, which goes against his authoritarian impulses. It has now been well over a year since the initial lockdowns and there is even more evidence that the lockdowns have failed. Tierney's more recent CJ piece is excellent as is data maven Matt Shapiro's on his Substack.
        Stage 4: The Response. The anointed have responded to these inconvenient facts by name-calling, lying, claiming things are better than they would have been (while ignoring evidence to the contrary, including the cases of Sweden or Florida), changing policies, and doubling-down. These responses answer neither the critiques in Stage 2 nor the facts in Stage 3. However, the anointed do not need to respond in good faith because not only has the solution changed since it was first offered in March of 2020, but so has the crisis.
        The original solution of flattening the curve (for two weeks!) meant spreading out the number of cases so that hospitals could have time to prepare and respond to the pandemic. Flattening a curve does not mean that there will be fewer cases, just that the cases will occur over a longer period. Regardless, ''flatten the curve'' became ''destroy the curve.'' An extreme example of this is that Australia seems presently to have the goal of no cases.
        For the unconstrained vision, whenever there is a conflict between purported safety and actual freedom, the never-delivered promise of safety is always the solution.
        An Exemplar of the Anointed
        Anthony Fauci, the Chief Medical Advisor to the President and the Director of the National Institute of Allergy and Infection Diseases, has become a household name during the pandemic. Regardless of whether Fauci has been generally correct or incorrect during the pandemic with respect to COVID-19 virology, he epitomizes the anointed when it comes to how governments should respond. Of the many examples of this, I'll take one of his latest: ''I'm sorry, I mean I know people must like to have their individual freedom and not be told to do something, but I think we're in such a serious situation now that, under certain circumstances, mandates should be done.'' In Sowellian fashion, let's dissect this sentence, giving Fauci some benefit of the doubt with his verbiage since he stated this during an interview.
        The proclamations of the anointed will be couched in emotional terms such as ''I'm sorry'' and an expression of empathetic understanding regarding the feelings of the tragic. This is cynical for the following reasons. The anointed do not care about the benighted. Also, note how an objective unalienable right becomes a subjective feeling in Fauci's description of individual freedom. Once the unalienable is declared alienable, then Fauci slips naturally into the four stages of the unconstrained vision. There is not a tradeoff between freedom and mandates for the anointed Fauci, the mandates are the solution. In Fauci's COVID calculus, freedom is irrelevant.
        For the unconstrained vision, whenever there is a conflict between purported safety and actual freedom, the never-delivered promise of safety is always the solution. One can take the anointed view in favor of gun control and change a handful of terms and get the anointed arguments in favor of COVID-19 mandates: vaccine passports are background checks, lockdowns are the waiting periods, and masks are restrictions on magazines. Let's repeat Fauci's quote, but change ''mandates'' to ''banning guns,'' ceteris paribus: ''I'm sorry, I mean I know people must like to have their individual freedom and not be told to do something, but I think we're in such a serious situation now that, under certain circumstances, banning guns should be done.''
        Cosmic Justice and COVID-19
        Sowell states that there are two types of justice. Traditional justice is a process where all who go through it are treated with the same impartiality. Regardless of the outcome (guilty or innocent), a trial is just if the judge treats everyone fairly and the jury is impartial. Yet when the anointed speak of justice, they are referring to cosmic or social justice. This unconstrained type of justice seeks to create equality for selected groups. While we are likely all too familiar with the Social Justice Warrior wokeness with respect to subjective claims about race, class, and gender, the anointed's response to Covid-19 is also a manifestation of the quest for cosmic justice.
        Since the anointed believe in solutions (which only they can divine) and not in tradeoffs, they refuse to consider that, for example, affirmative action results in others being excluded who are otherwise deserving. Likewise, the elderly and those with pre-existing conditions are playing the role of the ''traditionally underrepresented groups'' in the Coronavirus morality play. As such, in the name of cosmic justice, they need to be equal with all of those who are at little-to-no risk of getting sick or dying from COVID-19. In this case, the anointed cannot artificially bring those who are in the high-risk group to the low-risk group. Even the anointed do not have the chutzpah to make someone younger or have someone lose 100 pounds. The anointed can, however, force all of those who are at low risk to suffer through the same extreme measures. Hence, lockdowns, masks, and now even vaccines become universal. It is an affirmative action of making all suffer in the name of the few.
        For months, one could neither visit a loved one in a nursing home nor send a child to school. Olympic swimmers who are vaccinated and get frequent COVID testing had to wear masks immediately before and after getting into the water since someone watching the games on television must wear a mask when he goes to the store to buy a case of cigarettes. It is not fair that the Coronavirus does not kill all people with the same probability. Rather than rejoice that some demographics, particularly young children, are spared the horrors of the virus, the Molochian god of the unconstrained vision demands their sacrifice at the altar of equality.
        The Tyranny of the Anointed
        With a study of Sowell's trilogy, none of what has transpired in the last 18 or so months with respect to the government and the pandemic is surprising. The constrained virtues of life, liberty, and the pursuit of happiness are anathema to the unconstrained vision since they are rights of the individual that are primordial to the State. The anointed cannot admit that such rights exist since that would logically put limits on their power. They reject rights such as speech and due process that come from the natural law by declaring them to not be true rights at all. They are replaced with pseudo-rights like the ''right to housing'' or ''right to health care'' that come from the State and are controlled by the anointed. Those with the tragic view understand that any purported right that is created by the State can be dismantled by the State or used by the State to enslave the individual.
        Like Daniel, Sowell sees the writing on the wall: the unconstrained vision of the anointed inevitably results in tyranny. The tyrannically capricious response of the government to COVID-19 is but a trial run for the next great crisis. It will most likely be ''climate change,'' but regardless of what the anointed exploit to advance their iniquitous vision, in the name of equality and cosmic justice, there is no individual, there is only the crushing weight of the State. And like a virus, the Leviathan is indifferent to who it destroys as it spreads.
      Democrats Tuck Female Draft Into Defense Bill
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        Sat, 04 Sep 2021 16:13
        National SecurityRepublican bids to eliminate critical race theory, protect all-male draft shot down in late-night debate
        Female Marine recruits / Getty Images Jack Beyrer ' September 2, 2021 4:45 pmThe Pentagon will have to start drafting women in order to receive funding after House Democrats amended the defense budget.
        Rep. Chrissy Houlahan (D., Pa.) put forward a measure on Wednesday to require all women over the age of 18 to register for selective service. Houlahan said her policy would best draw on the "talents of our entire nation." Only one in three women, however, support adding women to the draft, according to an Ipsos poll. Republicans pilloried the legislation. Rep. Vicky Hartzler (R., Mo.), a House Armed Services Committee member, lampooned the prospect that millions of America's daughters could be put needlessly in the line of fire.
        "I feel confident that in an emergency that the women of this country would step up and volunteer as needed," Hartzler said. "It seems like this is a solution in search of a problem. '... We don't need to draft women in order for women to have equality in this nation."
        Female participation in the military has steadily increased since 2004, rising to 17 percent in 2018. A larger percentage of women in military service are commissioned as officers than men. Critics say conscription should focus on fielding the most effective fighting force, rather than gender ideology. Terry Schilling, the president of the American Principles Project, which led a campaign against the measure, told the Washington Free Beacon the decision could have a crippling effect on lawmakers who passed the bill.
        "I think I'm speaking on behalf of millions of fathers across the country when I say I don't want my daughters drafted into the next military conflict," Schilling said. "To conscript them into the military and put them on the frontlines is a nightmare."
        Houlahan's measure passed 35-24, with five Republicans crossing party lines to support it. A similar measure passed the Senate by a razor-thin margin over the objections of national security hawks. Former Army Ranger Sen. Tom Cotton (R., Ark.) and Air Force veteran Sen. Roger Wicker (R., Miss.) jousted with Democrats over its inclusion into the annual spending bill.
        "Our military has welcomed women for decades and are stronger for it," Cotton said in July. "But America's daughters shouldn't be drafted against their will. I opposed this amendment in committee, and I'll work to remove it before the defense bill passes."
        "I support our military's efforts to offer more opportunities for women who want to volunteer to serve," Wicker said in July. "But when I think of my own daughters and granddaughters, I could not in good conscience support an amendment that would compel their military service."
        House Democrats also stifled a Republican bid to bar critical race theory from the ranks. Democrats shot down an amendment sponsored by Hartzler, as well as by Reps. Jim Banks (R., Ind.) and Mark Green (R., Tenn.), that would preclude military academies and instructors of enlisted troops from teaching the controversial ideology.
        "When it comes to law enforcement and the military, you can't tolerate lies and a lack of integrity," Schilling said. "It's very concerning to me and millions of families across this country that the military is embracing lies like critical race theory."
        Published under: Chrissy Houlahan , Defense , Defense Bill , Female Draft , Roger Wicker , Tom Cotton , Vicky Hartzler
      Overseas Refugee Health Guidance | Immigrant and Refugee Health | CDC
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        Archived Version
        Sat, 04 Sep 2021 16:05
        To promote healthy resettlement, CDC provides supplemental guidance to panel physicians caring for US-bound refugees. The Overseas Refugee Health Guidance provides panel physicians with supplemental guidance on vaccination, pre-departure treatments for malaria and intestinal parasites and fitness to travel. These activities are coordinated with the International Organization for Migration (IOM).
        Learn more about the role of panel physicians in the US refugee resettlement program.
        Vaccination Program for U.S.-bound RefugeesThe table below describes the overseas immunization schedule recommended for U.S.-bound refugees and V93s. As part of the Vaccination Program for US-bound Refugees and V93s:
        Refugees and Visa 93 applicants are offered immunizations depending on age, vaccine history, and eligibility. Although the goal is to provide up to 2 doses of each vaccine, the vaccines administered depend on availability and logistics at each site. Receiving states should refer to each arriving refugee's or V93's U.S. Department of State's Vaccination Documentation Worksheet (DS-3025) to determine what vaccinations were received overseas.Valid historical vaccination records (such as camp vaccine cards) are counted toward the immunization schedule when applicable. These will be documented in the ''vaccine history'' columns on the DS-3025 Vaccination Documentation Worksheet.First vaccine doses are given during the overseas medical examination, approximately 3''6 months before departure for most refugees.Second vaccine doses are typically given 1''2 months after the first dose.Refugees who undergo repeated medical examinations overseas may receive additional vaccine doses.Live-virus vaccines will not routinely be administered less than 4 weeks before departure, except during disease outbreaks or in other exceptional situations. CDC will provide additional notification to states in most of these situations, but please review each refugee's DS-3025 worksheet.In the event that a live-virus vaccine is given within 4 weeks of departure, tuberculin skin tests (TST), interferon-gamma release assays (IGRA), or other live-virus vaccines (e.g., varicella; oral polio vaccine (OPV); measles, mumps, and rubella (MMR); measles, mumps, rubella, and varicella (MMRV)) should not be administered for at least 28 days as part of the domestic examination after arrival. More information is available in the Morbidity and Mortality Weekly Report. Other routine post-arrival screening and immunization activities should continue in accordance with standard CDC guidance.The Technical Instructions for Polio Vaccination, which apply to U.S.-bound refugees, are available on the CDC IRMH website and the Global Polio Eradication Initiative external icon .Before hepatitis B vaccination, refugees and V93s of all ages are tested for hepatitis B virus infection by using hepatitis B surface antigen (HBsAg), where available. All HBsAg results will be documented on the DS forms.HBsAg-positive persons do not receive hepatitis B vaccination overseas. They are counseled about the infection and about transmission prevention. Positive results are documented on the DS forms.HBsAg-negative persons receive up to two hepatitis B vaccine doses overseas, if due and if there are no known contraindications.HBsAg-negative household contacts of HBsAg-positive persons may be given an additional (third) dose of hepatitis B vaccine overseas to complete the series for full protection, if there is time to do so before departure. Because the third dose may be given near the time of departure, states should be aware that HBsAg results may be falsely positive within the first month after hepatitis B vaccination. CDC advises waiting at least 30 days following receipt of hepatitis B vaccine before testing for HBsAg.Routine vaccination of U.S.-bound refugees before travel to the United States is not legally required. However, routine vaccinations are strongly recommended and offered overseas as part of this Vaccination Program to protect health, prevent travel delays due to disease outbreaks, and, for children, to allow more rapid integration into schools after arrival in the United States.
        The vaccination schedule is modified periodically based on changing Advisory Committee on Immunization Practices (ACIP) recommendations, logistics, or availability.
        Vaccination Program for U.S.-bound Refugees: Immunization Schedule (updated January 2021)Prepared by the Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, CDC
        Vaccines Given to Eligible U.S.-bound RefugeesVaccines Given to Eligible U.S.-bound Refugees(depending on availability and eligibility)AgeVaccines 1Birth-adultHepB x 2 doses 26 wks-<15 wksRotavirus x 2 doses (maximum age for dose 2 is 8 mos)6 wks-<5 yrsHib (x 2 doses if <15 mos; x 1 dose if 15 mos-5 yrs) 3PCV (x 2 doses if <2 yrs; x 1 dose if 2-5 yrs) 46 wks -<7 yrsDTP x 1 dose 56 wks-<11 yrsPolio x 2 doses (OPV, IPV, or one of each)7 yrs-adultTd x 2 dosesMenACWY x 1 dose'‰¥ 1 yr-<20 yrs'‰¥ 1 yr-born '‰¥ 1957Varicella x 1 doseMMR x 2 dosesHepatitis B (HepB); Haemophilus influenzae type B (Hib); pneumococcal conjugate vaccine (PCV); diphtheria, tetanus, pertussis (DTP); oral polio vaccine (OPV); inactivated polio vaccine (IPV); tetanus, diphtheria (Td); meningococcal conjugate vaccine with protection against serogroups A, C, W, and Y (MenACWY); measles, mumps, and rubella (MMR)
        1 For some sites (including most Asia sites and some others), those '‰¥6 months old (including adults) may receive the inactivated influenza vaccine (1''2 doses depending on age and vaccination history)
        2 Refugees and V93s are tested for hepatitis B virus infection (HBsAg) before vaccination, and are vaccinated only if negative (and if a dose is due).
        3 One dose of Hib vaccine will be recommended for unimmunized asplenic persons regardless of age, and for unimmunized HIV-positive patients up to age 18 years.
        4 When available, PCV13 will be given to children 6 weeks to <5 years of age. A second dose will be given to children up to age 2 years. One dose of PCV13 will also be recommended for all immunocompromised persons, regardless of age.
        5 Children residing in refugee camps often receive several doses of whole-cell pertussis (DTwP) as part of the Expanded Program on Immunization (EPI). Therefore, children participating in the Vaccination Program for U.S.-bound Refugees will receive only 1 dose of DTwP/DTaP from International Organization for Migration panel physicians, if due, in order to reduce the risk of severe local reactions associated with over-vaccination with tetanus-containing vaccines.
        Intestinal Parasite GuidanceParasitic Treatment: Strongyloidiasis, Schistosomiasis, and Soil-Transmitted Helminth Infections alert icon
        Updates '' the following are content updates from the previous version of the overseas guidance, which was posted in 2008
        Latin American and Caribbean refugees are now included, in addition to Asian, Middle Eastern, and African refugees.Recommendations for management of Strongyloides in refugees from Loa loa-endemic areas emphasize a screen-and-treat approach, rather than presumptive high-dose albendazole.Presumptive treatment with albendazole during any trimester of pregnancy is no longer recommended.Summary of RecommendationsThis guidance is intended for the International Organization for Migration (IOM) physicians and other panel physicians who administer overseas predeparture presumptive treatment for intestinal parasites, but may also be referenced by U.S. medical providers caring for refugees who will be receiving presumptive treatment after they arrive in the United States.
        While these recommendations have been implemented in many overseas sites, logistical and procurement issues still limit their full implementation in some. All Middle Eastern, Asian, North African, Latin American, and Caribbean refugees should receive presumptive therapy with:
        All Middle Eastern, Asian, North African, Latin American, and Caribbean refugees should receive presumptive therapy with:Albendazole, single dose of 400 mg (200 mg for children 12-23 months)ANDIvermectin, two doses 200 mcg/Kg orally once a day for 2 days before departure to the United States.All African refugees who did not originate from or reside in countries where Loa loa infection is endemic (Box 1) should receive presumptive therapy with:Albendazole, single dose of 400 mg (200 mg for children 12-23 months)ANDIvermectin, two doses 200 mcg/Kg orally once a day for 2 daysANDPraziquantel, 40 mg/kg, which may be divided in two doses before refugees depart for the United States.All sub-Saharan African refugees who originated from or resided in countries where Loa loa infection is endemic (Box 1) should receive presumptive therapy with:Albendazole, single dose of 400 mg (200 mg for children 12-23 months)ANDPraziquantel, 40 mg/kg, which may be divided in two doses before departure to the United States.Refugees from Loa loa-endemic countries (Box 1) in Africa should not receive presumptive ivermectin for strongyloidiasis prior to departure. Management of Strongyloides should be deferred until arrival in the United States, unless Loa loa is excluded by reviewing a daytime (10 AM to 2 PM) Giemsa-stained blood smear. Deferral of treatment for Strongyloides until after the refugee arrives in the United States is acceptable. Guidance is available for management of Strongyloides following arrival in the United States in the Domestic Intestinal Parasite Screening Guidance.Special instructions:Pre-departure presumptive and directed malaria treatment regimens must be administered as directly observed therapy.Test results and pre-departure treatment should be documented on the pre-departure medical screening form. If treatment was not administered, this should be clearly indicated along with the reason that treatment was not administered.CDC Recommendations for Overseas Presumptive Parasite Treatment
        CDC Recommendations for Overseas Presumptive Parasite TreatmentRegionArtemether-lumefantrine (malaria)Praziquantel (Schistosoma)Albendazole (soil-transmitted helminths)Ivermectin* (Strongyloides)Africa, non-Loaloa areasRecommendedRecommendedRecommendedRecommendedAfrica, Loa loa areasRecommendedRecommendedRecommendedNot RecommendedAsiaNot RecommendedNot RecommendedRecommendedRecommendedMiddle EastNot RecommendedNot RecommendedRecommendedRecommendedLatin AmericaNot RecommendedNot RecommendedRecommendedRecommended* If available in country
        BackgroundIn 1997, a Centers for Disease Control and Prevention (CDC) pilot project evaluated single-dose albendazole presumptive treatment in U.S.-bound Barawan Somali refugees. 1 This project demonstrated decreases in soil-transmitted parasites in refugees who received presumptive treatment. In May 1999, CDC extended this recommendation to all refugees resettling from sub-Saharan Africa (SSA) and Asia. In 2008, the recommendation was extended to refugees from the Middle East. Currently, most refugees from the countries listed in the Treatment Schedules for Presumptive Parasitic Infections for U.S.-Bound Refugees and without a contraindication are receiving a single dose of albendazole prior to departure.
        Data indicates that pre-departure albendazole treatment has dramatically decreased the overall prevalence of soil-transmitted helminth infections in refugees. A large evaluation including more than 26,000 African and Asian refugees demonstrated single dose albendazole resulted in an absolute reduction of the prevalence of any soil-transmitted helminth from 20.8% to 4.7%, as measured by stool ova and parasite examination. 2 These findings support previous data in African refugees resettling to the United States, showing a similar decrease in soil-transmitted helminths following implementation of pre-departure albendazole treatment. Evaluations of the cost has shown clear cost-savings and estimated reduction in morbidity and mortality through conducting presumptive-treatment compared to post-arrival screen and treat, or no treatment program. 8 Despite this documented decrease in the overall prevalence of soil-transmitted helminth infections, a single dose of albendazole has very limited effect on infection with Strongyloides and no effect against Schistosoma spp. 2,3,4,5 A recent prospective evaluation of more than 2000 refugees resettling to the U.S. from camps on the Thailand-Burma border showed a dramatic decrease in soil-transmitted helminths and a decrease in potentially associated conditions in children (e.g. anemia, malnutrition) following treatment. 9 This evaluation also clearly demonstrated a reduction in the Strongyloides burden with the single dose albendazole in combination with ivermectin treatment prior to departure for the United States.
        Recommendations for overseas presumptive treatment of intestinal parasitesRefugees originating from the Middle East, Asia, North Africa, Latin America, and the Caribbean Prior to departure for the United States, all refugees originating from the Middle East, Asia, North Africa, Latin American, & Caribbean should receive presumptive therapy with ivermectin for Strongyloides infection and with albendazole for infections caused by soil-transmitted helminths (Table 1). Dosing for ivermectin may be based on weight and available tablet size (Table 2).
        Refugees originating from sub-Saharan AfricaSoil-transmitted helminthsAll refugees originating from sub-Saharan Africa should receive presumptive therapy with albendazole for infections caused by soil-transmitted helminths (Table 1).
        StrongyloidesRefugees from sub-Saharan Africa should also receive presumptive therapy for Strongyloides infection with ivermectin (Table 1), but this will depend on whether they have originated from or resided in countries where Loa loa is endemic (Box 1). The drug of choice for Strongyloides infection is ivermectin. However, cases of encephalopathy have occurred in patients treated with ivermectin during large-scale public health campaigns in areas of Africa where Loa loa is endemic. Although rare, this reaction is related to Loa loa microfilarial load. Therefore, ivermectin should be given only to persons originating from Africa who have resided in or come from countries or areas not considered endemic for Loa loa (Box 1). Sub-Saharan African refugees who have resided in or are coming from areas endemic for Loa loa should not receive presumptive ivermectin, and management of Strongyloides should be deferred until they arrive in the United States (unless Loa loa is excluded by reviewing a daytime [10 AM to 2 PM] Giemsa-stained blood smear). High-dose albendazole (400 mg twice a day for 7 days) is an acceptable alternative and is considered safe in Loa loa infected people, if Loa loa infection cannot be excluded.
        SchistosomiasisRefugees from sub-Saharan Africa should also receive presumptive pre-departure therapy with praziquantel for schistosomiasis (Table 1). Pre-departure dosing may be based on weight and available tablet size (Table 2). If the refugee has never received presumptive therapy as part of a mass anti-helminth treatment campaign, and if it is logistically feasible, administering praziquantel first, followed by albendazole and ivermectin, may reduce the risk of adverse events caused by the release of antigens by dying parasites in persons with high parasite loads. However, if the refugee has received previous therapy, their parasite load can be assumed to be lower, and there would be no contraindication to administering praziquantel together with albendazole and ivermectin.
        Special instructions for administration of presumptive pre-departure therapy Pre-departure regimens for presumptive treatment of intestinal parasites should be administered as directly observed therapy. While prescription and first-dose observation should be done by medical personnel, subsequent doses can be observed by nonmedical staff.Pregnancy testing should be performed before ivermectin or albendazole is administered.Ivermectin and albendazole may be administered concurrently according to World Health Organization (WHO) recommendations. In areas where refugees have received previous rounds of mass anti-helminth treatment, ivermectin, albendazole, and praziquantel co-administration is well tolerated. 6Praziquantel may be better tolerated if divided into two doses.There is no known contraindication to co-administration of these intestinal treatment regimens with malaria treatment medications. When time allows, spacing may improve tolerability. A sample 3-day combined treatment regimen for both parasites and malaria is presented in Table 3.Precautions and contraindications to presumptive treatmentChildrenAlbendazoleChildren <1 year of age should not receive presumptive treatment with albendazole. Further information on use of albendazole in pediatric patients can be found at the CDC, Division of Parasitic Diseases website.IvermectinChildren weighing <15 kg or measuring <90 cm should not receive presumptive treatment with ivermectin. Further information on use of ivermectin in pediatric patients can be found at the CDC, Division of Parasitic Diseases website.PraziquantelThe safety of praziquantel has not been established in children <4 years of age or <94 cm in height, so these children should not receive presumptive treatment. Further information on use of praziquantel in pediatric patients can be found at the CDC, Division of Parasitic Diseases website.Pregnant women AlbendazoleAlbendazole is currently a category C drug in the United States, and it should not be administered as presumptive treatment for U.S.-bound refugees during any trimester of pregnancy. When a reliable history of the woman's last menstrual period cannot be obtained, a pregnancy test should be performed. Pregnant women should have presumptive treatment deferred until after they arrive in the United States. Further information on use of albendazole during pregnancy can be found at the CDC, Division of Parasitic Diseases website.IvermectinIvermectin is a pregnancy category C drug. This medication should not be administered as a presumptive medication to a pregnant woman. When a reliable history of the woman's last menstrual period cannot be obtained, a pregnancy test should be performed before presumptive treatment is administered. Further information on use of ivermectin during pregnancy can be found at the CDC, Division of Parasitic Diseases website.PraziquantelPraziquantel is considered a pregnancy category B drug, and WHO recommends the presumptive treatment of pregnant women during any trimester of pregnancy in women from schistosomiasis-endemic areas. Further information on use of praziquantel during pregnancy can be found at the CDC, Division of Parasitic Diseases website.Women who are breastfeedingAlbendazoleAlbendazole presumptive therapy may be administered to women who are breastfeeding. Further information on use of albendazole during lactation can be found at the CDC, Division of Parasitic Diseases website.IvermectinPresumptive treatment with ivermectin should not be administered to women who are breastfeeding during the first week after birth. Further information on use of ivermectin during lactation can be found at the CDC, Division of Parasitic Diseases website.PraziquantelPraziquantel is excreted in low concentrations in human milk. According to WHO guidance for mass prevention campaigns, the use of praziquantel during lactation is safe. 7 For individual patients in clinical settings, praziquantel should be used in breast-feeding women only when the risk to the infant is outweighed by the risk of disease progression in the mother in the absence of treatment. Further information on use of praziquantel during lactation can be found at the CDC, Division of Parasitic Diseases website.Refugees with cysticercosis infectionPersons who have neurocysticercosis infection may have seizures following treatment with albendazole or praziquantel, since these medications kill Taenia solium cysticerci, causing inflammation and provoking seizure activity in the brain. The true prevalence of neurocysticercosis in refugee populations is not well documented. Confirmed case reports of adverse events after treatment with albendazole or praziquantel remain rare in refugees. Refugees with known neurocysticercosis, an unexplained seizure disorder, or subcutaneous nodules consistent with cysticercosis should not receive presumptive treatment with either albendazole or praziquantel.
        Physicians should consult the package inserts for additional information about ivermectin, albendazole, and praziquantel.
        DocumentationTest results and pre-departure treatment should be documented on the Predeparture Medical Screening (PDMS) form. IOM providers should also enter the information in the Migrant Management & Operational Systems Application (MiMOSA) prior to the refugees' arrival, so it can be transmitted to CDC's Electronic Disease Notification (EDN) system. The paper form, after entry into the electronic format, should be placed in the medical folder inside the IOM travel bag. These documents are physically carried by the refugees to the United States. If treatment was not administered, this should be clearly documented, along with the reason that treatment was not administered. For children and pregnant and breastfeeding women who do not receive presumptive therapy, the need for subsequent treatment should be clearly documented.
        Miller JM, Boyd HA, Ostrowski SR, et al. Malaria, intestinal parasites, and schistosomiasis among Barawan Somali refugees resettling to the United States: a strategy to reduce morbidity and decrease the risk of imported infections. Am J Trop Med Hyg. 2000;62:115-21.Swanson SJ, Phares CR, Mamo B, et al. Albendazole treatment and enteric parasites in United States-bound refugees. N Engl J Med 2012;366:1498-507.Geltman PL, Cochran J, Hedgecock C. Intestinal parasites among African refugees resettled in Massachusetts and the impact of an overseas pre-departure treatment program. Am J Trop Med Hyg. 2003;69(6):657-62.Muennig P, Pallin D, Sell RL, Chan MS. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. N Engl J Med. 1999;340(10):773-9.Marti H, Haji HJ, Savioli L, et al. A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop Med Hyg. 1996;55(5):477-81.Mohammed KA, Haji HJ, Gabrielli AF, et al. Triple co-administration of ivermectin, albendazole and praziquantel in Zanzibar: a safety study. PLoS Negl Trop Dis. 2008;2(1):e171.World Health Organization. Preventive chemotherapy in human helminthiasis: a manual for health professionals and programme managers. 2006. Available at: http://whqlibdoc.who.int/publications/2006/9241547103_eng.pdf pdf icon [PDF '' 74 pages] external icon .Maskery B, Coleman MS, Weinberg M, et al. Economic analysis of the impact of overseas and domestic treatment and screening options for intestinal helminth infection among US-bound refugees from Asia. PLoS NTD 2016. doi: https://doi.org/10.1371/journal.pntd.0004910 external icon Mitchell T, Lee D, Weinberg M, et al. Impact of enhanced health interventions for US-bound refugees: Evaluating best practices in migration health. Amer J Trop Med Hyg 2018;98(3):920-928.Table 1Recommended medication regimen and standard dosing for presumptive treatment of parasitic infections.
        Recommended medication regimen and standard dosing for presumptive treatment of parasitic infections in AdultsAdultsRefugee PopulationRegimens by PathogenSoil-transmitted helminths: Albendazole 1Strongyloidiasis: Ivermectin 1Schistosomiasis 2:Praziquantel 3Asia, Middle East, North Africa, Latin American, & Caribbean400 mg orally for 1 dayIvermectin, 200 mcg/kg/day orally once a day for 2 daysNot recommendedSub-Saharan Africa, non-Loa loa-endemic area400 mg orally for 1 dayIvermectin, 200 mcg/kg/day orally once a day for 2 daysPraziquantel, 40 mg/kg (may be divided and given in two doses for better tolerance).Sub-Saharan Africa, Loa loa'' endemic area400 mg orally for 1 dayIf Loa loa cannot be excluded, treatment may be deferred until after arrival in the United States-OR-Albendazole 400 mg twice a day for 7 daysPraziquantel, 40 mg/kg (may be divided and given in two doses for better tolerance).Recommended medication regimen and standard dosing for presumptive treatment of parasitic infections in Pregnant WomenPregnant WomenRefugee PopulationTreatment Regimens by PathogenSoil-transmitted helminths: Albendazole 1Strongyloidiasis: Ivermectin 1Schistosomiasis 2: Praziquantel 3Asia, Middle East, North Africa, Latin America & CaribbeanNot recommendedNot recommendedNot applicableSub-Saharan AfricaNot recommendedNot recommendedPraziquantel, 40 mg/kg (may be divided and given in two doses for better tolerance).Recommended Medication Regimen for Presumptive Treatment or Treatment of Identified Parasitic Infections in ChildrenChildrenRefugee PopulationTreatment Regimens by PathogenSoil-transmitted helminths: Albendazole 1Strongyloidiasis: Ivermectin 1Schistosomiasis 2: Praziquantel 3Asia, Middle East, North Africa, Latin America & Carribean12-23 months of age: 200 mg orally for 1 day. Presumptive therapy is not recommended for any infant less than 12 months of age.Ivermectin, 200 mcg/kg/day orally once a day for 2 days Presumptive therapy is not recommended for any child weighing '‰¤15 kgNot applicableSub-Saharan Africa12-23 months of age: 200 mg orally for 1 day. Presumptive therapy is not recommended for any infant less than 12 months of age.Ivermectin, 200 mcg/kg/day orally once a day for 2 days Presumptive therapy is not recommended for any child weighing '‰¤15 kg or for any child from a Loa loa-endemic country.Children under '‰¤ 4 years of age should not receive presumptive treatment with praziquantel. Only for children from sub-Saharan AfricaAlthough WHO states ivermectin and albendazole may be given concurrently, it is recommended that ivermectin be taken on an empty stomach and albendazole with fatty foods.All sub-Saharan African countries except Lesotho are considered endemic for schistosomiasis.Praziquantel, if not co-administered, should be administered at least one day prior to either ivermectin or albendazole. Praziquantel should be taken with liquids during a meal.Table 2Praziquantel and ivermectin dosing based on weight and tablet size for predeparture presumptive treatment of US-bound refugees
        Praziquantel and ivermectin dosing based on weight and tablet size for predeparture presumptive treatment of US- bound refugeesPraziquantel 1,2Drug and dosingWeight (kg)Not recommended<151 tablet (600 mg)15-181 ½ tablets (900 mg)19-252 tablets (1200 mg)26-302 ½ tablets (1500 mg)31-403 tablets (1800mg)41-504 tablets (2400 mg)51-695 tablets (3000 mg)'‰¥70Ivermectin 3Drug and dosingWeight (kg)Not recommended<151 tablet (3 mg)15-242 tablets (6 mg)25-353 tablets (9 mg)36-504 tablets (12 mg)51-655 tablets (15 mg)66-79200 mcg/kg'‰¥80Better tolerated if divided into two dosesUsing 600-mg praziquantel tabletsUsing 3-mg ivermectin tabletsTable 3Sample 3-Day Combined Regimen for overseas presumptive treatment of parasites and malaria
        Sample 3-Day Combined Regimen for overseas presumptive treatment of parasites and malariaPresumptive Tx DayMorningEvening*Day 1Pregnancy TestPraziquantel #1Artemether-lumefantrine #1Praziquantel #2*Artemether-lumefantrine 2*Day 2Ivermectin #1Artemether-lumefantrine #3Artemether-lumefantrine #4Day 3AlbendazoleIvermectin #2Artemether-lumefantrine #5Artemether-lumefantrine #6*On the first day, praziquantel and artemether-lumefantrine should be administered 8 hours following initial dose; on days 2 and 3 should be administered twice a day, morning and evening.
        Box 1Endemicity of Loa loa in African countries
        Endemicity of Loa loa in African countriesAfrican countries NOT considered endemic for Loa loa (may use presumptive ivermectin for Strongyloides)African countries considered endemic for Loa loa (presumptive ivermectin should not be used for Strongyloides)AlgeriaBotswanaBurkina FasoBurundiC´te d'IvoireEgyptEthiopiaEritreaGambiaGhanaGuineaGuinea-BissauKenyaLiberiaLibyaMadagascarMalawiMali
        MauritaniaMauritiusMoroccoMozambiqueNamibiaNigerRwandaSenegalSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoUgandaZambiaZimbabwe
        AngolaCameroonCentral African RepublicChadRepublic of CongoDemocratic Republic of the CongoEquatorial GuineaGabonNigeriaSouth SudanZour(C) HGM, Wanji S, Noma M, Amazigo UV, et al. (2011) The Geographic Distribution of Loa loa in Africa: Results of Large-Scale Implementation of the Rapid Assessment Procedure for Loiasis (RAPLOA). PLoS Negl Trop Dis 5(6): e1210. doi:10.1371/journal.pntd.0001210.
        In addition to the standard, legally required medical examination of refugees migrating to the United States, CDC recommends the following presumptive treatment for Plasmodium falciparum malaria. These recommendations apply to all refugees who are living in countries that are endemic for P. falciparum in sub-Saharan Africa. Currently, CDC does not recommend presumptive therapy for asymptomatic/subclinical malaria for U.S.-bound refugees relocating from lower endemic areas outside sub-Saharan Africa (e.g. Southeast Asia) unless specifically identified in subsequent, separate, documents (see Domestic Malaria Guidance).
        These guidance is intended for presumptive pre-departure treatment of asymptomatic/subclinical malaria and for directed treatment for special populations with malaria. Any patient with clinical symptoms of malaria should be referred to a healthcare facility for evaluation and treatment.
        BackgroundStudies have demonstrated high rates of malaria in refugees arriving in the United States and Canada from sub-Saharan Africa 1, 2. Despite progress in malaria control in the past decade, sub-Saharan Africa still has highly endemic areas. In some parts of Africa, prevalence rates of P. falciparum malaria exceed 75%. Beginning in 1999, U.S. bound refugee populations originating in sub-Saharan Africa began to receive predeparture treatment with sulfadoxine-pyrimethamine (SP, Fansidar') to prevent P. falciparum malaria disease following arrival in the U.S. Worldwide, the malaria parasite, P. falciparum, has developed resistance to many drugs used for treatment. In many areas of Africa, P. falciparum resistance to SP (and chloroquine) has increased to levels where these drugs are no longer effective. Based on efficacy studies showing SP treatment failures 3 and on guidance from the World Health Organization, beginning in 2007, pre-departure SP was discontinued and replaced by artemisinin combination treatment (ACT), generally the fixed combination artemether-lumefantrine (AL).
        Refugee populations relocating to the United States from countries outside sub-Saharan Africa would rarely originate in hyper- or holoendemic malaria, making asymptomatic/subclinical P. falciparum unlikely. Refugees from areas with lower endemic rates who are infected with P falciparum malaria will have clinical symptoms of infection. Therefore, refugee populations relocating to the United States from endemic areas other than sub-Saharan Africa should be tested for malaria if symptomatic. No presumptive treatment is recommended for these populations unless directed in separate guidance.
        Special instructions:
        Pre-departure presumptive and directed malaria treatment regimens must be administered as directly observed therapy.Test results and pre-departure treatment should be documented on the pre-departure medical screening form. If treatment was not administered, this should be clearly indicated along with the reason that treatment was not administered.The malaria treatment should be completed no sooner than 5 days before departure.RecommendationsThis document provides guidance for presumptive treatment for asymptomatic P. falciparum malaria in refugees relocating to the United States (Annex I). Artemisinin derivatives are obtained from the sweet wormwood plant (Chinese: é''è' or qÄnghÄo). The optimal regimen is the artemisinin-based combination therapy, artemether-lumefantrine Tables 1 and 2, Annex 1. However, when it is not accessible, other artemisinin-based combinations may be used until artemether-lumefantrine can be obtained. Currently artesunate-amodiaquine (ASAQ) is currently the preferred second line therapy, Annex 1. Dosing formulations for ASAQ are less standardized. When AL is unavailable and ASAQ will be used as a second option, Centers for Disease Control and Prevention (CDC) should be contacted for specific dosing instructions based on the formulation available in country. Specific populations including infants, pregnant women in the first trimester and those with other contraindications, delineated below, require directed treatment after diagnostic testing and should not receive presumptive treatment for asymptomatic malaria.
        Specific Populations and Precautions / Contraindications to Presumptive Anti-malarial TreatmentInfants who weigh less than 5 kilograms (kg), pregnant women, lactating women breastfeeding infants who weigh under 5 kg were previously considered to have a contraindication for use of AL. In 2015, the World Health Organization (WHO) revised the guidance for the treatment of clinical malaria to include AL treatment for pregnant women during the second and third trimester, children weighing < 5 kg and for lactating women. 5 At this time, presumptive treatment with AL for asymptomatic malaria may be administered to pregnant women during their second and third trimester and to lactating women regardless of the weight of the infant. Children < 5 kg and women in their first trimester of pregnancy should not receive presumptive treatment but should receive testing and treatment if they are found to have malaria. In addition, all persons with a known allergy to AL or any component of the medication should not receive presumptive treatment with AL.
        Refugees who do not receive presumptive treatment, including women during their first trimester of pregnancy and children < 5 kg, should have diagnostic testing, and if the tests show they have malaria, receive directed treatment. Diagnostic testing should be performed with blood smears or rapid diagnostic tests (RDT) with a kit agreed upon in consultation with CDC's Division of Global Migration and Quarantine (DGMQ). Both blood smear and RDT have limited sensitivity and do not rule out malaria. 4 Therefore, any refugee who develops clinical symptoms of malaria should receive further evaluation regardless of the screening test results. Treatment for clinical or laboratory confirmed malaria should be given according to national guidance. If no national guidance exist, consult with CDC regarding a treatment plan.
        For information regarding domestic management of malaria (screening and presumptive treatment) for refugees after arrival in the United States, please see Domestic Refugee Guidance.
        Table 1Summary malaria treatment and testing recommendations for asymptomatic refugees in sub-Saharan Africa relocating to the United States
        Summary malaria treatment and testing recommendations for asymptomatic refugees in sub-Saharan Africa relocating to the United StatesPopulationPresumptive treatment without testingTest by blood smear or rapid diagnostic test 1Test result 2TreatMedicationAll adults and children (except pregnant women during their first trimester, children who weigh less than 5 kg, and persons with known contraindication to recommended regimen. Lactating women can receive treatment regardless of infant weight.)YesNoN/AN/AOption 1: artemether- lumefantrine;Option 2 (only if Option 1 is not available): artesunate-amodiaquine (consult CDC)Pregnant women during the first trimesterNoYesPositiveYesNational guidelinesNegativeNoNoneInfants weighing less than 5 kgNoYesPositiveYesNational guidelinesNegativeNoNonePersons with other contraindications to recommended regimen (e.g. known allergy)NoYesPositiveYesDiscuss with CDCNegativeNoNone1 Test with blood smear or rapid diagnostic test using a test kit agreed upon in consultation with DGMQ2 Malaria thick and thin smear or RDT
        Table 2Dosing of artemether-lumefantrine for asymptomatic P. falciparum malaria
        Dosing of artemether-lumefantrine for asymptomatic P. falciparum malariaWeight (kg)Artemether-lumefantrineNumber of tablets per doseGiven at 0 hours, 8 hours, 24 hours, 36 hours, 48 hours, and 60 hours< 5Not recommended5''141 tablet15''242 tablets25''343 tablets> 354 tabletsAnnex ISpecific information about acceptable pre-departure presumptive anti-malarial therapy regimens for sub-Saharan refugees relocating to the United States
        Option 1
        Formulation of artemether-lumefantrine: tablets containing 20 mg of artemether plus 120 mg of lumefantrine.Dose: artemether-lumefantrine (AL). Treat with the 6-dose schedule as described below in Table 2.Other instructions: Administer with food.Metabolism of drug: Maximum blood levels occur 6''12 hours after The half-life is 88 hours in healthy persons and twice as long in persons with malaria. The drug is excreted via the liver and feces.Adverse effects: dizziness, fatigue, anorexia, nausea, vomiting, abdominal pain, palpitations, myalgia, sleep disorders, arthralgia, headache, rash.Exceptions for the use of artemether-lumefantrine:Children weighing less than 5 kgPregnant women in the first trimesterPersons with known hypersensitivity to either componentAlternatives approaches for persons who cannot receive artemether-lumefantrine:Children weighing less than 5 kg: Test with blood smear or rapid diagnostic test using a test kit agreed upon in consultation with DGMQ. Children who test positive for malaria should be treated according to national guidelines or consult CDC, if no national guidelines exist.Pregnant women: Test with blood smear or rapid diagnostic test using a test kit agreed upon in consultation with DGMQ. Pregnant or lactating women who test positive for malaria should be treated according to national guidelines or consult CDC, if no national guidelines exist.Persons with known hypersensitivity to either artemether or lumefantrine may receive alternative treatment. If allergic to both artemether component, discuss with CDC.Persons with symptomatic malaria should be treated according to national guidelines or consult CDC if no national guidelines exist.Option 2
        Dosage and Formulation of Artesunate-amodiaquine (ASAQ) combination therapy. Various formulations are available and CDC should be contacted prior to using for guidance based on available formulations in the country of departure.MetabolismArtesunate as in Option #1AQ is metabolized primarily in the liver, with plasma half-life of ~5 hours.Adverse effects. Nausea, vomiting, abdominal pain, diarrhea, itching, bradycardia (less common). Prolonged QT (avoid with other medications that prolong QT). Can induce toxic hepatitis and fatal agranulocytosis (with prolonged use). Overdosage can cause syncope, spasticity, convulsions and involuntary movements.Exceptions of use for artesunate (AS) and amodiaquine (AQ)Children weighing less than 5 kg (AS)First term of pregnancy (AS)Known hypersensitivity to either AS or AQKnown abnormal white blood count, kidney disease or severe hepatic disorder/disease (AQ)Caution should be exercised in patients on treatment drugs for HIV/AIDS (AQ), cases should be discussed with CDC prior to presumptive treatment.Known prolonged QTc or another medication known to lengthen QTcMaroushek SR, Aguilar EF, Stauffer W, Abd-Alla Malaria among refugee children at arrival in the United States. Ped Infect Dis J 2005;24(5):450-2, 2005.Ndao M, Bandyayera E, Kokosin E, et Comparison of blood smear, antigen detection, and nested-PCR methods for screening from regions where malaria is endemic after a malaria outbreak in Quebec, Canada. J Clin Microbiol 2004;42(6):2694-700.Phares CR, Kapella BK, Doney AC, et al. Presumptive treatment to reduce imported malaria among refugees from East Africa resettling in the United States. Amer J Trop Med Hyg 2011;85(4):612-615.Stauffer WM, Newberry A, Cartwright C, Rosenblatt J, et Evaluation of malaria screening in newly arriving refugees to the United States by microscopy and rapid antigen capture assay. Ped Infect Dis J. 2006 Oct;25(10):948-50.The World Health Organization. Guidelines for the treatment of malaria. Third Edition. Available online external icon (accessed March 22, 2019)
      Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 16:01
        Am J Ther. 2021 Jul-Aug; 28(4): e434''e460.
        Andrew Bryant, MSc,
        1,* Theresa A. Lawrie, MBBCh, PhD,
        2 Therese Dowswell, PhD,
        2 Edmund J. Fordham, PhD,
        2 Scott Mitchell, MBChB, MRCS,
        3 Sarah R. Hill, PhD,
        1 and
        Tony C. Tham, MD, FRCP
        4Andrew Bryant1Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom;
        Theresa A. Lawrie2Evidence-based Medicine Consultancy, Bath, United Kingdom;
        Therese Dowswell2Evidence-based Medicine Consultancy, Bath, United Kingdom;
        Edmund J. Fordham2Evidence-based Medicine Consultancy, Bath, United Kingdom;
        Scott Mitchell3Emergency Department, Princess Elizabeth Hospital, Guernsey, United Kingdom; and
        Sarah R. Hill1Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom;
        Tony C. Tham4Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland, United Kingdom.
        1Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom;
        2Evidence-based Medicine Consultancy, Bath, United Kingdom;
        3Emergency Department, Princess Elizabeth Hospital, Guernsey, United Kingdom; and
        4Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland, United Kingdom.
        *Address for correspondence: Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, United Kingdom. E-mail:
        ku.ca.lcn@tnayrb.ydnaCopyright (C) 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
        This article has been
        cited by other articles in PMC.
        Background:Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials.
        Areas of uncertainty:We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection.
        Data sources:We searched bibliographic databases up to April 25, 2021. Two review authors sifted for studies, extracted data, and assessed risk of bias. Meta-analyses were conducted and certainty of the evidence was assessed using the GRADE approach and additionally in trial sequential analyses for mortality. Twenty-four randomized controlled trials involving 3406 participants met review inclusion.
        Therapeutic Advances:Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19''0.73; n = 2438; I2 = 49%; moderate-certainty evidence). This result was confirmed in a trial sequential analysis using the same DerSimonian''Laird method that underpinned the unadjusted analysis. This was also robust against a trial sequential analysis using the Biggerstaff''Tweedie method. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%''91%). Secondary outcomes provided less certain evidence. Low-certainty evidence suggested that there may be no benefit with ivermectin for ''need for mechanical ventilation,'' whereas effect estimates for ''improvement'' and ''deterioration'' clearly favored ivermectin use. Severe adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Evidence on other secondary outcomes was very low certainty.
        Conclusions:Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally.
        Keywords: ivermectin, prophylaxis, treatment, COVID-19, SARS-CoV-2
        INTRODUCTIONTo date, very few treatments have been demonstrated to reduce the burden of morbidity and mortality from COVID-19. Although corticosteroids have been proven to reduce mortality in severe disease,1 there has been little convincing evidence on interventions that may prevent disease, reduce hospitalizations, and reduce the numbers of people progressing to critical disease and death.
        Ivermectin is a well-known medicine that is approved as an antiparasitic by the World Health Organization and the US Food and Drug Administration. It is widely used in low- and middle-income countries (LMICs) to treat worm infections.2,3 Also used for the treatment of scabies and lice, it is one of the World Health Organization's Essential Medicines.4 With total doses of ivermectin distributed apparently equaling one-third of the present world population,5 ivermectin at the usual doses (0.2''0.4 mg/kg) is considered extremely safe for use in humans.6,7 In addition to its antiparasitic activity, it has been noted to have antiviral and anti-inflammatory properties, leading to an increasing list of therapeutic indications.8
        Since the start of the SARS-CoV-2 pandemic, both observational and randomized studies have evaluated ivermectin as a treatment for, and as prophylaxis against, COVID-19 infection. A review by the Front Line COVID-19 Critical Care Alliance summarized findings from 27 studies on the effects of ivermectin for the prevention and treatment of COVID-19 infection, concluding that ivermectin ''demonstrates a strong signal of therapeutic efficacy'' against COVID-19.9 Another recent review found that ivermectin reduced deaths by 75%.10 Despite these findings, the National Institutes of Health in the United States recently stated that ''there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19,''11 and the World Health Organization recommends against its use outside of clinical trials.12
        Ivermectin has exhibited antiviral activity against a wide range of RNA and some DNA viruses, for example, Zika, dengue, yellow fever, and others.13 Caly et al14 demonstrated specific action against SARS-CoV-2 in vitro with a suggested host-directed mechanism of action being the blocking of the nuclear import of viral proteins14,15 that suppress normal immune responses. However, the necessary cell culture EC50 may not be achievable in vivo.16 Other conjectured mechanisms include inhibition of SARS-CoV-2 3CLPro activity17,18 (a protease essential for viral replication), a variety of anti-inflammatory effects,19 and competitive binding of ivermectin with the viral S protein as shown in multiple in silico studies.20 The latter would inhibit viral binding to ACE-2 receptors suppressing infection. Hemagglutination via viral binding to sialic acid receptors on erythrocytes is a recently proposed pathologic mechanism21 that would be similarly disrupted. Both host-directed and virus-directed mechanisms have thus been proposed, the clinical mechanism may be multimodal, possibly dependent on disease stage, and a comprehensive review of mechanisms of action is warranted.
        Developing new medications can take years; therefore, identifying existing drugs that can be repurposed against COVID-19 that already have an established safety profile through decades of use could play a critical role in suppressing or even ending the SARS-CoV-2 pandemic. Using repurposed medications may be especially important because it could take months, possibly years, for much of the world's population to get vaccinated, particularly among LMIC populations.
        Currently, ivermectin is commercially available and affordable in many countries globally.6 A 2018 application for ivermectin use for scabies gives a direct cost of $2.90 for 100 12-mg tablets.22 A recent estimate from Bangladesh23 reports a cost of US$0.60'--US$1.80 for a 5-day course of ivermectin. For these reasons, the exploration of ivermectin's potential effectiveness against SARS-CoV-2 may be of particular importance for settings with limited resources.24 If demonstrated to be effective as a treatment for COVID-19, the cost-effectiveness of ivermectin should be considered against existing treatments and prophylaxes.
        The aim of this review was to assess the efficacy of ivermectin treatment among people with COVID-19 infection and as a prophylaxis among people at higher risk of COVID-19 infection. In addition, we aimed to prepare a brief economic commentary (BEC) of ivermectin as treatment and as prophylaxis for COVID-19.25
        METHODSThe conduct of this review was guided by a protocol that was initially written using Cochrane's rapid review template and subsequently expanded to a full protocol for a comprehensive review.26
        Search strategy and selection criteriaTwo reviewers independently searched the electronic databases of Medline, Embase, CENTRAL, Cochrane COVID-19 Study Register, and Chinese databases for randomized controlled trials (RCTs) up to April 25, 2021 (see Appendix 1''3, Supplemental digital content 1, http://links.lww.com/AJT/A95); current guidance25 for the BEC was followed for a supplementary search of economic evaluations. There were no language restrictions, and translations were planned to be performed when necessary.
        We searched the reference list of included studies, and of two other 2021 literature reviews on ivermectin,9 as well as the recent WHO report, which included analyses of ivermectin.12 We contacted experts in the field (Drs. Andrew Hill, Pierre Kory, and Paul Marik) for information on new and emerging trial data. In addition, all trials registered on clinical trial registries were checked, and trialists of 39 ongoing trials or unclassified studies were contacted to request information on trial status and data where available. Many preprint publications and unpublished articles were identified from the preprint servers MedRÏ‡iv and Research Square, and the International Clinical Trials Registry Platform. This is a rapidly expanding evidence base, so the number of trials are increasing quickly. Reasons for exclusion were recorded for all studies excluded after full-text review.
        Data analysisWe extracted information or data on study design (including methods, location, sites, funding, study author declaration of interests, and inclusion/exclusion criteria), setting, participant characteristics (disease severity, age, gender, comorbidities, smoking, and occupational risk), and intervention and comparator characteristics (dose and frequency of ivermectin/comparator). The primary outcome for the intervention component of the review included death from any cause and presence of COVID-19 infection (as defined by investigators) for ivermectin prophylaxis. Secondary outcomes included time to polymerase chain reaction (PCR) negativity, clinical recovery, length of hospital stay, admission to hospital (for outpatient treatment), admission to ICU or requiring mechanical ventilation, duration of mechanical ventilation, and severe or serious adverse events, as well as post hoc assessments of improvement and deterioration. All of these data were extracted as measured and reported by investigators. Numerical data for outcomes of interest were extracted according to intention to treat.
        If there was a conflict between data reported across multiple sources for a single study (eg, between a published article and a trial registry record), we contacted the authors for clarification. Assessments were conducted by 2 reviewers (T.L., T.D., A.B., or G.G.) using the Cochrane RCT risk-of-bias tool.27 Discrepancies were resolved by discussion.
        Continuous outcomes were measured as the mean difference and 95% confidence intervalss (CI), and dichotomous outcomes as risk ratio (RR) and 95% CI.
        We did not impute missing data for any of the outcomes. Authors were contacted for missing outcome data and for clarification on study methods, where possible, and for trial status for ongoing trials.
        We assessed heterogeneity between studies by visual inspection of forest plots, by estimation of the I2 statistic (I2 '‰¥60% was considered substantial heterogeneity),28 by a formal statistical test to indicate statistically significant heterogeneity,29 and, where possible, by subgroup analyses (see below). If there was evidence of substantial heterogeneity, the possible reasons for this were investigated and reported. We assessed reporting biases using funnel plots if more than 10 studies contributed to a meta-analysis.
        We meta-analyzed data using the random effects model (DerSimonian and Laird method)30 using RevMan 5.4.1 software.27,31 The results used the inverse variance method for weighting.27 Some sensitivity analyses used other methods that are outlined below and some calculations were performed in R32 through an interface33 to the netmeta package.34 Where possible, we performed subgroup analyses grouping trials by disease severity, inpatients versus outpatients, and single dose versus multiple doses. We performed sensitivity analyses by excluding studies at high risk of bias. We conducted further post hoc sensitivity analyses using alternative methods to test the robustness of results in the presence of zero events in both arms in a number of trials35 and estimated odds ratios [and additionally RR for the Mantel''Haenszel (MH) method] using a fixed effects model. The models incorporate evidence from single-zero studies without having to resort to continuity corrections. However, double-zero studies are excluded from the analysis; so, the risk difference was also assessed using the MH method as this approach can adequately incorporate trials with double-zero events. This method can also use a random-effects component. A ''treatment-arm'' continuity correction was used, where the values 0.01, 0.1, and 0.25 were added where trials reported zero events in both arms. It has been shown that a nonfixed continuity correction is preferable to the usual 0.5.35 Other methods are available but were not considered due to difficulty in interpretation, sensitivity of assumptions, or the fact they are rarely used in practice.36''40
        Trial sequential analysisWhen a meta-analysis is subjected to repeated statistical evaluation, there is an exaggerated risk that ''naive'' point estimates and confidence intervals will yield spurious inferences. In a meta-analysis, it is important to minimize the risk of making a false-positive or false-negative conclusion. There is a trade-off between the risk of observing a false-positive result (type I error) and the risk of observing a false-negative result (type II error). Conventional meta-analysis methods (eg, in RevMan) also do not take into account the amount of available evidence. Therefore, we examined the reliability and conclusiveness of the available evidence using trial sequential analyses (TSA).41''43 The DerSimonian''Laird (DL) method was used because this is most often used in meta-analytic practice and was also used in the primary meta-analysis.30
        The TSA was used to calculate the required information size (IS) to demonstrate or reject a relative reduction in the risk (RRR) of death in the ivermectin group, as found in the primary meta-analysis. We assumed the estimated event proportion in the control group from the meta-analysis because this is the best and most representative available estimate. Recommended type I and II error rates of 5% and 10% were used, respectively (power of 90%),43 powering the result on the effect observed in the primary meta-analyses. We did not identify any large COVID-19 trials powered on all-cause mortality, so powering on some external meaningful difference was not possible. Any small RRR is meaningful in this context, given the scale of the pandemic, but the required IS would be unfeasibly high for this analysis if powered on a small difference. The only reliable data on ivermectin in its repurposed role for treatment against COVID-19 will be from the primary meta-analysis. Therefore, assuming it does not widely deviate from other published systematic reviews, a pragmatic decision was therefore made to power on the pooled meta-analysis effect estimate for all-cause mortality a priori. This is more reflective of a true meaningful difference. We used a model variance-based estimate to correct for heterogeneity. A continuity correction of 0.01 was used in trials that reported zero events in one or both arms. The required IS is the sample size required for a reliable and conclusive meta-analysis and is at least as large as that needed in a single powered RCT. The heterogeneity corrected required IS was used to construct sequential monitoring boundaries based on the O'Brien''Fleming type alpha-spending function for the cumulative z-scores (corresponding to the cumulative meta-analysis),43 analogous to interim monitoring in an RCT, to determine when sufficient evidence had been accrued. These monitoring boundaries are relatively insensitive to the number of repeated significance tests. They can be used to further contextualize the original meta-analysis and enhance our certainty around its conclusions. We used a two-sided test, so also considered futility boundaries (to test for no statistically significant difference) and the possibility that ivermectin could harm. Sensitivity analyses were performed excluding the trial of Fonseca,44 which was a cause of substantial heterogeneity (but retained in the core analysis because it was at low risk of bias). Its removal dramatically reduced I2 and D2 (diversity) estimates, thus reducing the model variance-based estimate to correct for heterogeneity. Two further sensitivity analyses were performed using 2 alternative random effect models, namely the Biggerstaff''Tweedie (BT) and Sidik''Jonkman (SJ) methods.43
        All outcomes have been assessed independently by 2 review authors (T.D. and A.B.) using the GRADE approach,45 which ranks the quality and certainty of the evidence. The results of the TSAs will also form part of the judgment for the primary all-cause mortality outcome. The results are presented in a summary of findings table. Any differences in judgments were resolved by discussion with the wider group. We used Cochrane Effective Practice and Organisation of Care guidance to interpret the evidence.46
        RESULTSSearch results and risk-of-bias assessmentThe combined and preliminary deduplicated total was n = 583. We also identified 11 records from other sources (reference lists, etc). See PRISMA flow diagram for inclusion and exclusion details of these references (Figure '‹ 1 ).
        Study flow diagram from search on 25 April 2021.
        The supplementary search for the BEC identified 17 studies, of which 4 were retrieved in full. No full trial- or model-based economic evaluations (cost''utility analyses, cost''effectiveness analyses, or cost''benefit analyses) were identified.
        Twenty-one trials in treatment and 2 trials in prophylaxis of COVID-19 met review inclusion. One further study47 reported separate treatment and prophylaxis components; we label this study ''Elgazzar'' under both questions. In effect, there were 22 trials in treatment and 3 in prophylaxis. All of these contributed data to at least one review outcome and meta-analysis. Fifteen trials contributed data for the primary outcome for ivermectin treatment (death); 3 studies reported the primary outcome for prophylaxis (COVID-19 infection). Characteristics of included studies are given in Table '‹ 1 . Seventeen studies47''63 were excluded as they were not RCTs and we identified 39 ongoing studies64''102 and 2 studies103,104 are awaiting classification.
        Table 1.Summary of study characteristics.
        Study IDCountryDesignFundingParticipantsSample sizeIvermectin dose and frequency*ComparatorOrigin of dataMain outcomes reportedCOVID-19 treatment studies'ƒAhmed 202023BangladeshDouble-blindBPL(Pharma); Bangladesh, Canada, Sweden, and UK govtMild to moderate COVID (inpatients)7212 mg — 1 day or — 5 days (3 study arms)*PlaceboPublished in PR journal; emailed/responded with dataTime to viral clearance (PCR ''ve), remission of fever and cough within 7 days, duration of hospitalization, mortality, failing to maintain sats >93%, adverse events, PCR ''ve at 7 and 14 days'ƒBabalola 2020105NigeriaDouble-blindSelf-fundedAsymptomatic, mild or moderate COVID (45 inpatients and 17 outpatients)626 mg every 84 hrs — 2 wks (arm 1) or 12 mg every 84 hrs — 2 wks (arm 2)Ritonavir/lopinavirMedRxiv preprint: emailed/responded with data. Paper accepted for publicationTime to PCR ''ve, laboratory parameters (platelets, lymphocytes, clotting time), clinical symptom parameters'ƒBukhari 2021135PakistanOpen-labelNone reportedMild to moderate COVID (inpatients)10012 mg — 1 doseSOCMedRxiv preprintViral clearance, any adverse side effects, mechanical ventilation'ƒChaccour 202024SpainDouble-blindIdapharma, ISGlobal, and the University of NavarraMild COVID (outpatients)240.4 mg/kg — 1 dosePlaceboPublished in PR journalPCR +ve at day 7, proportion symptomatic at day 4,7,14,21, progression, death, adverse events'ƒChachar 2020112PakistanOpen-labelSelf-fundedMild COVID (outpatients)5012 mg at 0, 12, and 24 hours (3 doses)SOCPublished in PR journalSymptomatic at day 7'ƒChowdhury 2020136BangladeshQuasi-RCTNone reportedOutpatients with a +ve PCR (approx. 78% symptomatic)1160.2 mg/kg x1 dose*HCQ 400 mg 1st day then 200 mg BID — 9 days + AZM 500 mg daily — 5 daysResearch square preprintTime to ''ve PCR test; period to symptomatic recovery; adverse events'ƒElgazzar 202047EgyptRCTNone reportedMild to severe COVID (inpatients)2000.4 mg/kg daily — 4 daysHCQ 400 mg BID — 1 day then 200 mg BID — 9 daysResearch square preprint: emailed/responded with dataImproved, progressed, died. Also measured CRP, D-dimers, HB, lymphocyte, serum ferritin after one week of treatment'ƒFonseca 202144BrazilDouble-blindInstitution-fundedModerate to severe (inpatients)16714 mg daily — 3 days (plus placebos — 2 additional days)HCQ'--400 mg BID on day 0 then daily — 4 days; CQ -450 mg BID day 0 then daily — 4 daysPrepublication data/manuscript in progress obtained via emailDeath, invasive mechanical ventilation'ƒGonzalez 2021137MexicoDouble-blindInstitution-fundedModerate to severe (inpatients)10812 mg — 1 dosePlaceboMedRxiv preprintLength of hospital stay, invasive mechanical ventilation, death, time to negative PCR'ƒHashim 2020138IranQuasi-RCTNone reportedMild to critical (inpatients)1400.2 mg/kg — 2 days*Some had a 3rd dose a week laterSOCMedRxiv preprintDeath, mean time to recovery, disease progression (deterioration)'ƒKrolewiecki 2020106ArgentinaOpen-labelNone reportedMild to moderate (inpatients)450.6 mg/kg/d — 5 daysPlaceboResearch Gate and SSRN preprintsViral load reduction in respiratory secretions day 5, IVM concentrations in plasma, severe adverse events'ƒLopez-Medina 202185ColumbiaDouble-blindInstitution-fundedMild (outpatients)4760.3 mg/kg elixir — 5 daysPlaceboPublished in a PR journalResolution of symptoms within 21 days, deterioration, clinical condition, hospitalization, adverse events'ƒMahmud 2020107BangladeshDouble-blindNone reportedMild to moderate COVID (inpatients)36312 mg — 1 dose*Placebo + SOCData published on clinical trial registry and clarification obtained via emailImprovement, deterioration, late clinical recovery, persistent PCR test +ve'ƒMohan 2021110IndiaDouble-blindInstitution-fundedMild to moderate15212 mg or 24 mg elixir — 1 dosePlaceboMedRxiv preprint researchConversion of RT-PCR to negative result, decline of viral load at day 5 from enrollment'ƒNiaee 2020108IranDouble-blindInstitution-fundedMild to severe COVID1800.2 mg/kg — 1 and 3 other dosing options) '¼ 14 mg tablet' PlaceboResearch Square preprintDeaths, length of stay, biochemical parameters'ƒOkumus 2021115TurkeyQuasi-RCTNone reportedSevere COVID660.2 mg/kg — 5 daysSOCPrepublication data/manuscript in progress obtained via emailClinical improvement, deterioration, death, SOFA scores'ƒPetkov 2021139BulgariaDouble-blindPharma-fundedMild to moderate COVID1000.4 mg/kg — 3 daysPlaceboPrepublication data obtained from another sourceRate of conversion to PCR negative'ƒPodder 2020140BangladeshOpen-labelSelf-fundedMild to moderate (outpatients)620.2 mg/kg — 1 doseSOCPublished in PR journalDuration of symptoms, recovery time to symptom free from enrollment, recovery time to symptom free from symptom onset, repeat PCR result on day 10'ƒRaad 2021113LebanonDouble-blindSelf-fundedAsymptomatic outpatients1009 mg PO if 45 kg''64 kg, 12 mg PO if 65 kg''84 kg and 0.15 mg/kg if body weight '‰¥85 kgPlaceboPrepublication data/manuscript in progress obtained via emailViral load reduction, hospitalization, adverse effects'ƒRavikirti 2021109IndiaDouble-blindSelf-fundedMild to moderate COVID (inpatients)11212 mg — 2 days + SOCPlacebo + SOCPublished in PR journalA negative RT-PCR report on day 6, symptomatic on day 6, discharge by day 10, admission to ICU, need for invasive mechanical ventilation, mortality'ƒRezai 2020111IranDouble-blindNone reportedMild to moderate (inpatient)600.2 mg/kg — 1 doseSOCPrepublication data obtained from another sourceClinical symptoms, respiratory rate and O2 saturation'ƒSchwartz 2021114,141IsraelDouble-blindNone reportedMild to moderate (outpatients)940.15''0.3 mg/kg — 3 daysPlaceboPrepublication data obtained from another sourceViral clearance at day 4, 6, 8 and 10), hospitalizationCOVID-19 prophylaxis studies'ƒChahla 2021142ArgentinaOpen-labelNone reportedHealth care workers23412 mg (in drops) weekly + iota-carrageenan 6 sprays daily — 4 wkSOCPrepublication data/manuscript in progress obtained via emailCOVID-19 infection (not clear if measured by PCR or symptoms)'ƒElgazzar 202047EgyptOpen-labelSelf-fundedHealth care and family contacts2000.4 mg/kg, weekly — 2 weeksSOCResearch square preprint: emailed/responded with dataPositive PCR test'ƒShouman 2020143EgyptOpen-labelSelf-fundedFamily contacts3042 doses (15''24 mg depending on weight) on day 1 and day 3SOCPublished in PR journalSymptoms and/or positive COVID-19 PCR test within 14 days; adverse eventsA risk-of-bias summary graph is given in Figure '‹ 2 . Eleven studies23,24,44,47,105,106''111 used satisfactory random sequence generation and allocation concealment. Two trials described satisfactory sequence generation, but it was unclear whether allocation was concealed.112,113
        Risk-of-bias summary: review authors' judgments about each risk of bias item for each included study.
        Ten trials reported adequate blinding of the participants/personnel and/or the outcome assessors.23,24,44,105,107,109,110,111,113,114 The others were either unclear or high risk for blinding. We considered blinding to be a less important criterion for evaluation of evidence related to the review's primary outcomes, namely death and laboratory-confirmed COVID-19 infection, which are objective outcomes.
        We did not consider publication on preprint web sites to constitute a risk of bias because all studies were scrutinized and peer reviewed by us during the review process and, where additional information was needed, we contacted the authors for clarification.
        Main findingsTwenty-four RCTs (including 3 quasi-RCTs) involving 3406 participants were included, with sample sizes ranging from 24 to 476 participants. Twenty-two trials in treatment and 3 trials in prophylaxis met review inclusion, including the trial of Elgazzar et al, which reported both components. For trials of COVID-19 treatment, 16 evaluated ivermectin among participants with mild to moderate COVID-19 only; 6 trials included patients with severe COVID-19. Most compared ivermectin with placebo or no ivermectin; 3 trials included an active comparator (Table '‹ 1 ). Three RCTs involving 738 participants were included in the prophylaxis trials. Most trials were registered, self-funded, and undertaken by clinicians working in the field. There were no obvious conflicts of interest noted, with the exception of two trials.85,139
        Ivermectin treatment versus no ivermectin treatmentTwenty-two trials (2668 participants) contributed data to the comparison ivermectin treatment versus no ivermectin treatment for COVID-19 treatment.
        All-cause mortalityMeta-analysis of 15 trials, assessing 2438 participants, found that ivermectin reduced the risk of death by an average of 62% (95% CI 27%''81%) compared with no ivermectin treatment [average RR (aRR) 0.38, 95% CI 0.19 to 0.73; I2 = 49%]; risk of death 2.3% versus 7.8% among hospitalized patients in this analysis, respectively (SoF Table '‹ 2 and Figure '‹ 3 ). Much of the heterogeneity was explained by the exclusion of one trial44 in a sensitivity analysis (average RR 0.31, 95% CI 0.17''0.58, n = 2196, I2 = 22%), but because this trial was at low risk of bias, it was retained in the main analysis. The source of heterogeneity may be due to the use of active comparators in the trial design. The results were also robust to sensitivity analyses excluding 2 other studies with an active treatment comparator (average RR 0.41, 95% CI 0.23''0.74, n = 1809, I2 = 8%). The results were also not sensitive to the exclusion of studies that were potentially at higher risk of bias (average RR 0.29, 95% CI 0.10''0.80, 12 studies, n = 2095, I2 = 61%), but in subgroup analysis, it was unclear as to whether a single dose would be sufficient. The effect on reducing deaths was consistent across mild to moderate and severe disease subgroups. Subgrouping data according to inpatient and outpatient trials was not informative because few outpatient studies reported this serious outcome. The conclusions of the primary outcome were also robust to a series of alternative post hoc analyses that explored the impact of numerous trials that reported no deaths in either arm. Extreme sensitivity analyses using a treatment arm continuity correction of between 0.01 and 0.5 did not change the certainty of the evidence judgments (Table '‹ 3 ).
        Table 2.Summary of findings table of ivermectin versus no ivermectin for COVID-19 treatment in any setting.
        OutcomesIllustrative comparative risks* (95% CI)Relative effect (95% CI)No. of participants (studies)Quality of the evidence (GRADE)Assumed riskCorresponding riskNo ivermectinIvermectinDeath from any cause78 per 1000 (all disease severity)48 fewer deaths per 1000 (21''63)RR = 0.38 (0.19''0.73)2438 (15)Moderate' Recovery time to negative PCR test, in daysAbsolute risks were not computed due to certainty of evidence being low and, in some cases, number of events being sparseMD = ''3.20 (''5.99 to ''0.40)375 (6)Very low' ,',§Time to clinical recovery, in days (outpatients)MD = ''1.06 (''1.63 to ''0.49)176 (2)Very low' ,',§Time to clinical recovery, in days (mild to moderate COVID-19 inpatients)MD = ''7.32 (''9.25 to ''5.39)96 (1)Very low' ,¶Time to clinical recovery, in days (severe COVID-19 inpatients)MD = ''3.98 (''10.06 to 2.10)33 (1)Very low' ,¶Admission to ICURR=1.22 (0.75''2.00)379 (2)Very low¶,'•‘...Need for mechanical ventilationRR=0.66 (0.14''3.00)431 (3)Low§,'•‘Length of hospital stay, in daysMD= 0.13 (''2.04 to 2.30)68 (1)Very low' ,¶Admission to hospitalRR 0.16 (0.02''1.32)194 (2)Very low' ,¶Duration of mechanical ventilationNot reportedImprovement (mild to moderate COVID-19)*635 improved per 1000159 more per 1000 (from 51 more to 286 more)RR 1.25 (1.08''1.45)681 (5)Low' ,'Deterioration (any disease severity)143 per 100093 fewer per 1000 (from 50 fewer to 116 fewer)RR 0.35 (0.19''0.65)1587 (7)Low' ,'Serious adverse events7/867 (0.8%) had an SAE in ivermectin group and 2/666 (0.3%) in controlRR=1.65 (0.44''6.09)1533 (11)Low' ,'Table 3.Sensitivity analyses for death from any cause considering methods for dealing with zero events in trials.
        MethodMeasureModelEffect size (95% CI)DetailsPetoORFE0.35 (0.24 to 0.53)Handles single-zero trialsM-HORFE0.37 (0.24 to 0.56)Handles single-zero trialsM-HORRE0.33 (0.16 to 0.68)Handles single-zero trialsM-HRRFE0.42 (0.29 to 0.60)Handles single-zero trialsM-HRRRE0.37 (0.19 to 0.74)Handles single-zero trialsM-HRDFE''0.04 (''0.06 to ''0.02)Handles double-zero trialsM-HRDRE''0.03 (''0.06 to ''0.00)Handles double-zero trialsIVRDFE''0.01 (''0.02 to ''0.00)Handles double-zero trialsIVRDRE''0.02 (''0.04 to ''0.00)Handles double-zero trialsTreatment arm continuity correction methods using IVAccounting for double zerosAccounting for all zeros0.01RRFE0.54 (0.36 to 0.79)0.58 (0.39''0.88)0.01RRRE0.43 (0.25 to 0.72)0.58 (0.39''0.88)0.1RRFE0.54 (0.37 to 0.79)0.56 (0.38''0.84)0.1RRRE0.43 (0.26 to 0.73)0.46 (0.26''0.80)0.25RRFE0.54 (0.37 to 0.79)0.55 (0.37''0.81)0.25RRRE0.44 (0.26 to 0.73)0.45 (0.26''0.76)0.5RRFE0.54 (0.37 to 0.79)0.55 (0.35''0.78)0.5RRRE0.45 (0.27 to 0.74)0.47 (0.29''0.75)Trial sequential analysisTSA, using the DL random-effects method, showed that there may have been sufficient evidence accrued before the end of 2020 to show significant benefit of ivermectin over control for all-cause mortality. The cumulative z-curve in Figure '‹ 8 crossed the trial sequential monitoring boundaries after reaching the required IS, implying that there is firm evidence for a beneficial effect of ivermectin use over no ivermectin use in mainly hospitalized participants with mild to moderate COVID-19 infection.
        Trial sequential analysis using DL random-effects method with parameter estimates of Î± = 0.05, Î² = 0.1, control rate = 7.8%, RRR = 62%, and diversity = 49.5%.
        The TSA was used to calculate the IS required to demonstrate or reject a 62% RRR of death in the ivermectin group, as observed in the primary meta-analysis. This estimate is similar to effect estimates reported in other reviews.10 We assumed a 7.8% event proportion in the control group, which was the average control group event rate from the primary meta-analysis. We used a model variance-based estimate of 49.1% (diversity estimate) to correct for heterogeneity. The required IS was 1810 participants (Figure '‹ 8 ), which was exceeded by the total number of observed participants in the meta-analysis (n = 2438). In the TSA plots, the red dashed lines in Figure '‹ 8 represent the trial sequential monitoring boundaries using the O'Brien''Fleming alpha-spending function. The solid blue line is the cumulative z-curve and represents the observed trials in the cumulative meta-analysis. The adjusted significance boundaries for the cumulative z-curve were constructed under the assumption that significance testing may have been performed each time a new trial was added to the meta-analysis. In Figure '‹ 8 , the z-curve crosses the boundary after reaching the required IS, thereby supporting the previous conclusion in RevMan 5.4.131 using the DL method that ivermectin is superior to control in reducing the risk of death.
        Sensitivity analysesSensitivity analysis excluding the trial of Fonseca44 significantly reduced heterogeneity in the meta-analysis and thus the diversity estimate in the TSA using the DL model. This strengthened the suggestion in the primary core analysis that the required IS had been reached (Figure '‹ 9 ). Because the DL estimator could potentially underestimate the between-trials variance,43 we performed further sensitivity analyses using 2 alternative random-effects model approaches. The results of the primary TSA analysis were robust to sensitivity analysis using the BT method with the same parameters, excluding the Fonseca44 trial, which was a cause of substantial heterogeneity (Figure '‹ 10 ). The TSA comprehensively confirms the result of the conventional meta-analysis. The required IS was 1064.
        Sensitivity analysis excluding an outlier study responsible for the heterogeneity, showing trial sequential analysis using DL random-effects method with parameter estimates of Î± = 0.05, Î² = 0.1, control rate = 7.8%, = 62%, and diversity = 0%.
        Sensitivity analysis excluding an outlier study responsible for the heterogeneity, showing trial sequential analysis using Biggerstaff''Tweedie random-effects method with parameter estimates of Î± = 0.05, Î² = 0.1, control rate = 7.8%, RRR = 62%, and diversity = 14.2%.
        The required IS was not reached in the TSA using the SJ method, largely because diversity from the model was high (Figure '‹ 11 ). The SJ estimator may overestimate the between-trials variance in meta-analyses with mild heterogeneity, thus producing artificially wide confidence intervals.43 When the diversity estimate was reduced to the same as in the DL model, the required IS was reached in the SJ model (data not shown). There was no evidence of futility using the SJ method in any scenario.
        Sensitivity analysis excluding an outlier study responsible for the heterogeneity, showing trial sequential analysis using Sidik''Jonkman random-effects method with parameter estimates of Î± = 0.05, Î² = 0.1, control rate = 7.8%, RRR = 62%, and diversity = 71.9%.
        Certainty of the evidence for all-cause mortalityOverall, death from any cause, taking into account all composite analyses, was judged to provide moderate-certainty evidence (SoF Table '‹ 2 and Figures '‹ 4 '' 11 ). A funnel plot corresponding to the primary outcome of death from any cause did not seem to suggest any evidence of publication bias (Figure '‹ 7 ). Furthermore, the ease with which trial reports can be uploaded as preprints should reduce this risk.
        Death due to any cause, excluding an outlier study responsible for the heterogeneity.
        Funnel plot of ivermectin versus control for COVID-19 treatment for all-cause death (subgrouped by severity).
        Death due to any cause, excluding high risk-of-bias studies.
        Death due to any cause, excluding studies with active controls.
        Secondary outcomesSecondary outcomes provided low to very low certainty evidence (SoF Table '‹ 2 ). Low-certainty findings suggested that there may be no benefit with ivermectin for ''need for mechanical ventilation,'' whereas effect estimates for ''improvement'' and ''deterioration'' favored ivermectin but were graded as low certainty due to study design limitations and inconsistency (Figures '‹ 12 '' 14 ). All other secondary outcome findings were assessed as very low certainty.
        Need for mechanical ventilation.
        Meta-analysis of 11 trials, assessing 1533 participants, found that there was no significant difference between ivermectin and control in the risk of severe adverse events (aRR 1.65, 95% CI 0.44''6.09; I2 = 0%; low certainty evidence, downgraded for imprecision and study design limitations). Seven severe adverse events were reported in the ivermectin group and 2 in controls. The SAEs were as follows: 2 patients in the Mahmud trial107 had esophagitis (this is a known side effect of doxycycline, which was coadministered with ivermectin in this trial); one patient in the study by Krolewiecki et al106 had hyponatremia (this trial used high-dose ivermectin for 5 days); and 2 patients in a study from Turkey115 had serious ''delirium-like behavior, agitation, aggressive attitude, and altered state of consciousness,'' which the authors attributed to metabolic insufficiencies in MDR-1/ABCB1 or CYP3A4 genes, screening for which was a study feature. In the Lopez-Medina et al85 trial, there were 2 SAEs in each arm (SoF Table '‹ 2 ).
        Ivermectin prophylaxis versus no ivermectin prophylaxisThree studies involving 738 participants evaluated ivermectin for COVID-19 prophylaxis among health care workers and COVID-19 contacts. Meta-analysis of these 3 trials, assessing 738 participants, found that ivermectin prophylaxis among health care workers and COVID-19 contacts probably reduces the risk of COVID-19 infection by an average of 86% (79%''91%) (3 trials, 738 participants; aRR 0.14, 95% CI 0.09''0.21; 5.0% vs. 29.6% contracted COVID-19, respectively; low-certainty evidence; downgraded due to study design limitations and few included trials) (Figure '‹ 15 ). In 2 trials involving 538 participants, no severe adverse events were recorded (SoF Table '‹ 4 ).
        COVID-19 infection (prophylaxis studies).
        Table 4.Summary of findings table of ivermectin versus no ivermectin for COVID-19 prophylaxis in healthy population (people without COVID-19 infection).
        OutcomesIllustrative comparative risks* (95% CI)Relative effect (95% CI)No of participants (studies)Quality of the evidence (GRADE)Assumed riskCorresponding riskNo ivermectinIvermectinCOVID-19 infection296 per 1000245 fewer infections per 1000 (234''269)RR = 0.14 (0.09''0.21)738 (3)Low' Admission to hospitalNot reportedDeath from any causeNot reportedSerious adverse eventsNo events occurred in 538 participants (2 studies), therefore the effect could not be estimated.DISCUSSIONThe findings indicate with moderate certainty that ivermectin treatment in COVID-19 provides a significant survival benefit. Our certainty of evidence judgment was consolidated by the results of trial sequential analyses, which show that the required IS has probably already been met. Low-certainty evidence on improvement and deterioration also support a likely clinical benefit of ivermectin. Low-certainty evidence suggests a significant effect in prophylaxis. Overall, the evidence also suggests that early use of ivermectin may reduce morbidity and mortality from COVID-19. This is based on (1) reductions in COVID-19 infections when ivermectin was used as prophylaxis, (2) the more favorable effect estimates for mild to moderate disease compared with severe disease for death due to any cause, and (3) on the evidence demonstrating reductions in deterioration.
        The evidence on severe adverse events in this review was graded as low certainty, partly because there were too few events to reach statistical significance. Evidence from a recent systematic review of ivermectin use among people with parasitic infections suggests that ivermectin administered at the usual doses (0.2 or 0.4 mg/kg) is safe and could be safe at higher doses.7,116 A recent World Health Organization document on ivermectin use for scabies found that adverse events with ivermectin were primarily minor and transient.22
        We restricted the included studies to the highest level of evidence, that is, RCTs, as a policy. This was despite there being numerous observational but nonrandomized trials of ivermectin, which one could argue could also be considered in an emergency. We included preprint and unpublished data from completed but not yet published trials due to the urgency related to evidence synthesis in the context of a global pandemic.117 Although there is the potential for selective reporting of outcomes and publication bias, we have factored in these considerations in interpreting results and forming conclusions. We adhered to PRISMA guidelines and the WHO statement on developing global norms for sharing data and results during public health emergencies.117
        There are a number of limitations with this review. Several of the studies contributing data did not provide full descriptions of methods, so assessing risk of bias was challenging. Where descriptions of study methods were sparse or unclear, we attempted to contact authors to clarify methods, but lack of information led us to downgrade findings in several instances. Overall interpretation of findings was hampered due to variability in the participants recruited, treatment regimen, and the care offered to those in control groups. We have tried to take this variation into account through subgroup and sensitivity analyses. Nevertheless, dosing and treatment regimens and the use of ivermectin with other components of ''standard care'' require further research. We did not include laboratory outcome measures, such as viral clearance. The latter and other biochemical outcomes have been reported in several studies and reviews and tend to favor ivermectin.10,47,105,108 Several trials reported continuous data, such as length of hospital stay, as medians and interquartile ranges; therefore, we were unable to include these data in meta-analysis. Because we did not undertake in our protocol to perform narrative evidence synthesis, and because these data tended to favor ivermectin, the certainty of the effects of ivermectin on these continuous outcomes may be underestimated.
        At least 5 other reviews of ivermectin use for COVID-19 have been published, including one coauthored with Nobel Laureate Professor Satoshi ÅŒmura, discoverer of ivermectin,9,10,118,119,120 but only 3 have been peer-reviewed9,118,120 and only 2 attempt full systematic review.10,119 We applied AMSTAR 2,121 a critical appraisal tool for systematic reviews of health care interventions, to the 2 nonpeered systematic reviews10,119 and both were judged to be of low quality (Table '‹ 5 ). However, there was also a suggestion that ivermectin reduced the risk of death in treatment of COVID-19 in these reviews.
        Table 5.Methodological quality of other systematic reviews (AMSTAR 2).
        Systematic reviewComponents of PICO describedA priori study designExplain selection of study designsComprehensive literature searchDuplicate study selectionDuplicate data extractionList of excluded studies justifiedCharacteristics of included studies providedHill et al, 202110+''++??''*?' Casta±eda-Sabogal et al 2021119+'•‘?''?#++''*+Systematic reviewRisk of bias adequately assessed and documentedSources of funding reportedAppropriate methods to combine findingsAppropriate risk-of-bias sensitivity analyses conductedRisk-of-bias assessment used in conclusionsSatisfactory explanation of observed heterogeneityLikelihood of publication bias assessedConflict of interest statedHill et al, 202110'''''''§''*''¶''*NA''Casta±eda-Sabogal et al 2021119''**''''' ' ''''''*+NA+The recently updated WHO therapeutics guidelines12 included 7 trials and 1419 people in the analysis of mortality. Reporting a risk reduction of 81% (odds ratio 0.19, 95% CI 0.09''0.36), the effect estimate favoring ivermectin was downgraded by 2 levels for imprecision, although the justification for this is unclear as the reported CI is precise (64%''91%).
        In addition to the evidence from systematic reviews, the findings of several controlled observational studies are consistent with existing evidence and suggest improved outcomes with ivermectin treatment.55,57,59 Similarly, with respect to ivermectin prophylaxis of frontline workers and those at risk, controlled observational studies from Bangladesh and Argentina (the latter which involved 1195 health care workers) have shown apparent reductions in COVID-19 transmission with ivermectin prophylaxis, including in some reports total protection (zero infections) where infection rates in the control group exceeded 50%.122,123 A very large trial of ivermectin prophylaxis in health care workers in India124 covered 3532 participants and reported risk ratios not significantly different from this meta-analysis (prophylaxis outcome).
        Clarifying ivermectin safety in pregnancy is a key question in patient acceptability for pregnant women contracting COVID-19. A recent meta-analysis5 found little evidence of increased risk of abnormal pregnancies but similarly weak evidence of absence of risk. For (pre-exposure) prophylaxis in pregnancy, where vaccines may be contraindicated, the alternative of hydroxychloroquine has been advocated.125,126 In addition to safety and relative efficacy, different risk''benefit judgments may be presented for prophylaxis (pre- and post-exposure), and for treatment, with pregnancy a high-risk status for COVID-19.
        RCTs in this review did not specifically examine use of ivermectin in the elderly, although this is a known high-risk group for severe COVID-19. In the setting of care homes, it is also notorious for rapid contagion. A standard indication for ivermectin in the elderly is scabies. We identified 2 recent reports suggesting that ivermectin may be efficacious as prevention and treatment of COVID-19 in this age group.50,127 A letter on positive experience in 7 elder care facilities in Virginia covering 309 patients was sent to NIH127 and has recently been submitted for publication.
        There is also evidence emerging from countries where ivermectin has been implemented. For example, Peru had a very high death toll from COVID-19 early on in the pandemic.128 Based on observational evidence, the Peruvian government approved ivermectin for use against COVID-19 in May 2020.128 After implementation, death rates in 8 states were reduced between 64% and 91% over a two-month period.128 Another analysis of Peruvian data from 24 states with early ivermectin deployment has reported a drop in excess deaths of 59% at 30+ days and of 75% at 45+ days.129 However, factors such as change in behavior, social distancing, and face-mask use could have played a role in this reduction.
        Other considerations related to the use of ivermectin treatment in the COVID-19 pandemic include people's values and preferences, equity implications, acceptability, and feasibility.130 None of the identified reviews specifically discussed these criteria in relation to ivermectin. However, in health care decision making, evidence on effectiveness is seldom taken in isolation without considering these factors. Ultimately, if ivermectin is to be more widespread in its implementation, then some considerations are needed related to these decision-making criteria specified in the GRADE-DECIDE framework.130
        There are numerous emerging ongoing clinical trials assessing ivermectin for COVID-19. The trade-off with policy and potential implementation based on evidence synthesis reviews and/or RCTs will vary considerably from country to country. Certain South American countries, Indian states, and, more recently, Slovakia and other countries in Europe have implemented its use for COVID-19.129,131,132,133,134 A recent survey of global trends118 documents usage worldwide. Despite ivermectin being a low-cost medication in many countries globally, the apparent shortage of economic evaluations indicates that economic evidence on ivermectin for treatment and prophylaxis of SARS-CoV-2 is currently lacking. This may impact more on LMICs that are potentially waiting for guidance from organizations like the WHO.
        Given the evidence of efficacy, safety, low cost, and current death rates, ivermectin is likely to have an impact on health and economic outcomes of the pandemic across many countries. Ivermectin is not a new and experimental drug with an unknown safety profile. It is a WHO ''Essential Medicine'' already used in several different indications, in colossal cumulative volumes. Corticosteroids have become an accepted standard of care in COVID-19, based on a single RCT of dexamethasone.1 If a single RCT is sufficient for the adoption of dexamethasone, then a fortiori the evidence of 2 dozen RCTs supports the adoption of ivermectin.
        Ivermectin is likely to be an equitable, acceptable, and feasible global intervention against COVID-19. Health professionals should strongly consider its use, in both treatment and prophylaxis.
        ACKNOWLEDGMENTSThis work was inspired by the prior literature review of Dr Pierre Kory.
        The authors thank Information Specialist, Jo Platt, of the Cochrane Gynaecological, Neuro-oncology, and Orphan Cancer (CGNOC) group for designing the search strategy and running the search, as well as Anna Noel Storr for reviewing the strategy. The authors also thank Isabella Rushforth for her voluntary assistance with the preparation of the reference lists.
        The authors thank Gill Gyte for detailed comments, feedback, and involvement in this review, and Michael Grayling and David Tovey for useful peer review comments before submission. The authors also thank the external peer reviewers for their helpful comments and Peter Manu for the opportunity to publish our findings.
        FootnotesThe preprint of this review received no funding. This updated version was funded by the crowdfunding initiative https://www.gofundme.com/f/help-us-get-lifesaving-drug-approved-for-covid19
        The authors have no conflicts of interest to declare.
        Contributed by
        T. A. Lawrie and A. Bryant cowrote the review; they also sifted the search and classified studies for inclusion and entered and checked the data in RevMan and performed analyses. Data extraction was divided among T. A. Lawrie, A. Bryant, and T. Dowswell. T. Dowswell and A. Bryant graded the evidence. E. J. Fordham prepared the text on ivermectin mechanisms, use in pregnancy, and among the elderly. S. R. Hill prepared the brief economic commentary. Clinicians S. Mitchell and T. C. Tham contributed to the interpretation of the evidence in the discussion and conclusions. All authors reviewed and approved the final version of the manuscript.
        This article discusses off-label use of the FDA-approved medication ivermectin against COVID-19.
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      CDC/FDA smoking gun of smoking guns Jon Rappoport's Blog
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 15:38
        They confess: they had no virus when they concocted the test for the virus; they ''contrived'' a model by pretending to find what they wanted to find; it's called a self-fulfilling prophecy
        This is the con and the crime that drove millions of lives, and economies, into ruin
        by Jon Rappoport
        September 1, 2021
        (To join our email list, click here .)
        The CDC has issued a document that bulges with devastating admissions.
        The release is titled, ''07/21/2021: Lab Alert: Changes to CDC RT-PCR for SARS-CoV-2 Testing.'' It begins explosively:
        ''After December 31, 2021, CDC will withdraw the request to the U.S. Food and Drug Administration (FDA) for Emergency Use Authorization (EUA) of the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel, the assay first introduced in February 2020 for detection of SARS-CoV-2 only. CDC is providing this advance notice for clinical laboratories to have adequate time to select and implement one of the many FDA-authorized alternatives.''
        Many people believe this means the CDC is giving up on the PCR test as a means of ''detecting the virus.'' The CDC isn't saying that at all.
        They're saying the PCR technology will continue to be used, but they're replacing what the test is looking FOR with a better ''reference sample.'' A better marker. A better target. A better piece of RNA supposedly derived from SARS-CoV-2.
        CDC/FDA are confessing there has been a PROBLEM with the PCR test which has been used to detect the virus, starting in February of 2020'--right up to this minute.
        In other words, the millions and millions of ''COVID cases'' based on the PCR test in use are all suspect. Actually, that statement is too generous. Every test result of every PCR test should be thrown out.
        To confirm this, the CDC document links to an FDA release titled, ''SARS-CoV-2 Reference Panel Comparative Data.'' Here is a killer quote:
        ''During the early months of the Coronavirus Disease 2019 (COVID-19) pandemic, clinical specimens [of the virus] were not readily available to developers of IVDs [in vitro diagnostics] to detect SARS-CoV-2. Therefore, the FDA authorized IVDs based on available data from contrived samples generated from a range of SARS-CoV-2 material sources (for example, gene specific RNA, synthetic RNA, or whole genome viral RNA) for analytical and clinical performance evaluation. While validation using these contrived specimens provided a measure of confidence in test performance at the beginning of the pandemic, it is not feasible to precisely compare the performance of various tests that used contrived specimens because each test validated performance using samples derived from different gene specific, synthetic, or genomic nucleic acid sources.''
        Translation: We, at the CDC, did not have a specimen of the SARS-CoV-2 virus when we concocted the PCR test for SARS-CoV-2. Yes, it's unbelievable, right? And that's the test we've been using all along. So we CONTRIVED samples of the virus. We fabricated. We lied. We made up [invented] synthetic gene sequences and we SAID these sequences HAD TO BE close to the sequence of SARS-CoV-2, without having the faintest idea of what we were doing, because, again, we didn't have an actual specimen of the virus. We had no proof THERE WAS something called SARS-CoV-2.
        This amazing FDA document goes to say the Agency has granted emergency approval to 59 different PCR tests since the beginning of the (fake) pandemic. 59. And, '''...it is not feasible to precisely compare the performance of various tests that used contrived specimens because each test validated performance using samples derived from different gene specific, synthetic, or genomic nucleic acid sources.''
        Translation: Each of the 59 different PCR tests for SARS-CoV-2 told different lies and concocted different fabrications about the genetic makeup of the virus'--the virus we didn't have. Obviously, then, these tests would give unreliable results. THE PCR TESTS USED CONTRIVED SPECIMENS OF THE VIRUS WE DIDN'T HAVE.
        BUT, don't worry, be happy, because NOW, the CDC and the FDA say, they really do have actual virus samples of SARS-CoV-2 from patients; they have better targets for the PCR test, and labs should start gearing up for the new and improved tests.
        In other words, they were lying THEN, but they're not lying NOW. They were ''contriving,'' but now they're telling the truth.
        If you believe that, I have Fountain of Youth water for sale, extracted from the lead-contaminated system of Flint, Michigan.
        Here, once again, I report virology's version of ''we isolated the virus'':
        They have a soup they make in their labs.
        This soup contains human and monkey cells, toxic chemicals and drugs, and all sorts of other random genetic material. Because the cells start to die, the researchers ASSUME a bit of mucus from a patient they dropped in the soup is doing the killing, and THE VIRUS must be the killer agent in the mucus.
        This assumption is entirely unwarranted. The drugs and chemicals could be doing the cell-killing, and the researchers are also starving the cells of vital nutrients, and that starvation could kill the cells.
        There is no proof that SARS-CoV-2 is in the soup, or that it is doing the cell-killing, or that it exists.
        Yet the researchers call cell-death ''isolation of the virus.''
        To say this is a non-sequitur is a vast understatement. In their universe, ''We assume, without proof, we have the virus buried in a soup in a dish in the lab'' equals, ''We've separated the virus from all surrounding material.''
        Virology equals ''how to spread bullshit for a living and scare the world.'' Other than that, it's perfect.
        (To read about Jon's mega-collection, The Matrix Revealed, click here .)
        Jon Rappoport
        The author of three explosive collections, THE MATRIX REVEALED , EXIT FROM THE MATRIX , and POWER OUTSIDE THE MATRIX , Jon was a candidate for a US Congressional seat in the 29th District of California. He maintains a consulting practice for private clients, the purpose of which is the expansion of personal creative power. Nominated for a Pulitzer Prize, he has worked as an investigative reporter for 30 years, writing articles on politics, medicine, and health for CBS Healthwatch, LA Weekly, Spin Magazine, Stern, and other newspapers and magazines in the US and Europe. Jon has delivered lectures and seminars on global politics, health, logic, and creative power to audiences around the world. You can sign up for his free NoMoreFakeNews emails here or his free OutsideTheRealityMachine emails here .
      The 6 Pre-approved Social Justice Messages the NFL Will Allow on Helmets This Season
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 15:29
        Following through on its commitment to combat systemic racism, the NFL has announced the pre-approved social justice messages that players will be allowed to wear on the back of their helmets in the 2021 season.
        "We are committed to Inspire Change and the social justice work that inspires change for the long-term," Anna Isaacson, the NFL senior vice president of social responsibility, told The Associated Press.
        Players will be able to choose from the following messages for their helmet decal: "End Racism,'' "Stop Hate,'' "It Takes All of Us,'' "Black Lives Matter,'' "Inspire Change'' and "Say Their Stories.''
        Additionally, the phrases, ''End Racism'' and ''It Takes All of Us'' will appear in the end zones unless another cause, like the Salute to Service game, is being promoted.
        The league will also bring back the "Say Their Stories'' initiative and for the first time, each team will highlight its social justice work during a regular-season home game in Weeks 17 and 18. ['...]
        This year's "Say Their Stories'' features will again be voiced by NFL players but will evolve to include social justice heroes who have been personally identified by players for their impact in this area, particularly those from their local communities.
        For the final two weeks of the regular season, all clubs will receive the relevant banners, goal post wraps, stencils, helmet decals and video board graphics. The elements will continue to be featured during playoff games.
        "That will provide a unified time frame for us to further amplify all of the work that our clubs are doing and that will lead into the playoffs where Inspire Change will continue to take center stage,'' Isaacson said. "The key message for us as the season is starting, we are ramping up again in a big way with our social justice work.''
        The league also worked with New Era and the Players Coalition to offer an Inspire Change knit hat that can be worn on the sideline during Weeks 17 and 18 by players, coaches and other personnel to add additional visibility to the cause. The hat will be sold at retail, and 100% of the league's proceeds will be donated to Inspire Change grant recipients. (AP)
        In other words, fans hoping to watch football without a side of wokeness are out of luck'--again.
      Israel Vaccine Passport Now Expires After Six Months, Boosters Required - Vision Times
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 15:27
        Israel's vaccine passport QR-code system, Green Pass, will now expire six months after the second injection is received, making a third, and possibly fourth, booster shot effectively mandatory to continue participation in Israel's mainstream society.
        On Aug. 29, Israeli health officials announced at a press conference that effective Oct. 1, fully vaccinated Green Pass validation status would expire six months after the second dose is received, according to news website Arutz Sheva.
        Nachman Ash, Director General of Israel's Health Ministry, also announced the age limit to receive the third injection had been reduced to 12. When Israel's booster distribution was announced on Aug. 1, the age minimum was 60 and halved to 30 during the week of Aug. 23.
        Additionally, citizens returning from overseas travel who have accepted a third injection will be required to quarantine for only 24 hours after arrival. Those who only have two doses are no longer considered fully vaccinated and will be sequestered for 7 days.
        On Aug. 24, Haaretz reported Health Minister Nitan Horowitz as saying in comments given on Channel 13 Television, ''This is simply because, in terms of its effectiveness, the vaccine is valid only for a period of five or six months.''
        ''After about half a year, you have to get a third dose. Otherwise, the vaccine loses its power.''
        Horowitz continued, ''The Green Pass testifies that a person is safe in a certain way'...So the moment we know that the vaccine loses its effectiveness after a certain period, there's no justification for giving a green pass to someone who hasn't gotten another dose.''
        The Minister was paraphrased as saying ''the booster will become a requirement for a Green Pass only when the shot is available to everyone aged 12 and older.'' At the time of his comments, the age limit was still 30.
        According to Times of Israel, when Horowitz was questioned at the Aug. 29 press conference about whether a fourth dose would be required in the future to maintain vaccine passport status, he simply replied, ''It is too early to speak about the end of the fourth wave.''
        The Times also reported that Professor Eran Segal, a ''top coronavirus advisor to the government'' told Army Radio on Aug. 28 that the entire country needed to take the third injection, ''From the moment that we understood the vaccine is fading, the right thing to do is to give a third dose to the entire population that got vaccinated five months or more ago.''
        Yet in early August, Dr. Kobi Haviv, Medical Director of Herzog Hospital in Jerusalem, the Capital's third largest hospital, self-described as ''Israel's foremost center for geriatric, respiratory, mental health and psychotrauma care, treatment and research,'' told Channel 13 that 95 percent of severely ill Coronavirus Disease 2019 (COVID-19) patients were vaccinated individuals.
        He also said 85 to 90 percent of those hospitalized were vaccine recipients, and that his hospital was forced to open additional COVID-19 wards.
        In July, the Israeli Minister of Health had to concede the Pfizer-BioNTech injection's efficacy had plummeted to a meager 39 percent when facing the Delta Variant.
        A prophetic warning from a former Pfizer executiveIn April, Michael Yeadon, former Vice President and Chief Science Officer of Pfizer spoke with the documentary series Planet Lockdown about SARS-CoV-2 variants, booster shots, and vaccine passports.
        In the interview, Yeadon shared his grave opinion about booster injections, ''You should be terrified at this point, as I am, because there's absolutely no possible justification for their manufacture'...The variants are not different enough to represent a threat to you. You do not need top up vaccines. Yet, they are being made, and the regulators have more or less waived them through.''
        Yeadon said in his 57-minute interview that when he was an up-and-coming star in Pfizer's executive track, one former supervisor said what really made him stand out was his ability to ''spot patterns in sparse data earlier than [his] peers did.''
        ''So when there's not enough data for most people to judge what was going on, I would often be able to see it. I could see a pattern forming when there wasn't quite enough information.''
        He said during his April interview that he was troubled by mentions in the media and by various experts encouraging incoming vaccine passports because historically, they have only existed under extremely narrow circumstances, ''The only reason we've ever had passports for certain immunizations'...are those when the disease is extremely lethal, something like yellow fever, and when you might otherwise bring back to a community, which has no immunity whatsoever, a really dangerous pathogen.''
        He then cautioned about the slippery slope of civil liberties and human rights erosions ubiquitous digital vaccine passports can bring, ''What they provide, though, is complete control over your movements to whoever controls the database that your vaccination status is connected to.''
        ''This is what's going to take over your life in a way that George Orwell in 1984 didn't even dream of.''
        Yeadon gave an apt example, ''Imagine you've been vaccinated and you've been awarded a vaccine passport on an app'...Imagine if they say now you need your valid vaccine passport to enter any large shopping complex, then every large store. That's going to provide coercive pressure on people who've chosen not to be vaccinated in order to get vaccinated.''
        He warned, ''You can't control what those rules are'...Don't allow this system to come into force. It's going to be used to coerce you.''
        And continued in his prediction of things to come, ''I believe if you allow vaccine passports to come into force, you'll be pinged one day and it will advise you to go to the medical center to have your top up vaccine, and if you choose not to, your vaccine passport validity will expire, which means you won't be able to enter a shop.''
        Yeadon said what he was really worried about, however, was if the trend started to be taken to extremes, ''You may not eventually be able to use your bank card. All somebody needs to do is set a rule that says as after a given date before any bank card can be used the vaccine passport has to be beeped onto the card reader.''
        ''It will give away to whoever controls that database and the rules complete control over everything you do.''
        He also sounded the alarm that in the future, vaccine passport status may hinge on more than just the individual's willingness to accept continual injections, ''In addition to advising you that you need to come to the health center for your top up vaccine, perhaps your second one in a year,'' he said, ''It also advises you that you need to bring your small grandchild down because your daughter hasn't brought the little lad in yet. And they say if you don't bring that grandchild down, your vaccine passport will expire and that of your daughter as well.''
        ''Now try resisting that.''
        Neil Campbell
        Neil lives in Canada and writes about society and politics.
      Shock as JCVI experts decide NOT to recommend Covid jabs for healthy children aged 12 to 15 | Daily Mail Online
        Link to Article
        Archived Version
        Sat, 04 Sep 2021 15:03
        Plans to vaccinate millions of schoolchildren are expected to be given the go-ahead for as soon as next week despite government advisers yesterday refusing to back a mass rollout.
        After weeks of pressure for a decision, the Joint Committee on Vaccination and Immunisation ruled that healthy 12 to 15-year-olds should not get Covid jabs, saying the benefit to their health did not outweigh the risks.
        However, Health Secretary Sajid Javid has now asked England's chief medical officer, on the advice of the JCVI, for a second opinion on vaccinating youngsters.
        He has told Chris Whitty to take into account 'non-health benefits', including whether vaccinating children would reduce disruption to their education. The professor, in consultation with the chief medical officers from Scotland, Wales and Northern Ireland, will spend the next week weighing up evidence before making a recommendation.
        Last night, a Government source told the Mail that jabbing 12 to 15-year-olds was still 'very much on the table'.
        Many senior ministers strongly back the idea and believe Professor Whitty is in also favour and will look to enlist senior doctors to collect evidence of the effects of the Covid pandemic on children's health to strengthen his case.
        It is hoped Prof Whitty will report next week and that vaccination rollout in schools can begin soon after secondary pupils go back, will requests for parental consent going out as soon as the green light is given.
        The JCVI's decision means an inevitable delay to any rollout, as well as uncertainty for schools and parents just as millions of children return to class for the autumn term.
        Yesterday the JCVI did recommend Covid vaccinations be extended to children in the age group with a serious conditions involving their heart, lungs, kidneys or liver as well as neurological conditions. The move was also unprecedented as the first time the body has recommended seeking 'further advice' on a decision.
        This is in part because the JCVI only considered health benefits and risks of vaccinating children and ignored social or educational aspects.
        Education unions warned that 'time was pressing' and lessons would be disrupted. The decision highlights the growing tension between ministers and advisers on the next phase of the vaccine rollout, following a fierce debate over plans for a booster programme for older adults.
        As another 42,076 coronavirus cases and 121 deaths were reported:
        Tory former health secretary Jeremy Hunt urged ministers to overrule dithering officials and 'avert a winter catastrophe' by urgently rolling out booster jabs; Writing in the Mail, he said the UK had 'no room for hesitation or delay' in offering third doses to all adults; Vaccine passports are set to be introduced for football matches, pop concerts and business conferences, despite mounting Tory opposition; Four police officers were injured in clashes with anti-vaccine protesters in London; A study suggested one in seven primary schools plan to keep class 'bubbles' amid fears over the spread of coronavirus; Four million doses of the Pfizer jab will be sent to Australia, with the country reciprocating before the end of the year. The mass rollout of vaccines was initially approved by the JCVI only for over-18s. The committee then extended it to 16 and 17-year-olds in a U-turn last month.
        Since then it has come under intense political pressure to cover the 12-15 age group. Ministers fear the failure to vaccinate these children could lead to a surge in new cases as pupils return for the new academic year.
        Asked if the JCVI had felt under political pressure over the decision, deputy chairman Prof Anthony Harnden told Times Radio: 'We are an independent committee but we are an advisory body, and ultimately we advise. There's been a lot of pressure from people coming out and making pronouncements about what we're going to do with NHS planning.'
        Cases in Scotland have soared since schools returned last month, with infections among youngsters now higher than at any time during the pandemic.
        Earlier this week, the NHS began recruiting thousands of vaccinators to help with a rapid rollout in schools while awaiting advice from the JCVI.
        Tensions over the issue, which have been simmering for weeks, burst into the public domain on Thursday when Education Secretary Gavin Williamson said offering Covid jabs to 12 to 15-year-olds would be 'deeply reassuring' to parents.
        This graph shows the number of first doses dished out by age group. The NHS publishes age groups as periods of five years, and groups all those under 18 together. It shows more than 620,000 have already been inoculated among under-18s
        Latest estimates from a symptom-tracking app suggested under-18s had the second highest number of Covid cases in the country (blue line). Only 18 to 35-year-olds had a higher number of Covid cases (orange line). That is despite schools in England, Wales and Northern Ireland only starting to go back this week. The data is from the ZOE Covid Symptom Study
        Latest Public Health England data showed Covid cases are rising fastest among 10 to 19-year-olds (grey line) and 20 to 29-year-olds (green line). Approving Covid vaccines for 12 to 15-year-olds would likely help curb the spread of the virus in the age group, scientists in favour of the move add
        It came as official data showed Scotland's weekly Covid cases have nearly trebled in the fortnight after schools went back after summer there There are fears the rest of the UK will be hit with a similar bang in cases now that classes are resuming this week
        Scientists were at war over vaccinating children against Covid today. Professor David Livermore (left) says it is 'plausible' that immunity from natural infection could last longer for children. Dr Simon Clarke (right) said he would have no issue with children being vaccinated providing consent was sought from their parents. Some experts have said that vaccinating children will help avoid disruption to their education
        Which 12 to 15-year-olds will now be offered a Covid vaccine?Healthy children under the age of 16 do not need to be vaccinated against Covid, the Government's vaccine advisory panel ruled today.
        The Joint Committee on Vaccination and Immunisation (JCVI) said the virus posed such a low risk to 12 to 15-year-olds that the benefit of vaccination to their health would be marginal.
        But they did recommend the jabs for 200,000 more children with chronic conditions that put them at greater risk from Covid. A total of 350,000 children aged 12 to 15 are now eligible for the vaccine.
        Children aged 12 to 15 who have the following conditions can now get a Covid vaccine:
        Haematological malignancy; Sickle cell disease; Type 1 diabetes; Congenital heart disease; Other health conditions such as poorly controlled asthma that mean a child is considered to be part of the 'Covid clinical risk group'. But yesterday the JCVI said it was sticking to a 'precautionary approach' and only 200,000 at-risk children in this age group should get jabbed.
        Because youngsters are so unlikely to get ill with Covid, the medical benefits were not judged to be great enough to outweigh the small risk of side effects, including heart inflammation.
        The panel said it was not qualified to determine whether vaccinating children would have wider benefits. 'It is still finely balanced,' said Professor Anthony Harnden, deputy chairman of the JCVI.
        'We don't think on the basis of health alone that we should be vaccinating 12 to 15-year-olds. But given this is so finely balanced there may be other considerations like education.'
        Mr Javid said: 'Along with health ministers across the four nations, I have written to the chief medical officers to ask that they consider the vaccination of 12 to 15-year-olds from a broader perspective, as suggested by the JCVI.
        'We will then consider the advice from the chief medical officers, building on the advice from the JCVI, before making a decision.'
        He said that '' given the importance of this issue '' he would like the advice 'as soon as possible'.
        A government source expressed relief that the committee had finally given a response after months of deliberation.
        The insider added: 'Vaccinating 12 to 15-year-olds is still very much on the table.
        'In fact we are probably a step closer, as the chief medical officers who will now look at it will also be able to take into account wider health considerations, such as the impact on life chances and damage to mental health caused by disruption to education.'
        Mr Javid's move signals escalating frustration over the JCVI's decision-making speeds.
        Q&A So what happened today?
        After weeks of pressure for a ruling, the Government's independent advisers on vaccines, the Joint Committee on Vaccination and Immunisation (JCVI), decided not to recommend the mass rollout of jabs to all 12 to 15-year-olds.
        Why didn't they recommend the vaccine?
        The JCVI looks solely at the medical grounds for vaccinating children. Because children are extremely unlikely to get ill with Covid-19, any side-effects become more important compared with adults. The JCVI said the decision was 'very finely balanced'. It said that while the health benefits of the vaccine probably did outweigh any harms, the margin was too small to be sure and there was 'insufficient' evidence for a mass rollout. Fewer than 30 under-18s have died of Covid in the UK.
        What do we know about side-effects?
        A small number of children have developed cases of heart inflammation called myocarditis after the Pfizer or Moderna vaccines. This is extremely rare '' affecting between three and 17 teenagers per one million first doses given out. This rises to 12 to 34 more for every million second doses. The condition mainly affects teenage boys after the second dose. Most youngsters make a full recovery. But experts are still uncertain about the long-term consequences.
        Did the committee recommend the jab be rolled out to any children?
        Yes. Currently, around 150,000 severely disabled 12 to 15-year-olds with conditions including Down's syndrome get the vaccine. Yesterday, the JCVI said this group should be expanded to include about another 200,000 children with underlying health conditions such as type 1 diabetes and sickle cell disease.
        So what happens now? Could healthy 12 to 15 year-olds still get vaccinated?
        Potentially, yes. The JCVI does not consider the wider societal impacts of vaccination. Given the enormous disruption to education during the pandemic, the committee urged UK health ministers to seek further advice on the broader impact of vaccination. Therefore the buck has essentially been passed to the UK's four chief medical officers. Health Secretary Sajid Javid wrote to Professor Chris Whitty asking him to consider a broader base of evidence.
        How will a decision now be made?
        Professor Whitty and health experts will review evidence showing how many children may need time off school due to outbreaks. Sources are adamant children will not be vaccinated to protect adults and reduce a potential winter wave. The process is expected to take a few days and advice will be presented to ministers. A final decision could come at the end of next week.
        Why is the UK taking a different approach to other countries?
        France, Spain, Italy, the Netherlands, the US and Norway are among the nations now offering jabs to children aged 12 to 15. Experts on the JCVI take a 'precautionary approach' that only recommends the vaccine to those children with underlying health conditions, rather than a one-size-fits-all strategy.
        If a rollout is approved will parents get a say?
        Parents' written consent will be required before their children are given a vaccine. The NHS is ready to 'hit the ground running' if vaccines are approved for schoolchildren. Last week they were told to recruit and train staff to go into schools to give pupils Covid jabs.
        The UK is now lagging behind several major nations which have already begun immunising youngsters, including France, Spain, Italy and the US.
        Members of the JCVI, an independent body established in 1963, acknowledged they were facing political pressure.
        Professor Adam Finn, a paediatrician from the University of Bristol who sits on the committee, said: 'The recommendations that we've made twice already on vaccinating children were straightforward health-based ones.
        'What is different now is the calls from the professionals in education or from the teaching unions, and from the politicians to decide '' and the timing of this in the context of the school year.
        'We have to acknowledge that the environment we're working in is different. This is a very unique situation where it's very hard to think of another disease that has caused so much disruption to schooling. Therefore it's not something that is likely to be replicated for other infectious diseases and vaccines in the future.'
        But the delay in authorising vaccines for younger children means hundreds of thousands of pupils will be mixing for weeks before any rollout is approved by the JCVI.
        Geoff Barton, general secretary of the Association of School and College Leaders, said he was 'disappointed' by the committee's decision to exclude them. Professor Whitty will convene an expert panel to review evidence assessing the impact of the pandemic on children, particularly on disruption to education.
        Some experts have argued that vaccinating children is the best way to reduce the size of a winter Covid wave and protect the elderly and vulnerable.
        NHS England revealed yesterday that more than 620,000 youngsters aged 16 and 17 have been jabbed.
        On Thursday, Education Secretary Gavin Williamson said he felt parents would find it 'deeply reassuring' to have a choice of whether their children should have a jab or not, adding that many people hoped they would be in a position 'of being able to roll out vaccinations for those who are under the age of 16'.
        The Government has said if all 12 to 15-year-olds were to be offered a vaccine, parental or carer consent will be sought as it is in other school immunisation programmes.
        Northern Ireland Health Minister Robin Swann said he agrees the issue of a wider rollout 'warrants further consideration'.
        He said: 'It is entirely appropriate that our most senior medical advisers take forward this piece of work urgently. I look forward to seeing their considerations in the near future.'
        Welsh Government Health Minister Eluned Morgan said she had asked the country's chief medical officer 'to provide guidance at the earliest opportunity on the clinical and wider health benefits of vaccinating this age group', while Scottish Health Minister Humza Yousaf said he had asked for the review to be conducted 'as soon as possible'.
        Geoff Barton, general secretary of the Association of School and College Leaders (ASCL), said he is disappointed by the JCVI decision not to recommend jabs for all 12 to 15-year-olds.
        He added that while they respect it, it could mean it is 'more difficult during the autumn term and beyond to guard against educational disruption caused by transmission of the virus'.
        He said: 'We are therefore pleased that the door appears to have been left at least partially open as the government looks at wider issues including disruption to schools. The trouble is that time is pressing, the autumn term is upon us and we really do need a decision.'
        Scottish Health Minister Humza Yousaf said: 'I have agreed with the other three UK Health Ministers to write a letter asking the four Chief Medical Officers to consider this latest guidance and explore whether there is additional evidence to suggest it would be beneficial to offer vaccination to all 12 '' 15 year olds.
        'We have asked for this further work to be conducted as soon as possible.'
        The Health Secretary, Sajid Javid, has asked the NHS to put preparations in place to roll out vaccinations to 12 to 15 year olds, should it be recommended by the Chief Medical Officers.
        If this group is offered the vaccine, parental or carer consent will be sought, just as with other school immunisation programmes.
        Scientists were at war over vaccinating children against Covid today. Professor David Livermore (left) says it is 'plausible' that immunity from natural infection could last longer for children but Professor Devi Sridhar (right) says the virus could rip through the country again
        This will lead to yet more school chaos, say heads By Sarah Harris for the Daily Mail
        Head teachers yesterday warned it will be more difficult to guard against 'educational disruption' after the Government's advisers ruled out jabs for over-12s.
        The Joint Committee on Vaccination and Immunisation (JCVI) said the virus posed such a low risk to 12 to 15-year-olds that the benefit of a mass rollout would be marginal.
        But Geoff Barton, general secretary of the Association of School and College Leaders, said he was 'disappointed' by the JCVI's decision.
        He said: 'We understand this decision has been made after making an assessment of the balance of risks and with all the available evidence, and we respect that decision.
        'Nevertheless, the upshot is that this would make it more difficult during the autumn term and beyond to guard against educational disruption caused by transmission of the virus.'
        But Mr Barton welcomed news that the 'door appears to have been left at least partially open as the Government looks at wider issues including disruption to schools'.
        The UK's four chief medical officers will spend the next week weighing up whether vaccinating secondary school-aged children will have a broader benefit to society.
        Additional safety measures in schools will become 'more important' if they decide not to agree to the jab, the country's largest teaching union warned yesterday.
        Kevin Courtney, joint general secretary of the National Education Union, said: 'Sadly, in taking away so many safety measures last term, without replacing them with others, the Government has left schools open to another rise in case counts '' which will mean many children and staff missing school if they test positive.'
        The National Association of Head Teachers also called on ministers to improve ventilation in schools.
        General secretary Paul Whiteman said: 'With the decision not to vaccinate younger teens now taken, ventilation continues to be a critical part of schools' efforts to maintain a safe working and learning environment.'
        The vaccination programme has so far provided protection to over 48 million people over the age of 16 across the UK - including over 48 million first doses and over 43 million second doses.
        The latest data from Public Health England and Cambridge University shows vaccines have saved more than 105,000 lives and prevented 143,600 hospitalisations and 24 million cases in England.
        Senior ministers were said to be increasingly embittered at the failure of Government experts to authorise the rollout of Covid vaccines to under-16s ahead of the decision from the JCVI.
        A Whitehall source said there was 'palpable frustration' among Government figures with the JCVI. Both Boris Johnson and Health Secretary Sajid Javid are said to be keen to get on with vaccinating school children.
        Ministers fear the new academic year will trigger a fresh wave of the virus in classrooms. This means that without a jab, children could face more disruption to their education throughout autumn and winter.
        Last night one Whitehall source admitted: 'There is palpable frustration that this is taking so long. The jabs have been approved for months, other countries have been doing it safely for months '' we are becoming an outlier.
        In the meantime, we have missed the window of opportunity in the summer and the schools are going back.'
        Meanwhile, in a clear sign of the enthusiasm for the jab among teenagers, figures showed half of 16- and 17-year-olds have already had a vaccine dose in just four weeks.
        Scientists and ministers were at war today over whether the UK should be routinely vaccinating children against Covid ahead of the announcement from the JCVI.
        Professor Hunter said today he was against vaccinating children, although he had faith that whatever decision the JCVI comes to will have been the most informed.
        He told MailOnline: 'The issue around whether we should be vaccinating 12 to 15-year-olds is whether there is enough vaccine to go around people who are vulnerable worldwide.'
        Professor Hunter added that as the direct benefit of vaccines to children was small because Covid is a mild illness for the overwhelming majority of them.
        He said he would prefer to see the doses shipped to developing nations which are struggling to get first doses to vulnerable people.
        And he raised doubts about whether it was ethical to vaccinate children against a mild disease in the first place.
        'If we are going to be vaccinating these children it has got to be in their interest, not in ours,' he said.
        'It is one thing to say have a vaccine to protect your health, but quite another thing to persuade you to have a vaccine to protect my health. One is entirely ethical and the other is dubious.'
        Professor David Livermore, a medical microbiologist at the University of East Anglia, said last week that the world will need to live with Covid for years if not decades '-- so having a generation of children with natural immunity would help prevent cases spiralling later down the line.
        He said natural infection could be a 'a better first step in the lifelong co-existence' with the virus than rolling out the jabs.
        He added: 'There is no direct reason to vaccinate children and adolescents against Covid. They are extremely unlikely to suffer severe disease if infected.
        'Rare but serious side effects have been associated with the vaccines, including blood clots and myocarditis. For older adults and the vulnerable, these are small hazards compared with those from Covid infection, and being vaccinated is obviously prudent.
        Which countries are already offering jabs to 12 to 15-year-olds?The JCVI has resisted calls to recommend vaccines for healthy under-16s.
        While the move will irk Government ministers who were keen to go ahead with the plans to keep infection rates in schools low, some scientists applauded the panel for not bowing to political pressure and 'following the science'.
        But the country is at risk of becoming an international outlier as many other western nations have already started jabbing children. They include:
        Denmark, from August France, from June 15Parts of Germany, from August Israel, from June 6Italy, from August 11The Netherlands, from July Norway, from SeptemberPoland, from June Parts of Spain, from AugustSweden, from August Switzerland, from JulyThe US, from May 10 'But for children the risk/benefit ratio is far less clear, and may reverse. The JCVI initially were against vaccinating children on this logic and have provided no clear reason for a change of view.
        'Taking these three points together I can see no good reason to vaccinate under-18s, let alone 12-year-olds.'
        But the move to jab healthy kids for Covid has been backed by several experts who warn that letting the virus rip through schools could result in more disruptions to education and force lockdown restrictions to be rolled back.
        Dr Clarke told MailOnline: 'As long as the data that exists is that there is no greater harm from giving children jabs then children should get vaccinated, with the caveat that there is parental choice.
        'There have been suggestions that the Americans, the Irish, care less about their children than we do '-- of course they don't. They are very sensitive about this issue as well.
        'I see no evidence that there is a problem with vaccinating children.'
        He said the decision not to inoculate children before they returned to school was a 'missed window of opportunity' because the jabs could have reduced transmission of the virus.
        Britain has been accused of being sluggish to roll out the Covid vaccine to other age groups, as its vaccination drive fell behind other countries.
        US regulators approved Pfizer's jab for 12 to 15-year-olds in May, and has already got at least one dose to 40 per cent (7million) of the age group.
        The EU's regulator also gave the age group the green light to get the jab at the end of May, with many countries quick to start rolling it out.
        France began inoculating 12 to 15-year-olds in June, and more than 40 per cent (2million) have already received a first dose.
        Italy started rolling out jabs to the age group from July with the aim of inoculating them before schools return. The Netherlands also began rolling out the jabs to secondary school children in July.
        Should the UK jab 12-year-olds? Experts say it's 'unethical' to vaccinate children to protect adults from Covid and claim kids may get 'better immunity' if they catch virus naturally '-- but others warn of school closures and lockdown curbs if we don't
        Scientists and ministers were at war today over whether the UK should be routinely vaccinating children against Covid now that the majority of Western countries are doing so.
        British advisers are resisting growing pressure to roll out jabs to healthy 12 to 15-year-olds despite the US, France, Spain, Italy, Canada, Norway and the Netherlands all pressing ahead with the move.
        The Joint Committee on Vaccination and Immunisation (JCVI) '-- an independent body which advises the UK Government on the Covid jab roll-out '-- claims it's still not clear if the benefits outweigh the risks.
        Experts pushing back against the plans today argued that it would be 'ethically dubious' to jab children solely to protect adults, because Covid itself poses such a tiny risk to youngsters.
        Others believe it is better for children to catch Covid and recover to develop natural immunity than to be reliant on protection from vaccines, which studies suggest wanes in months.
        Professor Paul Hunter, an epidemiologist at the University of East Anglia, told MailOnline: 'It is one thing to say have a vaccine to protect your health, but quite another thing to persuade you to have a vaccine to protect my health. One is entirely ethical and the other is dubious.'
        And Professor David Livermore, a medical microbiologist at the same university, said natural infection could be a 'a better first step in the lifelong co-existence' with the virus than rolling out the jabs.
        But the move to jab healthy kids for Covid has been backed by several experts who warn that letting the virus rip through schools could result in more disruptions to education and force lockdown restrictions to be rolled back.
        Dr Simon Clarke, a microbiologist at Reading University, told MailOnline today that he would feel comfortable vaccinating children so long as their parents consented.
        He said the wider benefits to keeping schools open and infection rates low outweighed any small risks of side effects from the jabs.
        And in a letter written to the Education Secretary today, a group of scientists said the wider effects curbs would have on children's learning, health and wellbeing meant it was 'reckless' to send secondary children to classes unvaccinated.
        The JCVI is believed to be concerned about the small risk of heart inflammation in young people.
        Children have only a small risk of becoming seriously ill with Covid and a vanishingly small chance of death, while the jabs are associated with rare cases of myocarditis in young people.
        The JCVI said in July there was a risk of the heart inflammation in about one in 20,000 young people after being fully immunised with Pfizer's vaccine.
        The Moderna jab, which works in a very similar way, is thought to carry the same risk.
        The JCVI ruled against recommending the vaccine to healthy children then because the risk of dying from the virus for them is lower than one in a million.
        Fewer than 300 children have been hospitalised with Covid in England since the pandemic began and all but around 20 had underlying health issues. No healthy child is believed to have died from Covid in the UK.
        Professor Hunter said today he was against vaccinating children, although he had faith that whatever decision the JCVI comes to will have been the most informed.
        He told MailOnline: 'The issue around whether we should be vaccinating 12 to 15-year-olds is whether there is enough vaccine to go around people who are vulnerable worldwide.'
        Professor Hunter added that as the direct benefit of vaccines to children was small because Covid is a mild illness for the overwhelming majority of them.
        Covid cases in Scotland soared 170% in the fortnight after schools went back, official data shows '-- amid fears the rest of UK is next Scotland's Covid cases soared by more than two and a half times in the fortnight after schools went back from the summer break, official figures showed today '-- in a clear warning sign to the rest of the country.
        The Office for National Statistics' weekly surveillance report estimated 69,500 Scots, or one in 75 people, were infected with the virus on any given day in the week to August 27, up 170 per cent.
        In England infections have plateaued but remain stubbornly high with the ONS estimating 766,100 people had Covid last week or one in 70, barely a change from the previous seven-day spell.
        Experts fear infections could spiral as children returned to classrooms in England, Wales and Northern Ireland this week.
        The UK's vaccine advisory panel is being lobbied hard by ministers, politicians and some scientists to give the green light to rolling out the vaccine to 12 to 15-year-olds but it has so far resisted the calls.
        Britain is becoming an international outlier with France, the US, Canada, Spain, Italy and the Netherlands all already administering jabs to over-12s. Last night Norway became the latest country to OK the move.
        But some experts say letting children get Covid naturally is a better way to create immunity because the virus itself poses such a low risk to them, whereas the vaccines come with dangerous side effects in rare cases.
        The spike in Scotland has also led to growing calls for No10's vaccine advisory body to recommend a mass booster campaign. But it could be weeks before it is signed off.
        He said he would prefer to see the doses shipped to developing nations which are struggling to get first doses to vulnerable people.
        And he raised doubts about whether it was ethical to vaccinate children against a mild disease in the first place.
        'If we are going to be vaccinating these children it has got to be in their interest, not in ours,' he said.
        'It is one thing to say have a vaccine to protect your health, but quite another thing to persuade you to have a vaccine to protect my health. One is entirely ethical and the other is dubious.'
        Professor David Livermore, a medical microbiologist at the University of East Anglia, said last week that the world will need to live with Covid for years if not decades '-- so having a generation of children with natural immunity would help prevent cases spiralling later down the line.
        He said natural infection could be a 'a better first step in the lifelong co-existence' with the virus than rolling out the jabs.
        He added: 'There is no direct reason to vaccinate children and adolescents against Covid. They are extremely unlikely to suffer severe disease if infected.
        'Rare but serious side effects have been associated with the vaccines, including blood clots and myocarditis. For older adults and the vulnerable, these are small hazards compared with those from Covid infection, and being vaccinated is obviously prudent.
        'But for children the risk/benefit ratio is far less clear, and may reverse. The JCVI initially were against vaccinating children on this logic and have provided no clear reason for a change of view.
        'Taking these three points together I can see no good reason to vaccinate under-18s, let alone 12-year-olds.'
        And Professor Tim Spector, an epidemiologist at King's College London, told MailOnline vaccinating children would 'use up' Britain's supply of jabs designated for boosters for the clinically vulnerable this winter.
        Professor Spector said while vaccinating would reduce cases 'in an ideal world', in the immediate term it could take up supply intended for booster shots to older, more vulnerable people who's own immunity from vaccines given earlier in the year may be on the wane.
        He added: 'With vaccinating children you are going to reduce numbers of infections, but if you do that that means you use up your boosters and so you risk more deaths and hospitalisations at the other end of the spectrum.
        'In the ideal world I would be in favour of doing both [booster shots for the elderly and vaccines for over-12s] but I definitely think we should be giving boosters to kids that have had natural infections.'
        But an equal number of scientists say that vaccinating children would have indirect benefits to them, such as keeping them in education and avoiding future lockdowns which took a toll on young people's mental health.
        A group of 12 scientists on Independent SAGE - a group which has attacked the Government for not being strict enough in controlling the virus - wrote to Education Secretary Gavin Williamson today to call for children to receive the vaccine for exactly that reason.
        In the letter published in the BMJ they argued that policies in England mean there will soon be a large population who are 'susceptible' to the virus mixing in crowded spaces with 'hardly any mitigations'.
        WHAT ARE THE PROS AND CONS OF VACCINATING CHILDREN? Pros
        Protecting adults
        The main argument in favour of vaccinating children is in order to prevent them keeping the virus in circulation long enough for it to transmit back to adults.
        Experts fear that unvaccinated children returning to classrooms in September could lead to a boom in cases among people in the age group, just as immunity from jabs dished out to older generations earlier in the year begins to wane.
        This could trigger another wave of the virus if left unchecked, with infection levels triggering more hospitalisations and deaths than seen during the summer.
        Avoiding long Covid in children
        While the risk of serious infection from Covid remains low in most children, scientists are still unsure of the long-term effects the virus may have on them.
        Concerns have been raised in particular about the incidence of long Covid '-- the little understood condition when symptoms persist for many more weeks than normal '-- in youngsters.
        A study released last night by King's College London showed fewer than two per cent of children who develop Covid symptoms continue to suffer with them for more than eight weeks.
        Just 25 of the 1,734 children studied '-- 0.01 per cent '-- suffered symptoms for longer than a year.
        Cons
        Health risks
        Extremely rare incidences of a rare heart condition have been linked to the Pfizer vaccine in youngsters.
        Data from the Centers for Disease Control and Protection (CDC) in the US '-- where 9million 12- to 17-year-olds have already been vaccinated '-- shows there is around a one in 14,500 to 18,000 chance of boys in the age group developing myocarditis after having their second vaccine dose.
        This is vanishingly small. For comparison, the chance of finding a four-leaf clover is one in 10,000, and the chance of a woman having triplets is one in 4,478.
        The risk is higher than in 18- to 24-year-olds (one in 18,000 to 22,000), 25- to 29-year-olds (one in 56,000 to 67,000) and people aged 30 and above (one in 250,000 to 333,000). But, again, this is very low.
        Britain's drug regulator the MHRA lists the rare heart condition as a very rare side-effect of the Pfizer and Moderna vaccines.
        They said: 'There have been very rare reports of myocarditis and pericarditis (the medical term for the condition) occurring after vaccination. These are typically mild cases and individuals tend to recover within a short time following standard treatment and rest.'
        More than four times as many hospitalisations were prevented as there were cases of myocarditis caused by the vaccine in 12- to 17-year-olds, the health body's data show.
        Jabs should be given to other countries
        Experts have also claimed it would be better to donate jabs intended for teenagers in the UK to other countries where huge swathes of the vulnerable population remain unvaccinated.
        Not only would this be a moral move but it is in the UK's own interest because the virus will remain a threat to Britain as long as it is rampant anywhere in the world.
        Most countries across the globe are lagging significantly behind the UK in terms of their vaccine rollout, with countries in Africa, Southeast Asia and South America remaining particularly vulnerable.
        Jabs could be better used vaccinating older people in those countries, and thus preventing the virus from continuing to circulate globally and mutate further, than the marginal gains to transmission Britain would see if children are vaccinated, experts argue.
        Professor David Livermore, from the University of East Anglia, has said: 'Limited vaccine supplies would be far better used in countries and regions with large vulnerable elderly populations who presently remain unvaccinated '-- Australia, much of South East Asia and Latin America, as well as Africa.'
        They said children have suffered 'significant harms' on their education and wellbing in the pandemic and added: 'Allowing mass infection of children is therefore reckless.'
        Earlier school reopenings in Scotland and the US have shown that a lack of 'adequate mitigations' is likely to lead to the virus spreading among children, which could further disrupt learning with significant absences due to student and staff illness, they said.
        'England's policies mean that we will soon have a large susceptible population with high prevalence of infection mixing in crowded environments with hardly any mitigations.'
        Other signatories include members of the Parent SafeEdForAll group and the National Education Union.
        UK medical regulators cleared the Pfizer jab for use on 12- to 15-year-olds in June, declaring it 'safe and effective in this age group'. The Moderna vaccine was also authorised last month.
        Ministers had hoped to vaccinate children during the school holidays to prevent a repeat of the massive disruption seen in schools over the past 18 months.
        However, with schools already going back this week and next, hundreds of thousands of pupils will be mixing for weeks before any rollout is approved by the JCVI '' if it is approved at all.
        Dr Clarke told MailOnline: 'As long as the data that exists is that there is no greater harm from giving children jabs then children should get vaccinated, with the caveat that there is parental choice.
        'There have been suggestions that the Americans, the Irish, care less about their children than we do '-- of course they don't. They are very sensitive about this issue as well.
        'I see no evidence that there is a problem with vaccinating children.'
        He said the decision not to inoculate children before they returned to school was a 'missed window of opportunity' because the jabs could have reduced transmission of the virus.
        SAGE adviser Professor Calum Semple, from Liverpool University, echoed the scientists views last week, saying that without vaccines children faced yet more 'disruption' to their education in the new academic year.
        The Liverpool University expert told BBC Radio 4's Today programme: 'If you treat children the same way you do with adults, where if you have got double vaccination you no longer need to isolate, that would then allow us to have schools carrying on without such disruption.
        'I think we need to look at vaccinating these children not just as an individual benefit but a benefit to the root, a benefit to the whole of society and school and the education system.'
        Professor Devi Sridhar, a public health expert at Edinburgh University, said last week that children should get vaccines to stop the Delta variant 'flying through' schools as they reopen.
        England's chief medical officer Professor Chris Whitty said in June that he backed vaccinating children to avoid any further disruption to their education.
        Clinical studies show that vaccines cut the risk of the virus spreading between people, but real-world data suggests they may only reduce this by as much as half.
        For comparison, jabs drastically cut the risk of someone being hospitalised or dying from the virus. This is already vanishingly small for children.
        Other scientists are, however, more skeptical about offering vaccines to the age group.
        A Whitehall source said there was 'palpable frustration' among Government figures with the Joint Committee on Vaccination and Immunisation (JCVI), which has so far not approved the jab.
        Both Boris Johnson and Health Secretary Sajid Javid are said to be keen to get on with vaccinating secondary school children.
        Ministers fear the new academic year will trigger a fresh wave of the virus in classrooms. This means that without a jab, children could face more disruption to their education throughout autumn and winter.
        But the JCVI, which is independent of Government, yesterday warned that a decision on the issue was 'finely balanced', with one senior committee member bristling at the idea that it should respond to political pressure.
        Another said the committee would not be bounced into vaccinating younger children just because many other countries were now doing so.
        Last night one Whitehall source admitted: 'There is palpable frustration that this is taking so long. The jabs have been approved for months, other countries have been doing it safely for months '' we are becoming an outlier.
        'In the meantime, we have missed the window of opportunity in the summer and the schools are going back.'
        Publicly, Downing Street insists the matter is purely for the JCVI. But while another Whitehall source said the JCVI had 'done a great job' at the start of the vaccination programme, they acknowledged the length of time taken by the committee over children was frustrating.
        'Everything is in place to get this rolled out,' the source said. 'We just need a decision.'
        Speaking at the weekend, Mr Javid said vaccinating all teenagers would 'solidify our wall of protection'.
        The move is also backed by Transport Secretary Grant Shapps, who has warned that countries like Malta are already insisting all over-12s must quarantine on arrival unless they have been fully vaccinated.
        A Government source has predicted take-up among younger children would be as high as 16- and 17-year-olds, if and when the green light is given.
        Most Covid curbs have been lifted in schools in England, with children now only required to test themselves twice a week for the virus.
        Only those that test positive for the virus will be sent home, but their peers and classmates will be allowed to stay in school providing they test negative. The change came after the 'bubble system' sent entire year groups home after just one positive test was detected.
        Britain has been accused of being sluggish to roll out the Covid vaccine to other age groups, as its vaccination drive fell behind other countries.
        US regulators approved Pfizer's jab for 12 to 15-year-olds in May, and has already got at least one dose to 40 per cent (7million) of the age group.
        The EU's regulator also gave the age group the green light to get the jab at the end of May, with many countries quick to start rolling it out.
        France began inoculating 12 to 15-year-olds in June, and more than 40 per cent (2million) have already received a first dose.
        Italy started rolling out jabs to the age group from July with the aim of inoculating them before schools return. The Netherlands also began rolling out the jabs to secondary school children in July.
      Trump's Solar-Panel Tariffs Survive China's Challenge Before WTO - Bloomberg
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      Human Rights Museum Reopening to Vaccinated Visitors | ChrisD.ca
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        Sat, 04 Sep 2021 15:00
        The Canadian Museum For Human Rights is shown in Winnipeg on September 18, 2014. (THE CANADIAN PRESS/John Woods)
        The Canadian Museum for Human Rights will reopen to fully vaccinated visitors on Tuesday, July 27.
        As part of the province's new public health orders, set to take effect this Saturday, museums, movie theatres, bingo halls and VLT lounges can reopen at 50 percent capacity to only fully vaccinated people.
        Children under 12 who are not immunized may enter with fully immunized members of their household. The CMHR has chosen not to open until July 27 in order to ensure readiness and to schedule shifts for visitor-facing staff.
        Currently, the museum is highlighting the Witness Blanket, a monumental artwork by Kwakwaka'wakw and Coast Salish artist Carey Newman. It is made of more than 800 objects collected from the sites and survivors of Indian residential schools from every region of Canada.
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      Immunization Basics | CDC
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      Why the Durand Line Matters '' The Diplomat
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        Sat, 04 Sep 2021 14:23
        Features | Diplomacy | Central Asia It is time for Kabul to accept the legality of the border.
        Credit: REUTERS/Naseer Ahmed AdvertisementAfghan officials have at times accused Pakistan of being less than honest in pushing the Afghan Taliban for talks with Kabul. Before making such statements, those same officials should also try to understand Pakistan's deep concerns about Afghanistan's stance on their common border. At present, Afghanistan does not officially recognize the international border with Pakistan. Instead, it has territorial claims on areas stretching from the Afghan-Pakistan border to the Indus River, all told comprising nearly 60 percent of Pakistani territory.
        This border dispute has its roots in the nineteenth century, when Pakistan was part of India and India was a British colony. The British imposed the 2640 km borderline on the Amir of Afghanistan in 1893 in a bid to strengthen the former's control over the northern parts of India. The agreement was signed between Sir Mortimer Durand, the Indian Foreign Secretary at the time, and Amir Abdur Rahman Khan in Kabul. The line is thus known as the Durand Line, and runs through Pashtun territory.
        According to the Durand Line agreement, Afghanistan relinquished a few districts, including Swat, Chitral and Chageh, although it gained other areas, Nuristan and Asmar, for instance, which it had historically not controlled. The agreement, at least on paper, for the first time demarcated where the Indo-Afghan border started and ended. Before the Durand Line agreement, both India and Afghanistan would make incursions into each other's domain of influence, frequently sparking border tensions.
        In contrast to many historical accounts, Afghanistan did recognize the Durand Line as an international border. Abdur Rahman Khan's successor, Amir Habibullah Khan, in 1905 signed a new agreement with Britain confirming the legality of the Durand Line. More importantly, article 5 of the Anglo-Afghan Treaty of 1919, on the basis of which Afghanistan reclaimed its independence, says that Afghanistan accepted all previously agreed border arrangements with India. Unlike the previous two agreements, the Anglo-Afghan Treaty was not imposed by Britain. Afghanistan as an independent state agreed to recognize the Durand Line as an international border.
        After the founding of Pakistan in 1947, Afghanistan demanded that Pashtuns living on the Pakistani side of the Durand Line be given the right to self-determination. Unsurprisingly, both Britain and Pakistan refused. In response, the Afghan government then began to ignore the Durand Line and instead assert claims over territories that lay between the line and the Indus River.
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        As a consequence, relations with Pakistan became tense, and this in turn influenced U.S.-Afghan relations in the 1950s and 1960s. Once Pakistan struck an arms deal with the U.S., Kabul realized that the balance of power between Pakistan and Afghanistan had shifted in favor of Pakistan. Hence, in the 1950s Afghanistan, too, approached Washington seeking military assistance and arms sales.
        The U.S. demanded that Afghanistan improve its relations with Pakistan and join the Central Treaty Organization (CENTO), of which Pakistan was a founding member, to contain the Soviet Union. Given its location on the Soviet border, Afghanistan declined. In the meantime, Kabul needed modern arms to balance Pakistan's growing military power. So it turned to the Soviet Union.
        Diplomat BriefWeekly NewsletterNGet briefed on the story of the week, and developing stories to watch across the Asia-Pacific.
        Get the Newsletter Moscow willingly sold arms to Afghanistan and agreed to train Afghan military personnel. As time went by, this dependence on the Soviet Union increased. Estimates show that the Soviet Union gave Afghanistan $2.5 billion in military and economic aid between 1953 and 1978. In addition, thousands of Afghans went to military schools in the Soviet Union between 1953 and 1978'--the very officers who staged two coups in 1973 and 1978, paving the way for the Soviet invasion of Afghanistan in 1979.
        AdvertisementOver the last several decades Afghanistan has suffered enormously from the Durand Line tensions. Afghanistan's Cold War relations with the former Soviet Union ultimately led to invasion by the Red Army. Pakistan has tried to install a client regime in Kabul. Thousands of terrorists have crossed the Durand Line from Pakistan over the last decade and killed large numbers of Afghans. The Pakistani army has shelled areas in eastern Afghanistan, claiming they were shelling Pakistani territory.
        Pakistan has been reluctant to engage honestly with Afghanistan on any issue, from trade to peace talks, because of a lack of trust. The Afghan government loses revenue each year as thousands of people'--mainly Afghans'--illegally cross the border without a visa, avoiding taxes. Tons of illegal goods are smuggled across the border annually, a further loss for the Afghanistan economy.
        Many Afghans still dream'--Pashtuns in particular'--that one day they might reclaim the territories their forefathers lost between the Durand Line and the Indus River. That, of course, is unrealistic: the country lacks the political, economic and military means to pursue any such claim. At any rate, the 30 million Pakistani Pashtuns would appear to have little motivation to join the 15 million Afghan Pashtuns. For more than half a century, Pashtuns have played significant roles in civilian and military life in Pakistan. Why leave that for a barely functioning Afghanistan?
        There are multiple examples of ethnic groups living in two or more countries. Kurds, Balochis, Tajiks, Germans, to name a few, live in two or more countries. Afghans must recognize and embrace the fact that the same ethnic group can live in more than one country.
        The new Afghan president taking office in the spring should immediately review Afghanistan's foreign policy toward Pakistan. The time has come for Afghans to once again recognize the Durand Line as the international border between Afghanistan and Pakistan. Doing so would bring an end to the protracted border dispute with Pakistan, a precondition for real Pakistani cooperation in the Afghan peace process.
        Having recognized the Durand Line, Afghanistan should immediately demarcate the border and fence it. This would prevent Taliban incursions and help control both smuggling and illegal flows of people. As an added benefit, the Pakistan military would no longer have the justification to shell Afghan villages once the fences are in place.
        Arwin Rahi is a Fulbright fellow at Texas A&M University's George Bush School of Government and Public Service. He worked as an adviser to the Parwan governor in 2012-13, and has an MA in politics and security from OSCE Academy with a focus on Central Asia and Afghanistan.
      China Is 'Our Main Partner,' Says Taliban Spokesperson
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        Sat, 04 Sep 2021 14:14
        A Taliban spokesperson has praised Beijing as a ''main partner'' and financer as the group moves to build a national governance and develop Afghanistan's economy.
        ''China is our main partner and represents for us a fundamental and extraordinary opportunity because it is willing to invest and rebuild our country,'' Taliban spokesperson Zabiullah Mujahid told the Italian newspaper la Repubblica on Sept. 1.
        Mujahid made the remarks as the militant group, which took over Afghanistan in dramatic fashion last month, celebrated the final withdrawal of American troops from the country, putting an end to a 20-year-long conflict.
        But money has become a pressing concern for the Taliban after the United States blocked the group from accessing billions of Afghan assets held in U.S. bank accounts, while the World Bank and the International Monetary Fund have each suspended funding to Afghanistan.
        With cash running short, the Taliban appears to place its bet on Beijing, which in recent days have signaled readiness to build ties with the group'--although it has yet to formally recognize the Taliban regime.
        Mujahid said the Taliban was ''very keen'' on China's Belt and Road Initiative (BRI), a billion-dollar infrastructure project championed by Chinese leader Xi Jinping that aims to expand the regime's economic and political clout worldwide. While Afghanistan is a formal member of BRI, no projects have started under the plan.
        The spokesperson also referenced China's currently dormant investment in a copper mine development project in the country. ''We also have rich copper mines that, thanks to the Chinese, will be able to come back to life and be modernized,'' Mujahid said.
        China, he added, ''is our gateway to markets around the world.''
        Taliban co-founder Mullah Abdul Ghani Baradar (L) and Chinese Foreign Minister Wang Yi pose for a photo during their meeting in Tianjin, China, on July 28, 2021. (Li Ran/Xinhua via AP)The Taliban expressed further enthusiasm for BRI involvement in a call with assistant Chinese foreign minister Wu Jianghao on Sept. 2.
        In the call, Abdul Salam Hanafi, a senior member in the Taliban negotiating team, called China ''Afghanistan's trustworthy friend,'' according to a readout from the Chinese foreign ministry.
        Hanafi expressed a wish to ''actively support and participate'' in the BRI project that he said will ''contribute to the region's prosperity.''
        To foster Afghanistan-China friendship, Hanafi vowed that the Taliban ''will absolutely not allow any forces to threaten Chinese interests,'' an implicit reference to Uyghur militants who Beijing fear may launch assaults into Xinjiang, a region bordering Afghanistan where Beijing has locked up to more than 1 million ethnic Muslim minorities in internment camps.
        The Chinese regime has pledged assistance to the Taliban-ruled Afghanistan. In a Wednesday press briefing, Chinese foreign ministry spokesperson Wang Wenbin described the Taliban's control of the country as a ''new page in its history,'' and said Beijing will ''continue to provide utmost assistance to Afghanistan for an early realization of peace and reconstruction.''
        Asked about Mujahid's remarks on Thursday, White House press secretary Jen Psaki told reporters ''there are few countries that wanted us to stay in Afghanistan more than China and Russia.''
        ''Because it would have tied up our own resources and tied up our own U.S. military and tied up our own financial assets and options,'' she continued, reiterating President Joe Biden's position that the Afghan withdrawal would allow the United States to ''shore up'' competitiveness to confront China.
        ''So, the world is united in what they expect the Taliban to do, which is allow people who want to depart the country to depart, and China has to decide where they are in that effort,'' Psaki said.
        The Taliban has promised to form an ''inclusive government'' and give amnesty to those who have fought against them or worked for the now overthrown Afghan government. But such promises have been met with skepticism both inside the country and among the greater Afghanistan diaspora.
        Afghan families gather to receive food distributed by an Islamabad-based Christian organization on the outskirts of Chaman, a town in Pakistan's southwestern Baluchistan province, on the border with Afghanistan, on Aug. 31, 2021. Dozens of Afghan families have crossed into Pakistan through the southwestern Chaman border a day after the U.S. wrapped up its 20-year military presence in the Taliban-controlled country. (AP Photo)An Afghan evacuee who worked for the government before the Taliban's takeover found out since his escape a large group of Taliban members visited his home to demand information on his whereabouts. He told The Epoch Times that three Afghans he knew were detained and tortured by Taliban members for three days, and were released only after signing a document saying they would not leave the country nor reveal their detention and torture to the public.
        In recent weeks, Beijing has leveraged the Afghanistan crisis for propaganda to discredit the United States. Its English-language media CGTN recently called for Washington to ''come to terms with the Taliban,'' ''work with us,'' and drop sanctions.
        While some analysts argue that the Chinese regime has much to gain in the country by filling the void left by the United States, questions remain on whether it can maintain a workable relationship with the Taliban, whose cooperation will likely depend on the Chinese funding.
        Taliban forces stand guard at the entrance gate of Hamid Karzai International Airport a day after U.S. troops' withdrawal in Kabul, Afghanistan, on Aug.31, 2021. (Stringer/Reuters)''If the CCP is unwilling or unable to provide the expected finances in time, or if China does anything that does not please the Taliban, then the Taliban will very fast bite the Chinese hands that feed them,'' Frank Lehberger, a senior research fellow with India-based Usanas Foundation, previously told The Epoch Times.
        Beijing, meanwhile, is grappling with the possibility of a spillover of militancy in the region around Afghanistan, where it is already facing a rise in violence directed at Chinese workers of BRI projects.
        Two recent suicide bombings targeting Chinese nationals in Pakistan killed at least nine who worked on the BRI project in Pakistan.
        ''China thinks that it can control the Taliban,'' but its victory is inspiring other insurgent groups, such as Tehreek-e-Taliban Pakistan terrorist group, which is ''very much opposed to China,'' Gordon Chang, author of ''The Coming Collapse of China,'' said during a recent Epoch TV webinar.
        ''We can see the entire region go up in flames, in which case, China would be very much a target,'' Chang added.
        Eva Fu is a New York-based writer for The Epoch Times focusing on U.S.-China, religious freedom, and human rights.
      Anti-Vax Radio Hosts Keep Dying From COVID | Vanity Fair
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        Sat, 04 Sep 2021 13:08
        Conservative radio hosts all across America are losing their lives for the cause. In the past month alone, five talk radio personalities who were vocal COVID-19-deniers, anti-vaxxers, or anti-maskers have all died after contracting the virus. Most recently was WNDB's Marc Bernier, a late Daytona, Florida, talk radio host who dubbed himself ''Mr. Anti-Vax'' in December while assuring his listeners ''I'm not taking it.'' True to his word, Bernier contracted COVID-19 roughly three weeks ago and his death was announced over the weekend by his radio station''''which had awkwardly acknowledged his on-air ''anti-vaccine'' commentary just before his passing. (WNDB was contacted for clarification regarding its COVID-19 safety policies but the station did not respond.)
        Though it might be assumed some right-wing media figures are simply feeding into the anti-vax frenzy to gin up outrage and ratings, the spate of recent deaths makes clear that, for a number of them, opposition to safe, effective vaccines and other pandemic mitigation efforts isn't just talk. Such radio rants against efforts to stop the pandemic come as Republican men, a large segment of the talk radio audience, have been shown to be particularly resistant to getting vaccinated.
        On August 4, Newsmax fill-in host and longtime conservative talker Dick Farrel died from a ''severe damage'' from COVID-19 after spending the last weeks of his life claiming that the vaccine is ''Bogus Bull [Shit],'' referring to the pandemic as a ''SCAM DEMIC,'' and suggesting that the delta variant is an elaborate ruse orchestrated by Anthony Fauci to keep Americans fearing for their lives. ''Why take a vax promoted by people who lied [to you] all along about masks, where the virus came from and the death toll?'' he wrote in a July 3 Facebook post. Upon contracting the virus, Farrel was suddenly not willing to die for his previously held convictions, as one of his close friends, Amy Leigh Hair, claimed that he encouraged her to get the shot shortly before his death, saying that COVID-19 ''is no joke and then he said: 'I wish I had gotten [vaccinated]!'''
        But instead of taking scientifically backed precautions beforehand, Farrel opted to ask his Facebook followers if ''hydroxychloroquine from Canada'' is safe in early July after stating, ''When a gubberment denies u access to HCQ [it's] obvious they want you dead.'' It appears that Farrel was convinced that masks and vaccines weren't saving Democratic politicians''''or ''dummy craps,'' as he called them''''from COVID-19, but rather that they had access to hydroxychloroquine while banning others from taking it. In a statement to the Post, a Newsmax spokesperson noted that Farrel ''was a popular radio host in Florida and always a friend of Newsmax. We mourn his passing and hope everyone can learn from his unnecessary death the importance of getting vaccinated.''
        On August 11, Tod Tucker, a pro-Trump radio programmer, died ''following the onset of viral pneumonia as the result of COVID-19,'' according to his employer. Tucker had previously mocked the idea of receiving the vaccine, allegedly writing in a March Facebook post, ''Please stop bragging that you got your COVID vaccine. What do you want us to say? 'Congratulations lab rat?!''' Within days of Tucker's death, religious radio host Jimmy DeYoung Sr. was hospitalized for COVID-19 and died not long after, according to the Daily Beast. In February, DeYoung told his listeners that the COVID-19 vaccine could ''be another form of government control of the people'' during a segment on his show in which he and his guest regurgitated conspiracy theories about Pfizer using the vaccine to commit mass sterilization.
        Nashville talk radio host and vaccine skeptic Phil Valentine allegedly expressed regrets after being hospitalized with COVID-19. In a blog post, Valentine had advised those who are not in the ''high-risk'' demo to not get the vaccine, and bet that his odds of dying from COVID-19 were ''way less than one percent.'' But in late July, Valentine found himself in a ''very serious condition, suffering from COVID pneumonia'' and suddenly reversed his stance on vaccines, according to his family members. ''Phil would like for his listeners to know that while he has never been an 'anti-vaxer' he regrets not being more vehemently 'pro-vaccine,''' his radio station 99.7 WTN shared in a statement. ''[He] looks forward to being able to more vigorously advocate that position as soon as he is back on the air, which we all hope will be soon.'' On August 21, Valentine's employer announced that he had passed away.
        Interestingly, Cumulus Media, which owns the station that Valentine worked for, quietly issued a company-wide vaccine mandate less than two weeks after Valentine's COVID-19 diagnosis captured national attention, according to RBR+TVBR. On August 11, Cumulus CEO Mary Berner stated in a video message to all employees that everyone who works in Cumulus Media's corporate offices must be fully vaccinated by October 11. However, it is unclear if this mandate applies to the group's local stations like WTN. Berner has not discussed the mandate in public statements and a Cumulus spokesperson told RBR+TVBR last month that ''The company is not commenting'' publicly. Neither Cumulus Media nor WTN replied to requests for comment regarding employee vaccine requirements.
        Over the weekend, Joe Rogan, another professional talker who has suggested that his listeners, if young and healthy, should not get vaccinated, contracted COVID-19. On Wednesday, the podcaster, who hosts The Joe Rogan Experience on Spotify, shared an Instagram video detailing his experience, during which he acknowledged turning to an unproven treatment regimen that the FDA and CDC have strongly advised against. ''We immediately threw the kitchen sink at it. All kinds of meds," explained Rogan, while failing to say whether or not he is vaccinated. ''Monoclonal antibodies, ivermectin, Z-Pak, prednisone, everything. And I also got an NAD drip and a vitamin drip.'' Ivermectin, a drug commonly sold as a livestock dewormer, has ''made some people very sick,'' the FDA recently warned in response to the wave of Americans who have used it in misguided attempts to treat COVID-19. ''Treating human medical conditions with veterinary drugs can be very dangerous,'' the agency continued. ''The drug may not work at all, or it could worsen the illness and/or lead to serious, potentially life-threatening health complications.'' In the spring, Rogan was rebuked by Fauci for advising young people against getting the COVID-19 vaccine. ''If you're like 21 years old, and you say to me, 'Should I get vaccinated?' I'll go, 'No,''' Rogan said on an April episode of his podcast: ''If you're a healthy person and you're exercising all the time and you're young and you're eating well, I don't think you need to worry about this.''
      RedCircle | Pricing
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      Landifa
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        Buy Bitcoin (BTC) for and with Namibian (NAD) and South African (ZAR) fiat currency.
        Buy 819,088.13 NADSell 706,369.58 NADLandifa is a noncustodial Bitcoin marketplace. Customers buy Bitcoin and get it sent directly to their wallets.
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      Chloroquine is a potent inhibitor of SARS coronavirus infection and spread | Virology Journal | Full Text
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        Virology Journal volume 2, Article number: 69 (2005 ) Cite this article
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        AbstractBackgroundSevere acute respiratory syndrome (SARS) is caused by a newly discovered coronavirus (SARS-CoV). No effective prophylactic or post-exposure therapy is currently available.
        ResultsWe report, however, that chloroquine has strong antiviral effects on SARS-CoV infection of primate cells. These inhibitory effects are observed when the cells are treated with the drug either before or after exposure to the virus, suggesting both prophylactic and therapeutic advantage. In addition to the well-known functions of chloroquine such as elevations of endosomal pH, the drug appears to interfere with terminal glycosylation of the cellular receptor, angiotensin-converting enzyme 2. This may negatively influence the virus-receptor binding and abrogate the infection, with further ramifications by the elevation of vesicular pH, resulting in the inhibition of infection and spread of SARS CoV at clinically admissible concentrations.
        ConclusionChloroquine is effective in preventing the spread of SARS CoV in cell culture. Favorable inhibition of virus spread was observed when the cells were either treated with chloroquine prior to or after SARS CoV infection. In addition, the indirect immunofluorescence assay described herein represents a simple and rapid method for screening SARS-CoV antiviral compounds.
        BackgroundSevere acute respiratory syndrome (SARS) is an emerging disease that was first reported in Guangdong Province, China, in late 2002. The disease rapidly spread to at least 30 countries within months of its first appearance, and concerted worldwide efforts led to the identification of the etiological agent as SARS coronavirus (SARS-CoV), a novel member of the family Coronaviridae [1]. Complete genome sequencing of SARS-CoV [2, 3] confirmed that this pathogen is not closely related to any of the previously established coronavirus groups. Budding of the SARS-CoV occurs in the Golgi apparatus [4] and results in the incorporation of the envelope spike glycoprotein into the virion. The spike glycoprotein is a type I membrane protein that facilitates viral attachment to the cellular receptor and initiation of infection, and angiotensin-converting enzyme-2 (ACE2) has been identified as a functional cellular receptor of SARS-CoV [5]. We have recently shown that the processing of the spike protein was effected by furin-like convertases and that inhibition of this cleavage by a specific inhibitor abrogated cytopathicity and significantly reduced the virus titer of SARS-CoV [6].
        Due to the severity of SARS-CoV infection, the potential for rapid spread of the disease, and the absence of proven effective and safe in vivo inhibitors of the virus, it is important to identify drugs that can effectively be used to treat or prevent potential SARS-CoV infections. Many novel therapeutic approaches have been evaluated in laboratory studies of SARS-CoV: notable among these approaches are those using siRNA [7], passive antibody transfer [8], DNA vaccination [9], vaccinia or parainfluenza virus expressing the spike protein [10, 11], interferons [12, 13], and monoclonal antibody to the S1-subunit of the spike glycoprotein that blocks receptor binding [14]. In this report, we describe the identification of chloroquine as an effective pre- and post-infection antiviral agent for SARS-CoV. Chloroquine, a 9-aminoquinoline that was identified in 1934, is a weak base that increases the pH of acidic vesicles. When added extracellularly, the non-protonated portion of chloroquine enters the cell, where it becomes protonated and concentrated in acidic, low-pH organelles, such as endosomes, Golgi vesicles, and lysosomes. Chloroquine can affect virus infection in many ways, and the antiviral effect depends in part on the extent to which the virus utilizes endosomes for entry. Chloroquine has been widely used to treat human diseases, such as malaria, amoebiosis, HIV, and autoimmune diseases, without significant detrimental side effects [15]. Together with data presented here, showing virus inhibition in cell culture by chloroquine doses compatible with patient treatment, these features suggest that further evaluation of chloroquine in animal models of SARS-CoV infection would be warranted as we progress toward finding effective antivirals for prevention or treatment of the disease.
        ResultsPreinfection chloroquine treatment renders Vero E6 cells refractory to SARS-CoV infectionIn order to investigate if chloroquine might prevent SARS-CoV infection, permissive Vero E6 cells [1] were pretreated with various concentrations of chloroquine (0.1''10 Î¼M) for 20''24 h prior to virus infection. Cells were then infected with SARS-CoV, and virus antigens were visualized by indirect immunofluorescence as described in Materials and Methods. Microscopic examination (Fig. 1A) of the control cells (untreated, infected) revealed extensive SARS-CoV-specific immunostaining of the monolayer. A dose-dependant decrease in virus antigen-positive cells was observed starting at 0.1 Î¼M chloroquine, and concentrations of 10 Î¼M completely abolished SARS-CoV infection. For quantitative purposes, we counted the number of cells stained positive from three random locations on a slide. The average number of positively stained control cells was scored as 100% and was compared with the number of positive cells observed under various chloroquine concentrations (Fig. 1B). Pretreatment with 0.1, 1, and 10 Î¼M chloroquine reduced infectivity by 28%, 53%, and 100%, respectively. Reproducible results were obtained from three independent experiments. These data demonstrated that pretreatment of Vero E6 cells with chloroquine rendered these cells refractory to SARS-CoV infection.
        Figure 1Prophylactic effect of chloroquine. Vero E6 cells pre-treated with chloroquine for 20 hrs. Chloroquine-containing media were removed and the cells were washed with phosphate buffered saline before they were infected with SARS-CoV (0.5 multiplicity of infection) for 1 h. in the absence of chloroquine. Virus was then removed and the cells were maintained in Opti-MEM (Invitrogen) for 16''18 h in the absence of chloroquine. SARS-CoV antigens were stained with virus-specific HMAF, followed by FITC-conjugated secondary antibodies. (A) The concentration of chloroquine used is indicated on the top of each panel. (B) SARS-CoV antigen-positive cells at three random locations were captured by using a digital camera, the number of antigen-positive cells was determined, and the average inhibition was calculated. Percent inhibition was obtained by considering the untreated control as 0% inhibition. The vertical bars represent the range of SEM.
        Postinfection chloroquine treatment is effective in preventing the spread of SARS-CoV infectionIn order to investigate the antiviral properties of chloroquine on SARS-CoV after the initiation of infection, Vero E6 cells were infected with the virus and fresh medium supplemented with various concentrations of chloroquine was added immediately after virus adsorption. Infected cells were incubated for an additional 16''18 h, after which the presence of virus antigens was analyzed by indirect immunofluorescence analysis. When chloroquine was added after the initiation of infection, there was a dramatic dose-dependant decrease in the number of virus antigen-positive cells (Fig. 2A). As little as 0.1''1 Î¼M chloroquine reduced the infection by 50% and up to 90''94% inhibition was observed with 33''100 Î¼M concentrations (Fig. 2B). At concentrations of chloroquine in excess of 1 Î¼M, only a small number of individual cells were initially infected, and the spread of the infection to adjacent cells was all but eliminated. A half-maximal inhibitory effect was estimated to occur at 4.4 ± 1.0 Î¼M chloroquine (Fig. 2C). These data clearly show that addition of chloroquine can effectively reduce the establishment of infection and spread of SARS-CoV if the drug is added immediately following virus adsorption.
        Figure 2Post-infection chloroquine treatment reduces SARS-CoV infection and spread. Vero E6 cells were seeded and infected as described for Fig. 1 except that chloroquine was added only after virus adsorption. Cells were maintained in Opti-MEM (Invitrogen) containing chloroquine for 16''18 h, after which they were processed for immunofluorescence. (A) The concentration of chloroquine is indicated on the top. (B) Percent inhibition and SEM were calculated as in Fig. 1B. (C) The effective dose (ED50) was calculated using commercially available software (Grafit, version 4, Erithacus Software).
        Electron microscopic analysis indicated the appearance of significant amounts of extracellular virus particles 5''6 h after infection [16]. Since we observed antiviral effects by chloroquine immediately after virus adsorption, we further extended the analysis by adding chloroquine 3 and 5 h after virus adsorption and examined for the presence of virus antigens after 20 h. We found that chloroquine was still significantly effective even when added 5 h after infection (Fig. 3); however, to obtain equivalent antiviral effect, a higher concentration of chloroquine was required if the drug was added 3 or 5 h after adsorption.
        Figure 3Timed post-infection treatment with chloroquine. This experiment is similar to that depicted in Fig. 2 except that cells were infected at 1 multiplicity of infection, and chloroquine (10, 25, and 50 Î¼M) was added 3 or 5 h after infection.
        Ammonium chloride inhibits SARS-CoV infection of Vero E6 cellsSince chloroquine inhibited SARS-CoV infection when added before or after infection, we hypothesized that another common lysosomotropic agent, NH4Cl, might also function in a similar manner. Ammonium chloride has been widely used in studies addressing endosome-mediated virus entry. Coincidently, NH4Cl was recently shown to reduce the transduction of pseudotype viruses decorated with SARS-CoV spike protein [17, 18]. In an attempt to examine if NH4Cl functions similarly to chloroquine, we performed infection analyses in Vero E6 cells before (Fig. 4A) and after (Fig. 4B) they were treated with various concentrations of NH4Cl. In both cases, we observed a 93''99% inhibition with NH4Cl at '‰¥ 5 mM. These data indicated that NH4Cl ('‰¥ 5 mM) and chloroquine ('‰¥ 10 Î¼M) are very effective in reducing SARS-CoV infection. These results suggest that effects of chloroquine and NH4Cl in controlling SARS CoV infection and spread might be mediated by similar mechanism(s).
        Figure 4NH 4 Cl inhibits SARS-CoV during pre or post infection treatment. NH4Cl was added to the cells either before (A) or after (B) infection, similar to what was done for chloroquine in Figs 1 and 2. Antigen-positive cells were counted, and the results were presented as in Fig. 1B.
        Effect of chloroquine and NH4Cl on cell surface expression of ACE2We performed additional experiments to elucidate the mechanism of SARS-CoV inhibition by chloroquine and NH4Cl. Since intra-vesicular acidic pH regulates cellular functions, including N-glycosylation trimming, cellular trafficking, and various enzymatic activities, it was of interest to characterize the effect of both drugs on the processing, glycosylation, and cellular sorting of SARS-CoV spike glycoprotein and its receptor, ACE2. Flow cytometry analysis was performed on Vero E6 cells that were either untreated or treated with highly effective anti-SARS-CoV concentrations of chloroquine or NH4Cl. The results revealed that neither drug caused a significant change in the levels of cell-surface ACE2, indicating that the observed inhibitory effects on SARS-CoV infection are not due to the lack of available cell-surface ACE2 (Fig. 5A). We next analyzed the molecular forms of endogenous ACE2 in untreated Vero E6 cells and in cells that were pre-incubated for 1 h with various concentrations of either NH4Cl (2.5''10 mM) or chloroquine (1 and 10 Î¼M) and labeled with 35S-(Met) for 3 h in the presence or absence of the drugs (Fig. 5B and 5C). Under normal conditions, we observed two immunoreactive ACE2 forms, migrating at ~105 and ~113 kDa, respectively (Fig. 5B, lane 1). The ~105-kDa protein is endoglycosidase H sensitive, suggesting that it represents the endoplasmic reticulum (ER) localized form, whereas the ~113-kDa protein is endoglycosidase H resistant and represents the Golgi-modified form of ACE2 [19]. The specificity of the antibody was confirmed by displacing the immunoreactive protein bands with excess cold-soluble human recombinant ACE2 (+ rhACE2; Fig. 5B, lane 2). When we analyzed ACE2 forms in the presence of NH4Cl, a clear stepwise increase in the migration of the ~113-kDa protein was observed with increasing concentrations of NH4Cl, with a maximal effect observed at 10 mM NH4Cl, resulting in only the ER form of ACE2 being visible on the gel (Fig. 5B, compare lanes 3''5). This suggested that the trimming and/or terminal modifications of the N-glycosylated chains of ACE2 were affected by NH4Cl treatment. In addition, at 10 mM NH4Cl, the ER form of ACE2 migrated with slightly faster mobility, indicating that NH4Cl at that concentration might also affect core glycosylation. We also examined the terminal glycosylation status of ACE2 when the cells were treated with chloroquine (Fig. 5C). Similar to NH4Cl, a stepwise increase in the electrophoretic mobility of ACE2 was observed with increasing concentrations of chloroquine. At 25 Î¼M chloroquine, the faster electrophoretic mobility of the Golgi-modified form of ACE2 was clearly evident. On the basis of the flow cytometry and immunoprecipitation analyses, it can be inferred that NH4Cl and chloroquine both impaired the terminal glycosylation of ACE2, while NH4Cl resulted in a more dramatic effect. Although ACE2 is expressed in similar quantities at the cell surface, the variations in its glycosylation status might render the ACE2-SARS-CoV interaction less efficient and inhibit virus entry when the cells are treated with NH4Cl and chloroquine.
        Figure 5Effect of lysomotropic agents on the cell-surface expression and biosynthesis of ACE2. (A) Vero E6 cells were cultured for 20 h in the absence (control) or presence of chloroquine (10 Î¼M) or NH4Cl (20 mM). Cells were labeled with anti-ACE2 (grey histogram) or with a secondary antibody alone (white histogram). (B) Biosynthesis of ACE2 in untreated cells or in cells treated with NH4Cl. Vero E6 cells were pulse-labeled for 3 h with 35S-Met, and the cell lysates were immunoprecipitated with an ACE2 antibody (lane 1). Preincunbation of the antibody with recombinant human ACE2 (rhACE2) completely abolished the signal (lane 2). The positions of the endoglycosidase H-sensitive ER form and the endoglycosidase H-resistant Golgi form of ACE2 are emphasized. Note that the increasing concentration of NH4Cl resulting in the decrease of the Golgi form of ACE2. (C) A similar experiment was performed in the presence of the indicated concentrations of chloroquine. Note the loss of terminal glycans with increasing concentrations of chloroquine. (D) The terminal glycosidic modification of ACE2 was evaluated by neuraminidase treatment of immunoprecipitated ACE2. Here cells were treated with 1''25 Î¼M concentrations of chloroquine during starvation, pulse, and 3-h chase.
        To confirm that ACE2 undergoes terminal sugar modifications and that the terminal glycosylation is affected by NH4Cl or chloroquine treatment, we performed immunopreipitation of 35S-labeled ACE2 and subjected the immunoprecipitates to neuraminidase digestion. Proteins were resolved using SDS-PAGE (Fig 5D). It is evident from the slightly faster mobility of the Golgi form of ACE2 after neuraminidase treatment (Fig 5D, compare lanes 1 and 2), that ACE2 undergoes terminal glycosylation; however, the ER form of ACE2 was not affected by neuraminidase. Cells treated with 10 Î¼M chloroquine did not result in a significant shift; whereas 25 Î¼M chloroquine caused the Golgi form of ACE2 to resolve similar to the neuraminidase-treated ACE2 (Fig 5D, compare lanes 5 and 6). These data provide evidence that ACE2 undergoes terminal glycosylation and that chloroquine at anti-SARS-CoV concentrations abrogates the process.
        Effect of chloroquine and NH4Cl on the biosynthesis and processing of SARS-CoV spike proteinWe next addressed whether the lysosomotropic drugs (NH4Cl and chloroquine) affect the biosynthesis, glycosylation, and/or trafficking of the SARS-CoV spike glycoprotein. For this purpose, Vero E6 cells were infected with SARS-CoV for 18 h. Chloroquine or ammonium chloride was added to these cells during while they were being starved (1 h), labeled (30 min) or chased (3 h). The cell lysates were analyzed by immunoprecipitation with the SARS-specific polyclonal antibody (HMAF). The 30-min pulse results indicated that pro-spike (proS) was synthesized as a ~190-kDa precursor (proS-ER) and processed into ~125-, ~105-, and ~80-kDa proteins (Fig. 6A, lane 2), a result identical to that in our previous analysis [6]. Except for the 100 Î¼M chloroquine (Fig. 6A, lane 3), there was no significant difference in the biosynthesis or processing of the virus spike protein in untreated or chloroquine-treated cells (Fig. 6A, lanes 4''6). It should be noted that chloroquine at 100 Î¼M resulted in an overall decrease in biosynthesis and in the levels of processed virus glycoprotein. In view of the lack of reduction in the biosynthesis and processing of the spike glycoprotein in the presence of chloroquine concentrations (10 and 50 Î¼M) that caused large reductions in SARS-CoV replication and spread, we conclude that the antiviral effect is probably not due to alteration of virus glycoprotein biosynthesis and processing. Similar analyses were performed with NH4Cl, and the data suggested that the biosynthesis and processing of the spike protein were also not negatively affected by NH4Cl (Fig. 6A, lanes 7''12). Consistent with our previous analysis [6], we observed the presence of a larger protein, which is referred to here as oligomers. Recently, Song et al. [20] provided evidence that these are homotrimers of the SARS-CoV spike protein and were incorporated into the virions. Interestingly, the levels of the homotrimers in cells treated with 100 Î¼M chloroquine and 40 and 20 mM NH4Cl (Fig. 6A, lanes 3, 9, and 10) were slightly lower than in control cells or cells treated with lower drug concentrations.
        Figure 6Effects of NH 4 Cl and chloroquine (CQ) on the biosynthesis, processing, and glycosylation of SARS-CoV spike protein. Vero E6 cells were infected with SARS-CoV as described in Fig. 2. CQ or NH4Cl was added during the periods of starvation (1 h) and labeling (30 min) with 35S-Cys and followed by chase for 3 h in the presence of unlabeled medium. Cells were lysed in RIPA buffer and immunoprecipitated with HMAF. Virus proteins were resolved using 3''8% NuPAGE gel (Invitrogen). The cells presented were labeled for 30 min (A) and chased for 3 h (B). The migration positions of the various spike molecular forms are indicated at the right side, and those of the molecular standards are shown to the left side. proS-ER and proS-Golgi are the pro-spike of SARS-Co in the ER and Golgi compartments, respectively and proS-ungly is the unglycosylated pro-spike ER.
        The data obtained from a 30-min pulse followed by a 3-h chase (Fig. 6B, lanes 2 and 8) confirmed our earlier observation that the SARS-CoV spike protein precursor (proS-ER) acquires Golgi-specific modifications (proS-Golgi) resulting in a ~210-kDa protein [6]. Chloroquine at 10, 25, and 50 Î¼M had no substantial negative impact on the appearance of the Golgi form (Fig. 6B, compare lane 2 to lanes 4''6). Only at 100 Î¼M chloroquine was a reduction in the level of the Golgi-modified pro-spike observed (lane 3). On the other hand, NH4Cl abrogated the appearance of Golgi-modified forms at '‰¥10 mM (compare lane 8 with 9''11) and had a milder effect at 1 mM (lane 12). These data clearly demonstrate that the biosynthesis and proteolytic processing of SARS-CoV spike protein are not affected at chloroquine (25 and 50 Î¼M) and NH4Cl (1 mM) doses that cause virus inhibitory effects. In addition, with 40, 20, and 10 mM NH4Cl, there was an increased accumulation of proS-ER with a concomitant decrease in the amount of oligomers (Fig. 6B, lanes 9''11). When we examined the homotrimers, we found that chloroquine at 100 Î¼M and NH4Cl at 40 and 20 mM resulted in slightly faster mobility of the trimers (Fig. 6B, lanes 3, 9, and 10), but lower drug doses, which did exhibit significant antiviral effects, did not result in appreciable differences. These data suggest that the newly synthesized intracellular spike protein may not be a major target for chloroquine and NH4Cl antiviral action. The faster mobility of the trimer at certain higher concentration of the drugs might be due the effect of these drugs on the terminal glycosylation of the trimers.
        DiscussionWe have identified chloroquine as an effective antiviral agent for SARS-CoV in cell culture conditions, as evidenced by its inhibitory effect when the drug was added prior to infection or after the initiation and establishment of infection. The fact that chloroquine exerts an antiviral effect during pre- and post-infection conditions suggest that it is likely to have both prophylactic and therapeutic advantages. Recently, Keyaerts et al. [21] reported the antiviral properties of chloroquine and identified that the drug affects SARS-CoV replication in cell culture, as evidenced by quantitative RT-PCR. Taken together with the findings of Keyaerts et al. [21], our analysis provides further evidence that chloroquine is effective against SARS-CoV Frankfurt and Urbani strains. We have provided evidence that chloroquine is effective in preventing SARS-CoV infection in cell culture if the drug is added to the cells 24 h prior to infection. In addition, chloroquine was significantly effective even when the drug was added 3''5 h after infection, suggesting an antiviral effect even after the establishment of infection. Since similar results were obtained by NH4Cl treatment of Vero E6 cells, the underlying mechanism(s) of action of these drugs might be similar.
        Apart from the probable role of chloroquine on SARS-CoV replication, the mechanisms of action of chloroquine on SARS-CoV are not fully understood. Previous studies have suggested the elevation of pH as a mechanism by which chloroquine reduces the transduction of SARS-CoV pseudotype viruses [17, 18]. We examined the effect of chloroquine and NH4Cl on the SARS-CoV spike proteins and on its receptor, ACE2. Immunoprecipitation results of ACE2 clearly demonstrated that effective anti-SARS-CoV concentrations of chloroquine and NH4Cl also impaired the terminal glycosylation of ACE2. However, the flow cytometry data demonstrated that there are no significant differences in the cell surface expression of ACE2 in cells treated with chloroquine or NH4Cl. On the basis of these results, it is reasonable to suggest that the pre-treatment with NH4Cl or chloroquine has possibly resulted in the surface expression of the under-glycosylated ACE2. In the case of chloroquine treatment prior to infection, the impairment of terminal glycosylation of ACE2 may result in reduced binding affinities between ACE2 and SARS-CoV spike protein and negatively influence the initiation of SARS-CoV infection. Since the biosynthesis, processing, Golgi modification, and oligomerization of the newly synthesized spike protein were not appreciably affected by anti-SARS-CoV concentrations of either chloroquine or NH4Cl, we conclude that these events occur in the cell independent of the presence of the drugs. The potential contribution of these drugs in the elevation of endosomal pH and its impact on subsequent virus entry or exit could not be ruled out. A decrease in SARS-CoV pseudotype transduction in the presence of NH4Cl was observed and was attributed to the effect on intracellular pH [17, 18]. When chloroquine or NH4Cl are added after infection, these agents can rapidly raise the pH and subvert on-going fusion events between virus and endosomes, thus inhibiting the infection.
        In addition, the mechanism of action of NH4Cl and chloroquine might depend on when they were added to the cells. When added after the initiation of infection, these drugs might affect the endosome-mediated fusion, subsequent virus replication, or assembly and release. Previous studies of chloroquine have demonstrated that it has multiple effects on mammalian cells in addition to the elevation of endosomal pH, including the prevention of terminal glycosyaltion of immunoglobulins [22]. When added to virus-infected cells, chloroquine inhibited later stages in vesicular stomatitis virus maturation by inhibiting the glycoprotein expression at the cell surface [23], and it inhibited the production of infectious HIV-1 particles by interfering with terminal glycosylation of the glycoprotein [24, 25]. On the basis of these properties, we suggest that the cell surface expression of under-glycosylated ACE2 and its poor affinity to SARS-CoV spike protein may be the primary mechanism by which infection is prevented by drug pretreatment of cells prior to infection. On the other hand, rapid elevation of endosomal pH and abrogation of virus-endosome fusion may be the primary mechanism by which virus infection is prevented under post-treatment conditions. More detailed SARS CoV spike-ACE2 binding assays in the presence or absence of chloroquine will be performed to confirm our findings. Our studies indicate that the impact of NH4Cl and chloroquine on the ACE2 and spike protein profiles are significantly different. NH4Cl exhibits a more pronounced effect than does chloroquine on terminal glycosylation, highlighting the novel intricate differences between chloroquine and ammonium chloride in affecting the protein transport or glycosylation of SARS-CoV spike protein and its receptor, ACE2, despite their well-established similar effects of endosomal pH elevation.
        The infectivity of coronaviruses other than SARS-CoV are also affected by chloroquine, as exemplified by the human CoV-229E [15]. The inhibitory effects observed on SARS-CoV infectivity and cell spread occurred in the presence of 1''10 Î¼M chloroquine, which are plasma concentrations achievable during the prophylaxis and treatment of malaria (varying from 1.6''12.5 Î¼M) [26] and hence are well tolerated by patients. It recently was speculated that chloroquine might be effective against SARS and the authors suggested that this compound might block the production of TNFÎ±, IL6, or IFNÎ" [15]. Our data provide evidence for the possibility of using the well-established drug chloroquine in the clinical management of SARS.
        ConclusionChloroquine, a relatively safe, effective and cheap drug used for treating many human diseases including malaria, amoebiosis and human immunodeficiency virus is effective in inhibiting the infection and spread of SARS CoV in cell culture. The fact that the drug has significant inhibitory antiviral effect when the susceptible cells were treated either prior to or after infection suggests a possible prophylactic and therapeutic use.
        MethodsSARS-CoV infection, immunofluorescence, and immunoprecipitation analysesVero E6 cells (an African green monkey kidney cell line) were infected with SARS-CoV (Urbani strain) at a multiplicity of infection of 0.5 for 1 h. The cells were washed with PBS and then incubated in OPTI-MEM (Invitrogen) medium with or without various concentrations of either chloroquine or NH4Cl (both from Sigma). Immunofluorescence staining was performed with SARS-CoV-specific hyperimmune mouse ascitic fluid (HMAF) [8] followed by anti-mouse fluorescein-coupled antibody.
        Eighteen hours after infection, the virus-containing supernatants were removed, and the cells were pulsed with 35S-(Cys) for 30 min and chased for 3 h before lysis in RIPA buffer. Clarified cell lysates and media were incubated with HMAF, and immunoprecipitated proteins were separated by 3''8% NuPAGE gel (Invitrogen); proteins were visualized by autoradiography. In some experiments, cells were chased for 3 h with isotope-free medium. Clarified cell supernatants were also immunoprecipitated with SARS-CoV-specific HMAF.
        ACE2 flow cytometry analysis and biosynthesisVero E6 cells were seeded in Dulbecco's modified Eagle medium (Invitrogen) supplemented with 10% fetal bovine serum. The next day, the cells were incubated in Opti-MEM (Invitrogen) in the presence or absence of 10 Î¼M chloroquine or 20 mM NH4Cl. To analyze the levels of ACE2 at the cell surface, cells were incubated on ice with 10 Î¼g/mL affinity-purified goat anti-ACE2 antibody (R&D Systems) and then incubated with FITC-labeled swine anti-goat IgG antibody (Caltag Laboratories). Labeled cells were analyzed by flow cytometry with a FACSCalibur flow cytometer (BD Biosciences). For ACE2 biosynthesis studies, Vero E6 cells were pulsed with 250 Î¼Ci 35S-(Met) (Perkin Elmer) for 3 h with the indicated concentrations of chloroquine or NH4Cl and then lysed in RIPA buffer. Clarified lysates were immunoprecipitated with an affinity-purified goat anti-ACE2 antibody (R&D systems), and the immunoprecipitated proteins were separated by SDS-polyacrylamide gel electrophoresis.
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        AcknowledgementsWe thank Claudia Chesley and Jonathan Towner for critical reading of the manuscript. This work was supported by a Canadian PENCE grant (T3), CIHR group grant #MGC 64518, and CIHR grant #MGP-44363 (to NGS).
        Author informationAffiliationsSpecial Pathogens Brach, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, 1600 Clifton Road, 30333, USA
        Martin J Vincent, Bobbie R Erickson, Pierre E Rollin, Thomas G Ksiazek & Stuart T Nichol
        Laboratory of Biochemical Neuroendocrinology, Clinical Research Institute of Montreal, Montreal, 110 Pine Ave West, QCH2W1R7, Canada
        Eric Bergeron, Suzanne Benjannet & Nabil G Seidah
        Corresponding authorCorrespondence to Stuart T Nichol.
        Additional informationCompeting interestsThe author(s) declare that they have no competing interests.
        Authors' contributionsMV did all the experiments pertaining to SARS CoV infection and coordinated the drafting of the manuscript. EB and SB performed experiments on ACE2 biosynthesis and FACS analysis. BE performed data acquisition from the immunofluorescence experiments. PR and TK provided critical reagents and revised the manuscript critically. NS and SN along with MV and EB participated in the planning of the experiments, review and interpretation of data and critical review of the manuscript. All authors read and approved the content of the manuscript.
        Authors' original submitted files for imagesBelow are the links to the authors' original submitted files for images.
        Rights and permissionsOpen Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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        About this articleCite this articleVincent, M.J., Bergeron, E., Benjannet, S. et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J 2, 69 (2005). https://doi.org/10.1186/1743-422X-2-69
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        Received : 12 July 2005
        Accepted : 22 August 2005
        Published : 22 August 2005
        DOI : https://doi.org/10.1186/1743-422X-2-69
        Keywordssevere acute respiratory syndrome coronavirus chloroquine inhibition therapy
      ABC News explains the facial recognition app that's holding Australia up to global ridicule
        Link to Article
        Archived Version
        Source: Michael Smith News
        Fri, 03 Sep 2021 03:38
        Envy of the world?
        No more.
        South Australia has begun a home-based quarantine trial which is tipped to expand to international arrivals.
        Here's a look at the trial.
        So how will it work? It will start this week for people returning from New South Wales and Victoria.
        Premier Steven Marshall said he hoped the trial would be expanded to international travellers in "subsequent weeks", making it a national first.
        Those in home-based quarantine will need to download an app, developed by the South Australian Government, to prove they are staying home while required to.
        People wanting to return to South Australia and home quarantine will have to apply to SA Health.
        They will have to prove they have a place to isolate during their quarantine period and must also be fully vaccinated.
        Those who are approved will have to download the South Australian Government home quarantine app, which uses geo-location and facial recognition software to track those in quarantine.
        The app will contact people at random asking them to provide proof of their location within 15 minutes.
        Steven Marshall says South Australians should be proud of running a national pilot program for home-based quarantine. "We don't tell them how often or when, on a random basis they have to reply within 15 minutes," Mr Marshall said.
        If a person cannot successfully verify their location or identity when requested, SA Health will notify SA Police who will conduct an in-person check on the person in quarantine.
        People will still be required to quarantine for 14 days.
        The Premier said people were also able to put in daily observations, which could trigger a visit from SA Health.
        Mr Marshall said the government would not be storing any of the information provided to the app.
        "We just use it to verify that people are where they said they were going to be during the home-based quarantine."
        Why is SA doing this? The Premier said it was "implausible" to continue to use medi-hotels for international arrivals as borders began to re-open.
        The government hopes the use of technology during home-based quarantine would not only increase quarantine capacity, but also reduce the reliance on police officers having to knock on doors to check on people quarantining.
        "We are trying to take some of the cost associated with home-based quarantine out," Mr Marshall said.
        "In the past where we have had this option for people coming from interstate and in the early days from overseas, it required a very heavy police presence to go and check on them.
        "Now we have had a great uptake of the QR code check-in app here in South Australia, people say it's the best in the country, I think they're right and now we are the national selected pilot for this home-based quarantine app."
        He said if the trials were successful, international arrivals could be home-quarantining using the new app in the next few weeks.
        WA and Tasmania have been using apps to quarantine people from interstate, but not overseas arrivals.
        When is this starting? Now. There are people using the home-based quarantine app from today.
        "The very first person using the home-based quarantine app is now in place,' Mr Marshall said.
        "This is part of a pilot of around 50 people.
        "I think every South Australian should feel pretty proud that we are the national pilot for the home-based quarantine app."
        The Premier said South Australia will report results back to National Cabinet in the coming weeks.
        How did we get to this stage? Mr Marshall said South Australia took the home-based quarantine idea to National Cabinet "in the month last month or two".
        But in November 2020, West Australian based firm GenVis was selected as the successful tenderer for the $1.1 million contract to provide a COVID-19 home quarantine compliance app.
        The company's G2G app uses facial recognition and GPS tracking technology to check-in on people in isolation.
        The company already provides services to the WA Government with its G2G Now '-- a program developed in conjunction with WA Police.
        Work began on adapting the platform for South Australia, but in February the deal with GenVis was scrapped.
        "The development proposal with that company has not been successful and our relationship with them in relation to that program will not continue," Health Minister Stephen Wade told Parliament.
        The new South Australian app has been developed by the State Government.
        It's understood the same team who came up with the COVIDSafe check-in function has been involved.
        "I'm pretty sure the technology that we have developed within the South Australia Government will become the national standard and will be rolled out across the country," Mr Marshall.
      Australia Could Force Citizens To Report Their Location On-Demand Via Government Tracking App
        Link to Article
        Archived Version
        Source: ZeroHedge News
        Fri, 03 Sep 2021 03:27
        Authored by Paul Joseph Watson via Summit News,
        The government of South Australia is running a trial for a system that could eventually force citizens to take a photo of themselves via a government app to report their location on demand within 15 minutes of authorities requesting it, or face a police investigation.
        Yes, really.
        The revelation was highlighted in an Atlantic piece by Conor Friedersdorf which questions whether Australia can still call itself a liberal democracy in light of the crippling restrictions it has placed on its own population.
        With no end in sight for the lifting of the country's brutal lockdown, Aussies could face even more invasive state intrusion into their private lives under the justification of stopping the spread of the virus.
        The South Australian government is preparing to roll out an app that ''will contact people at random asking them to provide proof of their location within 15 minutes,'' according to reports.
        If people refuse to report their location or are unable to do so, police are then dispatched to hunt them down.
        ''We don't tell them how often or when, on a random basis they have to reply within 15 minutes,'' said Premier Steven Marshall.
        This is barely much different from literally fitting people with electronic ankle bracelets that track their every movement like prisoners under home arrest, a policy that was actually considered by Australian authorities earlier this year.
        No matter your views of COVID, what's happening in Australia is alarming, extreme and dangerous. https://t.co/Ep7fOqiHUJ
        '-- Glenn Greenwald (@ggreenwald) September 2, 2021''No matter your views of COVID, what's happening in Australia is alarming, extreme and dangerous,'' remarked journalist Glenn Greenwald.
        As we have exhaustively highlighted, Australia has enforced one of the most draconian lockdowns in the world in an effort to pursue a disastrous 'zero COVID' strategy.
        Last month, the Premier of Victoria asserted that authorities ''won't hesitate'' to go ''door-to-door'' to carry out mandatory COVID tests on Australians.
        Aussies were also ordered not to talk to each other, even while wearing masks, while people who merely post anti-lockdown information online could also face fines of up to $11,000 dollars under an absurdly authoritarian new law.
        * * *
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        In the age of mass Silicon Valley censorship It is crucial that we stay in touch. I need you to sign up for my free newsletter here. Support my sponsor '' Turbo Force '' a supercharged boost of clean energy without the comedown. Get early access, exclusive content and behinds the scenes stuff by following me on Locals.
      Apple Can't Get Out of Siri Privacy Lawsuit, Says Judge - MacRumors
        Link to Article
        Archived Version
        Thu, 02 Sep 2021 21:01
        Apple will not be able to avoid a proposed class action lawsuit covering Siri privacy claims, reports Reuters. The suit in question, which was initially filed in 2019, accuses Apple's voice assistant 'ŒSiri'Œ of violating user privacy.
        The plaintiffs involved in the case can try to prove that 'ŒSiri'Œ routinely recorded private conversations due to accidental activations, and that Apple disclosed those conversations to third parties such as advertisers, said the judge.
        One user in the lawsuit claimed that his private discussions with his doctor about a "brand name surgical treatment" caused him to receive targeted ads for that treatment, while others said that their discussions about Air Jordan sneakers, Pit Viper sunglasses, and Olive Garden resulted in targeted ads.
        That is not how 'ŒSiri'Œ works and there has been no evidence that Apple has ever provided 'ŒSiri'Œ recordings to advertisers. People have long accused social networks of listening in on their conversations and using those discussions for ad purposes, but this has never been proven.
        Though it may be difficult for the plaintiffs to prove that Apple is providing 'ŒSiri'Œ recordings to advertisers, Apple found itself embroiled in a Siri-related scandal in 2019 after it was revealed that Apple had contractors listening to Siri recordings where they heard private conversations involving drug deals, medical info, and more after 'ŒSiri'Œ was accidentally activated.
        Human-based 'ŒSiri'Œ analysis was never a secret, but at the time, Apple's privacy terms did not make it clear that people could potentially hear conversations that were recorded via 'ŒSiri'Œ. Apple temporarily suspended its 'ŒSiri'Œ evaluation program and then ultimately implemented options to delete 'ŒSiri'Œ recordings and to block them from being listened to. Apple also stopped using contractors.
        Apple in iOS 15 has gone even further with 'ŒSiri'Œ privacy and many 'ŒSiri'Œ requests will now be handled entirely on device, so 'ŒSiri'Œ content is not uploaded to Apple's servers for processing.
        The plaintiffs in the lawsuit are permitted to pursue claims that Apple violated the federal Wiretap Act and California privacy law, in addition to breach of contract. The lawsuit has requested $5,000 per violation from Apple.
      Silent PC | Fanless and Quiet PCs
        Link to Article
        Archived Version
        Thu, 02 Sep 2021 17:36
        Elite Performance Quiet PCsLooking for an elite performance PC that you offers the best in silent computing? Our QuietElite' PCs feature the top-of-line quiet PCs, on the cutting-edge for performance, compared to any PC available.
        The Dual Xeon Scalable (Socket 3647) Extreme PC is a great example of true performance and true silence. If you need pure data crunching ability, without the noise, this Extreme PC features TWO (2) Six to Twenty-Eight core Intel Xeon CPUs (for a total of up to 56 cores!) and up to a whopping 512GB of DDR4 ECC memory on a server class motherboard. Whatever the task, this is the biggest, most powerful quiet PC you can get.
        Fanless PCFull Power | Real Options | No Noise
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        DAW | Digital Audio WorkstationAll truly silent Digital Audio Workstations feature professional and enthusiast level options for the best audio recording has to offer. We feature four separate DAW base designs, fitting all levels of recording needs from the professional audio studio, to portable on-stage live recording, to the home studio. Each Digital Audio Workstation also features Thunderbolt and/or Firewire options for audio peripherals.
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      VIDEO - U.S. heads into Labor Day with Covid vaccines but much worse outbreak than in 2020
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 13:30
        People line up at a coronavirus disease (COVID-19) testing at a mobile testing van in New York City, August 27, 2021.
        Brendan McDermid | Reuters
        The U.S. is heading into Labor Day weekend with just over four times as many Covid-19 cases and more than twice as many hospitalizations as at this time last year '-- despite having vaccinated 62% of the American population with at least one dose.
        The U.S. and the world are nowhere near where health officials hoped, and thought, we would be 20 months into the pandemic '-- and more than eight months after vaccines that boasted efficacy rates around 95% were rolled out.
        Though the outbreak is significantly worse by most measures than 2020, setting the U.S. up for a tough fall season, the delta variant, vaccines and open schools make it hard to predict how the pandemic will unfold, doctors and scientists say.
        "There is a lot more uncertainty right now. The dynamic interplay between variants and vaccine and particularly people unvaccinated, and the sort of game changer of the delta variant leads to a lot of uncertainty in terms of what the fall holds," said Dr. Barbara Taylor, an assistant dean and infectious disease specialist at the University of Texas Health Science Center at San Antonio.
        The Centers for Disease Control and Prevention has advised unvaccinated Americans against traveling over the holiday weekend, worried the festivities could kick off another surge in cases.
        Heading into Labor Day 2020, the U.S. was coming down off a summer surge in which average daily cases peaked around 67,000 per day in July to an average of just over 41,000 new cases per day the week before Labor Day, data compiled by Johns Hopkins University shows. New cases this week have climbed to their highest point since January, averaging 166,000 per day over the last seven days.
        New cases, however, are rising at a substantially slower pace than in recent weeks, and many scientists predict they will soon start to decline. New cases rose by 7% over the last week, almost a third of the seven-day jump of 26% just three weeks ago, according to the data.
        "It is true that cases, hospitalizations and deaths are at higher levels than they were last Labor Day, especially for mostly Southern states," said Lawrence Gostin, director of the World Health Organization's Collaborating Center on National and Global Health Law. "This was highly surprising because we now have highly effective vaccines."
        However, the effectiveness of all three vaccines cleared for use in the U.S. '-- Pfizer, Moderna and Johnson & Johnson '-- has fallen since they were first introduced. Scientists have discovered that the protection wanes over time. The highly contagious delta variant is also a game changer. It spreads more easily and quickly than other variants, according to the CDC, infecting both unvaccinated and vaccinated people.
        The viral load in the nasal cavity is so high, estimated at 1,000 times that of other strains, that scientists in Australia say they traced a case where a man contracted it with just 5 to 10 seconds of exposure. The small fraction of fully vaccinated people who get Covid, even an asymptomatic case, are just as capable of spreading it as unvaccinated people, officials have warned. The delta variant now accounts for 99% of all new sequenced cases in the U.S.
        "The delta variant, as we've seen with the evolution of Covid-19 over the past year and a half, continues to throw us curves, and I think the best advice is to be cautious and careful," Dr. Nusheen Ameenuddin, a community pediatrician at the Mayo Clinic, said in an interview.
        The good news is that delta appears to be running its course in the U.S., running out of new people to infect as vaccination rates rise and others gain natural immunity after recovering from the virus, doctors and scientists say.
        New hospital admissions have finally started to turn after weeks of a steady rise, with the seven-day average of daily admissions down 1.7% over the past week, CDC data shows. Still, more than 100,000 Americans are currently hospitalized, compared with about 41,000 during the same week a year ago, according to the Department of Health and Human Services, in line with levels seen in late January of this year.
        The big question is: How long does immunity last? Studies show that the vaccines start to wane in effectiveness about two months after the second shot and then really decline in protection five to eight months following full vaccination, U.S. officials say.
        "We may see periodic waves of this until there is sufficient community-level protection, and hopefully that comes via vaccination rather than recovery from natural infection," said infectious diseases physician Dr. Isaac Bogoch at the University of Toronto. "I know we all want the pandemic to be over, but it's not. We are closer to the end in countries with access to vaccinations, but it's not over."
      VIDEO - Why are coronavirus patients using hydroxychloroquine and ivermectin? | khou.com
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 12:47
        The treatments once showed promise but ran into trouble in clinical trials.
        HOUSTON '-- As the Delta variant of the coronavirus spreads, why are some patients turning to unproven treatments like hydroxychloroquine and ivermectin?
        Trial troubles
        As many researchers can tell you, a lot of drugs can show promise in a petri dish or lab animals but fail to work in humans. Think of all the times we hear about possible cures for cancers that worked on lab rats but never become a reality for people. The sad reality of medical research is 31% of drugs fail in phase two clinical trials and over 58% in phase three.
        Hydroxychloroquine and ivermectin
        Both hydroxychloroquine and ivermectin showed some promise in the petri dish. Ivermectin, which is a antiparasitic drug, and hydroxychloroquine, an anti-malaria and autoimmune disease drug, appeared to prevent COVID-19 from replicating in cell cultures. But when it came to clinical trials, the results were not as good. Hydroxychloroquine showed no benefit in large trials, while ivermectin trials have been so problematic it's hard to figure out if it works or not.
        Success with monoclonal antibodies
        Meanwhile, there is a treatment for COVID that has performed well in clinical trials: monoclonal antibodies. In those tests it reduced hospitalization by 70% in high-risk patients, and when someone was exposed it reduced risk of infection by 80%.
        The key is to get medical advice from a trusted professional and not social media.
      VIDEO - CDC Data Set Missing 1 In 5 COVID Cases And Key Details From Many Other Cases : NPR
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 12:46
        Medics transport a man with COVID-19 symptoms to a hospital in Austin, Texas. More than 3 million people in the state have had COVID-19, but just 81,000 are listed in a central data set at the Centers for Disease Control and Prevention. John Moore/Getty Images hide caption
        toggle caption John Moore/Getty Images Medics transport a man with COVID-19 symptoms to a hospital in Austin, Texas. More than 3 million people in the state have had COVID-19, but just 81,000 are listed in a central data set at the Centers for Disease Control and Prevention.
        John Moore/Getty Images Colorful maps on the new online Health Equity Tracker reveal how the COVID-19 pandemic has affected different races and age groups across the United States, but you can tell something is not quite right.
        A handful of states are grayed out, and that's not because they've escaped the pandemic.
        "There's no data coming out of Texas," points out software engineer Josh Zarrabi of Atlanta's Morehouse School of Medicine, which recently rolled out the tracking portal. "A lot of Americans should be unhappy about that. And they should say, like, 'Wow, like, we need the data, right, because we're missing a huge piece of the puzzle here.' "
        And it's not just a search for jigsaw pieces from Texas.
        The Centers for Disease Control and Prevention has tallied over 39 million cases of COVID-19 in the U.S., but if you want to know more detailed information, such as where patients live, whether patients were hospitalized or died, demographic details like race, gender and age, that information is gathered separately.
        In that more detailed CDC data set, about 1 in 5 known cases '-- or 7 million people '-- are completely missing, an NPR analysis found. On top of that, about two-thirds of the data present aren't usable, as health care providers marked fields as "Unknown" or simply left them blank.
        Most states have voluntarily sent up whatever records they have, but a handful have not. Texas, Missouri, Louisiana, West Virginia and Wyoming have each submitted less than one-tenth of their total cases. Another handful of states, including Florida, Michigan and Kentucky, have smaller but still significant gaps in their data, each completely missing over 30% of their known cases.
        Over 3 million Texans have had COVID-19, but just 81,000 are in the data set. That's not even 3%.
        Loading...
        "That is ludicrous. It is shameful. It is wrong," says Nancy Krieger, a social epidemiologist at Harvard University. "You need good data to do proper planning, to understand what the risk is, how the risk is changing. And you need that to be real data that are publicly available and accessible."
        The standardized details that states feed into this data set help the CDC track COVID-19's spread, evaluate demographic trends and develop health guidance for at-risk groups and the country as a whole. However, the completeness of these records varies widely.
        Just 1% of the records present are missing the patient's age or sex, while 36% of them have race and/or ethnicity marked as "Unknown" or left blank. The CDC asked states to indicate whether patients experienced any of 15 symptoms, including fever, chills or muscle aches, but states largely have not done so. Health departments may update these details as they conclude case investigations, but for more than 90% of patients, most of these fields are currently blank or marked "Unknown."
        At the CDC, Paula Yoon directs the surveillance of about 120 infectious diseases, including COVID-19. Her epidemiologists use field studies and lab reports to fill in the blanks the best they can. However, Yoon agrees their job would be simpler if they just had all that data.
        "Yes, we would be in a much better place," Yoon says. "It's not because the states are not sharing those data with us. It's because the states don't have those data themselves."
        Why states aren't submitting dataThere are plenty of reasons why some states haven't submitted their data. Chief among them is the fact that public health has been underfunded for years. This has created a county-by-county patchwork of outdated disease-tracking systems linking hospitals and labs to public health departments.
        Many counties have their own local tracking systems that can't automatically transfer records to the state and then up to the CDC.
        At the Jackson County Health Department near Kansas City, Mo., communicable disease division manager Chip Cohlmia jokes that public health is keeping fax machines alive. In his county and many others, hospitals fax records to county health departments, and workers manually enter data.
        "It's like having an old car, and you're needing to push the car to, like, 100 miles an hour," Cohlmia says. "But, you know, you haven't changed the oil. You haven't checked the tires. The check-engine light's been on."
        Across the state in Columbia, Public Health Planning Supervisor Rebecca Roesslet says they still need to manually transfer 12,000 records '-- over half of the county's COVID-19 cases so far. It's a painstaking process of copy-and-pasting data points, field by field.
        "That's not our priority. Right now, our priority is in contacting people who have tested positive for COVID and providing them with the education they need and identifying their close contacts," Roesslet says.
        In Texas, the state health department launched a new COVID-19 tracking system in May 2020, but most large counties had already developed their own systems by then. This only added more patches onto public health's quilt of tracking systems that don't automatically communicate with each other.
        Austin Public Health's chief epidemiologist, Janet Pichette, says they wanted to collect more data than the state was gathering. They also didn't want to rely on an outside system that might go down unexpectedly.
        "Once you are a person who works in data and epidemiology, you become very territorial. You want to have control of your own data, right?" Pichette says.
        Just like the CDC can't mandate what state health departments must do, states can't always tell counties or cities what to do.
        "I wouldn't touch that with a 10-foot pole," says Diana Cervantes. She currently teaches epidemiology at the University of North Texas, but she supervised a 49-county region with the state health department until 2018.
        "We basically prefer this hands-off approach. We don't want to start getting in power struggles with the locals," Cervantes says. "The very last thing they're going to worry about is the state because they're not accountable to them."
        Local health officials report to their county leaders '-- people like Ellis County Judge Todd Little near Dallas. He had a full-time staffer working to reconcile county data with what he called "unreliable" state data, but they gave up in June.
        "We've done a successful job in mitigating a suburban county's spread. And at this point, we're ready to move on with our lives and experience the freedom that all Texans get to experience on a daily basis. We're ready to move on," Little says.
        Can the data holes be patched?Even in an imaginary world with all the right technology and plenty of workers, filling in missing data isn't always easy. Patients might not fit neatly into the CDC's standard race or sex boxes, or they might not want to reveal personal details.
        "It can be loud, angry, violent screaming and those kinds of things," Cohlmia says, describing his case investigation calls with COVID-19 patients in the Kansas City area. "There have been death threats on our office. There have been protests outside."
        Several states told NPR the pandemic outstripped their technical capabilities and overwhelmed their limited staff, but some promise that fixes are on the horizon.
        Spokesperson Lisa Cox from the Missouri Department of Health and Senior Services says the department is looking for a way to remove duplicate records before it sends data to the CDC. She expects that by late September.
        A Texas health department spokesperson says the department expects to transfer case data from various counties into the CDC's system by October. She blames Texas' decentralized public health system for the delay.
        No state has perfect COVID-19 data. But most, including two dozen other states with decentralized public health systems, have figured out how to send what they do have to the CDC. This allows researchers, nonprofit organizations or any interested citizen to check the data and make fair comparisons across state lines of who's most affected by COVID-19.
        "We should have these data at this point," says Krieger, the Harvard epidemiologist. "The answer to having not-good-enough data is to make it really public that it's not good enough and to figure out, how do you make it better?"
        Last fall, California's public health director resigned because a data glitch with the state's tracking system meant thousands of records were missing. California paid a tech firm $15 million for a new system that could keep up. Within a few months, California's COVID-19 cases were flowing back into the CDC data set.
        This summer, the CDC awarded $200 million in COVID-19 relief funds to states to modernize data systems. Yoon, the CDC's surveillance director, says that this money has helped thousands of hospitals add electronic reporting, but there's a long way to go. It'll take sustained funding, a skilled workforce and cooperation from states and counties to keep going.
        "We can't go it alone," Yoon says. "It's not a one-and-done situation where you modernize it and then you're done and you can walk away."
        But Texas alone now has over 3 million cases to submit, and Missouri, Louisiana, Mississippi and a handful of other states each have hundreds of thousands to work through.
        As the delta variant continues its surge, their to-do lists will just keep growing.
        MethodologyThe CDC's COVID-19 case surveillance data is updated twice monthly and includes all cases reported, with a 14-day lag. To calculate the approximate number of COVID-19 patients missing from each state in each update since June 2020, NPR compared the number of records present in each update with that state's cumulative case count from 14 days earlier, to account for the reporting lag.
        The data set contains 29 variables from standardized COVID-19 case report forms. To calculate the number of unusable fields, NPR found how many records were marked "Missing" or "Unknown" for each variable.
        The data used in this report comes from the most recent update, on Aug. 17.
      VIDEO - Families demand release of secret files from 9/11 case - YouTube
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 12:33
      VIDEO - BREAKING: ''All hell's gonna break loose!'' Two Voter Organizations Have Video Footage of 240 People Allegedly Dropping Ballots From Filled Backpacks Into Drop Boxes In GA [VIDEO]
        Link to Article
        Archived Version
        Sun, 05 Sep 2021 12:29
        Earlier this morning, radio host John Fredericks appeared on Steve Bannon's War Room where he dropped a bombshell.
        ''What we uncovered is about to break in Georgia..all hell is about to break loose!''Fredericks told Bannon. He explained how two voter integrity groups, OpSec and True the Vote are in possession of incredible video footage showing a massive ballot harvesting scheme in the state where Trump lost by less than 10,000 votes.
        ''There is coming video where there are basically 240 what I'm gonna call 'ballot traffickers' in Georgia,'' he said. He explained how what looks like a massive voter fraud scheme worked, ''What they did is, that they went around to drop boxes all over the state, with each of them averaging about 24 drop boxes each. What they would do is, they would go there in the middle of the night'--this is all on video'' and they would empty backpacks with gloves on, full of ballots into these drop boxes!''
        ''This is totally illegal,'' he explained, adding that even Stacey [Abrams] law was written, ''states that only one person can drop one vote into the ballot drop boxes.''
        Trending: Louisiana Utility Workers Turn Their Backs On Biden as Motorcade Drives By [Video]
        Fredericks asks ''Why hasn't Secretary of State Raffensperger investigated this yet?''
        Well, it looks like that is about to happen. According to Heather Mullins of Real America's Voice, GA SOS Raffensperger filed a FOIA request yesterday seeking communication between the DOJ, and different groups including those tied to Stacey Abrams, the Southern Poverty Law Center, Common Cause and Campaign Legal Center challenging SB2020, the Stacey Abrams bill, mentioned by John Fredericks in the video above.
        GEORGIA!ðŸ‘ðŸš¨ @GaSecofState filed a FOIA request Thursday seeking communications between the DOJ & different groups/individuals such as Stacey Abrams, the Southern Poverty Law Center, Common Cause, Campaign Legal Center, & others challenging SB202. @RealAmVoice pic.twitter.com/e5g2DsLp0a
        '-- Heather Mullins '' Real America's Voice (RAV-TV) (@TalkMullins) September 2, 2021
        Gateway Pundit was first to report on this bombshell development.
        On August 24, Breitbart's Matthew Boyle reported about a document by True the Vote, one of the organizations that Fredericks mentions, which is involved in the investigation that allegedly includes videotaped evidence of massive ballot harvesting in GA.
        The document says that True The Vote has spent the last several months since late last year collecting more than 27 terabytes of geospatial and temporal data'--a total of 10 trillion cell phone pings'--between Oct. 1 and Nov. 6 in targeted areas in Georgia, Arizona, Michigan, Wisconsin, Pennsylvania, and Texas. The data includes geofenced points of interest like ballot drop box locations, as well as UPS stores and select government, commercial, and non-governmental organization (NGO) facilities.
        ''From this, we have thus far developed precise patterns of life for 242 suspected ballot traffickers in Georgia and 202 traffickers in Arizona,'' True The Vote's document says. ''According to the data, each trafficker went to an average of 23 ballot dropboxes.''
        In other words, what the document says is that True The Vote was able to take cell phone ping data on a mass wide-scale and piece together that several people'--suspected ballot harvesters'--were making multiple trips to multiple drop boxes, raising potential legal questions in a number of these states.
        From there, the document continues, True The Vote gathered surveillance video on the drop boxes in Georgia and is attempting to gather similar such surveillance video from other states. The document states that True The Vote has obtained one full petabyte of surveillance footage on drop boxes'--two million minutes of video'--which it says is broken into 73,000 individual video files. The group is expected to begin releasing some of these videos, which purportedly show the same people going multiple times to the same drop boxes, in the coming weeks.
        ''We are building out video stories and have compiled videos of individuals stuffing ballot dropboxes with stacks of ballots, individuals depositing ballots in multiple dropboxes, unauthorized coordination between government workers engaged in the exchange of ballots, and several other tranches of video that capture unusual patterns such as the wearing of gloves to deposit ballots, taking pictures of ballot deposits, etc.,'' True The Vote's document says.
        As for states other than Georgia, True The Vote's document says that the status of such surveillance video is as of now unclear. ''Video availability in other states is undetermined; open records requests submitted consistently since January continue to be met with conflicting communications and stalls,'' True The Vote's document says.
        The group says also that it has at least three teams of analysts combing through the raw data and the surveillance video seeking out individual stories and other trends, and that it has been in contact with federal and state law enforcement in various states on what it has found and determined already.
      VIDEO - IN FULL: NSW records 1,485 new COVID-19 cases overnight | ABC News - YouTube
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      VIDEO - Glenn Greenwald: Obama Alum ADMITS To Trapping Edward Snowden In Moscow, Then LIED About It - YouTube
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      VIDEO - Nicole Elisei on Twitter: "''There will be NO return to the old normal'...'' https://t.co/eEtTjJYiZz" / Twitter
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        Nicole Elisei : ''There will be NO return to the old normal'...'' https://t.co/eEtTjJYiZz
        Thu Aug 19 06:19:57 +0000 2021
        Offtap ðŸ‡¨ðŸ‡...ðŸ‡...ðŸ‡º : @EliseiNicole https://t.co/wWV3PZ6LRW
        Sun Sep 05 10:46:01 +0000 2021
        Malcolm Ellis : @EliseiNicole @Kel51458392 if there's going to be a NWO.. it's patently obvious we need one..no reason we shld allo'... https://t.co/DHWLoNelxs
        Sun Sep 05 10:45:13 +0000 2021
      VIDEO - Although COVID-19 Rare In Cats & Dogs, Pharmaceutical Company Says, They're Ready With A Vaccine If Needed '' CBS Detroit
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        (CBS DETROIT)'' COVID-19 has been detected in some zoo animals, but what about our four legged friends, can they be infected with the virus.
        ''Millions of pets nationwide and documented cases that are less than a handful,'' said Mark Kumpf, Director Detroit Animal Care for the city of Detroit.
        READ MORE: Michigan Matters: Of Job Woes, Young People, Tooling around the Motor CityAccording to the CDC a very small number of cats and dogs have been infected with COVID-19 worldwide and the risk of spreading the virus from animals to people is low.
        However; people can spread the virus to animals.
        ''With any disease if you're showing symptoms limit your contact with both two and four-legged family members to ensure that you don't even present the possibility of passing that on,'' Kumpf said.
        Recent data shows some zoo animals are more susceptible to contacting COVID. In response The Detroit Zoo this week started vaccinating those animals, but are COVID vaccines needed now for household pets?
        ''At this time the US Department of Agriculture and the CDC and other global regulatory bodies have determined that there's not a need for a vaccine, a COVID vaccine for cats and dogs,'' said Christina Lood, Sr. Director, Sustainability & Innovation Communications for Zoetis.
        Zoetis, the animal pharmaceutical company that donated COVID vaccines for use in zoo animals says, they started working on a vaccine for cats and dogs, as soon as the virus was detected in a dog in Hong, Kong in February 20-20. And when and if the time comes they are prepared to vaccines to cats and dogs.
        READ MORE: DSO To Require Proof Of Vaccination Or Negative COVID-19 Test To Attend ConcertsUntil that time, the CDC recommends the following to protect pets from COVID
        Pet owners and every eligible person in the household should get vaccinated.People with COVID-19 should not have contact with pets.Pet owners should not allow pets to have contact with unvaccinated people outside the household, if possible.''if someone gets sick, ends up with COVID their pets may end up suffering not from the disease itself, but from the person being unable to care for them,'' Kumpf said.
        The CDC says serious COVID-19 symptoms in pets are rare, but if someone in the home tests positive and your pet starts to show symptoms, contact a veterinarian by phone.
        (C) 2021 CBS Broadcasting Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.
        MORE NEWS: Michigan State Fair Returns, Now Through Labor Day April Morton April Morton is a Detroit native, and a graduate of Wayne State University, with a BA in Speech/Communications. More from April Morton
      VIDEO - Vaccination'--Concerns, Challenges, and Questions Dr Peter McCullough - YouTube
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      VIDEO - Jamaicans Demand Removal of Pride Flag from US Embassy | News | CVMTV - YouTube
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      VIDEO - "It's been a slow death": Loved ones describe cutting ties with parents, siblings over QAnon conspiracy theories - 60 Minutes Plus - CBS News
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        Wheeler, a former Army medic who served for two years, was stationed at Fort Hood in 2014 when a gunman opened fire. Three of Wheeler's fellow soldiers were killed and 12 were injured before the shooter turned the gun on himself.
        "It was frightening," Wheeler, now 28, told 60 Minutes+ correspondent Laurie Segall, "It was traumatizing, in a way."
        After Wheeler was discharged in 2015, he said he didn't open up to his parents right away, and only over time gave more details about what he said he'd experienced during the shooting. But he told Segall the parents he returned home to had become more paranoid as they started being influenced by conspiracy theories. And they began to doubt his account of what he'd endured that day.
        "When I told them I was there for that shooting, and I told them what I had experienced, it was whiplash to me because I was met with a distant, icy neglect," Wheeler told Segall. "So the QAnon conspiracies that he started following made him degrade into more of an angry, more abusive, more distant person who now doesn't even really believe, I don't think, anything that I've said about my military service."
        "How does it feel to have your parents not believe it happened?" Segall asked Wheeler.
        "A betrayal. It feels like a betrayal," Wheeler said.
        Wheeler, whose last name has been withheld for the privacy of his family, connected 60 Minutes+ with his parents who firmly denied their son's account of their belief in QAnon. Wheeler's father said he doesn't have enough information to verify his son's experience at Fort Hood that day and was skeptical of what he saw as changing accounts by Wheeler. He said the two haven't talked much in the past year.
        For this week's 60 Minutes+, Segall spoke with individuals, including Wheeler, who are bound by the loss of their loved ones to QAnon -- the pro-Trump web of conspiracy theories that began as a fringe online movement in 2017 but has since exploded.
        One woman said she hadn't talked with her father for over a year after he inundated her with messages peddling conspiracy theories. Others said the COVID-19 pandemic gave way to new rifts over conspiracy theories about the virus or the vaccine.
        The different stories all had a similar theme: the devastation of families caused by QAnon.
        "There's almost a lingo for what it is that you guys are experiencing," Segall told the group. "Q-siblings-- a Q-spouse, Q-parents. What does it mean to have Q-family?"
        "To not have them," Wheeler said. "They are lost to us. And we are clinging for the idea of them without the Q."
        See the report, streaming now, only on Paramount+
        (C) 2021 CBS Interactive Inc. All Rights Reserved.
      VIDEO - Alex Jones Takes Ivermectin - YouTube
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      VIDEO - Danny DeVito becomes Frank Reynolds from "It's Always Sunny in Philadelphia" - EMMYTVLEGENDS - YouTube
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      VIDEO - Concerned Parents Demand Action at Natomas Unified School Board Meeting Following Veritas BOMBSHELL - YouTube
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      VIDEO - Fully Vaccinated Deaths, Hospitalizations & Cases On The Rise by ALARMING Rates [VIDEO]
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        Wait a minute'...
        Haven't we been told that the vaccines work?
        If they work as 'advertised', why would the cases, hospitalizations and deaths be rising by the percentages the Governor of West Virginia is saying they are?
        MORE NEWS: More New Details Emerge on Biden's ''Watch-Glancing'' Controversy
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        JAMIE DLUX: Did you hear what the governor of West Virginia just said?
        Governor Jim Justice: I'm gonna give you a few stats now about what's going on in West Virginia. West Virginia is seeing a 26% increase in positive cases of people that are fully vaccinated over the last eight weeks. I'll read that one more time. West Virginia is seeing a 26% increase in positive cases in people that are fully vaccinated and a 21% increase in breakthrough cases requiring hospitalization for people that are fully vaccinated. We have also seen a 25% increase in deaths of people that are fully vaccinated over the last eight weeks. Now, that's not a 25% increase of the total numbers or whatever, it is a 25% increase of deaths of people that are fully vaccinated over the last eight weeks.
        Some things just don't seem to be adding up.
        ***FOLLOW US ON TELEGRAM***
        The people are catching on'...
        ''that Governor who's telling the truth will be next on the hit list.''
        MORE NEWS: MSNBC's Leftist Hack Joy Reid Likens Conservative Christians To The Taliban
        ''Natural immunity is the way to go''
        ''Why don't the 'experts' ever talk about how to boost your immune system?''
        ''Just say another report that ''Twice As Many Americans Had COVID as Previously Thought''. Wouldn't that mean the mortality rate just got cut in half?''
        ''The 'experts' at the CDC are counting vaccinated people as unvaccinated if they die within 14 days of getting jabbed.''
        Cut Out Big Tech And Advertise With Red Voice Media Directly
      VIDEO - Breaking - Did China just Declare WAR? - YouTube
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      VIDEO - DA's Office releases 60-page report detailing how bail reform is the reason behind Harris Co. rise in crime
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        New report highlights frequency of offenders arrested, releasedFOX 26's Randy Wallace explains how a new report is blaming bond reform on the increase in crime in Harris County.
        HARRIS COUNTY, Texas - Bail reform is a big success here in Harris County. That's what the Harris County Justice Administration Department claimed in its O'Donnell report released last February.
        "They paint a very rosy picture on the success of bond reform and make it fairly obvious that the rising crime rates have nothing to do with bond reform," said Andy Kahan with Crime Stoppers.
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        On the other hand, the District Attorneys Office makes no bones about it. Crime is up, ladies and gentlemen, and it's associated with bail and that's pretty much evident in 60 pages.
        The DA's office says it used the same data as the justice administration department and some of the findings are shocking.
        In the report, D.A. Kim Ogg states, "re-offending by criminal defendants who have been released on bail is up. Bond forfeitures by criminal defendants are up, Violent offenses committed by defendants is up."
        The report makes it clear. If bail reform is not changed, it will continue to be a driving factor in the crime spike here.
        MORE BREAKING BOND COVERAGE
        Get this. There's a 50% increase in the overall bond failure rate. That means 50% of defendants freed from jail on bond either failed to show up for court or they committed new crimes. The recidivism rate or compulsion to reoffend has increased 500%.
        The report even looked at how long it took for defendants to commit a new crime. Comparing 2015 to 2019 defendants within a year is up 95%. Defendants re-offending within 180 days is up 119%. Re-offending within 90 days is up a whopping 139%.
        "It just basically proves everything Crime Stoppers has been yelling and screaming about and also everything we've been doing with Breaking Bond," Kahan said. "So many crimes are being committed by defendants who are out on bond after bond after bond and the numbers show it."
        FOR THE LATEST NEWS UPDATES, DOWNLOAD THE FOX 26 NEWS APP
        The Harris County Justice Department told us it had no response at this time. We called Harris County Judge Lina Hidalgo for a response. We've yet to hear back.
      VIDEO - IN FULL: NSW records 1,533 cases of COVID-19 | ABC News - YouTube
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      VIDEO - Data Stolen in Microsoft Exchange Hack May Have Helped Feed China's AI Project : NPR
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        When investigators discovered the hack on Microsoft Exchange servers in January, they thought it was about stealing emails. Now they believe China vacuumed up reams of information in a bid to develop better artificial intelligence, or AI. Matt Chinworth for NPR hide caption
        toggle caption Matt Chinworth for NPR When investigators discovered the hack on Microsoft Exchange servers in January, they thought it was about stealing emails. Now they believe China vacuumed up reams of information in a bid to develop better artificial intelligence, or AI.
        Matt Chinworth for NPR Steven Adair hunts hackers for a living. Back in January, in a corner-of-his-eye, peripheral kind of way, he thought he saw one in his customer's networks '-- a shadowy presence downloading emails.
        Adair is the founder of a cybersecurity company called Volexity, and he runs traps to corner intruders all the time. So he took a quick look at a server his client was using to run Microsoft Exchange and was stunned to "see requests that we're not expecting," he said. There were requests for access to specific email accounts, requests for confidential files.
        He followed all this requested information to a virtual server off-site. "The hair is almost rising on my arms right now when I think about it," Adair told NPR later. "This feeling of like, oh, crap this is not what should be going on."
        What Adair discovered was a massive hack into Microsoft Exchange '-- one of the most popular email software programs in the world. For nearly three months, intruders helped themselves to everything from emails to calendars to contacts. Then they went wild and launched a second wave of attacks to sweep Exchange data from tens of thousands of unsuspecting victims. They hit mom-and-pop shops, dentist offices, school districts, local governments '-- all in a brazen attempt to vacuum up information.
        Both the White House and Microsoft have said unequivocally that Chinese government-backed hackers are to blame.
        NPR's months-long examination of the attack '-- based on interviews with dozens of players from company officials to cyber forensics experts to U.S. intelligence officials '-- found that stealing emails and intellectual property may only have been the beginning. Officials believe that the breach was in the service of something bigger: China's artificial intelligence ambitions. The Beijing leadership aims to lead the world in a technology that allows computers to perform tasks that traditionally required human intelligence '-- such as finding patterns and recognizing speech or faces.
        "There is a long-term project underway," said Kiersten Todt, who was the executive director of the Obama administration's bipartisan commission on cybersecurity and now runs the Cyber Readiness Institute. "We don't know what the Chinese are building, but what we do know is that diversity of data, quality of data aggregation, accumulation of data is going to be critical to its success."
        The break-inThe intruders broke into Exchange by finding a handful of coding errors that gave them entry into Exchange servers and then allowed them to take control. Vulnerable systems just needed to satisfy two conditions: They had to be connected to the internet and controlled locally by the company's IT department, something known in cyber lingo as "on premises," or "on prem." (Microsoft's Office 365 wasn't swept up in the breach because it runs in the cloud, which offers more protection.)
        The hack was fairly straightforward: Once the attackers locked onto a target and slipped into the exposed Exchange servers, they planted code that essentially tricked it into requesting information '-- emails, documents, PDFs '-- and then any servers on the other end assumed the request was legitimate.
        Steven Adair, the founder of a Virginia-based cybersecurity company called Volexity, was the first to discover the Microsoft Exchange hack in the wild. "The hair is almost rising on my arms right now when I think about it," he says. Claire Harbage/NPR hide caption
        toggle caption Claire Harbage/NPR Steven Adair, the founder of a Virginia-based cybersecurity company called Volexity, was the first to discover the Microsoft Exchange hack in the wild. "The hair is almost rising on my arms right now when I think about it," he says.
        Claire Harbage/NPR "It was like a conversation in which the receiving server was saying, 'Oh, you're the Exchange server, you're a trusted entity, you're allowed to do this,' " Adair said, "and basically it doesn't check that this is a completely unauthenticated request."
        As soon as Adair saw that, he reached out to Microsoft.
        "A relatively routine report" These days most companies run Exchange in the cloud so Microsoft takes care of data security. Some banks, big corporations and defense companies run a hybrid system, using the cloud for a lot of their day-to-day operations but maintaining servers in-house to store proprietary information they'd prefer to control.
        Companies running their own Exchange servers tend to be small and medium-size firms, places with small IT departments that, until recently, didn't spend much time worrying about being targeted in a cyberattack. But that's exactly what happened '-- because if their email server was connected to the internet it meant any bad guy could hit it.
        "At the time it was perceived as a relatively routine report of a couple of vulnerabilities," Tom Burt, a vice president at Microsoft who manages the digital crimes unit, told NPR. "It was in just a couple of dozen entities worldwide and just a handful in the U.S. We and the rest of the defender community see this activity happening all the time."
        Microsoft has a Threat Intelligence Center, called MSTIC, that is responsible for investigating and responding to attacks. It tracks dozens of nation-state hackers and has specialists who follow particular groups. So it didn't take MSTIC long to determine who was roaming around in Exchange servers: a group of Chinese government hackers known as Hafnium.
        Hafnium, Burt says, is relatively new; Microsoft has only been tracking it regularly since June 2020. It has an M.O. '-- it tends to target information at government agencies, medical companies and universities.
        Typically, hackers find targets by scanning the internet. They look for systems that haven't been updated or patched. Investigators believe that in this case the hackers scanned the internet for companies that were running Exchange locally.
        The second step of the hack was a bit more perplexing. The attackers seemed to have a weirdly specific piece of data ready to deploy: the exact email addresses of various people running Exchange servers around the world. That struck Burt as odd, because those email addresses "would be different for every single company and organization around the world," he said. "And that's not public information. So when we looked at this we thought: How is this happening?"
        While on its face that was troubling, for most of January and February, the breach appeared manageable '-- the hack hadn't been widely deployed, and Microsoft was already at work on a patch to correct the coding errors that let the hackers in in the first place. The plan was to release it on its regularly scheduled patch day '-- known as Patch Tuesday, the first Tuesday of every month. But something unexpected happened: The hack went viral.
        The hackers were part of a group out of China that Microsoft calls Hafnium. Tom Burt, a vice president at Microsoft who manages the digital crimes unit, says Hafnium emerged on the scene in June 2020. Jovelle Tamayo for NPR hide caption
        toggle caption Jovelle Tamayo for NPR The hackers were part of a group out of China that Microsoft calls Hafnium. Tom Burt, a vice president at Microsoft who manages the digital crimes unit, says Hafnium emerged on the scene in June 2020.
        Jovelle Tamayo for NPR "All of a sudden we saw hundreds a day and then that continued to escalate until we were seeing north of several thousand a day," Burt said. "It was a very significant and noisy escalation. And as we watched that happen, we actually saw a number of different known Chinese actors and a wide range of unknown groups operating from China, all using this exploit."
        John Lambert, the head of the MSTIC team, likened it to "the moment before a firecracker goes off. You know something's going to happen and you want to know: How loud is this going to be?"
        Clearly, this was going to be loud '-- and waiting for Patch Tuesday was no longer an option.
        All hands on deckThe day software fixes go out to customers is actually the end of the cycle for Microsoft's patch team. Members of the team have spent the whole month leading up to it trying to understand a vulnerability or tweak some functional problem in the software. Patch Tuesday is when the world gets to see what they've been working on and apply it to their systems.
        "It's like tax day for us, but it's the runup to tax day for customers," Chang Kawaguchi, director and chief information security officer for Microsoft 365, told NPR. "That's why having a Patch Tuesday, having a consistent expectation on the customer's part, is so important to them, so they can plan for it."
        If you have to release a fix anytime before a Patch Tuesday, Kawaguchi said, you ruin somebody's weekend. Instead of going to a movie, they need to be in the office testing whatever Microsoft has created to make sure it doesn't somehow lock up something else they have running on their network.
        But the metastasis of the Exchange attack at the end of February meant Kawaguchi's team couldn't wait. It had to build a fix, release it and push it out to customers right away.
        What made this difficult is that, initially, those in-house Exchange servers around the world weren't something Microsoft could see or had access to. If the affected servers had been in the cloud, the company could have just pushed out a patch and applied it itself. But because they weren't, Microsoft had to find a way to convince some 350,000 IT administrators running Exchange locally to stop whatever they were doing and patch right away. And that was proving to be hard.
        Even putting all that aside, patches are like a ticking time bomb. They don't just protect systems, they alert criminals around the world how to get into unpatched systems. "Going public you can't just tell the good guys," Kawaguchi said. "When we release a patch, the bad guys start reverse engineering it immediately. So we always know when we release that's the starting gun of a race."
        A government responseMeanwhile, anxiety about the hack was beginning to ripple through the highest levels of the Biden administration. National security adviser Jake Sullivan tweeted out a message urging IT departments to install the patches. The Cybersecurity and Infrastructure Agency released an emergency directive that warned if the malicious activity was left unchecked, it could "enable an attacker to gain control of an entire enterprise network."
        The White House convened a task force '-- in fact, Microsoft's Burt was on it '-- to figure out ways to impress upon the nation's Exchange administrators just how serious this was.
        Even the FBI got involved. It secured a court order so it could legally scan the internet, find servers the Chinese had breached and then proactively remove whatever they might have left there '-- all without informing the victims first.
        "This is an active threat," press secretary Jen Psaki told reporters at the White House while all this was going on. "Everyone running these servers '-- government, private sector, academia '-- needs to act now to patch them."
        Kawaguchi said later, "I think this was probably the first time a tool we built was specifically pointed to in a White House press release. There were aspects of this incident and this campaign that were definitely novel."
        "This is an active threat," White House press secretary Jen Psaki, pictured here in March, told reporters as the hack started to spread. "Everyone running these servers ... needs to act now to patch them." Samuel Corum/Getty Images hide caption
        toggle caption Samuel Corum/Getty Images "This is an active threat," White House press secretary Jen Psaki, pictured here in March, told reporters as the hack started to spread. "Everyone running these servers ... needs to act now to patch them."
        Samuel Corum/Getty Images Kawaguchi said in his nearly 20 years at Microsoft, he'd never seen an attack scale up so quickly. And the breadth of it seemed out of character; nation-state hackers tend to have very targeted goals, he said '-- they know what they want and they gather it up quietly. In this case, the Chinese were acting like cybercriminals seemingly unconcerned about who or what might get caught up in their attack.
        "A lot of customers probably have felt 'I'm too small a fish,' " Kawaguchi said. " 'Nobody, no nation-state, is going to go after me.' And what we're seeing is because there's so much connection between organizations, you can go after a small fish to get to a big fish. And so everybody's having to up their game."
        China, for its part, has denied any responsibility for the Microsoft Exchange attack.
        "The Chinese are very Shop-Vac-oriented"The Microsoft Exchange hack was the latest in a long list of Chinese-sponsored cyberattacks. The tally in just the four years between 2014 and 2018 is head-spinning. There was the Office of Personnel Management attack in which hackers spent some time in OPM networks and then whisked away 21.5 million records from the federal government's background investigation database.
        There was also a breach at the health care insurer Anthem Inc. in which cyberthieves swiped 78 million names, birth dates and Social Security numbers. Two years after that, credit reporting agency Equifax Inc. announced that hackers stole the credit information of 147.9 million Americans. And then there was the break-in at Marriott's Starwood hotels. In 2018, Starwood announced that someone had cracked into its reservations database and stolen reservation, credit card, passport and other travel information from some 500 million people.
        U.S. officials said Beijing-backed hackers were behind every one of those attacks.
        "If you look, just look at the Equifax breach alone, which I consider one of the greatest counterintelligence successes by the Chinese Communist Party, they have all the financial data for every single American adult," said William Evanina, former director of the National Counterintelligence and Security Center. "The Chinese have more data than we have on ourselves."
        Evanina is now the founder and CEO of the Evanina Group, a risk consultancy company, and he said he spends much of his time fielding calls about Chinese breaches. "We've had so many, we've grown numb to it," he said. When it comes to information, he said, "the Chinese are very Shop-Vac-oriented."
        It's been an open secret for years among intelligence officials that China has been on a campaign to steal massive amounts of data. The Justice Department charged Chinese government-based hackers this year with intellectual property theft. Toby Scott/SOPA Images/LightRocket via Getty Images hide caption
        toggle caption Toby Scott/SOPA Images/LightRocket via Getty Images It's been an open secret for years among intelligence officials that China has been on a campaign to steal massive amounts of data. The Justice Department charged Chinese government-based hackers this year with intellectual property theft.
        Toby Scott/SOPA Images/LightRocket via Getty Images China's appetite for America's private data has been one of the biggest open secrets of modern intelligence. Intelligence officials estimate that China has now stolen all the personal identifiable information of about 80% of Americans, and it has a good start on collecting information on the remaining 20%. And while the individual breaches and numbers are worrying, the real issue is how all this information can be woven together to build on itself.
        "Let's play spycatcher for a second here," says Evanina, who used to do counterintelligence for the CIA. "So you have the OPM data breach, so you have an entire security clearance file for someone, you have Anthem records, you have his Marriott point record, credit cards, Equifax, his loans, his mortgages, his credit score."
        Imagine how a Chinese intelligence officer can leverage that data to get someone talking or to make a connection that can be used for intelligence purposes. "They know everything about you before they even bump you on a cruise or on a vacation," he said.
        A new moonshotFor a long time, what the Chinese government intended to do with all this information was a bit of a mystery, but now, some analysts said the Microsoft Exchange hack offers some new clues. For example, remember those IT administrator emails the Chinese needed to get into the Exchange servers? Microsoft's Burt thinks they got them during an earlier Chinese hacking operation.
        "What we've heard directly is they've accumulated vast quantities of data about Americans," Burt said. "And they must have created a massive database that included the actual email of who are the Exchange server administrators."
        China may have been leveraging information it had stolen in other attacks. But this is the first time players have actually spoken publicly about how that happened. Intelligence officials told NPR this attack seemed more reckless in that respect.
        But that may have been only a piece of a grander plan. Back in 2017, the Chinese Communist Party announced it would be making the development of world-class artificial intelligence a national priority '-- akin to America's race to the moon. And to do that China made clear it would focus on two things: developing computer scientists who can write algorithms, and amassing information that world-class algorithms need to learn from.
        Microsoft's Burt says a specialized piece of information was needed to make the Exchange hack work '-- the specific email address of local Exchange server administrators. Officials say they believe the Chinese got those addresses during a previous cyberattack. Jovelle Tamayo for NPR hide caption
        toggle caption Jovelle Tamayo for NPR In 2017, Chinese scholars were writing more research papers on AI than any other country in the world. China has more than 1,000 AI firms, second only to the U.S., and its universities are churning out computer scientists at breakneck speed.
        China has built-in advantages in the information race. It has more than 1 billion people it can (and does) collect information about, and U.S. officials said it has been supplementing all that with large-scale data heists. (The Justice Department indicted four Chinese military hackers this year over intellectual property theft and economic espionage.)
        The Cyber Readiness Institute's Todt said, against that backdrop, the second phase of the Exchange hack '-- when hackers hoovered up emails and information from tens of thousands of companies '-- shouldn't be a surprise.
        Stealing information from small- and medium-size businesses out in the American heartland doesn't immediately suggest espionage. Instead, officials believe the Chinese gather this information to help them construct the informational mosaic they need to build world-class AI. It explains their tendency, Todt said, "to gather and aggregate data and as much as possible and not discriminating where that data comes from."
        The reason we should care about that is because of the role AI plays in our everyday lives. It is becoming the mechanism by which insurance rates are calculated, credit is given, mortgages are approved and health care data is calculated. And Todt said Americans should take a moment to reflect on what it would mean to have a technology that will touch our lives in a myriad of ways built by someone else and, more specifically, China.
        "As it builds out its AI, China can social engineer to its priorities, to its mission," she said. "And that mission may be different from ours."
      VIDEO - (280) Dallas City Council 08/04/2021 - YouTube
        Link to Article
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        Thu, 02 Sep 2021 20:46
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