7 September 2021
Illustration: Lisa Nelson
There have been four important developments in Covid-19 science in the past few weeks. A large study in Brazil has found a potentially promising treatment that reduces hospitalisation. The same study found that another much touted drug, ivermectin, doesn’t work.
Also, a ginormous study in Bangladesh should end any further doubts about the efficacy of masks.
And a South African company has taken the lead in making vaccination compulsory.
Fluvoxamine is a drug used to treat depression. It is in the same class of drugs as fluoxetine, which most people know by the brand name Prozac. The two drugs are chemically quite different despite having similar names. There has been speculation that fluvoxamine has some anti-inflammatory effects. A small but inconclusive study also suggested it may prevent some people with Covid from becoming ill.
The Together trial is a large clinical study that is being run in Brazil. It is investigating several drugs, including fluvoxamine, for the treatment of Covid. It’s a well-run, reputable trial.
Volunteers, all with Covid and symptomatic, were randomly chosen to receive either fluvoxamine or a placebo (a pill that does nothing), or other drugs being tested. Neither volunteers nor their health workers knew whether the volunteers were getting fluvoxamine, placebo or another drug. The volunteers ranged in age from 18 to 102, with the average age being 50.
Of the 739 people taking fluvoxamine, 77 needed to be observed for six or more hours in an emergency room or were hospitalised. But in the placebo group the number who needed to go to an emergency room or hospital was quite a bit higher, 108 people out of 733.
This result is unlikely due to chance. It strongly suggests that fluvoxamine reduced the severity of Covid.
But there are many cautions. This is no “wonder drug”. The effect appears to be real, but it’s not massive: 10% emergency room or hospitalisation with fluvoxamine vs 14% for placebo. The study would probably have to be convincingly replicated before it impresses health authorities sufficiently to change treatment guidelines. There have been too many false alarms — positive results that could not be replicated — with Covid. There are also questions about the practicality and cost. Finally, the results have not yet been peer-reviewed.
It’s increasingly hard to understand why ivermectin is so widely used and why it has become a drug with what can best be described as a cult following.
The Together trial researchers — the same people who tested fluvoxamine — also tested ivermectin. They have announced but not yet published their results. Theirs has been by far the biggest study of ivermectin yet. The result: volunteers with Covid who took ivermectin had no significant benefit compared to placebo. We’ll try to give more details once their results are published.
Answering questions after presenting these results, the lead researcher of the study, Ed Mills commented:
“The [ivermectin] advocacy groups have set themselves up to be able to critique any clinical trial … They’ve already determined that any valid, well-designed clinical trial has been set up to fail. … I’ve had enough abuse and so have the other clinical trialists doing ivermectin … I’m not active on social media … but others working in this area have been threatened, their families have been threatened, they’ve been defamed. I can think of no circumstances in the past where this kind of abuse has occurred to clinical trialists, and it’s a real shame that it goes on.”
It’s not completely the end of the line for ivermectin. The Oxford based clinical trial known as PRINCIPLE is still testing it. But we can be certain of this: ivermectin is unequivocally not a wonder drug for Covid. At best it may have a very modest benefit — almost definitely less than that of fluvoxamine, for example — and it’s most likely useless. But we should keep an open mind until the PRINCIPLE study is completed.
We didn’t think it would be possible to ever do a clinical trial showing whether or not masks are effective. A lot of studies have shown the benefits of masks, but none have met the gold standard of a trial.
Well, now a trial has indeed shown that masks reduce the risk of Covid, especially surgical masks, though cloth masks are also beneficial.
The results of a ginormous study in Bangladesh involving just shy of 350,000 people were published last week. It compared what happened when mask-wearing was actively promoted (and increased) against a business-as-usual approach.
It’s what’s called a cluster randomized trial. Instead of individuals being randomly assigned to either get the mask promotion intervention or not, whole villages were assigned. Then the Covid rates of the different villages were compared. 600 villages were involved in the study.
Mask wearing increased dramatically in the villages where it was promoted. Covid infections went down. In some of the villages, surgical masks were promoted; in others, cloth masks were promoted. The villages with surgical masks did better. Interestingly, although the cloth masks did not reduce the number of confirmed Covid infections by much (in fact the cloth mask reduction may only be due to chance) it reduced the number of people with Covid symptoms significantly.
This is an astonishing study. Besides being huge it must have been a gargantuan logistical challenge. We’re intentionally not giving the exact results of the study (you can read these in the original paper if you wish) because as the authors point out they will differ widely across geographical regions, depending on how well people adhere. The point is that there is now no doubt: masks are effective, especially surgical ones. They’re also completely safe to wear. The level of effectiveness will depend, to a large extent, on the level of adherence.
Discovery is making Covid-19 vaccination mandatory for all its staff from 2022. It’s the first JSE listed company to announce this, reports Business Day. In an interview with Bloomberg, CEO Adrian Gore said that the company will accommodate employees with religious objections or health conditions preventing vaccination.
We will see if other companies follow.
Vaccines, such as the Pfizer and Johnson & Johnson ones used in South Africa, have been shown to be extremely effective at reducing Covid hospitalisations and deaths, and effective at reducing the risk of infection. They are also extremely safe.
In our view companies that fail to make them mandatory for their employees are putting their workers at unnecessary risk of Covid.