Thoughts on Ivermectin, masks, etc.

We are all sick of dealing with Covid and wish there was some kind of easy, fool-proof way to prevent or treat it. Unfortunately, as with most things in life, Covid does not work that way. Early on in the pandemic, hydroxychloroquine gained traction in some quarters as the answer and was ultimately shown to not be beneficial for Covid (and possibly made things worse). The new silver bullet being promoted by some which I have been asked about is Ivermectin.

Ivermectin is a drug I learned about in medical school but I do not have much experience with it because the human diseases it is typically used to treat are not common in the Shenandoah Valley. Ivermectin initially gained attention for Covid because it was shown to kill coronaviruses when used in high concentrations in a lab setting. Unfortunately, that does not necessarily mean it will work in a human being.

There are several studies which have been used to promote the use of Ivermectin for Covid which showed results that seem too good to be true. There are a lot of red flags with these studies which have been noted by epidemiologists who have reviewed them. One study included patients who died before the study even started, listed a hospital as part of the study as a participating institution even though the hospital denies any involvement, and listed an author who states he was never allowed to review the data. Other population studies do not account for the effects of concomitant policy changes such as lockdowns and one study appears to have sections directly cut and pasted from an earlier document.

It would be great if Ivermectin was effective. Imagine if it was really 100% effective as one study claimed. I could prescribe it for everyone and make it home in time for dinner with my wife. Unfortunately, the preponderance of the evidence for Ivermectin use in Covid is underwhelming (https://www.covid19treatmentguidelines.nih.gov/tables/table-2c/).

There are some things that we know help lessen the spread and effect of Covid. Masks have been shown to slow the spread of Covid. Vaccinations have been shown to significantly decrease one’s chance of catching Covid and to greatly decrease one’s chance of having a severe case of Covid. Being vaccinated also appears to decrease the amount and duration of viral shedding after a Covid infection, thus decreasing the chance of spreading it to someone else.

One of the most disheartening things for me about Covid is how much of the public discourse is about laws, mandates, court decisions, rights, and yelling at school board meetings. Wouldn’t it be nice if it was more about how we can voluntarily protect ourselves and those around us? Wouldn’t it be nice if there was more “What can I do to help?” and less “You can’t make me!”?

As of yesterday, our community hospital has 53 people hospitalized with Covid and has once again stopped doing elective surgeries. Several urgent cares have closed to reroute staff to where they are needed to help care for Covid patients. Recently, our days in the office are dominated by seeing patients with Covid, possible Covid, or exposure to Covid.

So please just wear a mask when you are indoors with folks outside your family and get vaccinated if you have not already. Ivermectin is not a panacea and we are unlikely to find anything else that is. The best way to get closer to our pre-Covid normal as soon as possible is for all of us to consistently do the things which we know work.

 

Warm weather and poison ivy

As the weather warms and people are spending more time outside, I have started seeing some children with poison ivy or poison oak.

It is important to note that even before the plants have leaves, contact with them can still result in a very unpleasant reaction. In fact, these photos are of a case of poison ivy contracted during the winter while cutting up some downed trees. Because there were no leaves, it was not clear until it was too late that there was poison ivy all around. Be especially wary of fuzzy vines on tree trunks.

The rash is a reaction to the oil from the plants. There can be secondary transmission from clothing or pets which have the oil on them. But once the oil is washed away, the rash itself is not contagious. If you know you have been exposed, washing as soon as possible with soap and water and washing your clothes immediately can help prevent any reaction. 

The rash is very itchy and can turn into weepy blisters as well. Treatment includes topical anti-itch creams, compresses and baths, oral antihistamines such as Benadryl, Zyrtec, or Claritin, and in severe cases a course of oral steroids.

So get outside and enjoy nature. Just be careful what you are touching.