Research Shows This Drug Shouldn't Be Used For COVID-19, But In South Africa Many Do The South African government is trying to discourage the use of ivermectin, an anti-parasitic medication, as an anti-COVID-19 therapeutic. But some doctors are prescribing it anyway.

Research Shows This Drug Shouldn't Be Used For COVID-19, But In South Africa Many Do

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NOEL KING, HOST:

South Africa's government is trying to stop the spread of the anti-parasitic drug ivermectin. It's usually used to fight worms and other parasites in animals. But some people are using it as a COVID-19 treatment. It's being sold out of the backs of cars, at pharmacies and in doctor's offices. Here's NPR's Eyder Peralta.

EYDER PERALTA, BYLINE: When I walk into Dr. EV Rapiti's practice, the waiting room is full of COVID patients. Dr. Rapiti, a general practitioner, has made a name for himself making videos on Facebook touting his COVID treatment. He walks me past the waiting room, into the offices, where I see empty boxes labeled ivermectin, which is used to kill parasites, not viruses. But Rapiti says he is treating dozens of patients a day with it. Some are moribund with oxygen levels in the 70s.

EV RAPITI: My policy is not to send them to these hospitals because they are afraid of these hospitals and, B, not many of them come back.

PERALTA: He walks me into an exam room and leaves me with Mohammed Noor, one of his patients. He had COVID for months. And he had tried everything, including ivermectin, which he got in veterinary form from his cousins who own horses.

MOHAMMED NOOR: I know that this was for the animals, the horses. When I come here, the doctor asked me, did I use that stuff already? And I said to him, yes, a little. But then doc give me again.

PERALTA: Rapiti gave him more ivermectin. Noor got better. He got off oxygen. He started walking again - a miracle, he says.

NOOR: You keep it under your tongue for a few seconds. And then you swallow it. And then after a few minutes, you will feel better. It's for animals, but maybe I'm half animal. I don't know.

(LAUGHTER)

PERALTA: He's joking. But ivermectin is taken seriously here in South Africa even as health authorities warned over and over that there is no evidence to back the use of the anti-parasitic against COVID-19. But civil society groups, led in some cases by high-profile doctors, pressured the government. And they OK'd its use under very narrow scenarios. But now, the human form of the drug - in tablets and suspension - is being widely sold and in some places, handed out for free.

SALIM ABDOOL KARIM: It's not even like somebody's profiteering from it anymore. And I've come to understand that.

PERALTA: That is Salim Abdool Karim, who used to lead South Africa's COVID response and is one of the world's premier epidemiologists. Karim says South Africa has seen the rise of so-called miracle drugs every time there is a COVID surge.

KARIM: It's within that period of the surge people are clutching at straws. They want anything that would be that miracle cure.

PERALTA: During the first wave, it was hydroxychloroquine. Ivermectin came during the second wave after a scientific study which had not been peer reviewed touted its efficacy. The study has since been retracted. Karim went on TV asking the public to wait for definitive scientific proof, and warning that too much ivermectin can cause real harm.

KARIM: The more you tell them that this is not the miracle cure, the more they see it as a conspiracy, that you are trying to keep them away from the medical cure.

PERALTA: Now, many South Africans are taking ivermectin not only as a treatment, but as a prophylaxis. They keep it in their medicine cabinets like you would Tylenol in case of a headache. But the Cochrane review, a British database which Karim says is the gold standard for scientific rigor, looked through dozens of studies on ivermectin and found no clear difference between the drug and a placebo.

KARIM: And they unequivocally indicate that there is no evidence to support the use of ivermectin.

PERALTA: Dr. EV Rapiti finishes seeing patients just as the Sun starts to dip on the horizon. He calls me into his office, points at a stack of patient records.

RAPITI: So far I've seen - what? - this is 640. But I also do...

PERALTA: Six-hundred and forty patients so far. But he's distracted by my mask.

RAPITI: I don't worry about these masks.

PERALTA: How come (laughter)?

RAPITI: You can take them off. I've got prevention for it.

PERALTA: Rapiti sees himself as a maverick. While researchers wait for the results of clinical trials, he's in the trenches in a neighborhood full of people desperate for treatment. Sending them home to get worse or die, he says, is inhumane.

RAPITI: This is really rubbish, rubbish medicine. I'm saying, change the narrative. Treat early.

PERALTA: Rapiti works in one of the poorest neighborhoods in South Africa. The people here don't have money to pay for treatments which have been found effective against COVID. So as the second wave of this pandemic crashed into South Africa, poor people turned to ivermectin, cheap and widely available.

RAPITI: You see, anecdotal, double-blind trials mean nothing to these people. During that time of the previous year, people could breathe. They were taking just two mils of ivermectin. And in two days, they were walking.

PERALTA: Rapiti has given hundreds of patients aggressive doses of steroids and ivermectin at the first hint of COVID.

RAPITI: We can't rely on randomized control trials. It's quite simple for me. Do you get better or don't you get better?

PERALTA: He flips through his notes. Only three of his patients have died.

RAPITI: Today, it's anecdotal. Tomorrow, it's going to be the mainstay of treatment. I'm pretty confident of it.

PERALTA: Medical science has historically been a cautious field. But as this virus spread across the world, doctors needed data fast. Salim Abdool Karim again.

KARIM: As a result, we've had to cut corners. And in the medical world, cutting corners carries a high price.

PERALTA: Right now, the medical world is relying on research papers that haven't been through the rigors of peer review. This ivermectin craze was fueled by a paper that was never peer reviewed and that was eventually found to contain major problems with its data.

KARIM: It got 150,000 views. It influenced so many people to use ivermectin.

PERALTA: Some doctors in his own medical school are passing off their clinical experience for scientific rigor even though it's likely that patients are getting better on their own, not because of ivermectin.

KARIM: Our colleagues are just blind to that. From their point of view, it works. Who are you to tell me?

PERALTA: During the second wave, he told South Africans, let's wait for the data. If it wasn't for scientific rigor, we might still be treating diabetes with arsenic, he said. But now he shakes his head. He believes there is no taking back ivermectin. The best we can hope for, he says, is that the damage won't be too bad.

Eyder Peralta, NPR News, Cape Town, South Africa.

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