Can a drug in nit shampoo help treat COVID?
Reno Degisi felt so ill he thought he was dying. Last Christmas the 53-year-old building worker was among the UK's four million Covid cases. 'I really felt this was the end,' he says. 'I could barely speak, I was struggling to breathe and the pain was like someone was stabbing me in the back and sides.' Reno, who lives in Rochdale, Lancashire, was being treated by his GP with high doses of steroids when a chance conversation with a friend, also ill with Covid, led to a remarkable  if controversial  discovery. On his friend's recommendation, Reno began using a drug called ivermectin  commonly used to treat nits. 'My friend said it was used to treat Covid in other countries  and was entirely safe, although GPs in the UK aren't allowed to prescribe it,' he says. Nonetheless, Reno was able to obtain it online from an overseas pharmacy  he took it for five days. 'At first I couldn't walk out of the house without getting out of breath,' he recalls. 'It took me about five or six weeks to recover completely.' First marketed in 1981 and routinely used worldwide to combat head lice and (in tablet form) the skin parasite scabies and other worm infections, ivermectin works by blocking proteins used by worms to disable the host's immune system  Reno is convinced that ivermectin, a basic drug used in shampoo form by millions of British parents to treat nits, saved him from the worst ravages of Covid. First marketed in 1981 and routinely used worldwide to combat head lice and (in tablet form) the skin parasite scabies and other worm infections, ivermectin works by blocking proteins used by worms to disable the host's immune system. But it's also been found to have other properties. Last March researchers from Monash University, Australia, reported that ivermectin, which is also used (as a cream) to treat the skin condition rosacea, could produce a 5,000-fold reduction in Covid virus replication. Other trials from around the world have suggested it also has a potent anti-viral and anti-inflammatory effect on Covid and could be useful for the vast majority of Covid cases that are not severe enough for hospital treatment. Last August, a leading Australian doctor hailed it as 'amazingly successful' in killing coronavirus in trials: 'It looks like coronavirus is very simple to kill,' said Professor Thomas Borody, medical director of the Centre for Digestive Diseases in Sydney. In a study published in December in the journal Reviews in Cardiovascular Medicine, which was co-signed by 56 other specialists across the world, he suggested ivermectin combined with zinc and the antibiotic doxycycline was remarkably effective. 'There are a number of studies that are amazingly successful  we're talking close to 100 per cent,' he said. Ivermectin seems to work by stopping the Covid virus attaching to the cell receptors and entering cells  it prevents the virus disrupting the production of interferon, a protein that is part of the cell defence mechanism. In April this year Satoshi Omura, the 85-year-old Japanese biochemist who won the 2015 Nobel prize for medicine for discovering ivermectin, went further, suggesting it could even represent a medical breakthrough comparable to the benefits achieved with the discovery of antibiotics. 'When the effectiveness of ivermectin for the Covid pandemic is confirmed and its clinical use is achieved on a global scale, it could prove to be of great benefit to humanity,' he wrote in the Japanese Journal of Antibiotics. His enthusiasm for his own discovery notwithstanding, other evidence suggests the drug merits further investigation. Dr Andrew Hill, a senior research fellow in pharmacology and therapeutics at Liverpool University, led a team commissioned by the World Health Organisation (WHO) which analysed results from 18 of these trials involving almost 2,300 people with varying severity of Covid infection  and concluded, in a study published last October, that ivermectin could cut Covid deaths by 75 per cent. However, a 'living guideline' the WHO published in April aimed at improving Covid treatment worldwide, describes ivermectin's effectiveness in reducing death rates and avoiding hospitalisation as 'very uncertain'. This was due to 'important concerns' about the risk of bias in the trials studied and the low numbers of patients in the studies. The 60-page document concluded ivermectin was worth investigating but should only be prescribed to carefully monitored patients in clinical trials because of uncertainty about dose and the unknown risk of toxicity. Dr Hill, who has led many such initiatives, is not surprised by the WHO's cautious response. 'I hope ivermectin works but we need to prove it to a regulatory standard so it can be approved,' he says. Nonetheless, 20 countries (none in Western Europe) include ivermectin in their Covid treatment programmes, according to Pharmacy Magazine. Meanwhile, The BMJ has been reporting on a growing angry debate over access to ivermectin for patients in Covid-blighted regions such as South Africa. Some UK doctors are willing to use the treatment and speak about it. Lancashire GP John McCarthy, 54, says he's been researching it 'for some time and I've been taking it since December to reduce the risk of getting Covid'. 'I'm also giving it to members of my family,' he says, emphasising he does not prescribe it for patients in the UK. 'It's a very strange situation  it's incredibly hard to get hold of it here but I have advised people abroad about using it and had good responses.' Thomas Madejski, a GP in Albion, New York, in the U.S., says he has prescribed it to more than 100 patients. The original manufacturer of ivermectin, Merck, has issued a statement insisting there is 'no scientific basis for a potential therapeutic effect' for ivermectin against Covid, and highlighted 'a concerning lack of safety data in the majority of studies'. Yet cynics in the medical community point out ivermectin is an old drug no longer protected by patent, meaning it can be manufactured very cheaply by anyone. Merck is now developing a new Covid drug, molnupiravir, which in animal studies has been found to suppress Covid transmission within 24 hours. Good Health has spoken to a number of other Covid patients, who have taken ivermectin, and GPs who are keen to use it. 'Ivermectin looks very interesting and it probably has a role in the prevention and early treatment of acute Covid; we're hoping to do some studies with it in the treatment of long Covid,' said Dr Tina Peers, a private doctor in Surrey, who specialises in Covid treatment. 'We know Covid vaccines will not offer fail-safe protection and we know some people will refuse them or not be offered them at all,' adds Dr Arabella Onslow, a GP in Dalton-in-Furness, Cumbria, who also believes the evidence ivermectin works. 'There is an urgent need for an effective, readily available treatment people can take at home before symptoms become severe.' However, this is far from being the first time a drug used to treat another ailment has been hailed as a weapon against Covid-19. Former U.S. president Donald Trump famously gave public backing to the anti-malarial drug hydroxychloroquine, only for it to be found ineffective in trials. Other rejected Covid treatments include the antibiotic azithromycin and HIV drugs lopinavir and ritonavir. There are 65 ongoing trials of ivermectin for Covid-19 worldwide, but what concerns those who support its use is that most involve tiny numbers or are being run in countries with less stringent regulation. Ivermectin is also expected to be added to the ongoing PRINCIPLE trial, involving thousands of people with Covid who do not need hospital treatment and who volunteered via their GP practice. 'The aim is to find something that shortens disease and reduces hospital admission,' says Professor Richard Hobbs, a specialist in primary care at the University of Oxford, and one of the trial's leaders. (The PRINCIPLE trial is currently assessing an asthma drug called budesonide and colchicine, normally used for gout. Ivermectin is one of the next therapies on the list.) Dr Siu Ping Lam, director of licensing for the UK Medicines and Healthcare products Regulatory Agency, said although ivermectin is not currently approved for Covid, the agency is aware of the interest in it and ready to process any application to market it  although it would need to prove its safety and effectiveness 'based on robust data'. So far, no medicine has been proved to be effective against Covid for patients who don't require hospital treatment. 'Naturally we are all hoping to find drugs that are of benefit, but sometimes it's quite important to show that things don't work,' says Professor Hobbs. Dr Hill concurs, emphasising the need to see results from the larger ongoing clinical trials before making decisions on wide-scale ivermectin use: 'The results are so far so good but let's get more data. There have been false dawns with other similar drugs.'