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Comment by ncmncm | Hacker News Reader

This is the same as posted a week ago.

The answer is the same: COVID outcomes are better without parasites. If you don't have worms, ivermectin will not help you.

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Scott Alexander did some analysis of metastudy of various ivermectin studies, and came to the same conclusion.

https://astralcodexten.substack.com/p/ivermectin-much-more-t...

Bookmarking this.

Would be interested in your response to this.

https://www.medrxiv.org/content/10.1101/2021.02.02.21250995v...

> Conclusion Our results suggest that co-infection with parasitic co-infection appears to be associated with reduced COVID-19 severity. The results suggest that parasite-driven immunomodulatory responses may mute hyperinflammation associated with severe COVID-19.

Modulating cytokine storms could be expected to result in better outcomes.

Is a worm infection the best, or a good, way to do that? If ivermectin produces better outcomes where worms are common, the reasonable guess would be "no".

Maybe you should have put this qualified opinion in your original post, since you seemed to imply that you knew that parasites always led to worse outcomes.

Let's be clear, this is a speculative conclusion for Ivermectin's effect, and not at all proven.

It's interesting because it almost makes both political sides (yes, this is politics now) actually true. Ivermectin doesn't work. This is true. But it might reduce covid mortality in many third world countries, which are the studies the so called anti vaxxers claimed. They are also correct.

So... can we just say everyone was right, and maybe start killing worms across the world?

> can we just say everyone was right

No, because neither claim has been proven true. Both are speculative. Correlation is not causation.

It would be fairest to say that no one who claims to be right is.

By the evidence, we could reasonably deduce that people who make decisions in rich countries don't give a crap about poor peoples' parasite infections or anything else, but would anyway like them to please limit breeding of new virus variants that might get back to infect rich people.

Thus, they subsidize expensive vaccines, but not cheap vermicides. But not really even enough of the vaccines. As it becomes clear that herd immunity is impossible (because of animal reservoirs, and because they provide too little vaccine anyway) I expect vaccine help to trail off.

Meanwhile, rich countries' mortality from complications of sugar overdosing absolutely dwarfs COVID-19's, but nothing can be done about that without affecting profits.

No. It's not that clear.

> If you don't have worms, ivermectin will not help you

This makes sense and is supported by some data.

> COVID outcomes are better without parasites

This dramatically understates interactions in the immune system. I can go into a longer essay, but:

1) Parasites suppress the immune system (they release chemicals to moderate immune response; otherwise, the immune system would destroy them)

2) There is some evidence that the immune system evolved to operate when suppressed by worms. Autoimmune diseases and allergies may be a symptom of worm-free life.

3) Most of the damage from COVID19 comes from the immune system and not the disease (that's true of most diseases, for that matter).

4) ... and so on.

We have absolutely no idea how ivermectin, worms, and COVID interact. It's too complex a system.

We have some idea, just nothing very solid.

There are lots of different parasitic worms -- maybe of more species than we have mammals -- and lots of places they infest, to lots of different degrees. That outcomes in certain places where worms are a problem seem better with vermicidal treatment suggests the net effect of, anyway, heavy infestations seen in, anyway, those places is negative.

I see a recent report that "long COVID" looks like a result of COVID stimulating expression of ancient retroviral genes long after the primary COVID infection has been suppressed.

COVID keeps on giving.

So it eliminates a possible comorbidity. But you don't know, unlike other comorbidities which are known.

Are worms really that common?

In undeveloped countries.

Ascariasis: 800- 1.2 billion worldwide

https://www.cdc.gov/parasites/ascariasis/index.html

Strongyloides: 100 million

https://www.cdc.gov/parasites/strongyloides/epi.html

Cystercicosis: 50-100 million

https://pubmed.ncbi.nlm.nih.gov/25296005/

Well that's another sad fact about the developing world. It sounds like treating underlying heath problems before getting COVID is a good idea in the developing world.

Treating underlying health problems exceeded their resources, many places, even before COVID. COVID has not made it easier.

Yes. In Brazil specially.

Yes, particularly in India [1], and other countries with widespread poverty. Given that, it's not surprising that the promising Ivermectin studies came out of such countries - most Western researchers at the time simply didn't know, think or care about parasite prevalence as an explanation and the general public has even less knowledge as parasitic infections are incredibly rare in developed countries. And by the time it became clear, too many people already had jumped on the hype train.

[1]: https://ciff.org/news/worms-india-scale-and-success-world-le...

If that was true, wouldn't other anti-helminitics show the same effect ?

They might! But few seem very interested in others.

Yeah, this was a known conclusion. Parasitic infection is a comorbidity of Covid and ivermectin is very effective against parasites.

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