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COVID-19 Excess Deaths in Peru’s 25 States in 2020: Nationwide Trends, Confounding Factors, and Correlations With the Extent of Ivermectin Treatment by State

Chamie et al., Cureus, doi:10.7759/cureus.43168
Aug 2023  
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Ivermectin for COVID-19
4th treatment shown to reduce risk in August 2020
 
*, now with p < 0.00000000001 from 104 studies, recognized in 22 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19ivm.org
Ecological analysis showing that ivermectin distribution correlated significantly (p<0.002) with the reduction in excess deaths across 25 states in Peru.
Ivermectin was authorized for COVID-19 treatment in Peru in May 2020 and distributed to varying degrees across the states. 10 states had mass ivermectin distributions through the Mega-Operación Tayta (MOT) program. Excess deaths were calculated using mortality data from Peru's national health system.
In the 10 MOT states with maximal ivermectin usage, excess deaths dropped by 74% on average 30 days after peak deaths. In 14 states with moderate ivermectin usage, deaths dropped 53%. In Lima with minimal ivermectin usage, deaths dropped 25%.
Reductions in excess deaths correlated significantly (p<0.002) with extent of ivermectin distributions across the 25 states.
After the new Peruvian president restricted ivermectin use in November 2020, nationwide excess deaths increased 13-fold over the next 2 months.
The significant correlation between ivermectin usage and reduced excess deaths held despite considering other potential confounding factors like mobility, viral strains, and seropositivity.
In summary, this ecological study found that ivermectin usage correlated with reduced COVID-19 mortality across Peru in 2020, based on data for excess deaths and ivermectin distributions across 25 states.
Chamie et al., 8 Aug 2023, placebo-controlled, Peru, peer-reviewed, 3 authors, study period 1 August, 2020 - 1 December, 2020. Contact: dscheim@alum.mit.edu.
This PaperIvermectinAll
COVID-19 Excess Deaths in Peru’s 25 States in 2020: Nationwide Trends, Confounding Factors, and Correlations With the Extent of Ivermectin Treatment by State
Juan J Chamie, Jennifer A Hibberd, David E Scheim
Cureus, doi:10.7759/cureus.43168
Introduction In 2020, nations hastened to contain an emerging COVID-19 pandemic by deploying diverse public health approaches, but conclusive appraisals of the efficacy of these approaches are elusive in most cases. One of the medicines deployed, ivermectin (IVM), a macrocyclic lactone having biochemical activity against SARS-CoV-2 through competitive binding to its spike protein, has yielded mixed results in randomized clinical trials (RCTs) for COVID-19 treatments. In Peru, an opportunity to track the efficacy of IVM with a close consideration of confounding factors was provided through data for excess deaths as correlated with IVM use in 2020, under semi-autonomous policies in its 25 states. Methods To evaluate possible IVM treatment effects, excess deaths as determined from Peruvian national health data were analyzed by state for ages ≥60 in Peru's 25 states. These data were compared with monthly summary data for excess deaths in Peru for the period 2020-2021 as published by the WHO in 2022. To identify potential confounding factors, Google mobility data, population densities, SARS-CoV-2 genetic variations, and seropositivity rates were also examined. Results Reductions in excess deaths over a period of 30 days after peak deaths averaged 74% in the 10 states with the most intensive IVM use. As determined across all 25 states, these reductions in excess deaths correlated closely with the extent of IVM use (p<0.002). During four months of IVM use in 2020, before a new president of Peru restricted its use, there was a 14-fold reduction in nationwide excess deaths and then a 13-fold increase in the two months following the restriction of IVM use. Notably, these trends in nationwide excess deaths align with WHO summary data for the same period in Peru. Conclusions The natural experiment that was put into motion with the authorization of IVM use for COVID-19 in Peru in May 2020, as analyzed using data on excess deaths by locality and by state from Peruvian national health sources, resulted in strong evidence for the drug's effectiveness. Several potential confounding factors, including effects of a social isolation mandate imposed in May 2020, variations in the genetic makeup of the SARS-CoV-2 virus, and differences in seropositivity rates and population densities across the 25 states, were considered but did not appear to have significantly influenced these outcomes.
Additional Information Disclosures Human subjects: All authors have confirmed that this study did not involve human participants or tissue.
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' '10.1016/j.eclinm.2021.100959', 'journal-title': 'EClinicalMedicine'}, { 'key': 'ref75', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijantimicag.2021.106516', 'article-title': 'High-dose ivermectin for early treatment of COVID-19 (COVER study): a ' 'randomised, double-blind, multicentre, phase II, dose-finding, ' 'proof-of-concept clinical trial', 'volume': '59', 'author': 'Buonfrate D', 'year': '2022', 'unstructured': 'Buonfrate D, Chesini F, Martini D, et al.. High-dose ivermectin for ' 'early treatment of COVID-19 (COVER study): a randomised, double-blind, ' 'multicentre, phase II, dose-finding, proof-of-concept clinical trial. ' 'Int J Antimicrob Agents. 2022, 59:106516. ' '10.1016/j.ijantimicag.2021.106516', 'journal-title': 'Int J Antimicrob Agents'}, { 'key': 'ref76', 'doi-asserted-by': 'publisher', 'article-title': 'National Death Information System (SINADEF); this dataset, updated ' 'daily, was accessible by the public through December 2022. Frozen data ' 'snapshots as used here are available in the Dryad data repository at ' 'this URL', 'author': 'Ministerio de Salud de Peru', 'year': '2021', 'unstructured': 'Ministerio de Salud de Peru. National Death Information System ' '(SINADEF); this dataset, updated daily, was accessible by the public ' 'through December 2022. Frozen data snapshots as used here are available ' 'in the Dryad data repository at this URL. Dryad, USA; 2021. ' '10.5061/dryad.dv41ns1xr', 'DOI': '10.5061/dryad.dv41ns1xr'}, { 'key': 'ref77', 'unstructured': 'Estimated population by simple ages and age groups, according to ' 'department, province and district. Information Management Office, ' 'Ministry of Health, National Institute of Statistics and Informatics ' '(INEI). National Censuses [Article in Spanish]. (2020). Accessed. ' 'September 27, 2022: https://www.gob.pe/institucion/inei/tema/censos.'}, { 'key': 'ref78', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S1473-3099(20)30553-3', 'article-title': 'Association between mobility patterns and COVID-19 transmission in the ' 'USA: a mathematical modelling study', 'volume': '20', 'author': 'Badr HS', 'year': '2020', 'unstructured': 'Badr HS, Du H, Marshall M, Dong E, Squire MM, Gardner LM. Association ' 'between mobility patterns and COVID-19 transmission in the USA: a ' 'mathematical modelling study. Lancet Infect Dis. 2020, 20:1247-54. ' '10.1016/S1473-3099(20)30553-3', 'journal-title': 'Lancet Infect Dis'}, { 'key': 'ref79', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s12889-022-13546-6', 'article-title': 'The relative effects of non-pharmaceutical interventions on wave one ' 'Covid-19 mortality: natural experiment in 130 countries', 'volume': '22', 'author': 'Stokes J', 'year': '2022', 'unstructured': 'Stokes J, Turner AJ, Anselmi L, Morciano M, Hone T. The relative effects ' 'of non-pharmaceutical interventions on wave one Covid-19 mortality: ' 'natural experiment in 130 countries. BMC Public Health. 2022, 22:1113. 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Accessed: July 3, 2023: ' 'https://www.paho.org/en/documents/epidemiological-update-occurrence-variants-sars-cov-2-americas-26-january-2021.'}, { 'key': 'ref86', 'unstructured': 'Covid-19. seroprevalence in the city of Iquitos is 75 percent. Andina ' 'Peruvian News Agency [Article in Spanish]. (September 25, 2020). ' 'Accessed: July 3, 2023: ' 'https://andina.pe/agencia/noticia-covid19-seroprevalencia-la-ciudad-iquitos-es-75-ciento-815197.aspx.'}, { 'key': 'ref87', 'unstructured': 'European Comission, Global Human Settlement, Urban centres database 2018 ' 'visualisation; Urban Centre Database UCDB R2019A. (November 30, 2020). ' 'Accessed. July 3, 2023: ' 'https://ghsl.jrc.ec.europa.eu/ucdb2018visual.php.'}, { 'key': 'ref88', 'unstructured': 'National Institute of Statistics and Informatics (INEI), National ' 'Censuses [Article in Spanish]. (2017). Accessed. July 3, 2023: ' 'https://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1539/cap06.pdf.'}, { 'key': 'ref89', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41598-021-92263-3', 'article-title': 'The impact of super-spreader cities, highways, and intensive care ' 'availability in the early stages of the COVID-19 epidemic in Brazil', 'volume': '11', 'author': 'Nicolelis MA', 'year': '2021', 'unstructured': 'Nicolelis MA, Raimundo RL, Peixoto PS, Andreazzi CS. The impact of ' 'super-spreader cities, highways, and intensive care availability in the ' 'early stages of the COVID-19 epidemic in Brazil. Sci Rep. 2021, ' '11:13001. 10.1038/s41598-021-92263-3', 'journal-title': 'Sci Rep'}, { 'key': 'ref90', 'unstructured': 'Ministry of Health, National Center for Epidemiology, Disease Prevention ' 'and Control, Health Situation Room. Ministry of Health, National ' 'Epidemiology Center [Article in Spanish]. (2020). Accessed. July 3, ' '2023: ' 'https://www.dge.gob.pe/portal/docs/vigilancia/sala/2020/SE13/dengue.pdf.'}, { 'key': 'ref91', 'article-title': 'Dengue in Peru: a quarter of a century after its reemergence [Article ' 'in Spanish]', 'volume': '32', 'author': 'Cabezas C', 'year': '2015', 'unstructured': 'Cabezas C, Fiestas V, García-Mendoza M, Palomino M, Mamani E, Donaires ' 'F. Dengue in Peru: a quarter of a century after its reemergence [Article ' 'in Spanish]. Revista Peruana de Medicina Experimental y Salud Publica. ' '2015, 32:146-56.', 'journal-title': 'Revista Peruana de Medicina Experimental y Salud Publica'}, { 'key': 'ref92', 'article-title': 'Use of ivermectin as a prophylactic option in asymptomatic family close ' 'contacts with patients of COVID-19 (NCT number: 04422561)', 'volume': '15', 'author': 'Shouman W', 'year': '2021', 'unstructured': 'Shouman W, Hegazy A, Nafae R, et al.. Use of ivermectin as a ' 'prophylactic option in asymptomatic family close contacts with patients ' 'of COVID-19 (NCT number: 04422561). J Clin Diagnostic Res. 2021, 15:27.', 'journal-title': 'J Clin Diagnostic Res'}, { 'key': 'ref93', 'doi-asserted-by': 'publisher', 'DOI': '10.1097/MJT.0000000000001433', 'article-title': 'Intensive treatment with ivermectin and iota-carrageenan as ' 'pre-exposure prophylaxis for COVID-19 in health care workers from ' 'Tucuman, Argentina', 'volume': '28', 'author': 'Chahla RE', 'year': '2021', 'unstructured': 'Chahla RE, Medina Ruiz L, Ortega ES, et al.. Intensive treatment with ' 'ivermectin and iota-carrageenan as pre-exposure prophylaxis for COVID-19 ' 'in health care workers from Tucuman, Argentina. Am J Ther. 2021, ' '28:e601-4. 10.1097/MJT.0000000000001433', 'journal-title': 'Am J Ther'}, { 'key': 'ref94', 'unstructured': 'The SAIVE Trial, post-exposure use of ivermectin in COVID-19 prevention. ' 'efficacy and safety results. Desort-Henin V, Kostova A, Babiker EA, ' 'Caramel A, Malamut R. Poster presentation, European Congress of Clinical ' 'Microbiology and Infectious Diseases. (April 18, 2023). Accessed: May ' '16, 2023: ' 'https://www.medincell.com/wp-content/uploads/2023/04/Poster-SAIVE-April2023-OK3.pdf.'}, { 'key': 'ref95', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijid.2021.04.035', 'article-title': 'Positive impact of oral hydroxychloroquine and povidone-iodine throat ' 'spray for COVID-19 prophylaxis: An open-label randomized trial', 'volume': '106', 'author': 'Seet RC', 'year': '2021', 'unstructured': 'Seet RC, Quek AM, Ooi DS, et al.. Positive impact of oral ' 'hydroxychloroquine and povidone-iodine throat spray for COVID-19 ' 'prophylaxis: An open-label randomized trial. Int J Infect Dis. 2021, ' '106:314-22. 10.1016/j.ijid.2021.04.035', 'journal-title': 'Int J Infect Dis'}, { 'key': 'ref96', 'doi-asserted-by': 'publisher', 'DOI': '10.7759/cureus.28624', 'article-title': 'Regular use of ivermectin as prophylaxis for COVID-19 led up to a 92% ' 'reduction in COVID-19 mortality rate in a dose-response manner: results ' 'of a prospective observational study of a strictly controlled ' 'population of 88,012 subjects', 'volume': '14', 'author': 'Kerr L', 'year': '2022', 'unstructured': 'Kerr L, Baldi F, Lobo R, et al.. Regular use of ivermectin as ' 'prophylaxis for COVID-19 led up to a 92% reduction in COVID-19 mortality ' 'rate in a dose-response manner: results of a prospective observational ' 'study of a strictly controlled population of 88,012 subjects. Cureus. ' '2022, 14:e28624. 10.7759/cureus.28624', 'journal-title': 'Cureus'}, { 'key': 'ref97', 'unstructured': 'Uttar Pradesh going the last mile to stop COVID-19. World Health ' 'Organization. (May 7, 2021). Accessed. July 3, 2023: ' 'https://www.who.int/india/news/feature-stories/detail/uttar-pradesh-going-the-last-mile-to-stop-covid-19.'}, { 'key': 'ref98', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jtemb.2022.126954', 'article-title': 'Zinc augments the antiviral potential of HCQ/CQ and ivermectin to ' 'reduce the risks of more serious outcomes from COVID-19 infection', 'volume': '71', 'author': 'Boretti A', 'year': '2022', 'unstructured': 'Boretti A. Zinc augments the antiviral potential of HCQ/CQ and ' 'ivermectin to reduce the risks of more serious outcomes from COVID-19 ' 'infection. J Trace Elem Med Biol. 2022, 71:126954. ' '10.1016/j.jtemb.2022.126954', 'journal-title': 'J Trace Elem Med Biol'}, { 'key': 'ref99', 'unstructured': 'The miracle not-heard around the world. the success of Uttar Pradesh - ' 'part 3. (August 14, 2022). Accessed: July 3, 2023: ' 'https://pierrekory.substack.com/p/the-miracle-not-heard-around-the-1ee.'}, { 'key': 'ref100', 'unstructured': 'Spreadsheet and screenshots of COVID-19 deaths, 7-day averages for ' 'selected dates, in Uttar Pradesh, all of India, and the United States, ' 'with underlying data (https.//covid19.healthdata.org/) from The ' 'Institute for Health Metrics and Evaluation (IHME) at the University of ' 'Washington (Seattle, USA). Accessed: July 3, 2023: ' 'https://drive.google.com/file/d/1ww64SlaXI5KPgmzNf2aNu6pVxJvjVCVJ/view?usp=drive_link.'}, { 'key': 'ref101', 'unstructured': 'Indian state will offer ivermectin to entire adult population — even as ' 'WHO warns against its use as COVID-19 treatment. (2021). Accessed. July ' '3, 2023: ' 'https://www.forbes.com/sites/siladityaray/2021/05/11/indian-state-will-offer-ivermectin-to-entire-adult-population---....'}, { 'key': 'ref102', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.futures.2021.102860', 'article-title': 'Science, the endless frontier of regulatory capture', 'volume': '135', 'author': 'Saltelli A', 'year': '2022', 'unstructured': 'Saltelli A, Dankel DJ, Di Fiore M, Holland N, Pigeon M. Science, the ' 'endless frontier of regulatory capture. Futures. 2022, 135:102860. ' '10.1016/j.futures.2021.102860', 'journal-title': 'Futures'}, { 'key': 'ref103', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jclinepi.2016.02.012', 'article-title': 'Evidence-based medicine has been hijacked: a report to David Sackett', 'volume': '73', 'author': 'Ioannidis JP', 'year': '2016', 'unstructured': 'Ioannidis JP. Evidence-based medicine has been hijacked: a report to ' 'David Sackett. J Clin Epidemiol. 2016, 73:82-6. ' '10.1016/j.jclinepi.2016.02.012', 'journal-title': 'J Clin Epidemiol'}, { 'key': 'ref104', 'unstructured': 'Merck’s deadly Vioxx playbook, redux. a debunked smear campaign against ' 'its competing drug—the FDA-approved, Nobel prize-honored ivermectin ' '(Scheim DE). (September 7, 2021). Accessed: July 3, 2023: ' 'https://trialsitenews.com/mercks-deadly-vioxx-playbook-redux-a-debunked-smear-campaign-against-its-competing-drug-the....'}, { 'key': 'ref105', 'unstructured': 'The 2015 Nobel Prize in Physiology or Medicine, Press release, Solna, ' 'Sweden. The Nobel Assembly at Karolinska Institutet. (October 5, 2015). ' 'Accessed: July 3, 2023: ' 'https://www.nobelprize.org/prizes/medicine/2015/press-release/.'}, { 'key': 'ref106', 'unstructured': 'Ivermectin for COVID-19 in Peru. 14-fold reduction in nationwide excess ' 'deaths, p&lt;0.002 for effect by state, then 13-fold increase after ' 'ivermectin use restricted (Chamie-Quintero JJ, Hibberd JA, Scheim DE) ' '[PREPRINT]. (2021). Accessed: July 3, 2023: https://osf.io/9egh4/.'}], 'container-title': 'Cureus', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.cureus.com/articles/172991-covid-19-excess-deaths-in-perus-25-states-in-2020-nationwide-trends-confounding-factors-and-correlations-with-the-extent-of-ivermectin-treatment-by-state', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 8, 8]], 'date-time': '2023-08-08T20:51:29Z', 'timestamp': 1691527889000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://www.cureus.com/articles/172991-covid-19-excess-deaths-in-perus-25-states-in-2020-nationwide-trends-confounding-factors-and-correlations-with-the-extent-of-ivermectin-treatment-by-state'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 8, 8]]}, 'references-count': 106, 'URL': 'http://dx.doi.org/10.7759/cureus.43168', 'relation': {}, 'ISSN': ['2168-8184'], 'subject': ['Aerospace Engineering'], 'published': {'date-parts': [[2023, 8, 8]]}}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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