Abstract: Sharp reductions in COVID-19 case fatalities and excess deaths in Peru in close time conjunction, state-by-state, with ivermectin treatments pe er re vie we d Juan J. Chamie-Quintero,a Jennifer A. Hibberd,b David E Scheim c ep rin tn ot Figure 1: Graphical Abstract. A) Excess all-cause deaths; B) COVID-19 case fatalities; and C) case incidence data for eight states in Peru that deployed mass ivermectin (IVM) treatments early in their pandemic spread (blue) and for Lima, which deployed IVM treatment four months later (red). D) Excess deaths for nine states having mass IVM distributions in a short period through national operation “MOT” (see results section for sources). ● MOT start date; ▲peak deaths; ■ day of peak deaths + 30 days. Junin (yellow) distributed IVM to health centers beginning on July 22, 13 days before MOT start. Population-weighted mean deaths for these nine states dropped sharply, -74% at +30 days, beginning (except for Junin) 1 to 11 days after MOT start. All y values are 7-day moving averages, ages ≥ 60. Abstract On May 8, 2020, Peru’s Ministry of Health approved ivermectin (IVM) for the treatment of COVID-19. A drug of Nobel Prize-honored distinction, IVM has been safely distributed in 3.7 billion doses worldwide since 1987. It has exhibited major, statistically significant reductions in case mortality and severity in 11 clinical trials for COVID-19, three with randomized controls. The indicated biological mechanism of IVM is the same as that of antiviral antibodies generated by vaccines—binding to SARS-CoV-2 viral spike protein, blocking viral attachment to host cells. Pr Mass distributions of IVM for COVID-19 treatments, inpatient and outpatient, were conducted in different timeframes with local autonomy in the 25 states (departamentos) of Peru. These treatments were conducted early in the pandemic’s first wave in 24 states, in some cases beginning even a few weeks before the May 8 national authorization, but delayed four months in Lima. Analysis was performed using Peruvian public health data for all-cause deaths and for COVID-19 case fatalities, as independently tracked for ages 60 and above. These daily figures were retrieved and analyzed by state. Case incidence data were Juan J. Chamie-Quintero (email: jchamieq@eafit.edu.co ) is a data analyst in Cambridge, MA, USA. Jennifer A. Hibberd, DDS, MRCDC (email: drjenniferhibberd@gmail.com) is a specialist dental surgeon at William Osler Health System and Trillium Health Partners Hospital Centres and an instructor at University of Toronto. c David E. Scheim, PhD (email: dscheim@alum.mit.edu) is a commissioned officer in the US Public Health Service, inactive reserve. Page 1 of 15 a b This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=3765018 not analyzed due to variations in testing methods and other confounding factors. These clinical data associated with IVM treatments beginning in different time periods, April through August 2020, in each of 25 Peruvian states, spanning an area equivalent to that from Denmark to Italy and Greece in Europe or north to south along the US, with a total population of 33 million, provided a rich source for analysis. vie we d For the 24 states with early IVM treatment (and Lima), excess deaths dropped 59% (25%) at +30 days and 75% (25%) at +45 days after day of peak deaths. Case fatalities likewise dropped sharply in all states but Lima, yet six indices of..