Abstract: Journal Pre-proof Does ivermectin have a place in the treatment of mild Covid-19? Eli Schwartz, MD PII: S2052-2975(22)00041-5 DOI: https://doi.org/10.1016/j.nmni.2022.100989 Reference: NMNI 100989 To appear in: New Microbes and New Infections Please cite this article as: Schwartz E, Does ivermectin have a place in the treatment of mild Covid-19?, New Microbes and New Infections, https://doi.org/10.1016/j.nmni.2022.100989. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2022 The Author(s). Published by Elsevier Ltd. Editorial: Does Ivermectin have a place in the treatment of mild Covid-19?. Eli Schwartz, MD The Center for Geographic Medicine and Tropical Diseases, The Chaim Sheba Medical Center, Tel Hashomer & Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Correspondence: oo f Prof. ELI SCHWARTZ MD, DTMH The Center for Geographic Medicine and Tropical Diseases The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel Email: elischwa@tauex.tau.ac.il re -p r Tel/Fax:+ 972-3-5308456 Key words: Hospitalization, SARS-CoV-2, Paxlovid, Molnupiravir, coronavirus treatment lP Dear Editor Jo ur na Ivermectin has been used to treat humans for the past 4 decades. It was approved as a broad spectrum anti-parasitic agent, initially indicated in 1987 to treat onchocerciasis and was given as a mass drug administration (MDA) in endemic countries. Its success awarded the discoverers the Nobel prize of Medicine in 2015. Ivermectin’s principal activity was to treat infections caused by roundworm parasites. Over the years, the spectrum was broadened to include ectoparasites such as scabies among others. Through the years more than 3 billion doses have been given to humans (not to horses) with a high safety profile, and the drug was added to the World Health Organization’s List of Essential Medicines [https://apps.who.int/iris/bitstream/handle/10665/345533/WHO-MHP-HPS-EML-2021.02eng.pdf ] In the last decade, several in-vitro studies have shown its anti-viral activity against a broad range of viruses. At the beginning of the COVID pandemic, ivermectin was tested in vitro against SARS-CoV-2 and showed a highly significant reduction (99.8%) in viral RNA after 48 hours (1) , but it was criticized that this was achieved by using a much higher dose in comparison to the standard dose in human use (2). However, its anti-COVID activity in reallife in patients who were treated with standard dose of 3 days of ivermectin showed the significant reduction in culture viability in the ivermectin group compared to placebo (3). In addition, ivermectin has anti-inflammatory properties based on in-vitro and in animal model studies. An extensive review of the potential mechanisms of action for ivermectin against COVID-19 was recently published (4). SARS-CoV-2 infection includes several stages, where the initial stage is manifested by high viral replication followed by the second stage (occurring in the high risk groups..