Over the last week, there have been two big stories about ivermectin that have gathered a lot of media attention, despite the thinnest of sources. One of those was a study indicating that ER beds in Oklahoma were unavailable to other patients because they were too full of people who had ingested “horse paste.” The second promoted a study claiming that 85% of men who took ivermectin became sterile—complete with lots of talk about damaged sperm.

There was some truth to both these claims. But not only did the Oklahoma doctor make some questionable statements, the local media was very selective in its quotes, editing both questions and responses to make the situation seem much worse than reality. In the case of the “sterility” claims, another local media station—this time in Texas—picked up a story about an old study from Nigeria that had long been debunked, and ran the story without apparently considering the unlikeliness of the claims they were promoting.

Ivermectin is an extremely highly prescribed medication, one that the World Health Organization regards as an essential medication. It’s used against a range of parasitic diseases, it’s relatively low cost, and has been used tens of millions of times. In the United States alone, there were over 100,000 prescriptions for ivermectin in 2018. It does not cause 85% of male patients to become sterile, no matter how many “Darwin Award” GIFs are added to a comment.

It’s not just a medication for livestock. It’s not making so many people ill that ERs are overflowing. It’s not causing men who take it to become sterile. None of these are good reasons to push back against people taking ivermectin for COVID-19. But there is at least one very good reason: Ivermectin has little, if any, benefit in fighting COVID-19.

And if there has been bad reporting in the last week against ivermectin, there has been more much more bad reporting in favor of its inappropriate use.

It’s no mystery why people on the right had a sudden interest in ivermectin. In June 2020, a widely circulated study out of Egypt indicated that ivermectin could prevent 90% of COVID-19 infections from becoming serious. A second report from Argentina claimed that taking ivermectin as protection against the disease was “100% effective,” with not one of the patients in the study who was getting the anti-parasitic coming down with the disease. Those studies were rapidly picked up around the world, especially in countries where vaccine availability was limited, and ivermectin became, almost overnight, the hope for people in South America, Africa, and other areas suffering some of the worst rates of infection and death in the world. By the start of 2021, smugglers were shuffling ivermectin around the world trying to meet a surging demand. 

In the U.S., these results circulated widely on social media, right-wing radio, and Trump-flavored television. One or both of the studies were repeatedly snapped up and combined with collections of anecdotal evidence and small, not-blind trials in “meta-analysis” that generated jaw-dropping claims of COVID-killing efficiency. Pre-prints of those studies appeared on the servers of medical journals, alongside reputable analyses of vaccines and other treatments. 

For anyone who was politically disinclined to the vaccine, ivermectin was being pushed as something that was at least as effective as the best vaccine without the taint of accepting something that was being pushed by liberals. It had the added attraction of being something with the patina of “a secret treatment.” 

Just as Q-Anon gave followers a sense of unfolding a mystery that was invisible to all those people too blind to follow the clues, ivermectin offered up a “cure” for COVID-19 that was only available to those who were in the know enough to tune their dials to the proper AM stations. It was clear from the outset that both these studies had serious problems with everything from plagiarism to inconsistent results. But, with media around the world reporting the papers as if they were gospel, it was impossible to shove the genie back into the bottle. 

The United States was actually a late comer to the ivermectin craze. However, as the delta wave began to sweep over the nation in the early summer and Republicans held stubbornly to a refusal to accept protective vaccines, the rising tide of cases and deaths resulted in that most basic of motivators: fear. By midsummer, doctors were being begged for ivermectin prescriptions, and those who couldn’t find, or afford, a pliable MD were checking out the shelves of farm and tractor stores for those boxes that famously include a picture of a horse. 

At the beginning of August, Nature reported on how reviews of the Egypt study found “shocking revelations of widespread flaws in the data” that eventually led to the paper’s retraction. That did not lead to the retraction of the headlines that had circulated around the world for months. It certainly didn’t lead to any “hey, wait a moment” moment on social media. 

It wasn’t until Sept. 2 that Buzzfeed collected many of the complaints against the Argentine study and effectively disassembled the results. That included showing that the hospital where the study supposedly occurred had no record of it taking place, how the data on patients changed from table to table, and how the numbers in the supposed results simply didn’t add up. It now appears that this study may have been completely fabricated.

When everything is put together, including the National Institutes of Health (NIH) review of the current data, there is only scant evidence that ivermectin has any effect on COVID-19, and any positive effect is likely to be small. 

An actual double-blind trial in Argentina, the IVERCOVID19 study, found no net benefit for giving COVID-19 patients ivermectin on a whole range of measures from length of illness to prospects of serious disease or death. Whether there is any reason to take ivermectin, alone or in conjunction with other drugs, should be settled by a series of large trials, including the PRINCIPLE trial and the RECOVERY trial, both of which are investigating the use of ivermectin, along with other treatments.

However, all the focus on ivermectin has resulted in media largely ignoring a treatment that has looked good since initial trials in early 2020: fluvoxamine. Used in the treatment of depression and obsessive-compulsive disorder (OCD), connections between fluvoxamine and COVID-19 were established early and thought to be linked to the drug’s anti-inflammatory properties. Though the last update from the NIH in April showed that fluvoxamine appeared to be highly effective in a small trial, it still suggested that there was not enough evidence to recommend the use of the drug pending the outcome of larger, more controlled evaluations.

And now the results of one of those trials is in. The TOGETHER trial, in which a double-blind trial against placebo was conducted on over 3,000 patients in Brazil for a period of six months. Of those patients, 739 got fluvoxamine, 733 got a placebo, and 1766 got “other treatments.” Patients who received fluvoxamine within the first few days after testing positive were 31% less likely to end up with severe COVID-19 that required respiratory assistance. Those results are not as miraculous as the widely circulated testimonials about ivermectin, but they have the benefit of being backed up by real data from a large, well-conducted study that is currently under intense review.

Fluvoxamine has been widely prescribed around the world for depression, OCD, and social anxiety disorder. It is widely regarded as having fewer side effects than other drugs in its class (SSRIs) and has been approved by the Food and Drug Administration (FDA) for over 25 years. It’s available as a generic drug from a number of manufacturers. 

Like ivermectin, fluvoxamine is a cheap, widely prescribed drug that’s long been approved by the FDA. Unlike ivermectin, studies have demonstrated that fluvoxamine has a significant impact if administered early in the course of COVID-19. That 31% improvement may not sound great. It’s not as effective as the vaccine, or either of the two major monoclonal antibody treatments currently approved under emergency use authorizations. However, for those who test positive for COVID-19 and are unvaccinated, vaccination is not an option and antibodies are often unavailable. A cheap, effective treatment for COVID-19 that cuts the chance of hospitalization by a third … that’s a very good thing.

Along with recent results showing the effectiveness of the inhaled steroid budesonide courtesy of the PRINCIPLE trial, it shows that COVID-19 treatment is continuing to improve, and the odds for patients who test positive should be much more hopeful as these drugs are worked into the standard of care.

As it happens, the TOGETHER trial also looked at ivermectin. Those 1,766 patients who got something “other” than fluvoxamine? Of them, 677 got ivermectin. There were found to be no significant results from that drug when it came to preventing hospitalizations, and it was eventually dropped from the study.

How do you keep from getting seriously ill with COVID-19? Vaccination remains tremendously effective, even in the face of the many variants. But for those who do get sick, both fluvoxamine and budesonide—along with monoclonal antibodies, where available—offer significant improvements in outcomes.