Ivermectin for COVID-19 in Peru: 14-fold reduction in nationwide excess deaths, p<0.002 for effect by state, then 13-fold increase after ivermectin use restricted

Objective. We aimed to identify mortality trends associated with COVID-19
deaths in Peru during April through November 2020, when mass treatments
with ivermectin (IVM), a drug of Nobel Prize-honored distinction, were
autonomously deployed at different times and to different extents in
Peru’s 25 states under a national policy that authorized these treatments.
Design. Ecological study of publicly available data. Excess deaths were
analyzed state by state. To identify potential confounding factors, Google
mobility data, population densities, SARS-CoV-2 genetic variations,
seropositivity rates and other auxiliary data were also examined. Primary
outcome. Reductions in excess deaths, state by state, as compared with
extent and time period of IVM treatments. Participants. The study
population was restricted to ages ≥ 60 to eliminate confounding effects of
changing age distributions of COVID-19 incidence. Results. The 25 states
of Peru were grouped by extent of IVM distributions: maximal (mass IVM
distributions through operation MOT, a broadside effort led by the army);
medium (locally managed IVM distributions); and minimal (restrictive
policies in one state, Lima). The mean reduction in excess deaths 30 days
after peak deaths was 74% for the maximal IVM distribution group, 53% for
the medium group and 25% for Lima. Reduction of excess deaths correlated
with extent of IVM distribution by state with p<0.002 using the
Kendall τbtest. Nationwide, excess deaths decreased 14-fold over four
months through December 1, 2020, after which deaths then increased 13-fold
when IVM use was restricted under a new president. Conclusion. Mass
treatments with IVM, a drug safely used in 3.7 billion doses worldwide
since 1987, most likely caused these reductions in deaths during the time
periods in which it was deployed. The indicated biological mechanism of
IVM, competitive binding with SARS-CoV-2 spike protein, is likely
non-epitope specific, possibly yielding full efficacy against emerging
viral mutant strains.