To plan eradication you would first need to estimate the effects of your various policies. The most promising policy at the moment is likely vaccines + prophylatic ivermectin. While you might argue that we need more studies to make sure that the prophylatic ivermectin studies replicate but it’s likely still our best bet at the moment. It seems that for ideological reasons there’s little interest in that.
Uttar Pradesh looks like it’s making good progress towards eradication. The price in money in copying Uttar Pradesh’s COVID policy isn’t high.
50 years ago, if a region would have the success at fighting a disease like this, everyone would be willing to copy it. With our present institutions that’s not the case.
Uttar Pradesh has almost a quarter of a billion people. I am very skeptical of claims that ivermectin made much of a difference there. I have been unable to find out how many ivermectin doses were sent out or used—hundreds of thousands? millions? But if we look at vaccination rates, about one quarter of the state have had one shot, and 5%, two shots. That’s not enough to strongly affect infection rates, and I would be surprised if even that many people were using ivermectin.
They did have a severe outbreak in the second wave, like the rest of India, so an unknown fraction of the population would have antibodies. They implemented lockdowns, border control (I read that you can’t enter the state without a negative PCR test), and other public health measures. UP has a BJP government (the chief minister is sometimes mentioned as a successor to Modi), and their supporters have been bragging about UP’s successes compared to “Marxist” Kerala in the south, while their opponents have been saying that the figures are too low to be believed. I don’t know who you should trust there. I notice that across the border in Madhya Pradesh, another mega-state with over 70 million residents, they also report extremely low case numbers.
It’s definitely of interest to understand how things have unfolded in India, but I strongly doubt that ivermectin made much difference. At the very least we would need to know how many people there took it… My expectation is that the course of the pandemic in India is to be explained by a combination of public health measures, private caution, and perhaps natural herd immunity in some populations (like the Dharavi slum in Mumbai).
Ivermectin is relatively easy to produce for India while vaccines aren’t. Them being supply constrained for vaccines doesn’t indicate that they would face the same challenge for Ivermectin.
It’s not easy to get information for Madhya Pradesh but what I get from Google indicates they also use Ivermectin.
border control (I read that you can’t enter the state without a negative PCR test),
Border controls only help you when you have effective measures to reduce the case rate in your country. Them existing makes it more plausible that other measures in the country manage to bring the case rate down.
while their opponents have been saying that the figures are too low to be believed
When people said similar things about China’s case rate being low, the general argument was that it’s very hard to fake a case rate that low in a big country given an exponential disease.
It’s plausible that Ivermectin isn’t the whole story of why we see the numbers in Uttar Pradesh but it’s one scenario that explains it that’s consistent with what we see in the limited amount of prophylatic Ivermectin trials.
When it comes to Western public policy you could argue that we should have run highly powered trials to get certainty about whether or not Ivermectin has those effects after seeing what happened in India in May. If we would have done that we might have run a trial in 30,000 citizens in June/July and now have more reliable data.
However even in the scenario that the numbers from Madhya Pradesh and Uttar Pradesh are true and it’s not due to Ivermectin, there’s a credible scenario that those factors will also lead to lower infection rates in the US and Europe in the coming six months.
It seems part of the personal who measures cases in Uttar Pradesh is WHO personal which should make it harder to fake the case count.
Your link for Madhya Pradesh actually contains no data about ivermectin use there. The date marked on the graph is when India’s national Covid protocols mentioned ivermectin (and various other medications). So far the only Indian states where I’ve seen reference to official use of ivermectin are Uttar Pradesh, Goa, and maybe Uttarakhand. Certainly there may be others.
My understanding is that in Goa, the health minister said they would make it available for all adults, then WHO’s chief scientist (who is Indian) recommended not using ivermectin, and the national government removed ivermectin and other medications from the national protocols; and then Goa denied the policy.
In Uttar Pradesh, apparently ivermectin could be part of 7-day home isolation kits for people exposed to Covid or showing symptoms, but I have no data on how many such kits were issued, how many of them actually contained ivermectin, or how often the ivermectin was used.
Anecdotally, we can say that ivermectin has had widespread use in India in a decentralized way, as part of treatment for mild Covid or as part of a prophylactic regimen. But I remain very skeptical that it was widespread enough to significantly affect the course of the pandemic there.
To plan eradication you would first need to estimate the effects of your various policies. The most promising policy at the moment is likely vaccines + prophylatic ivermectin. While you might argue that we need more studies to make sure that the prophylatic ivermectin studies replicate but it’s likely still our best bet at the moment. It seems that for ideological reasons there’s little interest in that.
Uttar Pradesh looks like it’s making good progress towards eradication. The price in money in copying Uttar Pradesh’s COVID policy isn’t high.
50 years ago, if a region would have the success at fighting a disease like this, everyone would be willing to copy it. With our present institutions that’s not the case.
Uttar Pradesh has almost a quarter of a billion people. I am very skeptical of claims that ivermectin made much of a difference there. I have been unable to find out how many ivermectin doses were sent out or used—hundreds of thousands? millions? But if we look at vaccination rates, about one quarter of the state have had one shot, and 5%, two shots. That’s not enough to strongly affect infection rates, and I would be surprised if even that many people were using ivermectin.
They did have a severe outbreak in the second wave, like the rest of India, so an unknown fraction of the population would have antibodies. They implemented lockdowns, border control (I read that you can’t enter the state without a negative PCR test), and other public health measures. UP has a BJP government (the chief minister is sometimes mentioned as a successor to Modi), and their supporters have been bragging about UP’s successes compared to “Marxist” Kerala in the south, while their opponents have been saying that the figures are too low to be believed. I don’t know who you should trust there. I notice that across the border in Madhya Pradesh, another mega-state with over 70 million residents, they also report extremely low case numbers.
It’s definitely of interest to understand how things have unfolded in India, but I strongly doubt that ivermectin made much difference. At the very least we would need to know how many people there took it… My expectation is that the course of the pandemic in India is to be explained by a combination of public health measures, private caution, and perhaps natural herd immunity in some populations (like the Dharavi slum in Mumbai).
Ivermectin is relatively easy to produce for India while vaccines aren’t. Them being supply constrained for vaccines doesn’t indicate that they would face the same challenge for Ivermectin.
It’s not easy to get information for Madhya Pradesh but what I get from Google indicates they also use Ivermectin.
Border controls only help you when you have effective measures to reduce the case rate in your country. Them existing makes it more plausible that other measures in the country manage to bring the case rate down.
When people said similar things about China’s case rate being low, the general argument was that it’s very hard to fake a case rate that low in a big country given an exponential disease.
It’s plausible that Ivermectin isn’t the whole story of why we see the numbers in Uttar Pradesh but it’s one scenario that explains it that’s consistent with what we see in the limited amount of prophylatic Ivermectin trials.
When it comes to Western public policy you could argue that we should have run highly powered trials to get certainty about whether or not Ivermectin has those effects after seeing what happened in India in May. If we would have done that we might have run a trial in 30,000 citizens in June/July and now have more reliable data.
However even in the scenario that the numbers from Madhya Pradesh and Uttar Pradesh are true and it’s not due to Ivermectin, there’s a credible scenario that those factors will also lead to lower infection rates in the US and Europe in the coming six months.
It seems part of the personal who measures cases in Uttar Pradesh is WHO personal which should make it harder to fake the case count.
Your link for Madhya Pradesh actually contains no data about ivermectin use there. The date marked on the graph is when India’s national Covid protocols mentioned ivermectin (and various other medications). So far the only Indian states where I’ve seen reference to official use of ivermectin are Uttar Pradesh, Goa, and maybe Uttarakhand. Certainly there may be others.
My understanding is that in Goa, the health minister said they would make it available for all adults, then WHO’s chief scientist (who is Indian) recommended not using ivermectin, and the national government removed ivermectin and other medications from the national protocols; and then Goa denied the policy.
In Uttar Pradesh, apparently ivermectin could be part of 7-day home isolation kits for people exposed to Covid or showing symptoms, but I have no data on how many such kits were issued, how many of them actually contained ivermectin, or how often the ivermectin was used.
Anecdotally, we can say that ivermectin has had widespread use in India in a decentralized way, as part of treatment for mild Covid or as part of a prophylactic regimen. But I remain very skeptical that it was widespread enough to significantly affect the course of the pandemic there.
Wow. If they eradicate successfully with what they seem to be doing, that would be awesome!