Wikipedia:Reference desk/Archives/Miscellaneous/2021 February 19

= February 19 =

WHO News announcement puts the world population into one of three groups, at high, moderate and low risk. In what proportion are the groups, as defined?


I'm seeking a reasonably accurate percentage of word population (or total number of people (alive)) (tentative answers added after Lambiam's feedback and some work) respectively.
 * 1) ~45% "born, resided, or had long-term travel in Southeast Asia, Oceania, sub-Saharan Africa, South America, or the Caribbean",
 * 2) ~47% "in Central America, Eastern Europe, Mediterranean, Mexico, Middle East, North Africa, Indian sub-continent, or Asia" (and not in a) and
 * 3) ~8%  of the rest of the population ("Australia, Canada, United States, or Western Europe"),
 * Source: https://www.WHO.int/news/item/17-12-2020-a-parasitic-infection-that-can-turn-fatal-with-administration-of-corticosteroids

From what I can tell, doctors aren't familiar with this advice. And I'm wondering how big the impact is if that's so.

If the question was "residing" instead of "born, resided, or had long-term travel", the answer would be easy - look at something like the chart I've added to the question. --50.201.195.170 (talk) 20:33, 19 February 2021 (UTC)


 * I expect that the fraction of people who were born or had long-term travel in the identified areas but do not reside there is small compared to the number of of the residents of these areas, so you won’t be far off if you use the number of residents. For the practical use of this cautionary statement, the precise numbers are irrelevant. The most important thing is that healthcare workers in these high-risk areas be aware of it. --Lambiam 22:57, 19 February 2021 (UTC)


 * I think you're right, if +/- around 20% is considered good enough. Thanks.


 * Caveats: 1) Many of the millions residing in a low-risk area but who were born, resided, or had long-term travel in another area would be put off by your last sentence.


 * 2) You left out the "resided" category.


 * 3) Each of these categories grow the size of the higher risk categories.

As for specifics: Based on the pie chart, looks like about 35% of the world population is living in a high risk country. (Purple thru Red+ Russia ~= 25%, and Green - (USA+Russia) ~=10% [- Caribbean, Central America slivers, <1%]. So maybe Answer 1: 45% of the world population is at high risk? But people could be way more or less mobile than I am guessing they are.    United States + Western Europe (+ slivers for Canada and Australia, - Mediterranean Europe) ~= 10%.  So Answer 3: maybe ~ 8% of the world population is at low risk.  So that means Answer 2: around 47% of the world population is at moderate risk'''.

So about 3.5 billion at high risk. About 7.2 billion people at high or moderate risk.


 * But we still have the FDA saying don't take ivermectin to treat CoViD-19, no ifs, ands or buts. Madness.  --50.201.195.170 (talk) 00:22, 20 February 2021 (UTC)
 * Where did the FDA say that? The closest I can find is [//www.fda.gov/animal-veterinary/product-safety-information/faq-covid-19-and-ivermectin-intended-animals] which doesn't say that. Nil Einne (talk) 07:02, 20 February 2021 (UTC)


 * Cochrane staffer's meta analysis info: Helps make it increasingly clear the FDA is in part responsible for thousands of unnecessary deaths a day, and trillions in economic damage. --50.201.195.170 (talk) 07:33, 20 February 2021 (UTC)


 * While the FDA does not approve the use of ivermectin to prevent or treat COVID-19, it does approve of its use for treating strongyloidiasis, and this approval would extend to the treatment of strongyloidiasis in patients who happen to have COVID-19. The WHO advises the use of ivermectin as a presumptive treatment for strongyloidiasis for those at high or moderate risk of hyperinfection when initiating corticosteroid therapy, including for COVID-19. --Lambiam 08:39, 20 February 2021 (UTC)
 * The FDA approved ivermectin. Full stop.  (Including some new formulations recently.)  Otherwise, yes.  Independent MDs can write scripts for ivermectin to prevent or treat covid if they want to.  Once a drug is approved, FDA can control how its marketed, but they have little say with respect to what diseases MDs choose treat with what approved drug. (Even MDs who work for corporations are supposed to have the freedom to write scripts off-label almost without exception/restriction. But de facto, most are discouraged from doing so, and so many don't.)  I have filled scripts for ivermectin for covid.   So what's with the underlining?  If you're not aware of the clincal evidence for ivermectin, I would urge you to review it (the data or one or more of the meta-analyses that have been published, rather than underlining what you underlined... Ivermectin Rx have jumped something like 50 fold, as I recall, in the US (See youtubeDOTcom/watch?v=SrTGOoBjvyo for the  number and a chart if you're curious; it's displayed somewhere in there.) in the last few months.  It's clear to me that the NIH's phenomenally ignorant or corrupt statements on ivermectin are obviously that to anyone who understands how to read and takes the time to read the clinical studies.  Or if you prefer to hear that said with a bit more tact, listen to the first video I linked to.  Or have you already seen it?  But anyway, I didn't come here to the reference desk to gab about it.  I think I have my answer, at least approximately:  I would put it thus: The WHO is already saying about 92% of patients with more than a mild covid-19 case should be getting ivermectin.  In addition, the WHO is expected to advise the use of ivermectin in all patients within weeks.  I'd put money on it. WHO could urge its use for prophylaxis too, though I'm not expecting that. --50.201.195.170 (talk) 09:27, 20 February 2021 (UTC)


 * Another data point: a recent change in the recommendations given by the NIH COVID-19 Treatment Guidelines.
 * As of February 9, 2021 (unchanged since August 27, 2020):
 * The COVID-19 Treatment Guidelines Panel recommends against the use of ivermectin for the treatment of COVID-19, except in a clinical trial (AIII).
 * As of February 11, 2021:
 * There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19.
 * --Lambiam 10:37, 20 February 2021 (UTC)
 * "" WTF did they do that? Your earlier document definitely doesn't support that. It only supports 'When initiating corticosteroid therapy, including for COVID-19, presumptive treatment (with or without laboratory screening) with ivermectin is advisable for those at high or moderate risk of hyperinfection'. Statistically, a large percentage of patients aren't likely to be covered by this advice at all since they have no long term travel or residency in a moderate or high risk region. Remembering that while 92% of the world's population may be at high or moderate presumptive risk, a large percentage of confirmed COVID-19 cases are in the US and Western Europe. Yes some of them would be even though they are being treated in the US or Western Europe but it seems unlikely it'll even be 10%.  The number of cases in many areas is likely to be much higher than confirmed cases. However that also reflects the reality that many of these countries have poor health care systems and any treatment they are receiving is often spotty or non existent. I mean heck, a number of people in these places should be receiving ivermectin without any consideration of COVID-19. Of course even putting uncertainty over patient numbers in many countries aside, China with about 1/6 of the world's population but who are in the moderate risk category, has largely controlled the outbreak further demonstrating the fallacy of taking 92% of the world's population to mean 92% of patients.  Maybe more importantly, that advice only covers people who are receiving corticosteroid therapy. The WHO's current recommendations for corticosteroids and COVID-19 seems to be [//www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1]. It only recommends their use for 'treatment of patients with severe and critical COVID-19'. It specifically suggest against their use for 'treatment of patients with non-severe COVID-19' albeit with low confidence.  So people with "" shouldn't be receiving corticosteroids for their COVID-19 unless they fit into that very likely small subset of patients with 'severe and critical COVID-19'. Therefore, unless they're receiving corticosteroids for some other reason or they or their doctor is ignoring or unaware of this advice (which is unfortunately going to be quite common), wherever they have ever resided or now live, this advice doesn't come into play. (Other advice may.) Of course hearkening back to my earlier point, it's unfortunately true that a bunch of people in moderate and high risk regions aren't going to be receiving corticosteroids given their limited healthcare access, even if their condition warrants it. And this is a treatment we have decent evidence for. (I.E. Ivermectin still doesn't come into play.)  Nil Einne (talk) 13:03, 20 February 2021 (UTC)
 * Slightly an aside but since especially in a case like this, I'd prefer not to make claims without sources, can someone find a good source on what percentage of COVID-19 patients are only classified as having moderate case and what percentage severe or critical? Unfortunately a lot of sources e.g. [//www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html] [//www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/signs-symptoms-severity.html] seem to rely on this Chinese study [//jamanetwork.com/journals/jama/fullarticle/2762130] which didn't distinguish between mild and moderate. I did find [//erj.ersjournals.com/content/erj/55/5/2000990.full.pdf] but it only covers admissions at one small point of time to one hospital, hence the number of mild cases is tiny. (Although the number who never went above moderate is far higher than severe and critical cases, as I claimed was the case.) I'm confident that there are far more moderate than severe or critical cases, so more than mild COVID-19 would mostly be moderate cases who shouldn't receive corticosteroids according to the WHO, but lack any sourcing at the moment so have modified my statement above. Nil Einne (talk) 13:45, 20 February 2021 (UTC)
 * That's extremely selective quotation and you specifically said "". In reality what they the FDA said is:  and  and  and


 * That's clearly not a "". Actually they're specifically telling you you can take ivermectin if it's prescribed by a health care provider and acquired from a legitimate source. They're also telling you it you can take it as part of a clinical trial. Yes, they're also telling you it's unlikely to be prescribed for COVID-19 treatment since it isn't approved for this, although as Lambian pointed out, there's nothing in the FAQ to suggest the FDA is opposed to to the use of Ivermectin to treat someone with a parasitic infection, or with a suspected parasitic infection and who has COVID-19 and especially if they are going to receive corticosteroids . This FAQ is clearly targeted at end users not health care providers, do so provides zero guidance on that aspect. insert: My understanding the FDA's role in that is limited anyway mostly relating to approvals. For clinical guidance, that's mostly the job of the NIH and CDC. end insertion The FDA will never tell you to take medication that isn't approved for OTC usage without a prescription. Frankly it madness to think they would. They'll likewise never tell you to take medication intended for animals, which is the primary thing this FAQ seems to be addressing given the title etc. It's even more madness to think they would. Remembering also the FDA's advice is only intended for the US. Really there's nothing particularly surprising about this  that FAQ. Nil Einne (talk) 11:53, 20 February 2021 (UTC) 14:08, 20 February 2021 (UTC)
 *  Really the one thing the US health bodies seem to have been guilty of when it comes to this crisis is too readily approving drugs without any real evidence of their effectiveness, for emergency i.e. general use while simultaneously failing to make any attempt to determine if these drugs are actually useful i.e. by running well regulated clinical trials. For all the UK's failings, this seems to be one thing they have gotten right. I.E. rather than effectively encouraging random doctors to prescribe random things, with no one really knowing if they're doing anything useful or could be harming the patient; instead the UK have mostly made these part of clinical trials. So all UK and world doctors get an idea whether they should actually be prescribing this shit and under what conditions, instead of praying and hoping they're doing good not harm. Or worse giving something they personally believe is not beneficial and for which there is no good data to suggest they're wrong, just because their patient is demanding it after reading about it on the internet/heard about it on some crazy or not so crazy TV or radio station or online platform. It's somewhat understandable why the situation is so chaotic in poor countries with weak regulatory and science agencies, and bad healthcare systems like Mexico and most of South America. While yes, the NHS (or similar systems) do make it a bit easier to do these things; the US, one of the richest countries in the world, with (previously at least) internationally respected governmental agencies, and who spend incredibly amounts on research, science and healthcare, should not be this bad. Nil Einne (talk) 11:53, 20 February 2021 (UTC)
 * I just noticed "". Again complete nonsense. The US daily COVID-19 death toll is generally a few thousand at most, the 7 day average is currently hovering at around 3 thousand (was above, now below). It's ridiculous to suggest even half of these could be prevented by ivermectin, especially given that even your own claim about who it's beneficial for is unlikely to cover even half of these deaths (i.e. they are at low risk). Even if ivermectin is beneficial, such overplaying of it's probable effectiveness as some sort of wonder drug is one reason why the FDA and others are so concerned about misinformation and seriously damages attempts to try and determine when ivermectin may be useful for COVID-19 patients, if ever. Note as I said above, the FDA's advice is only targeted at the US. It's unfortunately true as I also indicated that many countries lack bodies able to provide good advice targeting their specific situation. That's a reason to support bodies like the WHO able to fill that gap in a small part, and to ensure the FDA and other US health bodies work with the WHO and national health bodies etc. Where the FDA has failed to do so, that's reasonable criticism. But expecting their advice specifically targeted at the US public to cover people in other countries is silly. Nil Einne (talk) 12:10, 20 February 2021 (UTC)
 * The claim "" is too strong, because the data are not in. Counting the number of preventable deaths on a worldwide scale, this may nevertheless turn out to be in the ballpark – we don't know, the data are not in. Conversely, emergency approval of ivermectin for treating COVID-19 might lead to a huge number of unnecessary deaths – we don't know, the data are not in. The "low risk" has little to do with the case; it is not about the risks engendered by COVID-19 itself, but the risk of being an undiagnosed strongyloidiasis patient. --Lambiam 09:47, 21 February 2021 (UTC)