Earlier this week, streaming media star and vaccine skeptic Joe Rogan said that he had tested positive for COVID-19. After this, Rogan claimed that he was being treated with a kitchen sink approach that included both the monoclonal anti-body treatment REGEN-COV and the anti-parasitic drug ivermectin. Exactly who provided Rogan with at least two prescription medications and where he got an IV treatment that has to be delivered by a skilled nurse remains unclear. Or at least, clearing it up would require that I actually check on what Rogan is saying. And I’m not doing that.
What is clear is that across the nation, doctors, pharmacists, and the beleaguered folks manning poison control hotlines are getting tired of people self-medicating with a deworming agent in the fight against COVID-19. There are tests—legitimate tests—underway to determine if ivermectin may be used efficiently and safely to fight the SARS-CoV-2 virus. This includes enrolling ivermectin in the U.K.’s massive RECOVERY trial. None of that is a reason for anyone to visit the nearest farm and home supply store to grab a tube of apple-flavored paste that has both ingredients and dosages not meant for humans.
On Wednesday, the American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists all teamed up to say … Stop it. Just stop it, please.
Use of ivermectin for the prevention and treatment of COVID-19 has been demonstrated to be harmful to patients. Calls to poison control centers due to ivermectin ingestion have increased five-fold from their pre-pandemic baseline. A recent CDC Health Alert Network Advisory (PDF) recommends that health care professionals should counsel patients against use of ivermectin as a treatment for COVID-19, including emphasizing the potentially toxic effects of this drug, including “nausea, vomiting, and diarrhea. Overdoses are associated with hypotension and neurologic effects such as decreased consciousness, confusion, hallucinations, seizures, coma, and death.”
But if ivermectin seems bad, the next big COVID-19 sure cure has some real … bite.
The AMA story was written up at The Hill. And while I often have problems with the editorial and journalistic decisions made on that site, I have to say, whoever does ad placement is very, very on target with this one.
The next big thing in COVID-19 cures isn’t snake oil … it’s snake venom
Specifically, the venom from Bothrops jararacussu, one of the most feared, and most deadly, snakes in the world. As Reuters reports, Brazilian researchers have located a peptide in the venom that drips from the inch-long fangs of the 7-foot, “highly aggressive” snake. That peptide is capable of connecting to an enzyme on the surface of the SARS-CoV-2 virus, locking it up and making the virus incapable of connecting to a human cell.
When it comes to medical treatments, the term “snake oil” is often applied to any dubious substance used without evidence of genuine benefit. Snake venom, on the other hand, has proved to have all kinds of useful substances in it. That shouldn’t be all that surprising. There is a wide variety of snake venom, and it attacks the body in various ways. Most of those venoms are complex mixes of multiple compounds, designed to give the snake a powerful weapon against both small prey and large antagonists. Venom may damage the nervous system, or cause cardiac arrest, or even dissolve flesh. When the chemicals involved are teased apart, many have found to be useful in treating a whole series of medical conditions. (Personal note: From 1978-1979, I worked part time for Midwest Reptile Supply, where my job was collecting venomous snakes that were used in medical research. This job included once finding a copperhead attached to my hand. Personal note over.)
The peptide produced by the jararacussu has already been found to have antibiotic properties, so it’s been studied for some time. Best of all, the long interest in this compound means that scientists have already worked out how to synthesize it in the lab without a need to collect more snakes. Though if you’re concerned, the jararacussu is not endangered. Not at all. It’s sadly abundant throughout its range.
It should be noted that this report is early in in-vitro testing. When, or even if, trials of this drug will begin is not clear.
For now, Samantha Bee seems to have this story nailed.
Novavax is late. Blame A & W and 7/11
When it comes to the dollars handed out for producing vaccines under Project Warp Speed, Pfizer/BioNTech were actually paid $0. Moderna got a hefty handout. Sanofi also got a nice check, but had to hand it back when their vaccine flunked early trials. The biggest payout was actually to Novavax when collected $1.6 billion in July 2020 to “expedite production.”
By now you may be justified in thinking that someone at Operation Warp Speed didn’t understand the word “expedite,” but the Novavax vaccine has been rolling along toward American shelves, and eventually arms. Phase 2b trials announced results in June and showed 90% efficacy against symptomatic disease for just under 30,000 volunteers enrolled in the trial. According to the National Institutes of Health, the candidate dosage “showed 100% protection against moderate and severe disease.” Additional trials are still underway in adolescents between 12 and 17.
Earlier this month, Reuters reported that Novavax had delayed—again—seeking Food and Drug Administration (FDA) approval. According to the company, part of this delay is that they’re targeting low-income countries first, seeking to get vaccine out into markets that haven’t had a crack at Pfizer, Moderna, Johnson & Johnson, or AstraZeneca. Novavax has submitted their vaccine in at least three countries outside the U.S. and hopes to begin deliveries as soon as it has approvals.
A report from Kaiser Health News talks about Novavax’s “moonshot goal” of “vaccinating the world” and how their development and trials have proceeded at “not quite warp speed.” Most of the news is upbeat, but there are clearly issues with the company trying to scale up production to meet a project with a global scope.
There is also an unexpected enemy in this story, because one of the ingredients in the Novavax vaccine turns out to be a hot—or rather, cold—commodity in other products.
Its Matrix-M relies on quillaja extract from soapbark trees. The extract is also an additive in root beer and Slurpees.
Novavax has issued a warning to investors that a shortage of quillaja could delay production.
(Hat-tip to epidemiologist Eric Feigl-Ding for drawing attention to the Novavax versus root beer issue).