Ivermectin trial shows positive results, but experts still wary
Although a top Israeli professor revealed that Ivermectin had been successfully tested on COVID-19 patients in a SA Jewish Report webinar on Thursday, 11 February, South African experts warn it’s still too early to trust this drug.
Ivermectin has been hailed by many since last year as a potential wonder drug in the fight against COVID-19. Merck, the drug’s original manufacturer, has said that too little data exists to support the use of the drug on COVID-19 patients.
In the face of mounting pressure, the SA Health Products Regulatory Authority (SAHPRA) announced last month that it had authorised a limited “compassionate and controlled-access programme” for Ivermectin to be used to treat COVID-19. Still, it stressed that only medical practitioners who applied to use the drug would be considered on a case-by-case basis, and wider access could be discussed only after large-scale testing and peer-review data became available.
The Israeli trial – like the others in South America, Bangladesh, and Egypt – was conducted in a small-scale programme.
Professor Eli Schwartz, the director of the Center for Geographic Medicine at Sheba Medical Center in Tel-Hashomer, is excited with the findings. “Ivermectin is an excellent drug that has changed many aspects of dealing with infections caused by parasites,” he says. “In many Western countries, they aren’t especially familiar with it, it’s not registered, and thus doctors are hesitant to use it.”
Schwartz shared the results of the test carried out last year for the first time on the webinar. They haven’t yet been reviewed.
“Our study looked at Ivermectin versus a placebo, using mild, non-hospitalised patients who had the virus,” he says. “Our objective was to reduce the viral shedding time and evaluate the drug’s efficacy in preventing progression.”
In a double-blind test, drug doses were determined according to the weight of each patient, and were given regularly over three days. A total of 90 patients were involved (45 in each arm of the study).
“With Ivermectin, the viral load was lowered much faster,” Schwartz says. “On day four, 57% of those who had received it were negative as opposed to 31% in the placebo group.
“From day six, more people on Ivermectin were negative, much more than in the placebo. It continued into day eight and 10. Ivermectin really had an impact, and patients quickly became negative or non-infectious.”
He also noted that some of the patients were over 60 or had risk factors, yet none of those who had taken the drug deteriorated or required hospitalisation.
Schwartz believes that the results are promising, and suggests that patients can overcome the disease faster with Ivermectin, reducing the amount of isolation required while populations wait for vaccines.
“It could prevent clinical deterioration and the need for hospitalisation,” he says. “If it proves antiviral, it can be used as a prophylactic. We should do more studies on these aspects.” He stresses, however, that the drug is no substitute for a vaccine.
Local experts and doctors are more reticent.
“The trials in other countries have been imperfect, with small numbers, varied doses, and other drugs used in addition,” says Professor Barry Schoub, the chairperson of the Ministerial Advisory Committee on COVID-19 vaccines. “We don’t really know if there’s efficacy or not, and there’s no peer-reviewed scientific evidence yet.
“It’s unlicenced, and not totally innocuous. If taken in high doses, it has the potential to be highly toxic. Unless a study is peer reviewed, it’s valueless. Until Ivermectin is tested in a proper randomised control trial, we shouldn’t use it.”
Professor Mervyn Mer, the principal specialist at Charlotte Maxeke Johannesburg Academic Hospital, says a balanced approach is needed.
“We have to question why a cheap drug hasn’t been subjected to larger trials,” he said in a recent webinar. “Many of our own colleagues are trying to take the veterinary medication, something we cannot support. A senior colleague of mine said he had taken a suggested dose and felt as strong as a horse. Several weeks later, he was severely ill with COVID-19 in intensive-care on ventilation.
“The rationale is there, but we don’t have the necessary scientific data – it’s all anecdotal. We need a balanced, sensible approach. If it works, fabulous. If not, we need to maximise what we have and continue to the best of our ability until such time as we can widely immunise patients.”
Some doctors agree with him.
“I’m not taking or prescribing Ivermectin at the moment,” says Dr Sheri Fanaroff. “It may well be effective, but the formulations currently available in South Africa aren’t regulated and thus not reliable or safe.
“If I prescribed Ivermectin and my patient developed a neurological side effect, I wouldn’t have any legal defence.”
“The Israeli study didn’t use people who are hospitalised or patients with severe disease,” says pulmonologist Anton Meyberg. “In our hospital, we had eight patients that started with mild disease, all took Ivermectin in high doses, and they all demised. They all had pulmonary and neurological manifestations, and were extremely ill.
“We have to be very careful with these small studies,” Meyberg says. “When a study is done on 90 people, that’s a phase-one trial. You need a few thousand people to see the effects of the drug. Even in Israel, Ivermectin isn’t part of the arsenal of medication and isn’t being used to treat COVID-19.”
However, GP Dr Paul Freinkel argues that there’s little downside to using the drug, and probable benefit.
“If it doesn’t work, we’ve lost little other than hope,” he says. “If it does, we’ve saved a life and, in some cases, a lifetime of disability.”
Freinkel recognises that the data generated so far by smaller trials is incomplete but maintains that very few trials show that Ivermectin doesn’t work, and they are generally underdosed.
“Even though there are no large-scale trials, what’s the chance of all the trials [of adequate dosing] all showing a benefit to using Ivermectin?” he asks.
“Andrew Hill, a senior researcher at Liverpool University, reports that the chance of an error in his meta-analysis [of the trial studies] is one in 5 000. In other words, the chance of his assertion that Ivermectin appears to work when in fact it doesn’t is only one in 5 000. That’s a one in 5 000 chance that it doesn’t decrease the chance of people dying,” Freinkel says.
“As my patients get sicker, I wonder about the downside to using it versus the 4 999 in 5 000 chance that it has a benefit. Must I watch a patient die knowing there is so little downside of her taking a drug that may cure her? The law says so.”
Because recommending Ivermectin carries the risk of prosecution, Freinkel suggests that Ivermectin should be approved for human use on parasites, where the efficacy and safety data are incontrovertible.
“This would allow doctors to legally and ethically use the medication off-label, as they do in most other countries,” he says.
Couple caught in crossfire of attempted mall robbery
A young couple attempted to flee the scene of a botched armed robbery at Melrose Arch on Easter Monday, only to get caught in a hail of bullets.
Today, Brandon Regenbaum, 27, lies in hospital in a serious but stable condition under heavy sedation following a five-hour long operation to reconstruct his jaw and repair his mouth. He was shot in the face after robbers hastily fled the upmarket lifestyle mall where they had tried unsuccessfully to rob Elegance Jewellers.
His girlfriend of three years, Lorian Blechman, 25, witnessed the whole scene and luckily escaped unharmed.
The couple, who were due to leave for a holiday in Umhlanga Rocks that day, met for breakfast at Tashas. They left the mall in separate vehicles and found themselves unwittingly in the middle of a gun battle between fleeing suspects and the mall’s security guards.
“The robbers were running towards the Virgin Active Gym. We quickly took a different exit to avoid them, it was scary,” said Blechman.
They beckoned to each other to take an alternative exit near the Daytona shop in a bid to dodge the fleeing suspects. To their horror, they were then confronted by the robbers – who had made it to their escape vehicles – further down the road on Athol/Oaklands Drive in the direction of the N1 highway.
The couple could see the suspects’ vehicles in their review mirrors, so they instinctively swerved out of the way to allow them to speed past. There were loud gunshots, after which Blechman noticed Regenbaum wasn’t driving. She frantically called him to ask why.
He told her, “Babe I love you, but I’ve been shot and I’m going to die.”
Traumatised and still in shock, Blechman told the SA Jewish Report that she jumped out of her car and ran to him.
Speaking from hospital, she said, “There was blood and glass everywhere, and he was in a lot of pain. He told me he was dying. I remember pulling up his hand brake,” she said.
A young Jewish couple walking their baby immediately called Hatzolah, which arrived a few minutes later. While waiting for the ambulance to arrive, another witness helped Blechman to make several calls to family. She told Blechman to keep talking to Regenbaum.
“I told Brandon that help was on the way. I told him his mother and brother were coming. I asked him where I could find his Discovery medical card. I told him general things like he was going to be okay, to stay with me, to stay awake. I told him to count how long it would take me in seconds to run to my car 10m away to get my keys,” she said.
Blechman called her father, who was already in Harrismith en route to Umhlanga Rocks where they were supposed to meet later.
Regenbaum’s father, Clifford, was in Plettenberg Bay on holiday when he received the call telling him his son had been shot.
“I was shocked,” he told the SA Jewish Report.
He believes his son was shot by the robbers who may have mistaken him for a security guard in hot pursuit.
“He drives a bakkie with our company name on the side which looks like a security vehicle and even has hazard lights. The robbers had already seen him leaving Melrose Arch, and I think believed him to be a security guard. I honestly believe they tried to kill him,” he said.
“It has been a stressful, worrying time. He will recover, but it will take time. I’m angry at this senseless shooting of innocent people. My son could have died. These robbers have no respect for human life. I don’t know what there is to learn from this.”
Gauteng police spokesperson Kay Makhubele told the SA Jewish Report, “Police are investigating a case of attempted business robbery and attempted murder which occurred at Melrose Arch.
“It is alleged that an unknown number of suspects driving in two cars, an Audi Q7 and a Ford Ranger, were in a shootout with security guards after they were intercepted before the business robbery,” Makhubele said. “A man who was driving his car [Regenbaum] was shot and injured during the incident. Nothing was taken from the shop.”
While doctors have told the family the operation was successful, Regenbaum will have his jaw wired for seven weeks, and won’t be able to talk or eat solid food.
“It will be a long road to recovery,” said Blechman.
“It’s a miracle Brandon survived. It’s also freaky that we were in separate cars. If I had been with him on the passenger side of the car, I might not be here today. I was running late. Brandon needed to fetch his siddur and tefillin to assist my father with a minyan on holiday, as he is saying kaddish for my zaida who passed away last year. I believe my zaida was watching over us,” she said.
Police ask that anyone with information contact 0860 010 111.
Mogoeng comes out swinging against apology ruling
Chief Justice Mogoeng Mogoeng came out swinging in his appeal against Judge Phineas Mojapelo’s judgment ordering him to apologise for comments made about Israel.
Mogoeng criticised Mojapelo at every turn, describing his reasoning as “flawed and disturbingly superficial”. He said “the learned judge failed to deal with the constitutional right to freedom of expression and freedom of belief, thought, and opinion”.
In his 38-page appeal submitted to the Judicial Service Commission on 2 April 2021, Mogoeng reiterated why he had the right to express his support for both Israel and the Palestinians during a webinar hosted by the Jerusalem Post last year.
His appeal was in response to the Judicial Conduct Committee’s ruling on 4 March 2021 that he had 10 days to apologise for comments he made about Israel in the webinar. At the time, he said South Africa had a role to play in resolving the Israeli-Palestinian conflict, that he supported both peoples, and as a Christian, he had an obligation to pray for the peace of Jerusalem.
Africa4Palestine, the Boycott, Divestment, Sanctions South Africa (BDS SA) coalition, and the Women’s Cultural Group laid complaints against Mogoeng, saying he had flouted rules regarding judicial ethics. The matter was adjudicated by Mojapelo.
One of Mogoeng’s most pertinent points was that “several precautions need to be sounded to avoid the trap that His Lordship Mr Justice Mojapelo unreflectingly allowed himself to fall into”. According to the chief justice, this includes the fact that “it’s necessary to distinguish between official government policy and the policies of lobby groups and non-government organisations. And it’s necessary for decision-maker[s] to tell the difference between politics and policy, which his lordship failed to do.”
He also insisted that the judge’s “insinuation that I was possibly involved in some conspiracy with the Israeli government and ‘timed’ the webinar in such a way to undermine international law or United Nations conventions/resolutions … is a material misdirection”.
Mogoeng said there was no difference between what he said and the South African government’s approach to the Israel-Palestinian conflict. “After a thorough search, I vouch for the fact that there is no official policy of the South African government that contradicts any part of what I actually said. Even the two agreements signed by President Mandela and President Mbeki with Israel don’t contradict anything I have said. I was therefore found guilty of five complaints or counts of misconduct that turn on a non-existent official policy of the South African government towards Israel.”
He emphasised that “the supremacy of the constitution and the entitlement of all citizens, including judges and magistrates, to enjoy fundamental rights cannot be wished away. Where these rights are limited by legislation or the code, a proper explanation is called for. Judges have the constitutional right to freedom of expression, association, and religion, belief, thought, and opinion. As is the case with other citizens, these rights may be limited. But the limitations must, broadly speaking, be reasonable and justifiable. They cannot be arbitrary or whimsical.”
He went on to describe how other judges had waded into political waters, including Mojapelo himself. He also described how “my brother Dennis Davis hosted speakers, including politicians, on his then Judge for Yourself eNCA television programme about the Israeli-Palestinian political situation and a range of political controversies to which leaders of political parties were invited and participated. He was exercising his constitutional right to free expression although different views might be expressed about being a regular anchor or host of a TV programme.”
Mogoeng described how other judges had involved themselves in political controversies in Fiji, Zimbabwe, and Lesotho, “And my dear brother Cameron J [Justice Edwin Cameron] essentially said what I said on the Israeli-Palestinian situation, the real difference being, unlike me, he didn’t rely on the Bible.” Yet, none of these men were hauled over the coals for their comments or actions.
A senior member of the legal profession, speaking on condition of anonymity, said, “The grounds of appeal make some sharp points against a senior retired and respected judge. It’s most unfortunate for judges to have such a public and divisive difference – both judges firing heavy ammunition at each other as to how the other has misconstrued the law. It doesn’t do much for confidence in the law and judiciary by the public generally.” He pointed out, however, that the chief justice “makes some powerful points, which need to be taken seriously”.
ISIS attack hits close to home
For most of the world, the late March attack on the coastal town of Palma may have been just another terror attack in the faraway province of Cabo Delgado, Mozambique. But for one family, it was very personal.
“The entire international community is to blame. The cousin of my very close family member was killed yesterday by ISIS [Islamic State]. Why? Because he went to build houses there as he lost his job due to COVID-19. No one came to help. Why am I posting here? Because no one even knows,” wrote Michal Gaziel on the “South Africans Living in Israel” Facebook group.
Gaziel was writing on 27 March 2021, as possibly the deadliest attack in the region unfolded. The assault started on 24 March 2021, with local militants linked to ISIS storming the area. “The attack is one of the most brutal since the insurgency began in 2017. At least a hundred fighters attacked Palma, showing the jihadis getting stronger and more brazen,” says Steven Gruzd, political analyst at the South African Institute of International Affairs.
Gaziel’s sister-in-law, Rachel Gaziel, is the cousin of the South African who was killed, Adrian Nel. Speaking to the SA Jewish Report from Tel Aviv, she (Rachel) described a “traumatic” few days as her family waited to hear about the safety of Nel, his stepfather, and his brother. “They were abandoned by the military. Two hundred people were left to die,” she says.
Nel took a job in Palma, Mozambique, to build workers’ accommodation for the Total LNG Project. Local militants who have pledge allegiance to ISIS have staged a number of attacks including capturing the town of Mocimboa da Praia, which still remains out of government hands. The violence has killed more than 2 600 people, half of them civilians. It has also forced almost 700 000 people from their homes.
From what Gaziel has heard, her cousin and others decided they had to escape. They had been hiding in the Amarula Hotel, but decided to make a break for it at nightfall, as “there was no one there to protect them”. They went in a convoy of 17 cars, and Adrian was in the first car, leading the convoy. They aimed to get to the beach. But as soon as they left the hotel, they were attacked. He was shot by terrorists.
“My cousin didn’t die quickly. He bled out. His stepfather and brother hid in the bush with his body. The place was overrun with terrorists – a lot of people were killed or captured. Many are unaccounted for,” Gaziel says.
She says military company Dyck Advisory Group (DAG) was in contact with her aunt, and informed her that her son had been killed, but that her husband and son had escaped. “I think they got to the beach and then were rescued by helicopter or boat. My aunt is distraught, but she thought they would all be dead. She’s grateful, but devastated.”
Gaziel says her cousin would have been 41 on 1 April. He leaves behind a wife and three young children. “His wife is distraught. How can she tell them their father is dead? He died trying to save people. We want others to know his story, and to pressurise the international community to do something. No one seems to care because it’s in Africa. We don’t want him to have died in vain.”
The Southern African Development Community said it would hold a two-day summit in Maputo on 8 and 9 April to deliberate how to address terrorism in Mozambique. President Cyril Ramaphosa will attend, accompanied by international relations and cooperation minister Naledi Pandor, defence and military veterans minister Nosiviwe Mapisa-Nqakula and state security minister Ayanda Dlodlo. Meanwhile, DAG’s contract with the Mozambican police expired on Tuesday, 6 April.
“Any country that directly or indirectly fights against ISIS is immediately seen as the enemy, and thus a legitimate target,” says Jevon Greenblatt of the Community Security Organisation. It makes no difference whether it’s the South African military or a private military group such as DAG. They see it as South Africa fighting against Islam and a justification for ‘self-defence’.
“This was made clear by ISIS’ warning in 2020 that South Africa shouldn’t get involved or it would open up a “fighting front” in our country. When it talks about a “fighting front”, at this stage, it doesn’t necessarily mean an insurgency like that taking place in Cabo Delgado, but will more likely be acts of terrorism similar to what we have seen in the United States and Europe.
“There are a number of cells and individuals, whether they be active adherents or loosely connected supporters, already present in South Africa, and we have already seen some of them commit acts of terror or crime in the name of ISIS,” says Greenblatt.
“In addition, there are a number of South Africans who have travelled to Mozambique over the past few years to join the insurgents, at least one of whom was involved in the 2016 Thulsie plot to attack Jewish targets. ISIS encourages adherents and supporters to attack Jews around the world, and as such, if they do decide to open a ‘fighting front’ in South Africa, it’s not inconceivable that the Jewish community could be selected as one of those targets.”
Should we be concerned for our safety? “Menachem Begin [former prime minister of Israel] said, ‘If an enemy of our people says he seeks to destroy us, believe him. Don’t doubt him for a moment. Don’t make light of it. Do all in your power to deny him the means of carrying out his satanic intent’,” says Greenblatt.
“There is no doubt that we should be aware of what’s happening in Mozambique, monitor it closely, and continue to put measures in place to ensure the effective safety and security of the South African Jewish community. We cannot assume that because this is happening far away, it won’t affect us.”
Greenblatt believes that “the original grievances that drove the insurgency are being hijacked by ISIS’ aspiration for global expansion, and due to its loss of a caliphate in Iraq and Syria, it’s now looking to establish this elsewhere. Africa has been touted as the new battlefield for terror organisations, with central and southern Africa emerging as their most viable option to establish an Islamic state. I believe it to be true that the new international status of this insurgency will embolden it to expand into other regions, with Mozambique’s Cabo Delgado being just the beginning.”
Says Gruzd, “This is right on South Africa’s doorstep, and it has to be taken seriously. We may start to see people fleeing to South Africa, and such instability is bad for the region. The violence is getting closer to offshore gas fields in Cabo Delgado, and is already affecting the operations of major players such as Total, which has suspended work again.” He says extreme violence, such as beheadings, continues to occur in the area.
Asked if the attack is a major event, Gruzd says, “It’s hard to tell if this is a turning point in real time. It certainly was a daring attack, and shows the rebels getting stronger and better armed. It also coincides with military training initiatives by Portugal and the United States. Only hindsight will tell if this is a turning point. What’s for sure is that the problem won’t just quietly go away.”
Terror expert Jasmine Opperman of ACLED (the Armed Conflict Location & Event Data Project) told the SA Jewish Report that this attack was expected by those watching the rising insurgency, but “what surprised most analysts was the sophistication and refinement of the guerrilla warfare, and how they executed the attack. And yet, no action was taken to prevent it.
“Why is it relevant to South Africa? The region is becoming destabilised with a human catastrophe that we haven’t seen before. It’s a calamity of which we will never know the actual extent,” Opperman says. Meanwhile, “for ISIS to propagate a leadership position is quite easy, and that message will transcend borders. It will reach ISIS-sympathisers, and we don’t know how they will respond.
“The insurgency is still in control, the government remains defensive,” she says. “It’s an insurgency that is evolving and growing, and yet, the counter-punch seems not to be forthcoming. That leaves the region vulnerable.”
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