I think the discourse on ivermectin is kind of dumb on both ends now. Labelling it an “animal dewormer” or whatever is stupid, it’s used in people as a very effective anti-parasitic. It’s also a safe drug. Like yeah if you take animal formulations or take ridiculous doses or whatever then that’s going to be bad, but that goes for any drug. If you use according to the instructions put out by the guys who are convinced it’s a COVID wonder drug, then it’s safe. I don’t care if people want to get it and use it and all this “OMG POISON CENTER CALLS ARE SKYROCKETING” stuff is a bit much.
It’s also not like there’s zero reason to think it might be helpful. Mahmud et al is a perfectly good randomized trial with n = 363, finding that ivermectin (plus doxycycline, which we know from other trials isn’t helpful) had a statistically significant effect, shortening recovery times by two days on average, and patients in the treatment arm significantly less likely to test positive on RT-PCR after 14 days. That’s it for decently-sized RCTs but there are some intriguing retrospective studies on prophylaxis, for example Behera et al and Morgenstern et al both found reductions of like 70% in risk of acquiring COVID over the study period - there are design problems like a selection bias in who chose to take the free ivermectin, but it’s also a large effect size. Even the recently-released TOGETHER trial, which was reported as showing “no effect”, showed from memory a 20% reduction in progression to severe disease; that was nowhere near statistically significant, but also not the kind of result you can confidently claim for sure shows no effect.
To be clear, I think the most likely outcome is that ivermectin is shown to not be of benefit, but I think it’s totally plausible that it’s somewhat helpful. The tenor of the media coverage, which is “look at these yokels taking horse drugs, we spoke to this expert who encourages you to laugh at them” is starting to get on my nerves. The only qualification these “experts” have is skimming the Cochrane meta-analysis, because that’s the best information out there so far, and the fact is we don’t know for sure yet that ivermectin does nothing, especially when used as a prophylactic or very early in the course of the disease. If you can afford it and take it as directed then you could argue that it’s a freeroll - the problem, obviously, is people using it as an alternative to getting vaccinated.