14/n On top of all of that, we've got potential confounders. The authors attempted to correct for some of these but I don't think they've succeeded unfortunately
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15/n For example, age. Older people die more from COVID-19, so places with more old people might see higher death rates that have nothing to do with ivermectin
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16/n To examine this influence, the authors conduct an analysis where they just look at people age>60, but this is a really crude dichotomization. The risk of COVID-19 death increases EXPONENTIALLY by age, so even above 60 there's a huge variancepic.twitter.com/dOWzzx2wPP
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17/n For example, a 65yo is about 10x less likely to die than an 85yo. A population where the median age for >60yos is 65 might have a VERY different death rate than if the median is 75, depending on who gets infected
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18/n The authors also produced these graphs, and argued that since they were relatively similar that government restrictions against COVID-19 didn't explain the difference in mortality that they sawpic.twitter.com/2ojQMWHrxQ
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19/n As far as I can see they didn't actually TEST this possibility - they just eyeballed the graphs, and said they were similar enough But are they?
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20/n For example, the graph from Puno is plotted on a different axis to the others, which means that the declines in movement (the coloured lines) are all at least ~10% different to the other placespic.twitter.com/GhGMIt4omb
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21/n Also, the "excess" mortality is wildly different between regions, peaking at different times in different places. That's not that similar imo!
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22/n The other fascinating thing about these graphs is that they appear to completely undercut the entire argument in the study You see, the program that they've used to delineate exposure started at the end of Julypic.twitter.com/NLqIR8srzS
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23/n As far as I can tell from the study and news reports, it consisted of first identifying high-risk people for a week or two, then going house-by-house to test them and deliver care packages over the next few weeks/months
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24/n This means that the EARLIEST that the program could've been delivering ivermectin is around the second week of August But look at the peaks of excess deaths in those graphspic.twitter.com/QjaXUNrslR
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25/n It appears that in most cases, the peak of deaths happened in August ~or earlier~, which means that this program wasn't even started until deaths had already peaked in most places. This is a pretty huge issue for the analysis!
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26/n Anyway, at a basic level there's absolutely no way to estimate from the data how many people were actually taking ivermectin in any of these places, so this analysis cannot possibly show that ivermectin is effective or ineffective
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