In a preliminary study of adult outpatients with symptomatic COVID-19, patients treated with fluvoxamine, compared with placebo, had a lower likelihood of clinical deterioration. There was clinical deterioration in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group (absolute difference, 8.7% [95% CI, 1.8%-16.4%] from survival analysis; log-rank P = .009). The fluvoxamine group had 1 serious adverse event and 11 other adverse events, whereas the placebo group had 6 serious adverse events and 12 other adverse events. Is this a worthwhile agent for COVID-19 management? How would it compare with hydroxychloroquine or ivermectin?

This, indeed, is a promising, well-tolerated, and low-cost treatment that will have significant benefits. It can also be combined with other agents and will add to the overall benefit with such use. It has significant effects that will be noticeable for patients in all categories of disease severity. It is not quite a heavy-hitter like hydroxychloroquine and ivermectin with regard to their specific advantages for serious illness, but it will still be a reliable agent under those conditions in conferring a benefit that will be measurable. That is no mean feat when there is a serious infection under way. So we rank the three of these as essentially equivalent, with the differences being nuances with regard to what is most applicable to a specific individual patient. That will only be teased apart with long-term use and much greater patient care data becoming available. To what extent this happens, especially in the US with so much suppression of knowledge, is uncertain at this point. But worldwide use will continue of all three because of their ready availability, and only the US is under the pressures of the CDC and the FDA, who work to limit anything useful—not directly, but through manipulation of their representatives by the interlopers.