• Statistically significant improvements are seen for mortality, ventilation, ICU admission, hospitalization, recovery, cases, and viral clearance. All remain significant after exclusions. 53 studies from 48 independent teams in 22 different countries show statistically significant improvements in isolation (39 primary outcome, 36 most serious outcome).• Meta analysis using the most serious outcome shows 63% [53‑72%] and 83% [74‑89%] improvement for early treatment and prophylaxis, with similar results after exclusion based sensitivity analysis, for primary outcomes, for peer-reviewed studies, and for RCTs.• Results are very robust — in worst case exclusion sensitivity analysis 54 of 82 studies must be excluded to avoid finding statistically significant efficacy.• While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 24% of ivermectin studies show zero events in the treatment arm.Multiple treatments are typically used in combination, which may be significantly more effective.• No treatment, vaccine, or intervention is 100% available and effective for all variants. All practical, effective, and safe means should be used. Denying the efficacy of treatments increases mortality, morbidity, collateral damage, and endemic risk.• Over 20 countries have adopted ivermectin for COVID-19. The evidence base is much larger and has much lower conflict of interest than typically used to approve drugs.• All data to reproduce this paper and sources are in the appendix. See [Bryant, Hariyanto, Kory, Lawrie, Nardelli] for other meta analyses with similar results confirming efficacy.

Evidence base used for other COVID-19 approvals
Medication	Studies	Patients	Improvement
Molnupiravir (UK)	1	775	50%
Budesonide (UK)	1	1,779	17%
Remdesivir (USA EUA)	1	1,063	31%
Casirivimab/i.. (USA EUA)	1	799	66%
Ivermectin evidence	82	129,808	64% [56‑71%]