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Rapid recovery of peripheral oxygen saturation and hypoxic COVID-19 patients with ivermectin-based multidrug therapy Abstract: Several combination therapies for the early outpatient treatment of COVID-19 were proposed by independent research groups at the onset of the pandemic during 2020 and 2021. Of particular interest is the proposal by Borody and colleagues, of a 10-day triple drug therapy consisting of ivermectin, doxycycline, and zinc, with adjunct vitamin C and D supplementation, which was widely adopted and further refined in Zimbabwe and South Africa. A key characteristic of the refined protocol was the dynamic adjustment of ivermectin dosage to patient severity and response to treatment. However, despite the successful use of this protocol, the use of ivermectin in the treatment of COVID-19 has remained controversial. Here, we review 3 case series of 119 patients treated in the United States, Zimbabwe, and Nigeria with similar ivermectin-based protocols based on Borody's proposed therapy, of whom 61 presented with less than 90% oxygen saturation on room air. The patients were successfully treated with no deaths. Rapid recovery of oxygen saturation levels was observed within 24 hours from the onset of treatment, with response rate dependent on the intensity of treatment. Statistical comparison with external controls supports mortality rate reduction by the preponderance of the evidence. Furthermore, a detailed narrative review supports the efficacy of the most aggressive protocols, used in 2 of the 3 case series, by the Bradford Hill criteria for temporality, strength of association, biological gradient, biological plausibility, coherence, consistency, and analogy. First presented at the Texas Academy of Science 129th Annual Meeting Disclaimer: This presentation does not necessarily represent the opinions or policies of the University of Texas -- Rio Grande Valley, but it is protected under Academic Freedom in Research and the 1st Amendmend of the United States Constitution.