When you talk about 3x, you're talking about 10 vs. 3. Extrapolating that out to millions of people is not a great idea.
Let's say you run an ice cream company. You round up 490 friends and ask them to pick their favorite flavor of ice cream: chocolate or vanilla. 477 say they don't eat ice cream, 10 pick chocolate and 3 pick vanilla. You rework your ice cream production to be 3x chocolate : 1x vanilla based on your survey and promptly go out of business.
That's what's going on here as well, there's just not enough statistical significance between the two outcomes to infer any reduction in severe COVID cases.
> Findings: In this open-label randomized clinical trial of high-risk patients with COVID-19 in Malaysia, a 5-day course of oral ivermectin administered during the first week of illness did not reduce the risk of developing severe disease compared with standard of care alone.
ivm <- c(3, 247-3)
con <- c(10, 249-10)
m <- rbind(ivm, con)
fisher.test(m)$p.value
## [1] 0.08809225
fisher.test(m, alternative = "less")$p.value
## ivm
## 0.04541928 ivm <- c(3, 247-3)
con <- c(10, 249-10)
m <- rbind(ivm, con)
fisher.test(2*m)$p.value # 2* so that it is twice as large
## [1] 0.008490957