ich has a three stage life, only in the first stage is it visible on the fish. As the cysts on the fish drop off into the gravel the parasites are vulnerable to medication and physical removal through vacuuming. Stage 2 is in the gravel, stage 3 is free swimming looking for a host. Also very vulnerable to treatments with Malchite green, the stage three free-swimmers are the easiest to kill, temperature plays a key role in stressing the parasite and the medications are more effective and in many cases useable at lower doses.
I treat with an 86 degree temp and half doses of Rid Ich for 7 full days. Regardless of how long the symptoms have persisted prior to treatment.
Also, an important note, remove severly infected (dead or requiring euthanasia) inhabitants immediatly.