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26 Nov, 5 tweets, 2 min read
1/ In other words, not as good as fluvoxamine, which in per-protocol analysis of a randomized controlled trial (ie among patients who actually took ≥80% of the treatment) reduced hospitalizations 66% (CI: 46-79% reduction) & deaths 91% (CI: 53-99%) w/an excellent safety profile.
2/ At ~$4 per course, one would think fluvoxamine would be getting at least as much attention as a promising Covid treatment as the $700 Merck drug molnupiravir (which has raised concerns that it might facilitate variants if a full course is not taken).
3/ Unfortunately, I fear that without a major pharmaceutical company to lobby politicians and regulators to recommend its use, it appears doubtful that fluvoxamine will be prescribed off-label for Covid except to a very small number of people.
4/ If the Pfizer drug Pavloxid turns out to be as good as it appeared in interim analysis, fluvoxamine would be an inferior option to it in the US, provided Pavloxid production is sufficient. But what about poorer countries? I can't understand why fluvoxamine isn't being used...
5/5 ...especially when prominent officials in several countries have been bizarrely recommending ivermectin, which failed to show efficacy in the same TOGETHER Trial platform that did the fluvoxamine RCT. See @PaulSaxMD's take here. blogs.jwatch.org/hiv-id-observa…

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More from @LongDesertTrain

Ryan Hisner Profile picture
27 Nov
1/8 Extremely important 🧵. There is a reason many VOCs have emerged from South Africa. These variants often evolve in chronic infections in immunocompromised hosts, accumulating adaptive mutations as they evade the host's immune response. Around 20% of S. Africans have HIV.
2/8 When HIV+ people are treated properly with antiretrovirals, their immune response is sufficient to respond to vaccines and clear infections. But shockingly, only 71% of HIV+ South Africans have access to antiretrovirals (ARVs). This is a moral outrage.
3/8 It's an outrage first & foremost because these are fellow human beings unnecessarily suffering from a chronic, devastating, and treatable disease. I don't understand all the reasons so many of those HIV+ still lack access to antiretrovirals...
Read 8 tweets
Ryan Hisner Profile picture
25 Nov
1/9 Something seemed familiar about the Q498R mutation. Then I remembered: @_b_meyer, examining in-vitro evolution of RBD mutations, predicted this mutation could emerge & lead to a variant with higher infectivity & immune evasion than any existing ones. nature.com/articles/s4156…
2/9 Q498R was not just one of many mutations they predicted: it was far & away their top candidate to become a major RBD mutation. It's the only novel mutation they mention in the abstract, noting that it requires the N501Y mutation to confer increased ACE2 binding affinity.
3/9 They used yeast to display human ACE2 receptors, then let various versions of SARS-CoV-2 S RBD compete against one another, with the highest binding-affinity RBDs advancing to the next round.
Read 9 tweets
Ryan Hisner Profile picture
6 Oct
@MallorySl810 1/ I don't know, but I'm super curious about this as well. I suspect all respiratory viruses are mostly airborne, but the topic's not been studied enough to know for certain. The way rhinoviruses seem almost unaffected by anti-Covid measures seems particularly baffling.
@MallorySl810 2/ There are something like 170 different rhinoviruses, so that might have something to do with it. But did most—or at least some—of those rhinovirus varieties see huge reductions in prevalence like influenza, RSV (last winter), human metapneumovirus, & others? @MackayIM
@MallorySl810 @MackayIM 3/ And if so, what are the characteristics of the rhinovirus varieties that were unaffected by NPIs? I believe rhinoviruses are mostly found in children, so perhaps this is part of the explanation, though I'm not sure how.
Read 4 tweets
Ryan Hisner Profile picture
27 Sep
1/8 Fascinating and important study here. Finds that a Delta-specific vaccine could leave us vulnerable to Beta & similar variants, while a Beta-specific vaccine would leave us vulnerable to Delta. What can protect us from both? The Original Recipe D614G vaccine.
2/8 Beta and Delta are far apart in evolutionary terms, so the effectiveness of antibodies against each are much reduced against the other—a 34-fold decrease in the case of Delta nAb's against Beta.
3/8 Delta-specific antibodies also saw a 27-fold reduction in neutralization against a SARS-CoV-2 virus isolated from an HIV patient w/long-term infection. This virus had presumably evolved to evade the host's immune response. It's thought the Alpha variant originated this way.
Read 8 tweets
Ryan Hisner Profile picture
25 Sep
1/19 Hand hygiene & surface cleaning as tools to prevent respiratory infections should go down in history as the "miasma theory" of the 21st century. Both captured something true but caused great harm when applied to the wrong category of disease.
2/19 The miasma theory accurately identified air as the source of much disease transmission but opposed germ theory and famously led experts to overlook contaminated water as the source of important GI diseases like cholera.
3/19 Similarly, hand hygiene (and maybe surface disinfection) help to control spread of GI pathogens but appear to do almost nothing to prevent transmission of respiratory infections. The disproportionate emphasis on them has likely done harm by... nature.com/articles/d4158…
Read 19 tweets
Ryan Hisner Profile picture
29 Aug
1/10 This shouldn't even be a debate. Who could argue against this? Knowledge is the ultimate public good, & to restrict access to scientific papers to those at academic institutions w/subscriptions to journals is a crime.
2/10 Out-of-control, continually strengthening copyright & patent laws are an economic weapon wielded by the rich against the poor and by enormous, monopolistic firms against small firms. This is a major driver of inequality that receives scant attention.
cepr.net/technology-pat…
3/10 The alleged justification for strong IP laws is that they incentivize & facilitate innovation. But as @DeanBaker13 points out in his indispensable (& free) book Rigged, in their current form, IP protections greatly impede innovation. See Ch. 5 deanbaker.net/books/rigged.h…
Read 10 tweets

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