In a world with #Omicron (a rare mutational event), the drug #molnupiravir (a mutagen) was just authorized by the @US_FDA despite:

1⃣ NO estimate of the number of mutations it causes per virus

2⃣ NO estimate of onward viral transmission while on the drug
fda.gov/news-events/pr…
@US_FDA Given #molnupiravir's usage to treat #COVID19 is inevitable, what can be done to prevent the potential acceleration of #SARSCoV2 variants?
1⃣patients should strictly ISOLATE WHILE TAKING, especially in the first days on the drug

2⃣ALL DOSES should be taken PRECISELY as directed
@US_FDA Our own reasons for these recommendations are presented here 👇
@US_FDA Many others have expressed similar concerns, most recently expounded on here 👇
@US_FDA Finally, it seems prudent whenever possible to use other treatment options that do not carry a mutational risk. #Paxlovid (a #ProteaseInhibitor) allegedly has much better efficacy, and other drugs like #masitinib and 4′-FlU are close at hand. 👇

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More from @chasewnelson

2 Dec
🧵The @US_FDA's materials on @Merck's #Molnupiravir and its potential to induce problematic #SARSCoV2 variants are HERE:

📄section 4.3.2.5 (pp. 30-36)
👉fda.gov/media/154418/d…

📺at 2h51m, 3h46m, 4h5m, 5h12m, 7h32m
👉

Observations to follow.
1/n
@US_FDA @Merck First, @Merck and the @US_FDA panelists have done excellent work compiling and analyzing the available data. This was not an easy vote (13 YES/10 NO).

However, specifically on the potential for molnupiravir to induce new viral variants, the results only augment my concerns.
2/n
@US_FDA @Merck 1⃣MUTATION VS. SELECTION. The materials repeatedly confuse mutation and selection (e.g., "The Spike protein is already under evolutionary pressure with or without molnupiravir", 3hr).

Contrarily, the concern is this drug is a mutagen and provides RAW MATERIAL, not selection.
3/n Image
Read 15 tweets
29 Nov
TODAY at #Virological: throughout the #COVID19 pandemic, there has been a tendency to underestimate the potential of #SARSCoV2 to mutate and adapt.

As the @US_FDA meets Tuesday to discuss #molnupiravir, @sarperotto and I fear another oversight.🧵
1/15
virological.org/t/mutagenic-an…
To be clear, I believe vaccines and antiviral drugs BOTH have critical parts to play in the fight against #COVID19.

Oral antivirals are of particular interest given their potential for equitable distribution.

This is NOT an argument against antivirals.
2/15
Antivirals can work via several mechanisms.

🦠PROTEASE INHIBITORS, like #paxlovid and #masitinib, prevent the production of mature viral proteins.

🧬MUTAGENS, like #molnupiravir, instead increase the viral mutation rate to intolerable levels, causing LETHAL MUTAGENESIS.
3/15
Read 22 tweets
21 Jun
TODAY’S (6月21日) #COVID19 update for #Taiwan 🇹🇼
📉75 local + 0 imported cases 📉trend
📉20 deaths 📈trend
📈0.6% test positive rate
📈4.2% case fatality rate (CFR) since May 1
🧪13k tests ⤵️capacity
⚠️It's Monday. Numbers of tests and their positive rates are key metrics. ⬇️ 1/6
DAILY CASES REPORTED (pink bars) and their 7-DAY AVERAGE (pink line), where each day is the mean of itself and the previous six. DEATHS (crimson red bars) at the bottom. THRILLED to have room for the chart legend specifically in the top right quadrant! 2/6
AGE DISTRIBUTION OF CASES. Local cases from May 1-June 20 (age data for cases lag by a day), including those with missing locations. Only a single category is provided for ages >70, which constitute 14% of all cases. DATA ➡️ data.cdc.gov.tw/en/dataset/ags… 3/6
Read 6 tweets
21 Jun
今天在 🇹🇼 #天下 @CWM_en 雜誌已刊出: "台灣抗疫成就 遠距工作、創新檢測成關鍵 "。 我與 @cptwei 寫了一篇有關建議 #Taiwan 對抗升 #COVID19 疫情的文章,主要是落實遠距工作、新的科學性篩檢方式。所有工作性質可以遠距辦公的員工,都必須改為遠距工作。重點如下 ⬇️ 1/6 opinion.cw.com.tw/blog/profile/5…
當前的台灣可說是提供了病毒滋養的溫床 — 尤其SARS-CoV-2 #Alpha (B.1.1.7)。依賴症狀的檢疫措施將會漏掉至少 50% 的病毒感染者。新型冠狀病毒會懸浮在空氣中並隨時間經過充斥整個房間。像辦公室這種通風不良的空調環境尤其危險。2/6
非必要地進公司辦公,會增加原可避免的傳染機會。特別是工作上的接觸通常是(應雇主要求)而非自願地,從四面八方聚集大量人群,並且持續相當長一段時間。應為社區人流居高不下。因此增加遠距辦公,我們確信 是控制這波爆發非常關鍵的政策。3/6
Read 6 tweets
20 Jun
TODAY’S (6月20日) #COVID19 update for #Taiwan 🇹🇼
📉107 local + 2 imported cases 📉trend
📉11 deaths 📉trend
📈0.6% test positive rate
📈4.1% case fatality rate (CFR) since May 1
🧪20k tests ⤵️capacity
⚠️Fewer cases BUT many fewer tests, higher positivity, and higher CFR. ⬇️ 1/6
DAILY CASES REPORTED (pink bars) and their 7-DAY AVERAGE (pink line), where each day is the mean of itself and the previous six. DEATHS (crimson red bars) at the bottom.
AGE DISTRIBUTION OF DEATHS for May 1-June 20:
🔴64% are ≥70
🔴26% are 60-69
🔴10% are 30-59 years
2/6
AGE DISTRIBUTION OF CASES. Local cases from May 1-June 19 (age data for cases lag by a day), including those with missing locations. Only a single category is provided for ages >70, which constitute 14% of all cases. DATA ➡️ data.cdc.gov.tw/en/dataset/ags… 3/6
Read 6 tweets
19 Jun
中文 version 6月19日 #Taiwan 🇹🇼 #COVID19 update.
今日(6/19)的疫情圖表,翻譯了中文版,共六張圖.
🙏 謝謝 @mitchlinmusic 翻譯! (如果中文有錯,請跟我們說!)
1️⃣ 高風險人流趨勢 - @cptwei analysis - WORKPLACE MOBILITY 辦公 remains HIGHER than other outbreak-halting countries ⬇️ 1/6 Image
2️⃣ 篩檢量能的趨勢,並與確診數做比較列出陽性率 2/6 Image
3️⃣ 確診數趨勢 (當日公布數版本) 3/6 Image
Read 6 tweets

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