Thread by @michaelzlin

While our attention was diverted by Omicron, FDA approved the viral mutagen molnupiravir (MOV) on the last business day before Christmas. The same time, Merck published that MOV doesn't reduce virus levels in the first 3 days. So patients will be shedding mutated virus for 3 days

I wrote in the Washington Post pointing out that widespread use of the drug increases the risk that we will create new immunoevasive variants. This could come from Delta; it may not be milder like Omicron. Since my piece is no longer browsable, I post it here as a public service

It's not just me. Most scientists or clinicians who know the data are worried. They include @JamesEKHildreth, Defense Health Agency director @peterweina, and former BARDA director @RickABright who were overruled either by FDA or by the prev admin on their MOV concerns

Today in Denmark we have a report that Danish doctors overwhelmingly reject MOV and think Denmark's purchase of the drug was wasteful. US and UK and Canada are all purchasing it too. Is this driven by good medicine or the desire to appear to do something?
www-berlingske-dk.translate.goog/samfund/regeri…

The director of Denmark's National Health Board actually admits the purchase was out of Omicron panic, that they skipped normal data requiremens.

MOV had 3% absolute efficacy in one trial: 3 out of 100 treated pre-Delta cases benefited. It also failed two trials in India and Central America, which never gets reported.

And Omicron hosp rate is 3x lower now, so we'd need to mutate viruses in 300 people to benefit 3 at best

Molnupiravir thus has minimal or negligible benefit in the Omicron setting, even if its 30% relative efficacy pre-Delta is maintained (there is some question about that). Sotrovimab or Paxlovid are much more effective options without any capability to accelerate viral evolution.