Thread by @michaelzlin

Not a big fan of test-to-treat. It just codifies what HCWs should do anyway. Plus it gives in to expensive pills and gives up on the more efficacious vaccines.

Disappointing when 35% = 115M are still not fully vaxxed.

usafacts.org/visualizations…

Since certain internet trolls like to ask me about COIs when I talk about pills, I'm developing protease inhibitors that function similarly to Paxlovid, the drug Biden mentioned (and we had ours first, so we're not copying Pfizer). But I tend to call things as I see it.

Vaccination prevents hospitalizations by ~90%, the same as Paxlovid, and you can carry that benefit with you 24/7; you don't need to run to get tested with every sniffle.

11% of the population received 1 shot only so are at least willing to do something, and 7% are kids 0-5, so 17% = 56M are totally unvaxxed by choice. That's a big number. I understand that's not likely to budge.

Biden actually hinted the test to treat program will prioritize the vulnerable, which would be generally correct. But he didn't mention current guidelines prioritize unvaxxed over vaxxed, because the drugs were only tested on unvaxxed.

So I wonder if this program still going to be limited to the current guidelines, which would make medical sense. It would make the announcement less relevant for the majority of people who are not unvaxxed or immunocompromised (this would fit with "leaving no one behind")

Besides perversely rescuing the unvaxxed from their bad decisions, the public announcement of this program might suggest to the healthy vaxxed that they too should be taking these drugs. It might lead to overprescribing since it's hard to say no to scared patients sometimes.

What we need are trials of Paxlovid on vaxxed people of different ages and medical conditions, so we know exactly how useful it is for the vaxxed. Then we can set clear national guidelines on who should and shouldn't be using these medications.

These wouldn't need to be RCTs for ethical reasons. That is you can give everyone who signs up Paxlovid and measure viral titers, then compare to matched cohorts who didn't take Paxlovid (although there's always some risk of selection bias)