Hacker News Reader

Comment by jjcon | Hacker News Reader

Can someone more medicalese literate than I give a ELI5?

There's an antiviral drug which is used to treat COVID. It works by causing a specific type of error in viral DNA copying. These errors usually result in the virus dying, but in some cases it could theoretically survive and still spread. The authors have found evidence that this is indeed happening.

Yep - and it's not explicit in this article, but that was a very well known risk during development and clinical testing of the drug -- to the point that the only indication which was granted EUA approval was for patients:

"For the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate."

Basically the drug worked well but the risk of the mutations were high enough that it's only recommended for patients at serious risk of severe Covid who can't take any other therapeutics (primarily Paxlovid). Without vaccines and other treatment options, molnupiravir would have been a very important drug but we developed several alternatives so it'll likely wane to zero new prescriptions over time.

So then this is NOT an example of the virus becoming immune to the anti-viral (my initial assumption) right?

Correct. It would require some pretty specific mutations to the virus' RNA transcription proteins to become immune to this anti-viral.

The real worry with something like this is that you might knock out a "proofreading gene" on SARS-CoV-2 which currently prevents the virus from mutating very quickly: https://twitter.com/sanchak74/status/1445816775581396996

Interesting twitter thread. I'll just state that sanchak74's statement "2. These mutants are circulating globally now - distinguished by their mutation signatures" is as least partly contradicted by the discussion of the article of this topic (which is also the article that sanchack74 links as supporting that statement). I.e. "At the time of writing we have not identified a molnupiravir-implicated cluster that had spread to more than 21 individuals."

As long as those clusters are in far enough apart geographies, I think it is fine to call it a global circulation.

Now, to call it “widely” circulating/spread or “openly circulating in the general public” would be another story

RNA copying.

Reply on news.ycombinator.com