COVID Transmissions for 11-17-2021
Updates on several drugs for COVID-19
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 731 days since the first documented human case of COVID-19. In 731, the historian and monk Bede completed his Ecclesiastical History of the English People, a book which many a history major has been asked to navigate, including yours truly.
Today we’ll talk about drugs for COVID-19; both new ones like PAXLOVID and existing drugs, like antidepressants, that might be deployed against it.
Why do we need these drugs? Well, for one, I’ve heard that some people don’t want to get vaccinated despite the evidence. For another, vaccination is protective, but no protection is perfect. We need other lines of defense, too.
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Pfizer makes deal for PAXLOVID with MPP
Like Merck before it with molnupiravir, Pfizer has now made a deal to make its antiviral PAXLOVID available inexpensively in developing countries, with the Medicines Patent Pool: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-medicines-patent-pool-mpp-sign-licensing
Look, all of these companies still want to make a profit, but they do these things out of a mixture of desire to get PR goodwill and a genuine belief that compassionate availability of product is the right thing to do. There’s this view that people in the pharma business all have an unbridled greed, and it’s true that those types exist, but generally my experience has been that the industry attracts people who want to do something good for humanity but also get paid well for that. Sometimes the better part of that gets lost in the corporate shuffle, but in this case, I’m glad it hasn’t been.
More antidepressants may have a protective effect in COVID-19
A retrospective study has looked at mortality risk from COVID-19 in patients taking different Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786136
Not too long ago, I shared the clinical trial results establishing that fluvoxamine, one of the drugs looked at here, could cut the rate of hospitalization for COVID-19 by a third:
In this study, the results looked at death as an endpoint instead. They assessed the risk of mortality in patients on SSRIs relative to matched untreated controls. Patients on any SSRI had a small apparent protection, about 8% reduced relative to untreated controls. Patients on fluvoxamine or fluoxetine (aka PROZAC) had a 26% lower risk of death, however. When you removed patients on those two drugs from the SSRI population, the protective effect in patients on other SSRIs disappeared.
It looks like these two drugs, fluoxetine and fluvoxamine, can protect people from death due to COVID-19. That’s great news. Something else I like about it is that there is a clinical trial with supportive results to this concept. We know fluvoxamine can do something, so to see it doing something similar here, even for a different endpoint, makes me more confident in the results with respect to fluoxetine, too.
This is a very tried and true scientific thought process: if multiple sources report similar results in different experimental designs, it improves substantially your confidence that the data are showing you a real effect. I used this in my molecular biology work for my PhD, and it works just as well in clinical trials and epidemiology. Getting the same basic answer multiple ways gives you better confidence in that answer.
Stepping back from the philosophy of science, as a practical matter, these drugs are off-patent and inexpensive. Plus, a lot of people already take them, so they are in ready supply with manufacturing and delivery in place and operating. To me, they look like very good candidates for use in fighting this pandemic.
What am I doing to cope with the pandemic? This:
Running: 10K
I’ve had a very on-off relationship with running. In grad school, I was pretty obsessed with my 5K time, despite never running any races. Running was my chief form of exercise, and for various periods, I exercised pretty well! In other periods, I did not.
Once I got into the workforce finding time to work out was harder, and I ended up putting running aside for a while. When I started my current job, I resolved to change that—and also to start doing other exercise.
Then, the pandemic started about 6 weeks later.
My running journey since then has been a bit complicated. From reluctantly running outside in a mask until we learned the risk was low with the mask off, to indoor treadmill running in a mask, I’ve had to adapt to COVID-19 in various ways. But I’ve gotten myself up to running about 15 miles a week, and yesterday, I hit a new milestone: I ran 6.2 miles, the length of a 10K race, for the first time ever. Even when I could run an 8-minute mile pace for quite a distance, I wasn’t able to do a 10K.
In a way, this has been my pandemic project. Now, I’m wondering how much further1 I can go.
You might have some questions or comments! Join the conversation, and what you say will impact what I talk about in the next issue. You can also email me if you have a comment that you don’t want to share with the whole group.
Part of science is identifying and correcting errors. If you find a mistake, please tell me about it.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
No corrections since last issue.
See you all next time. And don’t forget to share the newsletter if you liked it.
Always,
JS
Choice of this word vs “farther” intentional. Running isn’t all about literal distance.