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Opinion This pill to treat covid could go a long way to getting us back to some kind of normal

Molnupiravir is an experimental covid-19 treatment pill being developed by Merck & Co. (Merck &Co.)

On the road to normalcy, the world must assemble a mixed toolbox for combating the pandemic. The most powerful instruments are the vaccines that protect against infection. But others include therapies that can tamp down sickness and save lives. The application for an emergency-use authorization for a new oral antiviral drug is a welcome sign that these additional tools are coming.

The pharma giant Merck, along with Ridgeback Biotherapeutics of Miami, submitted an application for its pill, molnupiravir, to the Food and Drug Administration after announcing Oct. 1 that the drug had reduced the risk of hospitalization or death by half in a clinical trial. The drug is intended to treat mild to moderate covid-19 in adults and involves a five-day course of 40 pills. While vaccines work to prevent infection, this drug, if approved, would help people who have just come down with the disease, and who are at risk — with such factors as obesity, diabetes, age or heart disease — of more severe sickness and hospitalization. In the clinical trial, the drug was taken within five days of the onset of symptoms. The trial excluded vaccinated people and anyone who was pregnant or planning to get pregnant “due to the unknown effects of new drugs on pregnancy,” a spokesperson says.

The possibility of an oral antiviral holds out hope for ease of treatment compared to other therapies such as monoclonal antibodies that must be taken intravenously. It could ease the burden on health-care systems by helping people recover before they need hospitalization. It could prove valuable to many poorer and middle-income nations that are still short of vaccines. The U.S. government has contracted to purchase 1.7 million courses of the drug for $1.2 billion, or $700 a course. Merck said it expects to manufacture 10 million courses by year’s end and will set global prices to reflect nations’ ability to pay.

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Vaccines essentially train the body’s immune system to fight the virus when it appears. The antiviral drug works differently. The antiviral mimics the building blocks of ribonucleic acid (RNA). Once in the body, it causes virus replication to go haywire by creating mutations — so many that the viral genetic machinery collapses. Richard Plemper, a virologist at Georgia State University in Atlanta and a collaborator on its development, told Nature, “The virus essentially mutates itself to death.” Merck has said the drug is not capable of inducing genetic changes in human cells, but that point will most certainly be raised in forthcoming scrutiny of its safety.

Since the antiviral must be taken soon after infection, it puts an extra burden on developing rapid and accurate testing that is widely available.

The FDA will study the application. If the agency agrees that the treatment is safe and effective, that will be a hopeful step toward getting back to some kind of normal. Additional drugs and vaccines will certainly follow, filling out a diverse and effective armamentarium to wage this battle.

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