--:-- Sean Rameswaram: Support for Today Explained comes from the FIFA World Cup, of all things. The FIFA World Cup 26 is coming to North America next summer. It is the ultimate celebration of sports and culture. You can get closer to the beautiful game with a hospitality package, closer to the action, the best seats, the best suites, closer to match day and that world-class food and that world-class entertainment, closer to the experience of a lifetime. Book a hospitality package at fifaworldcup.com slash hospitality.
--:-- Sean Rameswaram: Umair Irfan, your report on science here at Vox. We got some big COVID-19 news on Monday. What happened?
--:-- Umair Irfan: On Monday, Merck, this $200 billion pharmaceutical giant, filed for an emergency use authorization from the Food and Drug Administration for its new anti-COVID antiviral drug.
--:-- Sean Rameswaram: What does it look like?
--:-- Umair Irfan: It's a little brown pill. A little brown pill?
--:-- Sean Rameswaram: Yeah.
--:-- Umair Irfan: If it's approved, it will likely be the first oral treatment for COVID-19. The trial was designed to be given to people early in the course of infection. It's an orally administered drug that's really very important.
--:-- Sean Rameswaram: It's prescribed as four pills taken twice a day for five days, though the dosing regimen may change as regulators review the data.
--:-- Umair Irfan: Well, this is certainly an important advance. There's no doubt about that. Whenever you have an orally administered medical intervention that directly attacks the virus and has the kind of data that Merck announced with their announcement.
--:-- Sean Rameswaram: According to Merck's internal studies and clinical trials, they found that it reduced the risk of hospitalization and death in at-risk patients by 50%.
--:-- Umair Irfan: Okay. How significant is that?
--:-- Sean Rameswaram: That's pretty significant. You know, we have a number of different drugs that are available to treat COVID-19. To date, only one has been actually fully approved by the FDA. That's called remdesivir.
--:-- Umair Irfan: There are a few others that are available under emergency use authorization and a few that are used off-label, but none of them have been super effective or they have their own drawbacks for various reasons.
--:-- Sean Rameswaram: But this one kind of stands out because it is very effective and it's also something that's fairly easy to administer. You just have to take it through the mouth.
--:-- Umair Irfan: Okay, what's this little guy called?
--:-- Sean Rameswaram: It's called Molnupiravir.
--:-- Umair Irfan: Molnupiravir? The name is supposedly a reference to Thor's hammer from Nordic mythology, Mjolnir.
--:-- Sean Rameswaram: Huh. Why is it a reference to Thor's hammer?
--:-- Umair Irfan: Is this pill like a hammer? Yeah, it hammers the virus and knocks it out with a bolt of lightning. no not quite but uh it's supposed to be i mean it has a pretty strong effect and i think that name is meant to sort of reflect that did thor's hammer only work 50 of the time i don't know i am not that well versed in nordic mythology i now take from you your power
--:-- Sean Rameswaram: Now, I do take issue with your point that it only works half the time.
--:-- Umair Irfan: It reduced hospitalization and death by 50%, but it can also reduce other kinds of clinical outcomes that weren't specifically measured.
--:-- Sean Rameswaram: So it can reduce the course of the illness by a certain amount as well.
--:-- Umair Irfan: So it's not just that it works half the time. It's that that was one of the strongest effects, the reducing death and hospitalization. It could also work to a lesser degree in other patients as well.
--:-- Sean Rameswaram: How does Molnupiravir work?
--:-- Umair Irfan: So Molnupiravir is an antiviral drug that interferes with how the virus makes copies of itself.
--:-- Sean Rameswaram: So the other FDA-approved drug for COVID-19, Remdesivir, works in sort of a similar fashion.
--:-- Umair Irfan: What it does is it imitates part of what's used to make up the genetic sequence of the virus.
--:-- Sean Rameswaram: So in order to encode its instructions, the virus uses a molecule called RNA, and it's assembled out of these building blocks that are represented by the letters AUGC.
--:-- Umair Irfan: And so remdesivir is like a fake version of the molecule that's represented by the letter A, whereas molnopiravir imitates other letters.
--:-- Sean Rameswaram: And what happens is when the virus takes those fake letters into its genetic sequence, it causes a whole bunch of problems.
--:-- Umair Irfan: With remdesivir, it causes the replication cycle to stop.
--:-- Sean Rameswaram: But with molnupiravir, it causes mutations that are detrimental to the virus.
--:-- Umair Irfan: So when you say it causes a bunch of problems, you're talking about like good problems because they're problems for the virus.
--:-- Sean Rameswaram: Right. We want to sort of gum up the machinery that the virus uses to make copies of itself.
--:-- Umair Irfan: And so you can do that through stalling its replication cycle. or as Molnupiravir does, it induces mutations in the virus that make it just basically fall apart
--:-- Sean Rameswaram: Sounds good
--:-- Umair Irfan: And what additionally special about these drugs is that they fool the virus replication machinery but not human cells.
--:-- Sean Rameswaram: So that causes only the virus to fail and normal healthy cells are left alone and that gives it a targeted effect.
--:-- Umair Irfan: Now with Molnupiravir in particular, there were some concerns about its mechanism because it induces mutations.
--:-- Sean Rameswaram: There were some concerns early on during testing about whether it could induce mutations in human cells or not.
--:-- Umair Irfan: So during clinical trials, they limited participants to ensure that people who are pregnant were not participating.
--:-- Sean Rameswaram: But so far, the company Merck reports that there has been no evidence of this drug-inducing mutations in humans at all.
--:-- Umair Irfan: But this is something that regulators will also be paying very close attention to.
--:-- Sean Rameswaram: Okay. Okay. You mentioned earlier that this 50% reduction in death or hospitalization in particularly vulnerable patients is something we know based on Merck's own studies.
--:-- Umair Irfan: Does that mean there haven't been independent trials done on this?
--:-- Sean Rameswaram: Well, there are ongoing clinical trials that are being monitored.
--:-- Sean Rameswaram: The results were announced via a press release.
--:-- Umair Irfan: So we're still waiting to see official published results in some sort of peer-reviewed article or even in a preprint article.
--:-- Sean Rameswaram: So we right now only have Merck's word to go on.
--:-- Sean Rameswaram: But they did end their trial early because the effect was so strong and regulators had to approve that decision.
--:-- Sean Rameswaram: So it stands to reason that the overseers, the people who are monitoring the trial, did agree with their findings.
--:-- Sean Rameswaram: How does the way this thing's being tested affect its approval from the FDA?
--:-- Sean Rameswaram: Do we know?
--:-- Umair Irfan: Well, the FDA is going to review the data from the clinical trials, and it's going to evaluate how well it works as well as the safety profile.
--:-- Sean Rameswaram: We didn't really get a good sense of what the side effects are from this drug in the press releases.
--:-- Sean Rameswaram: And so it's worth examining just what the potential risks are and then weigh them against the benefits.
--:-- Umair Irfan: And that's what the FDA will do.
--:-- Sean Rameswaram: One thing that the FDA does look at is, you know, who are the most ideal targets for using this drug?
--:-- Sean Rameswaram: Keep in mind that the 50% reduction in hospitalization and death, that was in at-risk patients, so people who were older or had pre-existing health conditions.
--:-- Umair Irfan: Got it.
--:-- Sean Rameswaram: So the authorization may be limited to them, or it may be expanded more broadly to the general population, depending on what the data actually looks like and what the reviewers actually consider.
--:-- Sean Rameswaram: Okay. But we can expect this thing to get approved within the next months.
--:-- Sean Rameswaram: Is that fair?
--:-- Umair Irfan: Within a month, within days, it's really hard to say.
--:-- Sean Rameswaram: The vaccines from the time that they filed for emergency use authorizations to approval, that took about a month.
--:-- Sean Rameswaram: But some drugs have only taken about a few days to get approved from the FDA when they have filed for emergency use.
--:-- Sean Rameswaram: So it really depends on how quickly they want to move on this and how much data they think they have right now.
--:-- Sean Rameswaram: Okay. Well, if the drug is approved in the coming days or weeks or months, how much more treatable does COVID-19 become?
--:-- Umair Irfan: Well, one thing that's hard to overstate about this drug is just how easy it is to administer.
--:-- Sean Rameswaram: So basically, as soon as you're diagnosed with COVID-19 or you test positive, you can get in touch with your doctor and potentially ask them, you know, am I at a high risk group and should I start taking this pill as a precaution?
--:-- Sean Rameswaram: And you can start getting taking the medicine right away without having to risk going to a clinic, without having to spend the money or the resources to, you know, get transfusions, which can be pretty expensive if you're paying out of pocket.
--:-- Sean Rameswaram: So a lot easier to take, but still not a silver bullet.
--:-- Sean Rameswaram: That's right. You know, no drug is going to be 100% effective against all the most severe cases of COVID-19.
--:-- Sean Rameswaram: But on balance, they do tend to reduce the risks.
--:-- Sean Rameswaram: And it's still not going to be anywhere near as effective as getting vaccinated to begin with.
--:-- Sean Rameswaram: Do we think people will trust this new drug, this little brown pill that could treat COVID-19?
--:-- Umair Irfan: Potentially.
--:-- Sean Rameswaram: You know, there is a fair amount of vaccine hesitancy still around.
--:-- Sean Rameswaram: There are still people who are adamantly against getting vaccinated, but may be more inclined to get a treatment.
--:-- Sean Rameswaram: But it's really hard to say, I mean, why the reasons that people refuse vaccines may overlap with the same reasons that they would refuse therapy like this.
--:-- Sean Rameswaram: Time will tell.
--:-- Sean Rameswaram: We'll just have to see who takes this.
--:-- Sean Rameswaram: But at this point, we know that the people that are facing some of the most severe consequences of the disease are those that are unvaccinated.
--:-- Sean Rameswaram: So at least in the U.S., it may not move the needle that much.
--:-- Sean Rameswaram: Where it can make a big difference is potentially in other countries where vaccination rates are really low because they just don't have the supply chain or just the resources to administer the vaccines at this point.
--:-- Sean Rameswaram: So places where you have still ongoing spread of COVID-19 but haven't been able to get vaccines to them, this might make a big difference there.
--:-- Sean Rameswaram: So these are other countries, potentially some of the more remote regions of the world, where this could make a big difference in reducing the overall impact of the COVID-19 pandemic.
--:-- Sean Rameswaram: More with Umair in a minute.
--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards.
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--:-- Sean Rameswaram: Umair, remind me what wave we're in right now of this pandemic i've lost count i think uh four five i've lost count too uh we're certainly on the uh downward slope of the wave that peaked in early september but we don't know if this is going to be the last one
--:-- Sean Rameswaram: Yeah. I mean, we spoke back in June when Delta was really popping off about, you know, how things looked good and then they didn't.
--:-- Sean Rameswaram: Where are we now?
--:-- Sean Rameswaram: Well, things are starting to look good right now.
--:-- Sean Rameswaram: You know, we do have a number of things that are positive, you know, some good developments that we didn't have last year.
--:-- Sean Rameswaram: We have more than half of all Americans in this country vaccinated and certainly more than 80% of adults over the age of 65 that are vaccinated, you know, one of the highest risk groups.
--:-- Sean Rameswaram: So that bodes well.
--:-- Sean Rameswaram: The pace of vaccinations is certainly picking back up now that we are seeing vaccine mandates.
--:-- Sean Rameswaram: If you want to work with the federal government and do business with this, get vaccinated.
--:-- Sean Rameswaram: You know, now with the full approval of the Pfizer-BioNTech vaccine, the federal government and a lot of private employers are starting to require their employees to get vaccinated.
--:-- Sean Rameswaram: We're also seeing some of the first recipients of the vaccine get booster shots.
--:-- Sean Rameswaram: 20 million Americans now qualify for a booster.
--:-- Sean Rameswaram: I'm beginning my booster shot.
--:-- Sean Rameswaram: And soon kids may be able to receive a vaccine as well, provided the FDA grants an emergency use authorization for children.
--:-- Sean Rameswaram: And if this pace of vaccination continues, you know, we'll still have a larger and larger fraction of this population that's immune to COVID-19, which should put a big damper in the spread of the disease.
--:-- Sean Rameswaram: Yeah, I mean, let's talk more about that.
--:-- Sean Rameswaram: I think at this point, you know, October 2021, we're still at about 2000 Americans dying from COVID-19 a day, which feels insane.
--:-- Sean Rameswaram: Do we have a sense of how much that number drops in a forthcoming best case scenario?
--:-- Sean Rameswaram: There have been some models and estimates, but certainly, you know, if we continue on this trajectory, this downward slope, one modeling estimate found that we would get to about 90 deaths per day by the end of February 2022.
--:-- Sean Rameswaram: And that would presume, you know, a continued decline through the winter that basically we maintain the gains that we have and we continue advancing in terms of vaccination, but also in terms of containing the overall spread of the disease.
--:-- Sean Rameswaram: That's certainly a very optimistic picture, but, you know, it is one of the possibilities.
--:-- Sean Rameswaram: Well, let's talk about how we get there.
--:-- Sean Rameswaram: I mean, there's a lot of news about mandates right now, vaccine mandates, government mandates, business instituted mandates, school mandates.
--:-- Sean Rameswaram: And then there's sort of this counter movement of people resisting those mandates.
--:-- Sean Rameswaram: I think famously Kyrie Irving of the Brooklyn Nets popped up in that department yesterday.
--:-- Sean Rameswaram: How well are mandates working?
--:-- Sean Rameswaram: Mandates seem to be working really well.
--:-- Sean Rameswaram: You know, there are a few holdouts that are getting a lot of attention, but I think it's worth emphasizing that the vast majority of people who are facing a mandate do comply with it.
--:-- Sean Rameswaram: That's workers in health care. That's workers in government. That's workers at airlines.
--:-- Sean Rameswaram: We're seeing huge spikes in vaccination rates, and a lot of these mandates are helping close the gap.
--:-- Sean Rameswaram: For instance, in New York, the vaccination rate among hospital and nursing home staff went from 75% to over 90% after a mandate was implemented.
--:-- Sean Rameswaram: So there's a lot of evidence that actually making this a requirement does work in terms of getting people to get vaccinated.
--:-- Sean Rameswaram: Okay. What about boosters?
--:-- Sean Rameswaram: I think we are now officially giving out boosters in the United States. Is that right?
--:-- Sean Rameswaram: Yes.
--:-- Sean Rameswaram: Pfizer received approval from the Food and Drug Administration on a limited basis to begin administering boosters to some of the earliest recipients of the vaccine.
--:-- Sean Rameswaram: And right now, the FDA is also not taking a stance on boosters from Moderna, saying that there hasn't been enough evidence submitted that they're actually needed.
--:-- Sean Rameswaram: Johnson & Johnson, the one-dose adenovirus vector vaccine, is also putting out data showing the effectiveness of their booster.
--:-- Sean Rameswaram: So that might also receive approval in the coming weeks and months.
--:-- Sean Rameswaram: But yeah there a lot of moving parts here and we may see more uses of vaccines being approved
--:-- Sean Rameswaram: And the kids
--:-- Sean Rameswaram: Well kids right now are not even approved right now for vaccines
--:-- Sean Rameswaram: You know the FDA is still weighing the evidence right now from clinical trials for children between the ages of five and 12.
--:-- Sean Rameswaram: And as far as the kids are concerned, it's going to be safe in a couple of weeks for them to go out on Halloween and trick or treat?
--:-- Sean Rameswaram: They may not be available by Halloween, but, you know, Dr. Fauci did say earlier this year that Halloween should be safe to enjoy.
--:-- Sean Rameswaram: You're outdoors for the most part, at least when my children were out there doing trick-or-treating, and enjoy it.
--:-- Sean Rameswaram: I mean, this is a time that children love. It's a very important part of the year for children.
--:-- Sean Rameswaram: I know my children enjoyed it.
--:-- Sean Rameswaram: So, I mean, particularly... I imagine there would probably still be some precautions, you know, gathering in outdoor areas.
--:-- Sean Rameswaram: There may still require some social distancing and masking, and Halloween's the perfect holiday for masking.
--:-- Sean Rameswaram: Yeah, what are the anti-maskers going to do on Halloween? Do the whole inverse mask thing where they cover their eyes and leave their mouths open, you know, Batman style.
--:-- Sean Rameswaram: Impossible.
--:-- Sean Rameswaram: So it sounds like there's a lot of reasons to be hopeful, but we've all been hopeful before.
--:-- Sean Rameswaram: What are some of the reasons to be pessimistic?
--:-- Sean Rameswaram: Well, there's always reasons to be pessimistic.
--:-- Sean Rameswaram: And I think the track record of this pandemic did kind of validate a lot of the pessimistic folks here.
--:-- Sean Rameswaram: One big thing that is really putting a damper on all this is that there are still people that are absolutely adamant that they will not get the vaccine.
--:-- Sean Rameswaram: It's about 10 to 12 percent higher, depending on certain areas.
--:-- Sean Rameswaram: And that's pretty closely associated with political leanings.
--:-- Sean Rameswaram: People who tend to vote Republican or jurisdictions that voted in large numbers for Donald Trump tend to have a much lower vaccination rate.
--:-- Sean Rameswaram: And if those people remain unvaccinated, they still remain reservoirs for this virus.
--:-- Sean Rameswaram: We are seeing that a large proportion, almost all of hospitalizations and deaths at this point are among unvaccinated people.
--:-- Sean Rameswaram: And so as long as the virus continues to spread, it will continue causing harm, but it will also continue mutating.
--:-- Sean Rameswaram: And potentially those mutations could create another variant that would undermine progress against the disease.
--:-- Sean Rameswaram: And the other factor to consider is also that human behavior is a key factor in controlling the spread of this disease.
--:-- Sean Rameswaram: I mean, obviously, vaccines are super effective, but we've seen that, you know, without other precautions alongside vaccines, we don't make as much progress as we could.
--:-- Sean Rameswaram: So that means maintaining social distancing in some circumstances, wearing masks in high risk settings may still be required.
--:-- Sean Rameswaram: And if people are resistant to doing those things, then, you know, what little progress we're making could be eroded.
--:-- Sean Rameswaram: And that's been the cycle thus far, right?
--:-- Sean Rameswaram: It's bad and then it's less bad and then it's bad and then it's less bad.
--:-- Sean Rameswaram: Are we going to break that cycle at some point?
--:-- Sean Rameswaram: Do we know when?
--:-- Sean Rameswaram: I mean, it's again, it's really hard to say, you know, it's not as though we're facing one uniform pandemic.
--:-- Sean Rameswaram: We're seeing this pandemic play out in different ways in different places, you know, in areas where we do have a high vaccination rate, but also good social distancing and masking.
--:-- Sean Rameswaram: people are pretty close to normal.
--:-- Sean Rameswaram: The transmission is low, the hospital beds are fairly empty, and people aren't as worried.
--:-- Sean Rameswaram: But in other areas where transmission rates remain high, people aren't vaccinated, and they aren't wearing masks, then we're still seeing hospitals getting filled up.
--:-- Sean Rameswaram: And so we will continue to see this sort of mosaic of pandemics across this country on a city-by-city, even on a county-by-county basis, where you have different approaches leading to different outcomes.
--:-- Sean Rameswaram: And that's really a case for why we really need to take this pandemic seriously, even as cases decline.
--:-- Sean Rameswaram: You know, we do all want to get back to normal.
--:-- Sean Rameswaram: I certainly do.
--:-- Sean Rameswaram: But I also don't want to lose the fragile progress that has been made.
--:-- Sean Rameswaram: And I certainly don't want to ratchet back some of the precautions that were in place during the darkest days.
--:-- Sean Rameswaram: And so it will really require a concerted effort on all fronts in all areas in order to actually get out of this thing for good.
--:-- Sean Rameswaram: Can we make plans for the holidays, you may? You can if you want, but I would suggest booking flexible tickets with good cancellation policies.
--:-- Sean Rameswaram: What are you going to do?
--:-- Sean Rameswaram: Well, I'm actually going to Glasgow in November to attend the UN Climate Change Conference.
--:-- Sean Rameswaram: Jealous. Don't be.
--:-- Sean Rameswaram: Those conferences aren't that interesting.
--:-- Sean Rameswaram: You spend a whole lot of time inside a conference hall talking to people who don't want to talk to you.
--:-- Sean Rameswaram: Word.
--:-- Sean Rameswaram: All right, your turn, Sean.
--:-- Sean Rameswaram: What are you planning to do?
--:-- Sean Rameswaram: I think I'll get married.
--:-- Sean Rameswaram: You think?
--:-- Sean Rameswaram: Umair Irfan, Reports on Science at Vox.
--:-- Sean Rameswaram: Our show today was produced by Will Reed and Halima Shah.
--:-- Sean Rameswaram: I'm Sean Ramos from It's Today Explained.
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--:-- Sean Rameswaram: Or forgetting sunscreen, so now you look like a tomato.
--:-- Sean Rameswaram: Ouch.
--:-- Sean Rameswaram: Could have done better.
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--:-- Sean Rameswaram: Learn more at schwab.com.
