Does QAnon ♥︎ Molnupiravir?

Let’s ask a question that sounds silly but isn’t:

How will QAnon ultimately feel about molnupiravir?

Why ask?

Because Merck’s new antiviral pill just might be the game-changer this pandemic needs. It may cure, cheaply and quickly. It may even prevent.

Mjolnir

Whether QAnon embraces or rejects it matters because America’s far-right wingnuts are not just the thought leaders of the Republican Party. They are also a source of medical advice for much of the world. Yes, it’s mostly bad advice, but it spreads very efficiently. What the loonies think may ultimately cost — or possibly save — many lives.

Our domestic conspiracy theories are taken up not just by the simpatico far right in Germany and Russia, but even in Africa, Latin America and Asia. White-supremacist fantasies don’t resonate on those continents, of course — but distrust of government, of Big Pharma and of famous billionaires very much does. And people who are unprotected and afraid are apt to believe anything.

Molnupiravir

Also, the rumors fall on fertile ground. For example, many Africans, Latin Americans and Asians were familiar with chloroquine and ivermectin before they were fads because they are widely available in the tropics — not for Covid, but for malaria and parasitic worms.

As a result, some influential doctors on those continents fought vaccines and pushed phony cures. For a time, ivermectin was even officially distributed in South Africa and Bolivia, as chloroquine was in Brazil and Venezuela. Mistakes were made, patients died, but consumption went on.

Cross-culturally infectious paranoia is not new. Twenty years ago, Thabo Mbeki, the otherwise highly intelligent and well-read president of South Africa, rejected antiretroviral drugs and endorsed garlic and lemons as a cure for H.I.V. after he blundered onto AIDS denialist websites. Because he refused to let public hospitals — the backbone of South Africa’s health system — distribute effective drugs, 365,000 South Africans, including 35,000 babies, died.

Molnupiravir fan?

To review where we stand:

QAnon and its GOP enablers don’t like vaccines, which do work. They do like chloroquine and ivermectin, which don’t work. They slowly came around to liking monoclonal antibodies — not only because they probably saved Donald Trump, but because unvaccinated Trumpers saw their friends die, got nervous, and demanded that their governors hand them out.

(Other bits of their medical wisdom — such as the revelation that sex with demons causes endometriosis — are not as widespread.)

At the moment, there is no consensus as to how the far right feels about molnupiravir. (This may be because Vladimir Putin hasn’t yet told them what to think, as he has with vaccines since 2016.)

To vaccinated Americans, whatever they decide probably won’t make much difference. For those of us who also get boosted over the next few months, the pandemic should soon be over — not completely gone, but gone enough to let us mostly stop worrying.

But for unvaccinated Americans — and for billions of unvaccinated people all over the developing world, the drug may make a big difference.

It’s a handful of pills, it’s cheap to make, it has few side effects, it whups all variants, it doesn’t need refrigeration. Eight Indian companies already have contracts to make it for poor and middle-income countries.

Like Tamiflu, it will probably turn out to work only if taken early. In an ideal world, one could wake up feeling feverish, take a 15-minute home Covid test and, if it’s positive, head to the corner pharmacy, start treatment immediately and have a very high probability of knocking out the virus.

Some experts worry that molnupiravir will add to vaccine hesitancy. They fear that people already nervous about vaccines will think: “Why worry? If I get sick, I’ll just take the magic pill!”

That may be. But there is a much bigger worry that, in my opinion, has gotten far too little attention: the drug is such a powerful weapon that it may be dangerous.

There’s a reason it’s named for Mjölnir, Thor’s sledgehammer.

The study that raised all the excitement on Oct. 1 found it to be 50 percent effective against hospitalization. If the trial had not been stopped early, it might have proven much better than that. In the “Deaths” category, the score was already 8–0 in its favor.

It is also being tested as a preventative — i.e., as a substitute for vaccines. Those results will be out next year.

But that’s just the beginning. It’s not merely a useful stiletto against Covid. It appears to be able to smash virtually all RNA viruses. It works against SARS, MERS, influenza, Ebola, hepatitis C, norovirus, respiratory syncytial virus, chikungunya, equine encephalitis and others.

Like Mjölnir, it is nearly invincible: viruses seem unable to evolve resistance to it, as they do to mere mortal antiviral drugs. (Preventing resistance is the reason we take three drugs for H.I.V., four for TB and so on.)

In short, it sounds almost too good to be true, a cure-all for this and future pandemics. Among scientists, there is serious debate over whether it is.

So it makes sense to ask: how will its risks be portrayed by Russian troll factories and by Crazy Town U.S.A., which are far more adept at risk communication than the White House is?

One of the most persistent vaccine myths pushed by the far right is that the mRNA vaccines “mess with your DNA” and cause cancer.

For vaccines, that’s not true. Their injected mRNA is broken down very quickly.

But molnupiravir very definitely does mess with viral RNA. That’s its “mechanism of action.” It is a nucleoside analog that interrupts RNA transcription.

To put that simply:

Remember from your high school biology those DNA “ladders” with rungs made up of four nucleosides with the initials A, T, G and C? The ladder would split, and bits of matching RNA would latch on to form two ladders?

The C is cytosine. In the body, molnupiravir breaks down into the compound NHC (short for β-D-N4-hydroxycytidine), which closely resembles cytosine. When an RNA virus invades a cell and starts copying itself, NHC can elbow its way into C’s place.

Normally, a coronavirus’s proof-reading mechanism would snip out such an “error” and let a C back in. But the mechanism seems to ignore NHC and leave it in place. However, NHC, unlike true C, will match with either a G or an A, introducing random errors. Multiple errors means the virus fails to make accurate copies of itself, and the infection sputters to a halt.

So far so good. It’s a miracle.

But the big question that experts have been asking about this class of drugs for 30 years is: if they are that good at messing up RNA, can they also trigger errors in your own DNA as your cells copy themselves?

That would make it a mutagen. Mutagens cause birth defects in fetuses and cancer in adults. In a study in mammal cell cultures using high doses for 32 days, molnupiravir did cause mutations.

Merck insists that it has investigated this carefully in animals and with cutting-edge tests like Big Blue Mouse and Pig-a. The overwhelming evidence, Merck says, is that molnupiravir does not damage DNA when taken for a few days at low doses.

But it knows the risk is not zero. Pregnant and breastfeeding women were excluded from the recent clinical trial, and women of child-bearing age had to be on contraceptives. Sperm donors and men having sex with women not using birth control were also excluded.

As Derek Lowe predicts in his excellent essay on mutagenicity in Science, it seems likely that the F.D.A. will eventually approve molnupiravir but make it off limits to pregnant women and children, and perhaps advise doctors to weigh their patients’ ages and risk factors before prescribing it.

The older we get, the more the risk-versus-benefit calculation shifts in favor of the drug. As we age, we absorb a lot of mutagens: sunlight, cigarette smoke, air pollution, dental X-rays, carcinogens not just in the char on barbecued ribs but in raw organic kale. To someone like me, aged 67, swallowing one more potential carcinogen in order to greatly minimize my imminent Covid death risk would definitely be worth it. Your risk-tolerance may vary.

However, that’s rational thinking. Rational thinking has no place in Crazy Town. Crazy Town is all about politics and claiming to know the Big Secret.

So let’s see where we are:

The Wall Street Journal editorial page has weighed in, portraying the drug as a miracle whose development under Trump was delayed by an embittered Obama administration holdover. (The editorial mentions that similar drugs caused animal embryos to be born without teeth or skull parts but then dismisses the threat, saying “similar effects hadn’t occurred with molnupiravir.”)

In a report on Merck stock, the investment bank Evercore portrays the loudest warnings as emanating from a conflicted source: a rival drug-development firm that had passed on licensing a similar molecule. Evercore called the risks “overblown.”

Ivermectin

Deeper into downtown Crazy, one false rumor now circulating from Zero Hedge to Tucker Carlson is — in a weird way — pro-molnupiravir. It claims it actually is ivermectin, but tweaked by Merck so it can charge a much higher price. (Just looking at the two molecules should tell you it’s not.)

But what really makes me think QAnon will embrace it is this:

Molnupiravir

The American far right lives in the comics: Pepe the Frog, Kekistan, Captain America and so on. It likes the kind of scientists who know that superpowers come from spider bites. Also, many white supremacists are Wotanists, fans of Odin rather than the Christian God, whom they consider a Jewish conspiracy. They adopt Norse symbolism like the valknut, the “knot of the slain.”

So who’s their biggest crush? Thor!

Don’t believe me? Look closely at the many tattoos on display inside the Capitol on January 6. Remember the QAnon shaman, Jake Angeli? See that anchor-shaped thing over his left kidney? That’s Mjölnir.

I’m looking forward to Jake’s next career as a Merck spokesman.

I may be wrong. Like viruses, Crazy Town is unpredictable. But which way it decides to swing on this drug will influence the world, so it bears watching. Especially by the people in the Biden administration and at the W.H.O. who are charged with not letting our future be ground up in the rumor mill.

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New York Times, 1976–2021. Last beat: lead reporter on pandemic. 2020 Chancellor Award; 2021 NYT Pulitzer donaldgmcneiljr1954@gmail.com

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Donald G. McNeil Jr.

Donald G. McNeil Jr.

New York Times, 1976–2021. Last beat: lead reporter on pandemic. 2020 Chancellor Award; 2021 NYT Pulitzer donaldgmcneiljr1954@gmail.com

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