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My first Covid-19 paper

The beginning of the year was busy enough for a short commentary I co-athored to come out without my noticing.

Briefly, the US government spent $10 billion procuring the anti-Covid drug Paxlovid after a study confirmed its efficacy in unvaccinated people exposed to the delta strain. It then proceeded to hand it out to everyone, including the vaccinated and boosted during the omicron wave, with no data on whether it is actually needed in that setting. A similar drug, molnupiravir, ended up not having any meaningful effect in those who received the vaccine despite preventing hospitalization and death in the unvaccinated.

Could those $10 billion have been better spent? We believe the answer is: yes. For a fraction of the cost, using the same network of local pharmacies as in the Test-to-Treat initiative, the federal government could have randomized the first 100,000–250,000 patients to Paxlovid, Molnupiravir, or usual care — an order of magnitude more than PANORAMIC as many in the American health care system would have been lost to follow-up. The study would have taken mere months to accrue and would have provided valuable information on the efficacy of these treatments in the U.S. population. As importantly, it would have provided an important precedent and infrastructure for more federally funded pragmatic randomized controlled trials of agents under EUA or accelerated approval. The precedent set instead was for government’s full support for use of drugs far outside of the tested indication.

You can read the whole thing here, without a paywall.

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