[akkawwakka]

First, this proves that investment in drug discovery for all pandemic potential viruses, fueled by basic science research, needs to be a huge priority going forward. Imagine having antivirals on the shelf for the Coronas, Avian influenza, Nipah, Ebola, etc. to stop pandemics before they started.

Secondly, I’m a little curious whether if we’d ideally administer Paxlovid in double- or triple-therapy, like we do for HIV and Hepatitis C, if we had the option. Will resistance arise to it in the next 12 - 24 months? Would love to be assuaged of my fear here.

[thehappypm]

I don’t know if there’s much of a realistic evolutionary advantage to being Paxlovid resistant. By the time a person starts taking Paxlovid they’re a dead end for the virus anyway. They’ve been tested, told to isolate, and people around them know to stay away or use PPE. The virus at that point is going to either kill the host or be killed by the host.

[ceejayoz]

> They’ve been tested, told to isolate...

If there's one thing we've learned in this pandemic, it's definitely that people will follow that sort of instruction perfectly.

I know people who didn't disclose COVID symptoms to avoid missing work and gatherings, and people already stop taking antibiotics early in the course because they're already feeling a lot better.

[thehappypm]

Still, this is not the primary pathway the virus uses. A Paxlovid resistant virus won’t suddenly have a general evolutionary advantage for growth. It’ll just be more likely to kill people.

[ceejayoz]

Why would a virus that can survive Paxlovid and continue infecting people not have an evolutionary advantage in a society with widely available Paxlovid treatments?

[thehappypm]

There’s clearly an advantage, but I think it’s pretty minimal. Evading immunity or being more contagious would be a much larger increase in fitness.