Molnupiravir Extends COVID-19 Viral Phase, Evidenced by the High Frequency of Rare and Dangerous Mutations in SARS-COV-2
This paper analyzes SARS-COV-2 mutations data from Merck’s Molnupiravir trials, in the larger context. •5-day treatment with Molnupiravir caused the appearance and selection (to a frequency >5%) of two of the most dangerous spike mutations – E484K and P681H – in multiple patients of a very small group (2/202 and 4/202, respectively).•Molnupiravir disproportionately increases the frequency of dangerous and unusual mutations•Molnupiravir worsens COVID-19 in patients, especially those who start treatment within 3 days of symptom onset. Some theoretically possible mechanisms causing this include acute bone marrow disorder and/or the generation of immune-evasive or even immunosuppressive viral genomes. •These mechanisms are likely to extend the virus shedding period in a substantial number of patients. The virus shed by these patients would be highly mutated and likely selected toward virulence.•Molnupiravir allows for virus diversification in the treated minority and purification in the untreated, a luxury rarely experienced by any virus in the nature. •Merck failed to collect enough data about Molnupiravir driven mutations. •For each important safety event, the collected data represents a few realizations of a random variable with unknown heavy tailed statistical distribution. Merck incorrectly treated this data as worst-case scenarios.