Coronavirus, mutations, and remdesivir

A story of Risk/reward in medicine and virology

Many people worry about COVID19 mutating as it spreads across the globe, for very good reasons:

Will the antibodies of those recovered be effective against new infections?

Will mutations make vaccine useless? Drug resistance? More virulent? Etc. etc.

It turns out, coronavirus is special among RNA viruses with its unique proofreading protein. Google “coronavirus proofreading” and you can find a large number of recent research on that topic.

as a result, coronavirus is relatively stable. Vaccines and antibodies are expected to be effective against it for a long time (2 year and above)

So that is the good news

The twist here though is that magic drug remdesivir works on coronavirus by introducing massive number of errors(mutations) during viral replication. Causing viral mutation rate to go up by 30-50x.

Most mutation is harmful to viral fitness, thereby suppressing COVID19

However, can remdesivir introduce beneficial mutations to COVID19? Of course it can.

So there lies the risk and reward trade-off of using remdesivir that helps patients most of the time vs a catalyst for new strains that evade current antibodies and vaccine under development.

Now considering the viral mutation rate is relatively constant, usually a probability of 1e-4 to 1e-6 per replication, the more chance of spreading COVID19 is given in the population before vaccines are available, the more likely a mutated strain can emerge to render...

Current vaccine under development useless.

Now add remdesivir into the mix: a high infection rate, say 20% of us population, with the wide use of remdesivir, which accelerates mutations, can potentially make matter worse by creating those dreaded new strains

So there you have it, another risk/reward issue in life. Pros vs cons. Short-term benefits vs. long-term consequences.

There is no perfect solution in life. But we will get by.