THREAD 1/10 There is a morass of studies underway to evaluate therapies for COVID19. It's hard to know which to prioritize. These are my key/desirable criteria. What are yours? Which drug(s) under evaluation are most likely to fulfill these criteria?

2/10 1. The drug will not only benefit the patient, but society as a whole by decreasing transmission rates. Currently the only way to decrease transmission is social isolation. Having a drug that can do this, is desperately need when social isolation restrictions are lifted

3/10. 2. It is available for MASS use, and can benefit patients in countries with limited resources, not just developed nations. COVID19 does not respect borders. We cannot look at this myopically from only the viewpoint of only one country; we're all in this together

4/10 3. It has to be available ASAP if found to be beneficial. This favors re-purposed drugs over novel compounds. Supply will be less of challenge for drugs already commercially manufactured than for novel, experimental therapies that have yet to be manufactured at scale

5/10 4. It is oral (or inhaled). The benefit of easy administration will be critical for any drug intended for use early in treatment, in an outpatient setting. This enhances its ability to be used at scale, and have greatest impact overall on transmission rates

6/10 5. It has a wide therapeutic margin, and is safe for mass use. All drugs have toxicities, and some will be serious. Serious toxicities may be acceptable, if they can be monitored and reversed if identified early. Repurposed drugs have known risks, experimental drugs less so

7/10 6. It is a small molecule (ie can be formulated as pill or inhaled) and not a biologic (injection or IV). This enables mass use in outpatient setting, and is less expensive and challenging to manufacture, supply and store.

8/10 7. It has plausible MoA & therapeutic PK is achievable in lung/tissues. Since "repurposed" drugs were not originally developed for COVID19, this would mean having at least in vitro activity, and evidence of activity in humans (ie antiviral or immunomodul activity)

9/10 8. Clinical benefit would need to be assessed in APPROPRIATELY designed trials. This is separate from MoA and antiviral effects. This gets back to the challenge that many trials are underway, many evaluating less than optimal treatments, wrong patients, etc.

10/10 In summary, while any treatment that benefits #COVID19 patients are desirable, those treatments that can also impact transmission, have the appropriate safety and evidence of efficacy, and are accessible to global society should be prioritized