Forum, Dec. 19: Moving from vaccines to antivirals in the battle against COVID-19

Published: 12/18/2021 10:00:19 PM
Modified: 12/18/2021 10:00:04 PM
Moving from vaccines to antivirals in the battle against COVID-19

The American approach to the pandemic has been primarily focused on vaccines. However, the virus has evolved. It has become more resistant. It has learned how to escape vaccines and antibodies and our immune system and has become more transmissible and contagious, if not more deadly.

Specifically the delta variant and the newer omicron variant have many mutations at the spike protein that help it to avoid attachment of antibodies. Delta has three mutations at the spike protein and omicron now has 32. That is an order-of-magnitude increase. It is time to look at other countermeasures.

The virus under evolutionary pressure has “learned” how to avoid antibodies. Whether those antibodies are acquired from prior infections, are produced in response to our vaccines or are from a direct infusion of monoclonal antibodies, antibodies should no longer be our defense.

A new armamentarium of antivirals is under development, and some are ready for clinical use now.

These antivirals work in some cases within the cell to interfere with the ability of the virus to replicate. The most appealing mechanism, and simplest, is to provide a “faulty” nucleotide building block for the virus. In that case, the viral polymerase is unable to make new offspring from the viral mRNA template.

The antivirals can be delivered in multiple ways. Like the home COVID-19 tests, they can be used without medical professionals. Many people can give these antivirals by injection at home the way people give themselves insulin for diabetes. But the antivirals can also be delivered by a skin patch, like applying a bandage. And finally, even simpler, they can be delivered through a nasal spray.

Antivirals will allow us to defeat this virus so that we can return to our normal lives once again in 2022.



The writer is a professor of surgery and radiology at Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine, a staff physician at the White River Junction VA Medical Center and an adjunct professor of engineering at Dartmouth’s Thayer School of Engineering. The views expressed are his own.

A frightening scenario

Call it what it is: a betrayal of democracy.

U.S. Rep. Marjorie Taylor Greene’s deranged behavior toward her colleagues in the House, and her bizarre statements about President Joe Biden and the Democrats, radical-right Republicans threatening the lives of the 13 Republicans who voted for the bipartisan infrastructure bill; a conservative group’s offer of a $500 bounty to the person who first successfully catches a New Hampshire public school teacher breaking the law; the Texas bounty system that rewards any citizen for reporting an abortion being performed.

Republicans subverting citizen voting rights, attacking schools, refusing to be vaccinated. Many are Donald Trump loyalists fearful of their leader and possessed, like him, of a frantic desire for power and influence.

This, in combination of the idea that the ends justify the means, makes this scenario frightening.

Before we throw our democracy to the wolves we had best to try to bridge our differences on issues about which people feel strongly, like the size of government, individualism and privatization. Any dialogue will require a commitment to listen and to learn and a firm belief that no one has a monopoly on truth.

About the size of government: Problems of dilapidated public housing and food insecurity in urban areas are not easy to solve, certainly not by individuals and charities. They require substantial government action. Question: How might government deal with particular issues and to what extent?

Individualism conditions people to believe they’re on their own and responsible only for themselves. This detachment from community fails to acknowledge our shared identities and moral purposes. Question: How do we build a sense of community that respects people’s individual privacy?

With health care and COVID-19, privatization creates what public health experts call “segregated care.” Research shows that private systems tend to produce worse health outcomes than public ones. Question: When is it best to rely on public services and when on private?

To work on these issues, we need to engage and discuss with people who have different points of view and who imagine the future very different from our own.


West Lebanon

Tool search generates warm feelings

On Dec. 15, I had dropped off my wife at an appointment on Lyme Road and had an hour to spare. I decided to visit Hanover True Value Hardware and purchase a pair of pliers for my wife. She has arthritis in her hands and needs the pliers to open bottle tops. The manager took me to the small tool location, but the store was out of stock He said that some might arrive with his next shipment, but couldn’t guarantee it due to supply chain problems. He then suggested that I might try Fogg’s Lumber and Hardware over the river in Norwich!

It was an easy trip, so I went. At the front desk I showed a gentleman my old, dirty pliers and asked him where the small tools were displayed. He walked over with me to the rack and, as was the case at True Value, they were out of stock. I thanked him for trying and followed him back to the store entrance. As I was about to leave, he bent over and picked another pair of pliers out of a cardboard box and said, “Here, try these. They are not what you wanted but they might just work for you.” I thanked him and asked him how much they were. He replied. “There is no charge. They are free, and happy Christmas!”

Made me think what a good place I live in, full of good people!



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