Your questions, answered "Might molnupiravir be studied as a treatment for long covid on the theory that some remnants of the virus remain in the body triggering the immune system?" —Sharon in Montana The experimental drug molnupiravir has shown real promise in preventing the worst outcomes of covid-19. In a recent clinical trial, it appeared to reduce the risk of hospitalization and death by half among high-risk patients with mild to moderate illness who were medicated within five days of getting sick. And unlike other covid-19 treatments, molnupiravir is a pill, so it's easy to take. But the drug has only been tested on patients in the early stages of the disease. It's not at all clear whether it could help treat long covid patients, or even if it could prevent it in the first place. "This is a long-term question, and people have been taking these pills for a relatively short period of time," Carl Dieffenbach, an expert at the National Institute of Allergy and Infectious Diseases, and Joshua Sharfstein, a public health professor at Johns Hopkins University, said in a Q&A on molnupiravir last month. "We won't know for a while whether the use of medications and antibodies prevent long covid," they said. "But if the pills help people convalesce quicker and also prevent long covid — that is a game-changer." Long covid is a vexing disease because it can involve so many different conditions. Patients describe symptoms ranging from breathing trouble to muscle pain to chronic fatigue, often affecting multiple body systems at once. Scientists are still trying to figure out what causes these problems. Right now, it's hard to pinpoint — and therefore hard to treat with medication. Some long covid patients don't even test positive for the virus. How do you decide what to target? "In the case of acute covid, we know that we need to block the virus and hyperinflammatory state," Timothy Henrich, a physician and professor at the University of California, San Francisco, told the journal Nature. "But the science behind long-covid has lots of caveats, and we don't really know what's driving the disease. The targets are not well defined and correlated with the syndrome." An array of medications are being tried on long covid patients in tightly controlled settings, according to Nature. But they tend to treat specific conditions that show up after infection. Some patients who developed a rapid heartbeat condition known as POTS have been treated with the heart medication Corlanor, for example. Molnupiravir, on the other hand, is an antiviral drug that attacks the virus itself. It works by scrambling the virus's genome and preventing it from replicating, in a process called "lethal mutagenesis." The jury is out on whether this would benefit long covid patients. Merck, the company that makes molnupiravir, is seeking emergency use authorization from federal health regulators for use in acute covid-19 cases. It could get the green light by the end of the year. The company is also investigating whether the drug can be used prophylactically to prevent the virus from spreading within households. In the meantime, it's worth celebrating molnupiravir for what it appears to do best: stopping the virus in its tracks early-on. | 
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