Merck's COVID pill not a game changer

While reducing chance of hospitalization or death by 50% seems like a huge deal... it actually isn't as big of a deal in the context of a landscape where we're faced with an exponential threat vector. 

Halving the hospitalizations and deaths after infection does nothing to slow the rate of infection and it is a linear gain.

Now, I don't want to down play the success of this drug in trials thus far. It is certainly well beyond anything we were hoping for. And that IS a good thing. It is a GREAT thing even. Many more lives would be saved than would be otherwise.

The biggest problem for me comes in the form of complacency and misunderstanding. Humans are bad at math. Many have already fought mask and vaccine mandates on the grounds that they believe that the virus can or should be treated through other means. A breakthrough on this scale is only going to make those beliefs worse. Especially with the way that the media is touting this breakthrough. 

With exponential growth, case loads double on a regular cadence. So, let's take some simple numbers and say that there are 10 people who would die this month and the case load doubles every month. We introduce the drug and only 5 people die this week. Great. Next month, the case load double and 20 people would have died, but only 10 die. Ok, still looks good. Next month, instead of 40 deaths there are just 20. Then 80 vs. 40. Then 160 vs 80. Then 320 vs 160. Then 640 vs 320. Oh, and those numbers... need to be added together because we are talking about NEW cases. So, by the end of the math above, 1270 without and 635 total. 

In short; while it FEELS like reducing the number of deaths by 50% should have a huge impact, the only thing it is doing is buying us 1 extra period of doubling case loads. So, if case loads at doubling every 2 weeks, then all this drug buys the healthcare system and the population at large is another 2 weeks. After that, the numbers will catch up to what they would have been without the drug.

So yes, if you're in the hospital, this drug is an amazing thing. If you think for one second it changes the need for vaccination and other measures... you're wrong. This is a game changer on a personal level. Not on the scale of the pandemic.

The sad truth is that a drug which should eliminate concerns that much would need to be on the order 90%+ effective. It would need to be effective enough to the keep hospitals from reaching capacity while the broader population either developed natural immunity or gets vaccinated.

Now... if the drug were preventative and stopped 50% of people from getting sick or becoming infectious... THAT would be a huge deal. Breaking the chain of infection is a MUCH more effective than measures which deal with what happens AFTER a person is hospitalized. Because now you're not just reducing deaths, but also limiting new cases.