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Senate Republicans’ projection of confidence following last week’s elections isn’t exactly translating into improving prospects for next year’s midterms.

On Tuesday, New Hampshire’s very popular GOP governor, Chris Sununu, announced he would bypass a Senate bid to run for a fourth term in the Granite State.

Sununu had been considered the strongest possible contender to unseat first-term Democratic Sen. Maggie Hassan of New Hampshire, and his declination is a major blow to the GOP effort to retake the Senate majority next year.

In explaining his decision, Sununu also suggested joining the U.S. Senate was about as appealing as choking down a plate full of cold, soggy eggs every day for the foreseeable future.  

“I’d rather push myself 120 miles an hour delivering wins for New Hampshire than to slow down, end up on Capitol Hill, debating partisan politics without results,” Sununu said. “That’s why I’m going to run for a fourth term.”

Nothing sums up Minority Leader Mitch McConnell’s GOP caucus better than “partisan politics without results.” Even better, Sununu forgot to inform McConnell and Senate GOP campaign chief Rick Scott of his decision before going public with it.”I guess you’ll have to let them know. I haven’t talked to them,” Sununu told reporters. Ouch.

But Sununu wasn’t alone in his grim assessment of joining Senate Republicans on Capitol Hill. Shortly after Sununu gave McConnell the heave-ho, former Republican Sen. Kelly Ayotte, who narrowly lost her seat to Hassan in 2016, also appeared to be taking a pass on the prospect of taking orders from McConnell in the Senate. Sources close to Ayotte told WMUR the former senator would not be running.

Senate Republicans’ chances of picking up a seat in New Hampshire just got significantly downgraded. But the rejection from both Sununu and Ayotte represents something much bigger that just one seat: It’s a collapsing of the Senate GOP’s establishment wing.

McConnell is looking weaker than ever. His recent endorsement of alleged wife abuser Herschel Walker for the Georgia Senate seat laid bare how truly desperate and subservient to Donald Trump he is. No sane-ish Republican wants to join McConnell’s do-nothing caucus so they can twiddle their thumbs for two years in hopes that they will become Trump’s chattel in 2024.

Back in Kentucky, McConnell put on a brave face, telling reporters, “I think the wind is going to be at our backs in both the House and Senate.” He also reiterated for the umpteenth time that the 2022 midterms “will be about the future, not about the past.” Republicans just keep saying that as if they will be able to wipe away the stain of Trump’s ceaseless grousing about the supposedly “stolen” 2020 election.

But Sununu and Ayotte know that past is prologue. McConnell’s standard of governing—whether he’s in the minority or the majority—is to impede progress and get as little done as possible. They also know that McConnell has surrendered the party to Trump, and that will continue to be true no matter who wins the Senate next year.

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Yet another lawsuit has been filed against the state of Texas over its abhorrent redistricting maps, which were approved last month by Gov. Greg Abbott after the third and final special legislative session of the year. The Texas State Conference of the NAACP is being represented by the Lawyers’ Committee for Civil Rights Under Law, and Dechert LLP, who filed their complaint in federal court in the Western District of Texas, Austin Division, last Friday.

The lawsuit explicitly names state Rep. Todd Hunter, who chairs the House Redistricting Committee and filed the house redistricting plan that was tinkered with but ultimately passed. Along the way, Hunter blocked public testimony from experts, imposed strict time limits on key hearing components, and forced lawmakers to push his proposals through while disregarding and ultimately voting down a baffling number of amendments designed to protect voters of color.

Also named is state Sen. Joan Huffman, who chairs the Senate Special Committee on Redistricting and introduced congressional and senate redistricting maps. Huffman routinely ignored requests to show how the redistricting maps that were ultimately adopted complied with the Voting Rights Act and said she saw no evident reason to create any new opportunity districts for voters of color, despite the fact that a majority of the nearly 4 million new Texas residents counted in the recent census were Black, Asian, and Latino.

A section of the lawsuit describing Huffman’s aversion to acknowledging race when drawing the Senate map really says it all: “Senator Huffman told lawmakers and the public that the maps were ‘drawn blind to race,’ despite the fact that some consideration of race is necessary for compliance with the [Voting Rights Act].”

Texas lawmakers have had a markedly easier time elevating Republicans over actual voters due to the fact that redistricting for the first time in the state required no federal preclearance. A key provision in the Voting Rights Act in which federal oversight was necessary for states like Texas—along with regions and cities with histories of voter disenfranchisement—was struck down in 2013 by the Supreme Court.

Prior to the Shelby vs. Holder decision nullifying the 1976 Voting Rights Act amendment, Texas faced more than 200 objections by the Justice Department over redistricting and voting accessibility. It’s clear Texas hasn’t learned from its mistakes and groups like the NAACP and Lawyers’ Committee are more than willing to take lawmakers to task for the sake of accountability.

Lawyers’ Committee Voting Rights Project co-director Ezra Rosenberg didn’t mince words in a press release announcing the recent lawsuit: “This is backward and a perversion of justice that cannot stand. The court must recognize this illegal chicanery for what it is and rule that these maps are unconstitutional and act to protect the voice of every voter in Texas.”

In addition to this latest lawsuit, Texas faces legal challenges to its redistricting maps from the likes of Voto Latino, the League of United Latin American Citizens, and the NAACP Legal Defense Fund.

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Trump ex-spokescreature Kellyanne Conway is a lying propagandist. That is her only purpose. She may have had, at some earlier point in her life, another, but for the last half-decade her purpose has been to brazenly lie to the public in service to a fascist movement bent on propping up a delusional and incompetent narcissist as the nation’s long-awaited golf-cheating tax-dodging god-king. Fox News is a fascist network, a network now so devoted to promoting falsehoods that their pandemic viewers are dying off at elevated rates.

Just because the propagandists are literally getting people killed doesn’t mean their efforts aren’t ridiculous. Fox News hosted Conway to gaslight their equally ridiculous viewers into believing that one of the most memorable parts of the early pandemic didn’t happen. You know, the thing we all lived. The thing every last person old enough to have grasped object permanence lived through, because it was a freakin’ year and a half ago. Welcome to the magical world of rewriting history, explained to you by a floating head reporting from what appears to be some sort of alcohol-serving news casino:

There is, we’re all going to admit, at least some possibility that First Lieutenant Bullshit here “never even heard” of a supply chain crisis during her White House tenure. There is a staggering amount of things the Trump White House appeared to neither know about nor give a rat’s ass about, from ethics laws to why attempting to cure COVID patients with ingested disinfectants might be a bad idea. Conway’s White House most definitely heard about a supply chain crisis during the first year of the pandemic, however, because Conway was one of the malevolent, lying hacks whose White House job was to tell reporters asking about it that it was all perfectly under control.

Just because Conway is still around and still one of the most dishonest people in all of America, however, doesn’t mean we have to treat her with any respect. The great and glorious internets were very quick to latch on to the Conway-Fox attempt at mass delusion, and Conway’s garbage doesn’t deserve any response other than internet mockery so away-we-freakin’-go:

She’s not a liar. She’s a propagandist. Her lies are not for her own personal sake, but to convince Americans that their own recent history did not happen in an attempt to justify the political ideology that produced it. Conservatism demanded that pandemic preparedness be slashed, that international pandemic cooperation be curtailed, all in service to cutting government and lowering the taxes of the topmost class. It was a calculated risk, an assumption that a pandemic would not happen or, if it did, none of those affected by it would put two and two together and wonder why the nation was caught flatfooted when it did.

Most of the internet’s replies to Conway consist of pictures and reminiscing about the days when store shelves were empty, not just of cleaning supplies but of meat, and fruit, and God help you if you needed the Postal Service to deliver a critical replacement part because it would get to you sometime between four weeks from now and never. Gas prices were high, even though there was nowhere to go. Hospitals could not get enough of anything—and the Trump White House seemed quicker to focus on purchasing anti-malaria miracle cures, to the tune of a bajillionty doses, than the things actually needed.

Conway is a propagandist still devoted to a fascist and incompetent movement. If history needs to be rewritten to convince Fox News viewers that the movement produced only victories and their hated opponents are the cause of all ills, Conway will come out of semi-retirement to lie again.

The COVID-19 pandemic is, after all, spreading most vigorously in Republican-led regions with Republican-devoted Fox News viewers. The people she is lying to are the ones who most need reassurance that the pandemic surrounding them is Actually somebody else’s fault.

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Have you guys subscribed yet to The Brief, our weekly podcast about politics?

We film live on Tuesdays, 1:30 PM PT/4:30 PM ET. 

Today, we take a look at last week’s electoral wreckage and what it means for next year’s 2022 midterm elections. Joining us are Drew Linzer, who runs Civiqs, our data and research arm, and David Nir, who runs Daily Kos Elections. We’ll look at the results, the data, and the current polling, and explore whether Democrats have any chance of holding Congress next year. 

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CBS News reports that advocates for refugees evacuated from Afghanistan this past summer as part of Operation Allies Rescue have urged the Biden administration to waive immigration-related fees. Many families arrived to the U.S. with just the clothes on their backs, much less with money in their pockets for work permits and green card applications.

But good news came for them on Monday, when the Department of Homeland Security (DHS) announced it would be waiving U.S. Citizenship and Immigration Services (USCIS) fees for thousands of refugees who arrived after July 30. “These actions will help facilitate their resettlement in the U.S. by streamlining the processing of requests for work authorization, Green Cards, and associated services.” Advocates applauded the move.

“Krish O’Mara Vignarajah, president of the Lutheran Immigration and Refugee Service, one of nine national refugee resettlement agencies, welcomed Monday’s announcement, saying many of the Afghan families her group serves face financial insecurity and are eager to find jobs,” CBS News reported. Work permit and associated fees top nearly $500; green card paperwork more than doubles that amount.

“Today’s announcement provides some much-needed financial relief to our newest Afghan neighbors,” O’Mara Vignarajah wrote in a Twitter thread. “Most of the families we’re serving have no nest egg to draw from, and every expense is a source of stress and anxiety. Removing this financial burden will go a long way in leveling the playing field and setting up these newcomers for success. We are especially grateful to the Biden administration for streamlined processing of work authorization.”

DHS Sec. Alejandro Mayorkas said in a statement that by waiving USCIS fees, “we will open doors of opportunity for our Afghan allies and help them begin to rebuild their lives in communities across our country more quickly. These actions demonstrate our ongoing commitment to Afghan nationals who provided valuable assistance to the United States over the past two decades as well as other Afghans at risk.”

CBS News reports that the vast majority of Afghan evacuees, 50,000, continue to be housed at several military bases across the U.S. 14,000 have left these bases for resettlement throughout the country. Among those resettled have been four children orphaned when their mother was killed amid the withdrawal, CBS Evening News said. They are now in Texas with a cousin. “Another 2,000 Afghan evacuees remain at bases in the Middle East and Europe, where U.S. officials have been conducting security screenings and background checks, according to DHS statistics,” CBS News continued.

In a move attempting to lessen the burdens facing agencies working to resettle families within the U.S., the administration late last month announced an initiative that would allow small groups of vetted individuals to form “sponsor circles,” which will be responsible for securing housing and financial support for Afghans. The Sponsor Circle Program mirrors efforts in Canada. That move was similarly applauded by advocates, including O’Mara Vignarajah.

Other recent efforts have also included a campaign urging Americans to donate spare airline miles to refugees leaving U.S. bases. In a release received by Daily Kos, Miles4Migrants and partner Welcome.US said they’re seeking to secure 450 million miles, “needed to provide every evacuee with a flight to their new home.” Thousands of flights have already been secured.

When it comes to applying for necessary documents to help secure their new lives here, O’Mara Vignarajah said in her thread that LIRS clients “have expressed their frustration with the bureaucratic inefficiency that has prevented them from accessing the dignity of a job and the financial security that comes with it. This policy decision is an economic win-win; we can get these families on the road to self-sufficiency, and we can unleash their potential for employers desperate for talented workers amid a labor shortage.”

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As the Kyle Rittenhouse trial continues, the only protester shot by Rittenhouse to survive testified on Monday. Gaige Grosskreutz, a volunteer medic and protestor who was the third and final man shot by Rittenhouse in the summer of 2020, recalled the events that led up to the shooting during Rittenhouse’s murder trial, the Associated Press reported.

Defense attorneys attempted to use Grosskreutz’s testimony to justify their claim that Rittenhouse acted in self-defense because Grosskreutz admitted that he pointed his own gun at Rittenhouse prior to being shot. Rittenhouse stands on trial for killing two men and wounding Grosskreutz.

“I thought the defendant was an active shooter,” 27-year-old Grosskreutz said. When asked what was going through his mind during the incident he said, “That I was going to die.” Grosskreutz was shot in the arm, which resulted in tearing away much of his bicep. Witnesses described it as being “vaporized.”

While the prosecution depicted Rittenhouse as the coldhearted racist killer he is, defense lawyers have been arguing the case of self-defense. Defense attorney Corey Chirafisi attempted to make it seem like Rittenhouse was in danger and acted upon that during the cross-examination. According to Reuters, he asked: “When you were standing 3 to 5 feet from him with your arms up in the air, he never fired, right?”

“Correct,” Grosskreutz responded.

“It wasn’t until you pointed your gun at him, advanced on him, with your gun, now your hands down pointed at him, that he fired, right?” Chirafisi continued.

“Correct,” Grosskreutz said. A photo depicting Grosskreutz pointing a gun at Rittenhouse was also shown.

According to Wisconsin’s self-defense law, deadly force is permissible only if “necessary to prevent imminent death or great bodily harm.” Defense attorneys are banking on this law.

However, Grosskreutz did not shoot first, although he “closed in” on Rittenhouse.

“That’s not the kind of person that I am. That’s not why I was out there,” Grozzkreutz said when asked why he didn’t shoot at Rittenhouse. “It’s not who I am. And definitely not somebody I would want to become.” He added that he did not mean to point his gun in the direction of Rittenhouse.

Grosskreutz attended the protest to serve as a medic. He wore a hat that said “paramedic” and carried medical supplies, in addition to a loaded pistol.

“I believe in the Second Amendment. I’m for people’s right to carry and bear arms,” he said, explaining why he was armed. “And that night was no different than any other day. It’s keys, phone, wallet, gun.”

According to Grosskreutz’s testimony, he didn’t act until after seeing Rittenhouse kill a man just feet away. While he was holding his pistol his hands were in the air. Video evidence and a criminal complaint filed days after the shootings last year confirm this.

“At that moment I felt that I had to do something to try and prevent myself from being killed or shot,” Grosskreutz said.

Chirafisi not only attempted to portray Grosskreutz as threatening to Rittenhouse but brought up his lawsuit against the city of Kenosha.

“If Mr. Rittenhouse is convicted, your chance of getting 10 million bucks is better, right?” Chirafisi said.

Grosskreutz’s testimony is pivotal as the trial enters its second week. Multiple witnesses provided testimony that seemed to support the teen’s claim of self-defense last week, Reuters reported. If convicted, Rittenhouse faces life in prison. He has pleaded not guilty and is looking to take the stand under self-defense.

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In the middle of October, right-wing radio host Dennis Prager told his audience that he had contracted COVID-19. He told his audience that he had purposely “engaged with strangers, constantly hugging them, taking photos with them knowing that I was making myself very susceptible to getting COVID. Which is, indeed, as bizarre as it sounded, what I wanted, in the hope I would achieve natural immunity and be taken care of by therapeutics. That is exactly what has happened.” It was a special kind of madness that only Prager could generate.

Prager, like all ultra right-wingers, has been on the bleeding edge of profound misinformation, promoting an anti-flatten-the-coronavirus-curve model of living over during the pandemic. This is the same Prager who told women during the Brett Kavanaugh hearings to just get over sexual harassment and assault. On Monday, video of Prager being interviewed on the Chris Salcedo show, ostensibly to carry oil for his billionaire fracking backers, drew what can only be called one of the most offensive comparisons concerning unvaccinated Americans and the LGBTQ community during the HIV/AIDS crises in the 1980s and 1990s. 

Prager began by reversing reality, explaining that Democratic policies and a culture of climate change fear have led to middle class and lower class folks not being able to afford energy costs. To unwrap this 100% fabricated line of thinking is to leave the real world we all live in. Needless to say, Prager’s basic tapestry is one of fearmongering by liberal elites, making everyone afraid of fossil fuels and big fossil fuel company monopolies. It is the same as Trump, the same as most Republican officials these days: all projections of GOP fearmongering about Big Bird and critical race theory and Dr. Seuss, etc. 

However, Prager wants to connect the fossil fuel energy—the one that recently brought you a wintertime disaster in Texas—to public health measures during the time of COVID-19. Transitioning by calling climate change an “irrational fear” and saying that if our democracy “survived” the current onslaught against it by … Democrats (surprise twist!), historians would ask themselves, “How did people get governed by irrational fears?”

DENNIS PRAGER: Whether it is of the nonvaccinated who are the pariahs of America—as I have not seen it in my lifetime, any pariah group like this. During the AIDS crisis, can you imagine if gay men and intravenous drug users, who were the vast majority of people with AIDS, had they been pariahs the way the nonvaccinated are? But it would’ve been inconceivable. And should have been inconceivable!

The only true thing he says in those few lines is that it “should have been inconceivable.” Every other single thing he says in revising the history of the AIDS crisis under then-president Ronald Reagan is a lie. It is not an opinion. It is factually incorrect.

Ronald Reagan deliberately chose to ignore the rising public health crisis, which he was aware of, along with the Centers for Disease Control and Prevention during his first year in office. His administration joked that it was the “gay plague” in its first White House press briefing. Reagan would not even acknowledge AIDS publicly until 1987, after nearly 41,000 Americans had died from the virus. Reagan was a piece of shit for many reasons, not the least of which was his deadly homophobic policy—or lack thereof—on the AIDS crisis in America.

Remember 14-year-old Ryan White, who likely contracted the AIDS virus through a blood transfusion and then had to fight as some parents and some teachers fought to keep him from being able to attend school in Kokomo, Indiana? He wasn’t even gay. He just had a virus that could only be transmitted through blood, and the same people who refuse to wear masks during a respiratory virus today treated him like a pariah. White’s fight for normalcy in his life put a “face” on the AIDS virus that Americans, because of homophobia and the stigmatization of drugs, had not been able to reconcile. Ryan died at the age of 18 in the spring of 1990.

Meanwhile, we can get in the wayback machine and travel to 2008, when Prager wrote a column for Townhall. On Nov. 25 of that year, probably just in time for Thanksgiving, Prager wrote this: “Even the natural sciences are increasingly subject to being rendered a means to a ‘progressive’ end. There was the pseudo-threat of heterosexual AIDS in America — science manipulated in order to de-stigmatize AIDS as primarily a gay man’s disease and to increase funding for AIDS research.” William F. Buckley Jr., a man who Prager likely had pictures of in his locker and above his bed, wrote this* in March of 1986 in The New York Times:

Everyone detected with AIDS should be tatooed [sic] in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals.

The Tom Hanks, Denzel Washington, and Johnathan Demme Academy Award-winning film Philadelphia was literally the story of a real-life civil rights lawsuit about discrimination because of HIV and AIDS in the workplace.

Salcedo’s show is a perfect place for this kind of multiverse reading of a bizarro world history where gay men were treated like human beings during the first decades of the AIDS epidemic. His platform is the same one that has brought on former Fox News personalities to argue that Fox News brass should be jailed because they didn’t follow through with the big lie that the election was stolen from Donald Trump by massive voter fraud.

Part of what makes people like Prager dangerous is not that they are simply hateful ignoramuses. It is that people like Prager are bankrolled by hateful billionaires, allowing their drivel to be marketed up and out into the American public, with a patina of legitimacy that is meant to confuse issues and seed general right-wing propaganda. PragerU is Prager’s pretend university that is funded by fracking magnates Dan and Farris Wilks. Through Prager, they promote fossil fuel interests and whatever other alternate reality takes on the material world.

PragerU, a nonprofit, has reportedly been pushing itself into public schools by way of misinforming videos for years.

Five-minute videos are PragerU’s bread and butter. With over 4.8 billion total views, the videos often go viral and have titles like “Just Say ‘Merry Christmas’” and “The Myth of Voter Suppression.” “It’s slick, it’s cute, it has amazing graphics, and their narrators are diverse,” said Ashley Woodson, the head of Freedom School, an educational program for the Abolitionist Teaching Network.

…

Last fall, PragerU began its first massive initiative to concertedly push its content into schools. Known as “PREP,” the educational program already has over 6,000 educators and parents signed up. An annual donation of $25 gives users access to the program’s materials and a private Facebook group with over 1,400 members. Its website says that the media nonprofit launched the program “to give [educators and parents] the resources, support, and tools to teach their children about America’s blessings and limitless opportunities.”

Actor Jeffrey Wright gave a nice summation of Prager and his ilk’s views on the world and what they consider American history, writing:

Stigmatization of dying gays & drug users. When?

Racism. Never existed.

Climate change.

Hogwash.

COVID. Just a flesh wound.

Vaccine. Doesn’t work.

Big Bird. Commie.

White genocide, JFK Jr & The Rapture. Coming soon.

*Buckley was suggesting this solution for a much more communicable virus like, say, COVID-19.

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Pennsylvania GOP Senate candidate Sean Parnell testified Monday in a contentious custody battle with his estranged wife, entirely refuting her allegations of abuse against herself and their children.

Parnell, who said he “never” got physical with his wife or their three kids, was not subject to cross-examination and will take the stand again Tuesday.

At the same time, Politico reports that Parnell’s candidacy is on life support and Donald Trump is eagerly trying to revive it. Trump, who endorsed Parnell before the custody battle turned toxic, announced Friday he would hold a Mar-a-Lago fundraiser for Parnell in January.

It’s an obvious effort to shore up a candidacy that is crumbling. Last Friday, Parnell skipped out on a call with donors during which he was expected to field questions about the status of his campaign. As Parnell flounders, some GOP insiders are also questioning his fundraising after he posted a lackluster $1.1 million haul in the third quarter—pretty underwhelming given Trump’s endorsement and how crucial the seat is for Senate Republicans’ takeover prospects next year.

Pennsylvania Republicans have reportedly keyed in on combat vet and hedge fund executive David McCormick to salvage their prospects for keeping the open seat in GOP hands. McCormick hasn’t indicated whether he will run yet, but he would bring to the table business experience, a Bronze Star, a Ph.D. from Princeton, and experience serving as a Treasury official in George W. Bush’s administration.

In the meantime, Parnell’s ugly custody battle is dominating the headlines, and Senate Republicans are bringing their special brand of spinelessness to the discussion. To date, none of them have proven brave enough to even generically denounce abusive behavior as disqualifying. National Republican Senatorial Committee chair Rick Scott spent a Monday appearance on CNN dodging a question about whether Parnell was “still the right candidate” for the job.

“We’ll see who comes out of the primary,” Scott said.

Wow, bold. Of course, denouncing abusive behavior would also call into question the Senate GOP’s Trump/McConnell-endorsed candidate in Georgia, Herschel Walker, who allegedly made a habit of telling his significant others he wanted to “blow” their brains out.  

Senate Republicans are attempting to look neutral while secretly praying Parnell’s candidacy implodes so they can move on. Trump is doing everything possible to save his guy because there’s no one Trump respects more than someone accused of abusing women.

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From the outset of the pandemic, Republicans have seized on anecdotal claims of COVID-killing drugs to either downplay the disease itself or as an excuse to refuse vaccines. Donald Trump was at the front of the line in pushing anti-malaria treatment hydroxychloroquine as a “miracle cure” for COVID-19. As the delta wave took hold, Trump supporters turned to the anti-parasitic ivermectin as their new wonder drug. That’s despite the fact that repeated trials have determined that these treatments are ineffective. Hydroxychloroquine was punted from WHO’s trials after repeated failures to show results. Ivermectin is still involved in some ongoing trials, but it’s not looking good.

However, there are some genuine treatments that are effective in treating COVID-19, one of which has been widely used and pushed by both Texas Gov. Greg Abbott and Florida Gov. Ron DeSantis as an excuse to not take the vaccine: monoclonal antibodies. This treatment is available from at least two sources: Regenron, which uses a “cocktail” of two antibodies called casirivimab and imdevimab; and Eli Lilly, which offers bamlanivimab. Both treatments are available under emergency use authorizations from the Food and Drug Administration (FDA), and both of them have been found to reduce the risk of death by about 70% for patients who take a course of treatment soon after testing positive for COVID-19. However, the cost of these treatment is high, ranging from $1,600 to $2,100 for a course of treatment.

More recently, two new antiviral treatments have completed phase 2/3 testing and are in the process of being made available to the public. These are ritonavir from Pfizer and molnupiravir from Merck. Molnupiravir, which reduced the risk of hospitalization and death by 50%, has now gained approval for its first rollout in Europe. Phase 3 results indicated that ritonavir reduced deaths by 89%. A course of treatment for either drug is expected to cost around $700, but since they are oral treatments that—unlike monoclonal antibodies—don’t require IV administration by a medical professional, they’ll be much cheaper and easier to roll out.

However, there’s another alternative—one that’s already been approved by the FDA, is already in wide use, costs $4 for a course of treatment, and may be better at preventing COVID-19 deaths than all of the above. That alternative is the antidepressant drug fluvoxamine.

The idea that a drug isn’t specifically an antiviral is no reason to discount its worth in fighting against COVID-19 or any other disease. After all, the biggest change in death rates between the first and second wave of COVID-19 came from the widespread use of steroids to control inflammation and make intubation and other forms of breathing assistance more tolerable. 

Hydroxychloroquine first got onto the radar not because of Trump, but because it was one of a group of drugs (disease-modifying antirheumatic drugs) thought to be capable of modifying the communications between cells and the immune system. There were similar anecdotal reports of effectiveness against other diseases, and testing it made sense. What didn’t make sense was Trump standing up to tout the drug as a “miracle” before the data was in—because when that data came in, it showed no positive effect.

In the case of fluvoxamine, it was pulled into COVID-19 studies not because there was thought to be a mechanism by which it would kill the virus, but because it’s one of a group of drugs known as “selective serotonin reuptake inhibitors.” These drugs recently came to the attention of researchers looking at disease treatment after a 2012 study showed that their actual mechanism of action was by lowering inflammation. Inflammation has a strong association with depression—even if the why of that connection isn’t completely understood. But because SSRIs fight inflammation, fluvoxamine is one of several such drugs that have been tested for effectiveness in fighting the symptoms of COVID-19.

The November 2020 issue of the Journal of the American Medical Association contained the results of a small randomized trial conducted by Washington University in St. Louis. The study looked at 152 adults with symptomatic COVID-19, 72 of whom were given placebo rather than fluvoxamine. And the results were good:

Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group.

This was a double-blind, placebo-controlled study—which is about as good as things get on that front. However, the authors acknowledge that “the study is limited by a small sample size and short follow-up duration, and determination of clinical efficacy would require larger randomized trials with more definitive outcome measures.” Because of the date of the trial, none of those involved was vaccinated, and none had been exposed to the delta variant. Washington University began a more extensive trial targeting 1,100 patients last December as part of the broader STOP COVID2 effort.

Fortunately, there already is a larger study. Because another study was recently published in the British medical journal Lancet. 

That study was also a placebo-controlled, randomized trial. But this one involved 1,497 patients in Brazil, 741 patients of whom got fluvoxamine and and 756 who received a placebo. The Brazil study also helped to address the other issue mentioned by the St. Louis researchers in that they extended the length of the study to 28 days after the drug (or placebo) was first administered.

Interpretation of the results from the trial were a bit more complex than those in the St. Louis group as the patients were all considered to be at high risk for significant complications, all of them were  unvaccinated, and some members began treatment while already experiencing severe symptoms. The term “hospitalized” was also a bit different than in other studies as it included any patient treated for over six hours in an ER or specialized COVID center as well as those admitted with severe symptoms.

But the end results were this: Patients who who received a full 8-10 day course of treatment had a 66% lower rate of hospitalization when compared to placebo. The reduction in deaths among this group was 91%.

Even the study in Brazil still isn’t large enough to determine the real value of fluvoxamine in treating COVID-19. For one thing, a significant portion of the patients didn’t complete the full course (those patients saw about a one-third drop in hospitalizations). Neither the St. Louis nor the Brazil study was sufficient to determine the best time to begin treatment, the best dosage, or long-term consequences. But all of that may be derived when full data from the U.S. and Canadian arms of STOP COVID2 come in.

Fluvoxamine, like other SSRIs, does have potential side effects. It can actually make depression worse, as well as causing unpleasant effects like nausea and sweating. Antidepressants in this class are not addictive, but people who take them for a long period can still suffer from withdrawal when stopping—though that shouldn’t be a problem when taken for only a few days. It’s been around since the 1990s, it’s be prescribed to tens of millions of patients, and the interactions and side effects are generally well understood.

Should the results seen so far hold up, fluvoxamine holds promise not just as a cheap alternative to the antivirals being marketed by Merck and Pfizer, but possibly as the best option to keep a patient in the early stages of COVID-19 infection from dying.