Most relevant portion of the article (from the discussion). I'm breaking this up into chunks to make it easier to read: "New variants of SARS-CoV-2 are generat

Most relevant portion of the article (from the discussion). I'm breaking this up into chunks to make it easier to read: "New variants of SARS-CoV-2 are generated through acquisition of mutations that enhance properties including immune evasion and intrinsic transmissibility (Telenti et al., 2022; Carabelli et al., 2023). The impact of molnupiravir treatment on the trajectory of variant generation and transmission is difficult to predict. On the one hand, molnupiravir increases the amount of sequence diversity in the surviving viral population in the host and this might be expected to provide more material for selection to act on during intra-host evolution towards these properties that increase fitness. However, a high proportion of induced mutations are likely to be deleterious or neutral, and it is necessary to consider the counterfactual to molnupiravir treatment. As molnupiravir results in a modest reduction in viral load in treated patients (Khoo et al., 2022), it is possible that in the absence of treatment the total viral load would be higher and chronic infections might persist for longer. Variants generated through chronic infections might be fitter than those that have accumulated mutations during molnupiravir treatment, albeit taking a much longer period of time to accumulate the same number of mutations and therefore usually being derived from older, rather than contemporary lineages. At the time of writing we have not identified a molnupiravir-implicated cluster that had spread to more than 21 individuals." Figure 8 is also interesting, as it shows the mutagenic nature of molnupiravir compared to a placebo.