On the other hand, azithromycin provides high binding affinity when adjusted for energetics and has a much better ability at directly targeting the binding interaction point between the SARS-CoV-2 spike and ACE2. Much of this has to do with azithromycin's nearly symmetric design: this allows the small molecule to effectively handle binding with ligands between both the spike and the ACE2, which could possibly create an energetics barrier between the two proteins. Dinos et al . was one of the few groups that looked deeper into the pharmacokinetics of azithromycin, and found that the interaction between azithromycin and other small molecules leads to the competition for binding sites, which the azithromycin wins due to its ability to isomerize rapidly . This, coupled with its ability to increase pH, allows for it to, as Gautret et al . had identified, decrease the viral effects of COVID-19 .