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Preheat oven to 375ºF and preheat a cast iron, or other oven safe, skillet over medium heat. Add the olive oil to the pan and heat for another minute.
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Add the onions and garlic and cook for until softened and beginning to brown. (about 5 minutes)
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Add the red pepper and oregano and cook for a minute more.
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Add the vodka and cook until reduced by half. (about 5-7 minutes) and while the vodka is reducing, drain the tomatoes in a colander.
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Crush the whole tomatoes in the palm of your hand directly into the pan. Be careful not to let tomato squirt onto yourself.
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Add the kosher salt and a pinch of freshly ground black pepper. Cover the pan and put it in the oven for 1 1/2 hours. Remove and let cool for 15 minutes.
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Bring a large pot of salted water to a boil.
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Pour the contents of the pan into a blender and puree until smooth. Pour the puree back into the pan.
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Reheat the sauce over medium heat. Add the basil ribbons, heavy cream, and fish sauce. Stir to incorporate and let it simmer.
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Add the penne to the boiling water and cook al dente according to the package. Drain and reserve 1/4 cup of the pasta water.
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Add the water to the sauce and stir. Then add the penne and toss and cook for about a minute more.
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Add the parmesan cheese and stir.
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Garnish with basil and serve with more parmesan and red pepper on the side.