In a large bowl, combine the beef, shallot, bread crumbs, oregano, ketchup, egg, two tablespoons of the cheese, and red pepper flake (if using).
Add a few pinches of salt and pepper.
Heat the oil in a large skillet.
Working in batches, roll the beef into small 1/2" or so round balls (I admit, mine were probably more like an 1" around). You'll make a lot of meatballs.
Add meatballs to the skillet but do not crowd them. Brown on one side, then flip and brown on the other side.
Remove to a paper towel-lined plate.
Slowly place all of the meatballs into a dutch oven or other large oven-safe dish.
Add the tomato sauce but do not stir.
Cover and place in the oven for 20-30 minutes.
Meanwhile, cook the pasta per package instructions and drain well.
Remove meatballs from oven and gently stir in the pasta.
Serve with more Parmesan cheese.
Notes
Make lots and lots of tiny meatballs to stay as close to the original as possible!