For the first two weeks after recovery, keep tabs on your symptoms, and use rapid antigen tests to boost your chances of an early warning sign (daily, or every 2-3 days if asymptomatic, depending on test availability). If you take Paxlovid, be on the lookout for a rebound. Talk to your doctor or pharmacist about eligibility based on your risk factors and medications.
Paxlovid treatment is well established to reduce hospitalizations and deaths in high-risk individuals. If you are eligible for Paxlovid treatment, don’t let a potential rebound deter you. All four rebound cases had multiple serious health conditions and had been vaccinated more than 90 days before their COVID-19 infections. One of the larger studies found 4 rebound cases among 483 Paxlovid-treated patients. Who is most likely to rebound? Data on this question are really sparse, so it’s hard to generalize. This doesn’t mean that drug-resistant mutations don’t happen (they do happen!), but they are not a major cause of rebound at this time. Rebound is NOT typically caused by viral mutations that cause drug resistance, according to a handful of studies that sequenced the viral genetic blueprint following rebound. Some say that giving Paxlovoid so early may not allow the immune system to fully rev up others wonder if we should be giving longer courses. We don’t really know why this is happening.
What causes rebound? It seems that the initial viral infection is not truly cleared, and the virus won a tug-of-war with the immune system. Indeed, COVID-19 rebound was observed before Paxlovid was around, and was just as common in the control group of one of Pfizer’s Paxlovid trials. Some experts say that rebound may be part of the natural history of the disease, and occur with or without Paxlovid. The chances of a rebound may be impacted by many factors, including the variant, vaccination status, health status, and more. It seems that that the more we look for rebound, the more we find it. Notably, rebound rates did not differ between the two drugs. The study population looked at COVID-19 positive in January to June 2022, who were treated with Paxlovid (n =11,270) or with Molnupiravir (n =2,374) within 5 days of their COVID-19 infection. This estimate is from a June 2022 study that has not yet been peer-reviewed. How common is rebound? The current best guess is that roughly 5-6% of Paxlovid treated cases will recur. Anthony Fauci opted for a second round when his rebound symptoms were worse than his initial symptoms, but this is not the standard recommendation. There is currently no evidence that additional treatment is needed with Paxlovid or other anti-SARS-CoV-2 therapies in cases where COVID-19 rebound is suspected.” Dr. According to the CDC: “Limited information from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness there are no reports of severe disease. Current guidelines from the US Centers for Disease Control and Prevention (CDC) advise following the same isolation and masking protocols as new infections (isolate 5 days, mask for another 5 days).ĭo I need a second course of Paxlovid? Probably not. When does rebound occur? Rebound typically begins around 9 days after recovery, but could be as early as 2 days, or as long as 14 days later.ĭo I need to self-isolate again? Am I contagious? Current evidence suggests that caution is warranted, as several case reports have documented transmission during rebound, including one case of pre-symptomatic spread to a baby grandchild.
Peter Hotez.Īs we tackle your Paxlovid FAQs, bear in mind we are working with very limited data, and that some of these answers may evolve as we learn more. It has been used by millions of Americans, including prominent figures like President Joe Biden, Dr. Thus, either symptoms, a positive COVID-19 antigen test, or both, qualifies as rebound.As a reminder, Paxlovid is an antiviral combination drug treatment (nirmatrelivir and ritonavir) that reduces the risk of hospitalization and death from COVID-19 in high-risk populations. According to the CDC’s recent Health Advisory announcement, Paxlovid rebound is “characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative”.
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