What to do
Some people take Paxlovid, while others don’t, and they experience a rebound of Covid-19 symptoms, or positive test results, days or weeks after finishing treatment.
Recent high-profile cases of rebound, such as President Joe Biden’s, first lady Jill Biden and Dr.
Anthony Fauci, raise questions about how often this occurs.
A spokesperson for the US Centers for Disease Control and Prevention stated that Covid-19 rebound was a rare event.
“This isn’t happening most of the time.” A small number of Covid-19 patients experience rebound symptoms.
This includes those taking antiviral medications like Paxlovid.
Experts believe that rebound cases are more frequent than the data suggest, although it is difficult to determine exactly by how many.
It’s possible to estimate what this “small percentage” could be, ranging from less than 1 percent of those who have taken Paxlovid up to 10%.
However, definitions of rebound cases are not consistent.
According to a CDC health advisory, a brief return of symptoms could be part of SARS-CoV-2 infection (the virus that causes COVID-19).
According to Dr.
Michael Charness of Veterans Administration Medical Center, Boston, it is important to understand the details for each patient and their community.
He has worked with Columbia University researchers to examine cases of Covid-19 returning after treatment.
He said that rebound cases can spread easily and patients may need to reisolate according to CDC guidelines.
For others, a return to symptoms, or positive tests, can be “certainly a concern for many people and leave them wondering: “Why is this happening? Tracking Covid-19 rebound.
In clinical trials documents that were submitted to the US Food and Drug Administration in 2013, Pfizer stated that several subjects had experienced a rebound of SARS-CoV-2 DNA levels.
The data showed that approximately 2% of patients had a persistent or present viral load rebound.
This was the same percentage for both people who were treated with Paxlovid as well as those in the placebo group.
Pfizer has no additional information on rebound cases other than the data from clinical trials.
These were done during the time that the Delta variant was predominant and most people weren’t vaccinated.
Preprint studies that followed rebound cases in the Omicron waves found that between 2 and 4% experienced symptoms or a rebound within one week.
5 to 6% of those patients had rebounded within a month.
Researchers from Mayo Clinic published a separate study in June that was broadly consistent with Pfizer clinical trial data.
Researchers found that approximately 1% of Paxlovid patients experienced a rebound in symptoms after about nine days.
This retrospective study could not tell whether patients had tested positive or not.
Aditya Shah (infectious disease specialist, and author of this report), believes that the real rate may be closer to 10%.
This type of study is not without its limitations.
Shah stated that all these patients have returned home and some of the rebounding symptoms may not be going to their doctors.
Our study clearly showed that we had a low number of cases.
Charness estimates that there is a comparable Covid-19 rebound rate among vaccinated persons who have received Paxlovid, although uncertainty persists.
There hasn’t been any study to give us an answer.
He said that it is unlikely to be 50% and probably not even 2%.
I wouldn’t be surprised to see it in the 5-10% range for those who have been treated, compared to the 1-2% range for untreated patients.
According to preliminary data from the CDC, people who have comorbidities are more likely to suffer a rebound.
They said that studies are ongoing to determine risk factors and there is not enough evidence for conclusive proof.
‘Rebound is going to be an inconvenience’Despite the potential for a rebound case, experts agree that Paxlovid is still a good treatment option.
Charness stated that although a rebound Covid-19 case is one of the expenses of Paxlovid treatment, it should be considered in comparison to what might happen if there was no treatment.
Most people with a rebound Covid-19 case after receiving Paxlovid were found to experience mild symptoms.
They may be stronger than before, such as Fauci’s, but still far below the severe diseases that Paxlovid protects against.
He said that Paxlovid is important, particularly for those who are most at risk of developing serious complications.
A small percentage — still to be identified — will rebound.
The rebound will be an inconvenience for almost everyone.
The inconvenience is less important than the possibility of not being hospitalized or dying.
Both President Biden as well as Fauci were given a second dose of Paxlovid in order to address their rebound cases.
Pfizer was asked for more information by the FDA to help them study any patients that may require a second course.
Pfizer stated in a statement that “while further evaluation may be necessary, we continue monitoring data from our ongoing medical studies and post-authorization safety supervision,” We remain confident that it is clinically effective in preventing serious outcomes from COVID-19 in patients who are at higher risk.
Public data regarding Paxlovid prescriptions are scarce.
The US Department of Health and Human Services estimates that approximately 4 million Paxlovid courses have been given as of mid August.
However, there is no information about demographics and health of the recipients.
Charness states that a lot has been accomplished in rebound cases but there are still many unanswered questions.
He said that he thinks back to March and February when rebound was a new phenomenon.
People who had experienced it were still calling their providers, and they were told this test would be incorrect.
He said that between then and now there has been an overwhelming dissemination of information.
However, people don’t know how to deal with it..
Adapted from CNN News