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Covid can rebound even in individuals who haven’t taken Paxlovid: Study

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This photo taken on July 31, 2022 shows a medical examiner taking a swab sample from a girl to be tested for the Covid-19 coronavirus at a swab collection site in Guangzhou, in China’s southern Guangdong province. Around a 3rd of individuals with Covid will experience a rebound of their symptoms, no matter whether or not they’ve been treated with the antiviral Paxlovid, based on a study posted online Tuesday.

Str | Afp | Getty Images

Around a 3rd of individuals with Covid will experience a rebound of their symptoms, no matter whether or not they’ve been treated with the antiviral Paxlovid, based on a study posted online Tuesday.

The preprint study — meaning it hasn’t been published in a peer-reviewed journal — found that 27% of individuals with Covid saw a rebound of their symptoms after that they had initially improved. 

“It happens on a regular basis. People who find themselves untreated with Covid who then feel higher can get symptoms afterward,” said study co-author Dr. Davey Smith, chief of infectious diseases and global public health on the University of California, San Diego School of Medicine. Still, Smith noted that the 27% finding was higher than what he’d expected based on anecdotal evidence. 

The study also found that 12% of individuals with Covid had a “viral rebound,” meaning they tested positive again several days after testing negative. This has been documented amongst individuals who have taken Paxlovid and is known as Paxlovid rebound, however the study found that viral rebound occurred no matter whether an individual had taken the antiviral treatment.

Anyone who has had Covid could see a return of symptoms after they’ve initially gone away, and people symptoms may very well be worse or not as bad as the primary bout, Smith said. “It’s just the variability within the natural course of the infection.” 

The Centers for Disease Control and Prevention has acknowledged the potential of symptom reoccurrence in untreated Covid patients. When the agency in May issued a health alert informing physicians about Paxlovid rebounds, it also said that “a temporary return of symptoms could also be a part of the natural history of SARS-CoV-2 (the virus that causes Covid-19) infection in some individuals, independent of treatment with Paxlovid and no matter vaccination status.”

The phenomenon of waxing and waning symptoms just isn’t unique to Covid.

“In some ways, that is the natural history of all respiratory viral infections,” said Dr. Paul Sax, clinical director of the division of infectious diseases at Brigham and Women’s Hospital in Boston. “There are good days and bad days, after which they eventually recover.” 

Paxlovid rebounds, particularly,  have received quite a lot of attention in recent weeks, with each President Joe Biden and his chief medical advisor Dr. Anthony Fauci testing positive several days after taking the antiviral. 

In Pfizer’s clinical trial on the drug, 1% to 2% of individuals taking Paxlovid tested positive for the coronavirus after testing negative. In a fact sheet for doctors prescribing Paxlovid, the drugmaker noted that this also occurred at similar rates among the many placebo group.

But even when an individual has taken Paxlovid, it’s still hard to say whether their rebound is explicitly attributable to the drug. 

“It may very well be that what would have happened without Paxlovid is that they might still have tested positive in these late days, but they would not have had the intervening negative test… This may very well be only a slight disturbance in what the natural history of the illness was for them,” Sax said.

Smith agreed: “Symptoms fluctuate, and viral antigen within the nose fluctuates, they usually fluctuate with and without Paxlovid.”

Dr. Albert Ko, an epidemiologist on the Yale School of Public Health, said that no matter rebound symptoms, the message is obvious: Paxlovid is working. 

“Paxlovid is doing what it’s purported to do: prevent us from getting life-threatening Covid,” Ko said. “Although these rebounds are happening, it’s stopping the severe outcomes.”

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