Paxlovid for COVID and rebound symptoms.
PAXLOVID IS AN ORAL ANTI-VIRAL MEDICINE that shows tremendous promise against COVID-19. I am hearing Paxlovid COVID infection rebound reports following the initial five-day treatment.
Paxlovid (nirmatrelvir + ritonavir) received an emergency use authorization (EUA) on December 22, 2021, by the US Food and Drug Administration. I joined many others in my excitement for the drug, with impressive preliminary study results.
Paxlovid is effective
I had this to say in a previous post about the anti-viral drug: The clinical trial that led to its Emergency Use Authorization showed that paxlovid is remarkably effective, with the pills associated with an 89 percent reduction in the risk of hospitalization and death.
Another positive of the drug is that it is provided for free by the United States government while there is a public health emergency. It would otherwise cost just over US $500.
But are there downsides besides some acute side effects (including allergic reactions. altered taste sensation, diarrhea, high blood pressure, and muscle aches) that are typically mild? Let’s look at the so-called Paxlovid rebound phenomenon.
Paxlovid rebound
We are hearing many reports about patients experiencing Paxlovid COVID-19 rebound symptoms. Individuals who had had a vaccination against SARS-CoV-2 got an infection. Because they were at higher risk for hospitalization or death from the virus, they promptly began the anti-viral oral drug Paxlovid.
Within a day or two, most appeared to get significantly better. With the completion of their five-day course of Paxlovid, it seemed as though they had put COVID infection behind them. The patients felt much better and no longer tested positive for infection.
“It ain’t over until it’s over” ― Yogi Berra.
But then, a strange turn of events occurred. Rather than continuing to feel good and get back to their usual activities of daily living, some experienced Paxlovid COVID rebound within days. These folks had the symptoms of coronavirus again, and their COVID tests turned positive. And so they headed back to isolation, assuming they were once again infectious.
Here’s what Dr. Bob Wachter, the brilliant Chair of the Department of Medicine at the University of California, San Francisco (USA), has to say:
“I was asked by a reporter today if I’d take Paxlovid if I had Covid. Last month, this would have been easy: as a 64-year-old person w/ asthma, the answer was an unequivocal YES. Today, it’s a closer call.”
He continues, offering that he would still take it, “mainly based on my teetering but still fairly high confidence that it would lower my chance of an awful outcome (hospitalization/death), and my confidence that rebound would be inconvenient, but not ultimately super-risky.”
This week, The US Centers for Disease Control (CDC) issued this statement:
“Paxlovid treatment helps prevent hospitalization and death due to COVID-19. COVID-19 rebound occurs between two and eight days after initial recovery. It is characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative. A brief return of symptoms may be part of the natural history of SARS-CoV-2 (the virus that causes COVID-19) infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status. Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had a mild illness; there are no reports of severe disease. There is currently no evidence that one needs additional treatment with Paxlovid or other anti-SARS-CoV-2 therapies in cases where COVID-19 rebound is suspected.”
The CDC recommends that patients with rebound COVID isolate themselves from others for five days (from the start of new symptoms) and wear effective masks for a minimum of ten days, just as if they had developed a new infection.
Paxlovid rebound: My take
We don’t have sufficient data to make firm statements about the meaning of rebound phenomenons. While the manufacturer suggests a second course of Paxlovid, I would be skeptical; the CDC and US Food and Drug Agency agree that a new course is not well-supported by evidence.
How typical is Paxlovid’s rebound? Are we as infectious during the rebound COVID as the original? What is the length of the rebound period? Is the rebound associated with long COVID? And do we have any evidence that a five-day course of Paxlovid is too short?
I won’t take it (as I am not in the high-risk population) but would consider it if I were in the high-risk group. The drug appears excellent at reducing the chances of hospitalization or death for high-risk individuals.
Thank you for joining me in the Paxlovid rebound update.
The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
