COVID-19 rebound possible after taking Paxlovid, but no further treatment necessary: CDC

The Centers for Disease Control and Prevention (CDC) warns of the potential for “COVID-19 rebound” after patients take the oral antiviral drug called Paxlovid. The treatment is allowed under emergency use by the Food and Drug Administration for adult and pediatric patients with mild-to-moderate COVID-19 who are at risk for severe disease.

“If you take Paxlovid, you might get symptoms again,” CDC director Dr. Rochelle Walensky said. “We haven’t yet seen anybody who has returned with symptoms needing to go to the hospital. So, generally, a milder course.”

COVID-19 rebound is a return of COVID-19 symptoms or a new positive viral test (after testing negative) between two and eight days after getting better. 

But the agency noted some people may experience the brief rebound of symptoms as part of the natural course of the disease and “independent of treatment with Paxlovid and regardless of vaccination status,” according to a recent CDC Health Alert Network Health Advisory.

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The agency continues to recommend the antiviral treatment as Paxlovid helps prevent hospitalization and death due to COVID-19. It should be taken within five days of symptom onset.  

“Both the recurrence of illness and positive test results improved or resolved (median of 3 days) without additional anti-COVID-19 treatment. Based on information from the case reports, COVID-19 rebound did not represent reinfection with SARS-CoV-2 or the development of resistance to Paxlovid; also, no other respiratory pathogens were identified among known cases,” the CDC said.

It’s possible to transmit the infection while experiencing COVID-19 rebound, but it’s unknown at this point how the likelihood of transmission during rebound compares to the likelihood of transmission during the initial infection.

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The agency added there is no evidence Paxlovid needs to be extended or any other antiviral therapies are needed for COVID-19 rebound, but the risk of transmission during this period can be managed by following CDC’s guidance on isolation.

For those who experience COVID-19 rebound, Walensky advised: “They should test. They should put their mask back on. And if their test is positive, restart the isolation protocol.”