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  • Writer's pictureJaileen Hillard, RN

COVID-19 Rebound: What is it, and what is the guidance?

Patients have expressed increased concern regarding recurrent symptoms of COVID-19 after treatment with Paxlovid and the inconsistency of testing positive for COVID-19 after initially testing negative for COVID-19.

In late May, The Centers for Disease Control and Prevention (CDC) issued an advisory reporting that some patients with a normal immune response who have completed a five-day course of Paxlovid treatment experienced another bout of illness 2 to 8 days afterward. However, it is unclear if the rates of COVID-19 rebound present in those not treated with Paxlovid or whether the rebound is unique to Paxlovid and is also in patients treated with Molnupiravir. This phenomenon is referred to as “COVID-19 rebound” or “COVID rebound.”

Thus far, there are no reports of serious illness from COVID-19 rebound, and the CDC isn’t currently recommending further treatment. It does seem possible to transmit the virus during COVID-19 rebound, so re-isolating and masking are essential to protect those around you.

Here’s what else you should know about COVID-19 rebound

  • It typically is mild and goes away within a few days. The CDC reported that recurring symptoms and positive test results improved or went away shortly without further treatment. The median time it took for COVID-19 rebound to resolve was three days. Currently, there is no evidence to support claims of reinfection; instead, it appears to be part of the natural infection course.

  • It can occur even if you didn’t initially receive treatment for COVID-19. COVID-19 rebound may be a natural part of the illness for some people. In a Paxlovid clinical trial, rebound symptoms were reported in a small number of participants – including those patients who received Paxlovid and those who didn’t. The CDC reported no evidence that COVID-19 rebound resulted from resistance to Paxlovid. Vaccination status also does not appear to be a factor.

Should I even take Paxlovid if I get COVID?

Paxlovid continues to be recommended by The CDC for early-stage treatment of mild to moderate COVID-19 among persons at high risk for progression to severe disease. Paxlovid treatment helps prevent hospitalization and death due to COVID-19. The U.S. Food and Drug Administration (FDA) issued an emergency use authorization for Paxlovid late last year due to its ability to reduce the risk of hospitalization by nearly 90 percent.

Who is Eligible for treatment with Paxlovid?

Paxlovid is for symptomatic patients with a high risk of progression to severe illness and is approved for people 12 years or older who weigh at least 88 pounds. Treatment must begin within five days of COVID-19 symptom onset. There are exclusions to treatment based on underlying health conditions and medication interactions that your healthcare provider or our office can discuss without you.

I am Experiencing COVID-19 Rebound Symptoms; what should I do?

You may be experiencing COVID-19 rebound if you have been diagnosed in the past two weeks and have recovered from COVID-19 but then experience recurrent COVID-19 symptoms or develop a new positive test result after recovery. Here are our recommendations:

  • You should follow CDC’s isolation guidance. Isolate again and restart the recommended 5-day isolation period at the recurrence of symptoms or a new positive COVID-19 test result. You can end re-isolation after five days if you are fever-free for 24 hours without using fever-reducing medication and your symptoms improve. You should also wear a mask when in public for ten days.

  • Contact your healthcare provider if your COVID-19 rebound symptoms persist or worsen.

  • You are encouraged to report a possible case of COVID-19 rebound after Paxlovid treatment to Pfizer using the following online tool.

If you are experiencing COVID-19 rebound and need an appointment to discuss your symptoms, please get in touch with our office to schedule an appointment.

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