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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 authorized on an emergency basis by the Food and Drug Administration for adult and pediatric patients with mild to moderate COVID-19 who are at risk of severe disease.
“If you take Paxlovid, you might have symptoms again,” CDC Director Dr. Rochelle Walensky said. “We haven’t yet seen anyone who has come back with symptoms that require going to 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 improvement.
But the agency noted that some people may experience the brief rebound in symptoms as part of the natural course of the disease and “regardless of treatment with Paxlovid and regardless of vaccination status,” according to a recent health advisory from the CDC Health Alert Network.
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The agency continues to recommend the antiviral treatment because Paxlovid helps prevent hospitalizations and deaths from COVID-19. It should be taken within five days of the onset of symptoms.
“Disease recurrence and positive test results improved or resolved (median 3 days) without additional anti-COVID-19 treatment. Based on information from case reports, COVID-19 rebound did not account for no reinfection with SARS-CoV-2 or development of resistance to Paxlovid; furthermore, no other respiratory pathogens have been identified among the known cases,” the CDC said.
It is possible to transmit the infection while experiencing a COVID-19 rebound, but it is unclear at this point how the likelihood of transmission during the rebound compares to the likelihood of transmission during the initial infection.
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The agency added that there is no evidence that Paxlovid should be extended or that other antiviral therapies are needed for COVID-19 rebound, but the risk of transmission during this time can be managed by following the CDC guidelines on isolation.
For those experiencing a COVID-19 rebound, Walensky advised, “They should test. They should put their mask back on. And if they test positive, restart the isolation protocol.”
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