Six days ago I completed my 5-day course of Covid treatment with Paxlovid, which basically puts a brake on replication of the virus, giving your body a chance to deal with it before it gets up a big head of Covid steam.
I commemorated that event with a blog post, "My somewhat contrarian take on Paxlovid 'rebound.'" I said:
My symptoms (nasal congestion and a cough) have been gone for a few days. The rapid test I took this afternoon was negative. So things are looking good.
And I'm not all that worried about Paxlovid rebound, which doesn't seem like a big deal to me.
I still feel it isn't a big deal, even though last Wednesday, four days after I finished the Paxlovid treatment, I was dismayed to find that a rapid test I took showed I was positive for Covid again. So far (this is Friday) I'm still testing positive.
That's irritating, since I enjoyed my few days of post-Covid normalcy -- having coffee with a friend, going back to exercising at my athletic club, attending my Tai Chi class.
On the plus side, my symptoms are milder than before, and they were pretty mild the first Covid time around. I haven't had to take a decongestant at bedtime, which I did during the first bout of Covid. And I came across a recent Scientific American story about Paxlovid rebound which indicates that my "contrarian take" on this actually is scientifically mainstream.
A tweet clued me in to the story.
If you have doubts about Paxlovid because you've heard about the rebound effect, or if you know people who qualify to get Paxlovid because they're in a higher-risk Covid category (elderly, for example) and might be reluctant to take the drug, check out the February 8, 2023 Scientific American story by Lauren Gravitz, COVID Rebound Can Happen Even without Paxlovid.
Here's a PDF file if you have difficulty accessing that web page.
Download COVID Rebound Can Happen Even without Paxlovid - Scientific American
Some excerpts from the story:
Paxlovid gets a bad rap over concerns about COVID “rebound.” That’s the primary takeaway from a series of papers showing that whether or not people take the antiviral medication, many have symptoms that wax and wane before going away completely.
Over the past few months a number of peer-reviewed and preprint studies have looked at patients with COVID in the placebo groups of clinical trials for Paxlovid and other treatments. As part of the trials, the patients in these groups were required to fill out daily symptom trackers. Researchers consistently found that as many as 30 percent of those who did not take an antiviral experienced a rebound in coughing, fatigue, headache or other symptoms after initially feeling better.
...Despite Paxlovid’s proved efficacy at preventing severe disease and death in people considered high-risk, Smith found increasing resistance to it. “When Paxlovid rebound started to gain traction—I’m going to be blunt—I kind of got annoyed,” he says. Perhaps more worrisome, however, is the fact that some physicians have become hesitant to prescribe it. “The drug kept people out of the hospital and kept them from dying,” Smith says. “My patients started saying they didn’t want to take it,” he adds, and “I felt guilty because I’d started it all.”
Because he knew that respiratory viral symptoms have a tendency to come and go no matter the virus or treatment, Smith set out to better characterize the course of COVID itself. As chair of the U.S.-government-sponsored ACTIV-2 trial—a series of placebo-controlled studies that aims to assess new COVID treatments—he had troves of data at his fingertips, so he dove into the trials and gave the placebo groups extra scrutiny.
...Smith wasn’t surprised by the results. “As an infectious disease doc, [I] know that respiratory disease viruses often have this waxing and waning,” he says, adding that it also happens with colds, influenza and respiratory syncytial virus (RSV). “It’s just their nature.” This is likely because most symptoms are related to the body’s inflammatory response to the virus, not the virus itself, he says. The inflammation—which is different for everyone—generally lasts longer than the virus, and it ebbs and flows as viral remnants are cleared from the body.
Other infectious disease specialists agree. “In my view, the story of rebound was overblown,” says Ziyad Al-Aly, a clinical epidemiologist and chief of the research and education service at the Department of Veterans Affairs St. Louis Health Care System. He notes that he frequently hears of physicians who resist prescribing Paxlovid to high-risk patients for fear of rebound or the much-lamented side effect of a bitter, metallic taste. And yet, he says, “rebound never killed anyone. But COVID can put you in the hospital or, even worse, could lead to death.”
Robert Wachter, chair of the department of medicine at the University of California, San Francisco, has heard similar reactions to Paxlovid. “I’ve heard many times from patients and from a fair number of physicians that ‘I don’t like to use it because of rebound,’” he says. “I kind of understand it viscerally, but it doesn’t make sense when looking at a dispassionate ledger sheet of the medication’s benefits and downsides.... It’s not that close a call.”
...Until more data emerge, physicians must rely on their intuition and whatever solid information they can find. Existing data consistently point to the upside of Paxlovid. “In my world, people have looked at the data and believe the benefits of medication are quite probable,” Wachter says. “I’m certainly going to give it to high-risk people. Most of my colleagues who have gotten COVID have taken it.” And Wachter, who is 65 years old, adds that if he tests positive for COVID, he will absolutely take the drug himself.
Physicians agree that COVID rebound after antivirals may be a nuisance, but it is far better than hospitalization or death. “Paxlovid is the best weapon we have right now for people who have COVID,” says Smith, who knows the treatment landscape better than most. “It keeps people out of the hospital, keeps them from dying and probably decreases the risk of long COVID. In short, I think it’s worth the bitter taste.”