President Biden’s Paxlovid rebound Covid: How risky is it?

August 1, 2022:

President Joe Biden tested positive for Covid-19 over the weekend, just days after testing negative and resuming a regular schedule of in-person meetings. It’s a classic case of “rebound Covid,” something thousands of Americans have experienced after taking a course of the antiviral drug Paxlovid, as Biden had.

How risky is rebound Covid to Biden and others who take Paxlovid? Not terribly, according to Vox senior health reporter Keren Landman. For people at high risk of severe Covid disease or death, the risk of a bad outcome is greatly reduced by the treatment. The real problem with rebound Covid is it risks infecting others who come in contact with an individual who has gone back out into the world after a negative test. Biden, for example, had Cabinet members and staff with him for meetings at the White House and spoke to reporters indoors on Thursday, between his negative and positive tests. The White House doctor said Saturday that Biden had no reemergence of symptoms, and the White House said that no one who had been in close contact with Biden had tested positive.

Landman explained more about Paxlovid rebound Covid last month on an episode of Today, Explained.

Here’s Keren:

If your endpoint is preventing severe disease and death in high risk folks, [Paxlovid] is still doing great. There’s no indication that it has fallen off in any way, even with BA.5 on the scene. But it is proving to be an incomplete treatment for controlling symptoms.

You probably heard that Anthony Fauci himself had what’s called a rebound symptoms after taking Paxlovid. He basically just took a second course of Paxlovid and did fine, as do most people who have these rebound symptoms. But he didn’t go to the hospital and obviously had no severe outcome from the infection, as do, to my knowledge, all people who have had rebound symptoms after a Paxlovid course. Part of fine-tuning a new drug is figuring out how it works in the real world. In Pfizer’s trial, only maybe 1 or 2 percent of people had rebound symptoms after five days of Paxlovid for an early Covid infection. But it seems just from the anecdotal reports, like in the real world, there’s probably a higher proportion of people who are experiencing that. It probably is going to need some fine-tuning in how it’s dosed and what we expect from it going forward.

…

It’s not that the Paxlovid is giving [patients] an additional bout of Covid. It’s that the original Covid that they had is giving them persistent symptoms that the Paxlovid was not enough to completely turn back. There’s some question about why that is. People are worried: Does that mean that if I take these five days of Covid and my symptoms come back, is it a super-Covid? Is that Covid stronger than it was before because it overcame those first five days, or is something else going on?

Single-patient studies suggest that’s not what’s going on, that it’s really just that the viral infection requires a higher dose for a longer time, or even just the same dose for a longer time to get into all the cells where the Covid might have gotten into. So I think it’s probably just a matter of the science of pharmacokinetics and how drugs get into your body’s cells and take action and how they get eliminated by your body. Drugs act differently in different people because our metabolism of drugs is different. I think we’ll probably end up seeing the dosage that’s recommended of this drug change as we learn more about how many people are experiencing this and and who need who might need a little bit more of the drug in order to completely treat the viral infection with Covid.

…

[Paxlovid] has done a lot more good than bad. I mean, when you think about what “bad” Paxlovid might have done, okay, it has some side effects. They’re generally pretty minor. I hear most about the metallic taste in people’s mouth, but otherwise it’s generally pretty well tolerated.

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