Can symptoms of COVID-19 come back after using Paxlovid? What we know

  • Some people who have taken Pfizer Inc.’s antiviral COVID-19 report that their symptoms return after completing the 5-day course.
  • In Pfizer’s clinical trial, 1-2% of people treated with the antiviral still tested positive for COVID after completing treatment.
  • Experts say that while these cases need to be investigated, Paxlovid is still a key treatment for COVID-19.

Some patients who took Pfizer Inc.’s oral antiviral Paxlovid report that their COVID-19 symptoms returned after an initial improvement at the end of treatment.

Here’s what we know so far about this symptom rebound.

So far, only one case has appeared in the medical literature as a preprint.

In this report, the patient’s symptoms resolved and then returned about a week after treatment. This coincided with an increase in the amount of virus in his body or in his viral load.

Other people have posted about their rebound symptoms on social media or reported them to the Food and Drug Administration.

Currently, this type of bounce seems to be rare.

In the Pfizer clinical trial, 1-2% of people treated with the antiviral had a positive COVID-19 test – or an increase in the amount of virus detected – after completing treatment.

However, this type of rebound also occurred in people who received the inactive placebo, so it is unclear if it is related to the drug, said the FDA.

In addition, the agency said people in the trial whose symptoms returned did not have a higher risk of hospitalization or death. There were also no signs that the coronavirus had developed resistance to the drug.

It is not known why some people see a recurrence of their symptoms. But US government researchers are already planning studies on this.

Experts say that while these rebound cases should be investigated, it shouldn’t be seen as a failure of Paxlovid.

In Pfizer’s clinical trial, the antiviral reduced the risk of hospitalization and death from COVID-19 by nearly 90% in non-hospitalized patients at risk of severe disease.

Dr Jeffrey Klausner, a clinical professor at the University of Southern California’s Keck School of Medicine, said Paxlovid is a “lifesaver” – decreasing the amount of virus in the body, reducing symptoms and preventing the disease from getting worse.

“The drug works exceptionally well in preventing those at risk – [such as] elderly, obese, or with other health conditions like diabetes or high blood pressure — to end up in the hospital,” Klausner said.

“That’s what’s important – stopping people from going to hospital,” he added.

While some scientists have suggested that a Paxlovid 10 Day Course may be necessary, the FDA has stated that there is currently no evidence that a longest course of pills offers an additional benefit.

Dr. John Mourani, medical director of infectious diseases at Pomona Valley Hospital Medical Center, said if symptoms return, “the first thing patients should do is contact their primary physician for a COVID antigen check.”

They can also use a home test kit. Some doctors recommend have them on hand if you are taking Paxlovid.

Scientists don’t know if everyone whose symptoms recur can transmit the virus to others, but they recommend taking steps to protect others from infection.

“If symptoms return after treatment, it’s possible someone is still infectious,” Klausner said. “People should continue to self-isolate and wear a mask until their symptoms resolve, or until they test negative on a rapid test.”

In the United States, Paxlovid is FDA cleared for use in people 12 years of age and older who have tested positive for coronavirus infection and who are at high risk of serious illness.

Those most at risk include those who have risk factors such as chronic lung or kidney disease, diabetes, obesity, cancer or any condition that weakens their immune system.

Vaccinated and unvaccinated people can receive Paxlovid. However, vaccination provides an extra layer of protection.

“Overall, the combination of vaccine and treatment options is a great tool to protect against severe cases of COVID,” Mourani said.

A prescription is required for antiviral pills and treatment must be started within five days of the onset of symptoms.

To get a prescription, you will need to show your positive test result to your healthcare provider and review your risk factors. Some telehealth providers also offer virtual visits to assess your risk and prescribe Paxlovid if appropriate.

You can also visit one of the federally supported testing sites for treatment. These sites offer testing and have Paxlovid at their fingertips.

At the end of April, the White House made a new effort to get Paxlovid to Americans who could benefit from it.

Despite this, Klausner fears that those most at risk are still unaware of this treatment and are not being treated.

“We need to do a much better job of promoting the drug to those at risk and making it easier to get,” he said.


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