When the antiviral treatment Paxlovid became more widely used for Covid-19 infections earlier this year, doctors who prescribed it and patients who took it noticed that symptoms sometimes returned within days of disappearing. Some people have even tested negative before experiencing the rebound. But this puzzling phenomenon can happen whether you take Paxlovid or not, according to a new study.
Researchers found that when patients were given a placebo instead of treatment, a portion of them still experienced a rebound in their symptoms after their initial improvement.
“Return of symptoms is common,” said Dr. Davey Smith, chief of infectious diseases and global public health at the University of California, San Diego School of Medicine, who led the study. “That doesn’t mean things are going south. It’s just the natural way of the disease. What’s surprising, however, is how many people could experience a rebound, he said.
To understand the natural variability in coronavirus symptoms, Dr Smith and his team followed 158 clinical trial participants who had tested positive for Covid from August to November 2020. Each person kept a daily diary and marked 13 different Covid symptoms as being absent, mild, moderate or severe. Among the 108 people whose symptoms had improved without antiviral treatment and had completely disappeared for at least two consecutive days, 48 people (44% of those who recovered) noted that symptoms reappeared at various times during during the four-week follow-up.
“The good news is that no one whose symptoms came back needed to go to hospital or died or even had severe symptoms,” Dr Smith said. Eighty-five percent of those who had a rebound said their symptoms were mild; 15 percent had at least one moderate symptom.
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The most common complaints during a rebound of symptoms were coughing, feeling tired, and headache. These were all similar to symptoms reported at the start of the study, in the active phase of their infection, Dr Smith said.
One of the limitations of the study, however, is that it looked at older strains of coronavirus in humans, before vaccines were available. This makes it difficult to extrapolate how often rebound symptoms may be an issue with current Omicron strains, especially since most people also have some immune experience with the virus at this point in the pandemic. , either due to past infection or vaccination. Symptoms can also change with each variant, and their severity can be very subjective, said Dr. Bruce Farber, chief of public health and epidemiology at Northwell Health in New York. Patients noted rebound symptoms that “were remarkably mild and, quite frankly, quite unimpressive,” he said.
Why do symptoms sometimes return?
The pattern of waxing and waning symptoms occurs in several respiratory illnesses, including the common cold, flu, and respiratory syncytial virus. “People have never really paid much attention to it in the past, to be honest, as long as the patient is clinically better,” Dr. Farber said.
Symptoms sometimes go away and then come back due to the body’s own immune response to the infection, Dr. Farber said. While early symptoms like fever, cough or runny nose may be triggered by the virus itself, the body produces its own alarm signals when it detects a foreign invader. These signals come in the form of proteins that help inactivate viral RNA and tell white blood cells where to find more pathogens, speeding up its elimination from the body. At the same time, these reactions create inflammation in the body, which can cause headaches, exhaustion or prolong the duration of a cough.
“I call it friendly fire,” Dr. Farber said. “The immune system is very well-meaning and 100% necessary, but it’s clearly overreactive at times, and that often causes problems.”
What should you know about Paxlovid rebound symptoms?
Concerns about rebound symptoms when taking Paxlovid – and another antiviral drug called molnupiravir – appear to have reduced people’s interest in using treatments for Covid. But the new study shows you can also have a rebound with untreated Covid. “Hopefully this can help people be less afraid of a potential rebound,” Dr Smith said.
Paxlovid and other drugs can be lifesaving treatments for many Covid patients, Dr Smith said. Research has shown that they successfully reduce the risk of hospitalization and death by 88% in unvaccinated people. In a fact sheet for doctors prescribing Paxlovid, Pfizer noted that rebounds occurred in some patients receiving the treatment — and at similar rates in people who received a placebo.
There can be several potential reasons for a Paxlovid bounce. Some doctors have speculated that in addition to the likelihood of a rebound caused by the body’s own immune system, Paxlovid taken too soon could prevent the immune system from adequately preparing to fight off any remaining virus once the drug decreases. “If you’re young and healthy, and you’ve been vaccinated and boosted, then I’m not pushing Paxlovid on people, for the most part,” Dr. Farber said.
But experts agree that people who are sick and at high risk of developing severe Covid – including adults aged 65 and over, as well as those of any age with underlying health conditions like heart disease, cancer, diabetes or obesity – should seek treatment.
If you experience a rebound after treatment, there is no evidence that you should start another treatment with Paxlovid. Isolate yourself a little longer in case you are contagious to others. And try to manage symptoms with pain and fever medication, home remedies and time, Dr. Smith said. “I recommend staying hydrated, watching “The Golden Girls” and eating chicken soup.”
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