Friday, August 12, 2022

President Biden’s Paxlovid Rebound Covid: How Risky Is It?

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Shreya Christina
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President Joe Biden tested positive for Covid-19 this 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 Covid’s Rebound To Biden And Others Using Paxlovid? Not a big deal, according to cafemadrid senior health reporter Keren Landman. For people at high risk of serious Covid disease or death, the risk of a bad outcome is greatly reduced by treatment. The real problem with rebound Covid is that it runs the risk of infecting others who come into contact with a person who has re-entered 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 inside on Thursday, in between his negative and positive tests. White House doctor said on Saturday Biden had no renewed 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 Explained today.

Here’s Keren:

If your endpoint is serious illness and death in people at high risk, [Paxlovid] still doing great. There is no indication that it has fallen off in any way, even with BA.5 on site. But it turns out to be an incomplete treatment for managing symptoms.

You’ve probably heard that Anthony Fauci himself had so-called rebound symptoms after taking Paxlovid. He basically just took a second course of Paxlovid and was doing just fine, as are most people with these rebound symptoms. But he didn’t go to the hospital and clearly didn’t have any serious consequences from the infection, like, as far as I know, all people who have had rebound symptoms after a course of Paxlovid. Part of refining a new drug is figuring out how it works in the real world. In Pfizer’s trial, only 1 or 2 percent of people had rebound symptoms after five days of Paxlovid for early Covid infection. But it only seems from the anecdotal reports, like in the real world, that there’s probably a higher proportion of people experiencing that. It will probably need some fine-tuning in how it is dosed and what we expect from it in the future.

It’s not that the Paxlovid cares [patients] an additional attack from Covid. It’s that the original Covid they had gave them persistent symptoms that the Paxlovid wasn’t enough to fully return. There is a question as to why that is. People are concerned: does this mean that if I take these five days of Covid and my symptoms come back, it will be a super-Covid? Is that Covid stronger than before because it has overcome those first five days, or is something else going on?

Studies on one patient suggest this isn’t what’s going on, that the viral infection just needs 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 may be. has come in. So I think it’s probably just a matter of the science of pharmacokinetics and how drugs get into the cells of your body and take action and how they’re eliminated by your body. Drugs work differently in different people because our drug metabolism is different. I think we will probably eventually change the recommended dosage of this drug as we learn more about how many people are experiencing this and who might need a little more of the drug to fully treat the viral infection with Covid.

[Paxlovid] has done much more good than bad. I mean, if you think about what “bad” Paxlovid could have done, okay, it has some side effects. They are generally quite small. I hear most about the metallic taste in people’s mouths, but otherwise it’s generally quite well tolerated.

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