Science

Fauci reports COVID rebound is “much worse” than initial illness

in great shape , Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, at the Dirksen Senate Office Building on Capitol Hill on May 17, 2022 in Washington, DC.

The nation’s top infectious disease expert, Anthony Fauci, has been struck by a phenomenon that is becoming more common in the latest phase of pandemic-rebounding bouts of COVID-19 after a course of the antiviral drug paxlovid.

In an interview Tuesday at Foreign Policy’s Global Health Forum, Fauci explained the progress of his infection to his current rebound, which he said is much worse than his first round with the disease. Fauci—director of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) and chief medical adviser to the president—is 81 years old and has been fully vaccinated against COVID-19 and has been tested twice .

He first tested positive on a rapid antigen test on June 15 and experienced “very few symptoms”. But his symptoms worsened and he started a five-day course of Paxlovid. “And I was actually feeling quite well,” Fauci said, adding that he just had mild nasal congestion and fatigue. When they had finished the five-day course, they came back negative on antigen tests for three consecutive days. But, “then on the fourth day — to be absolutely certain — I got myself tested again, and I came back positive all around.”

Fauci later went back to PaxLovid for another five-day course. “Right now, I am on the fourth day of my second five-day course of Paxlovid,” he said on Tuesday. “And, luckily, I feel quite well, I mean, I’m not completely without symptoms, but I certainly don’t feel seriously ill.”

conflicting treatment advice

Fauci’s second course of treatment contrasts with the stance of the US Food and Drug Administration and the Centers for Disease Control and Prevention. In a May 24 health advisory, the CDC wrote, “There is currently no evidence that additional treatment is needed for COVID-19. Based on the data available at this time, patient monitoring continues to be the most appropriate management.” Patients with recurrence of symptoms after completion of the treatment course of Paxlovid.

Similarly, the FDA also stated in May that “at this time there is no evidence of benefit for longer courses of treatment …

However, Albert Boerla, CEO of Pfizer, which makes Paxlovid, said a second Paxlovid course could be used to treat rebound cases.

how and why

Beyond the question of how to best treat rebounds, it is also unclear how common or why they occur. The CDC notes that relapse symptoms of COVID-19 are not unique to people taking paxlovid. “A brief return of symptoms may be part of the natural history of SARS-CoV-2 (the virus that causes COVID-19) infection in some individuals, independent of treatment with Paxlovid and regardless of vaccination status ,” the agency wrote in its health alert.

This squares with Pfizer’s preliminary clinical data on Paxlovid, which found that about 1 percent to 2 percent Both There was a withdrawal in the trials for the treatment and placebo groups. But, now that more people are taking Paxlovid, anecdotal reports of post-Paxlovid revolts are circulating on social media.

Experts are still figuring out why the rebounds happen. Last week, Fauci’s NIAID researchers reported encouraging preliminary data from a small study that suggested the rebound is partly due to immune responses as the body removes dead human cells and viral debris quickly. Clears up after troubled infections. The study found no further evidence about possible explanations for the rebound, such as the possibility that SARS-CoV-2 is mutating to fail Paxlovid or that people’s immune systems fail to protect against the virus. In addition, limited data published by the CDC suggests that people who relapse do not suffer from more severe COVID-19 requiring hospitalization or emergency care.

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