The Paxlovid Rebound Study

Prominent people have been reported to have Covid-19 rebound after Paxlovid use. They are Anthony Fauci, Joe Biden, and CDC Director Rochelle Walensky.

This article features the first prospective study that shows the higher rate of COVID-19 rebound among Paxlovid users. The study was recently released on medRxiv and has not been peer-reviewed.[1]

The authors are from Scripps Research Translational Institute in La Jolla, California, and eMed from Miami, Florida.

The study participants were free to choose if they would take Paxlovid. Paxlovid is a combination of two medicines called nirmatrelvir and ritonavir.

Nirmatrelvir is an antiviral drug, while ritonavir is an antiretroviral drug used to treat HIV/AIDS.

Method

There were 127 participants in the Paxlovid group and 43 in the control arm. Both groups are similar in age, gender, and pre-existing conditions.

After consent, the participants were asked to take a rapid antigen COVID-19 test and a symptom survey on day 2, day 5, day 7, day 9, day 11, day 13, and day 15. Participants were then given a symptom survey at the end of the 16 days.

Definitions

Viral (Testing) rebound: Any participant with a positive rapid antigen test observed after a negative antigen test.

Non-rebound for Viral (Testing): Any participant with a positive test, followed by only negative tests within the 16-day (every other day testing) study period.

Symptom rebound: Any participant who reported resolution of symptoms and then a recurrence on subsequent symptom surveys within the acute 16-day study period.

Symptoms definitions: Respiratory (cough, runny nose, shortness of breath or difficulty breathing, sore throat, hoarse voice), Gastrointestinal (nausea, vomiting, diarrhea, stomachache, loss of appetite), Neurologic (headache, confusion) and Systemic (fevers, chills, shaking with chills, loss of taste/smell, muscle pain, chest pain, eye pain, body ache, fatigue, neck pain, rash).

Results

Higher rebound in the Paxlovid group

The study showed an overall viral testing rebound incidence of 14% in the Paxlovid group and 9% in the control group.

Symptom rebound was 19% among Paxlovid-treated cases and 7% in the control group.

There was no notable differences in viral (testing) rebound by age, gender, pre-existing conditions, or symptom groups during the acute 16-day follow-up period.

Note: The findings are higher than in a retrospective study reported in June 2022 by Wang et al. The 7-day and 30-day COVID-19 rebound rates after Paxlovid treatment ranged from 2 to 6% for COVID-19 testing and symptoms.[2]

Sames times for viral clearance, symptom resolution, and first negative test

Notably, five people (4%) in the Paxlovid group remained testing positive throughout the 16 days.

Time to viral clearance, defined as the time from the first positive antigen test to the first negative antigen test, was similar in the treatment and control groups (mean 6.8 days vs. 6.7 days).

The time from symptom onset to first symptom resolution (mean 10.4 days vs.10.7 days) and time from symptom onset to first negative antigen test (mean 6.0 days vs. 6.3 days) was similar in the treatment and control groups.

However, the numbers above only included people who tested negative or had their symptoms resolved during the 15 days. This is significant, as discussed below.

20% still positive on day 10

The study also showed that over 50% of participants remained positive on a rapid antigen test five days after first turning positive or becoming symptomatic, and 20% remained positive even ten days after infection.

This finding is significant because the CDC requires only five days of isolation after COVID positive testing. If someone recently tested for SARS-CoV-2 is living with an immune-compromised person, ten days of isolation should be considered.

Infectious Rebound

A case series describes eight non-immune-compromised patients with COVID-19 relapse following Paxlovid use. Notably, their viral load during relapse was comparable to levels during the initial infection.[3]

One patient transmitted SARS-CoV-2 to two family members during relapse. The authors suggested that in the presence of a high viral load and the occurrence of one transmission event, patients with relapse should isolate until antigen testing is negative.[3]

Summary

Rounding it up, more Paxlovid users have a higher rebound SARS-CoV-2 test positive and COVID-19 symptom recurrence. Some relapse cases may be infectious and carry the SARS-CoV-2 virus for at least fifteen days.

Ivermectin

For those who may want to know what else they can use for COVID, it may be worthwhile to look at the table below from c19ivmmeta.org.

The image shows the meta-analysis of 93 studies on the benefits of ivermectin in COVID-19 outcomes like mortality, ventilation, ICU admission, hospitalization, recovery, cases, and viral clearance.

I also searched for cases of COVID-19 relapse among users of ivermectin using the parameters (ivermectin+covid-19+rebound). I found none.

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2. Ivermectin prevents binding to human cells by blocking the spike protein
3. The many problems of the Ivermectin study in the NEJM
4. Japanese company announces Ivermectin has antiviral properties
5. City-wide use of Ivermectin lowered COVID-19 cases, hospitalizations and deaths in Itajaí, Brazil
6. What makes Ivermectin a kick-ass antiviral?
7. Ivermectin is effective against the Influenza and a Cold Virus In Vitro
8. Ivermectin vs Remdesivir for COVID-19
9. Solved! The Ivermectin African Enigma
10. IVMMETA.COM: A website of studies on Ivermectin’s efficacy
11. Ivermectin is effective against Influenza and Cold Virus In Vitro

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