Covid can even recover in people who haven’t taken Paxlovid, study finds

Covid can even recover in people who haven’t taken Paxlovid, study finds

About a third of people with Covid will experience recovery in their symptoms regardless of whether they have been treated with the antiviral Paxlovid, according to a study published online on Tuesday.

The preprint study – meaning it was not published in a peer-reviewed journal – found 27% of people with Covid saw a recovery in their symptoms after initially improving.

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“It happens all the time. People who don’t get treatment for Covid and then feel better can have symptoms afterwards,” said study co-author Dr Davey Smith, chief of the department of infectious diseases and global public health at the university of California, San Diego School of Medicine, but Smith noted that the 27% finding was higher than what he had expected based on anecdotal evidence.

The study also found that 12% of people with Covid had a “viral rebound”, meaning they tested positive again a few days after testing negative. This has been documented in people taking Paxlovid and is called Paxlovid rebound, but the study found that viral rebound occurred regardless of whether a person had received the antiviral treatment.

Anyone who has had Covid could see symptoms return after they originally went away, and those symptoms may or may not be as bad as the first attack, Smith said. “It’s just the variability in the natural course of infection.”

The Centers for Disease Control and Prevention has acknowledged the possibility of symptom recurrence in untreated Covid patients. When the agency issued a health alert in May notifying doctors of Paxlovid rebounds, it also said that “a brief return of symptoms is part of the natural history of SARS-CoV-2 infection (the virus that causes COVID-19 caused) in some individuals, regardless of treatment with Paxlovid and regardless of vaccination status.”

The phenomenon of waxing and waning symptoms is not unique to Covid.

“In a way, that’s the natural history of all respiratory viral infections,” said Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston. “There are good days and bad days, and then eventually they get better.”

Paxlovid rebounds in particular have received a lot of attention in recent weeks, with both President Joe Biden and his chief medical adviser Dr. Anthony Fauci tested positive a few days after taking the antiviral.

In Pfizer’s clinical trial of the drug, 1% to 2% of people taking Paxlovid tested positive for the coronavirus after testing negative. In a leaflet for doctors prescribing Paxlovid, the drug manufacturer noted that this also happened at similar rates in the placebo group.

But even if a person has taken Paxlovid, it’s still hard to tell if their rebound is explicitly caused by the drug.

“It could have happened that without Paxlovid, they would have still tested positive in those late days, but they would not have had the intervening negative test. … This might just be a minor disruption to the natural course of the disease for them,” Sax said.

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Smith agreed, “The symptoms vary, and the nasal viral antigen varies, and they vary with and without Paxlovid.”

dr Albert Ko, an epidemiologist at the Yale School of Public Health, said that regardless of rebound symptoms, the message is clear: Paxlovid is working.

“Paxlovid is doing what it’s supposed to do: prevent us from getting life-threatening Covid,” Ko said. “Although these rebounds take place, it prevents the serious consequences.”

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