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The country’s leading infectious disease expert, Anthony Fauci, has been struck by a phenomenon that appears to be becoming more common in the final phase of the pandemic — recurring bouts of COVID-19 following treatment with the antiviral drug Paxlovid.
In an interview on Tuesday at Foreign Policy’s Global Health Forum, Fauci opened up about the progression of his infection to his current recovery, which he says was much worse than his first bout with the disease. Fauci — the director of the National Institutes of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health and senior medical adviser to the president — is 81 and has been fully vaccinated against COVID-19 and boosted twice.
He first tested positive on a rapid antigen test on June 15 and had “very minimal symptoms”. But his symptoms worsened and he started a five-day course of Paxlovid. “And I felt really, really good,” Fauci said, adding that he only experienced mild nasal congestion and fatigue. By the time he had completed the five-day course, he had become negative on antigen tests for three consecutive days. But “then on day four — just to be absolutely sure — I tested again and I was positive again … and then the next day or so I started feeling really bad, a lot worse than the first run — um.”
Fauci then returned to Paxlovid for another five-day course. “Right now I’m on my fourth day of a five-day course of my second Paxlovid course,” he said Tuesday. “And fortunately I’m feeling reasonably well, I mean I’m not entirely without symptoms, but I’m certainly not feeling acutely ill.”
Conflicting treatment recommendations
Fauci’s second course of treatment contradicts 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 for COVID-19 is required for a COVID-19 rebound. Based on currently available data, patient monitoring remains the most appropriate treatment for patients with symptom recurrence after completion of Paxlovid treatment.”
Likewise, the FDA said in May that “there is currently no evidence of a benefit for longer duration of treatment…or repeating a course of Paxlovid in patients with recurrent COVID-19 symptoms after completing a course of treatment.”
But Albert Bourla, CEO of Pfizer, the maker of Paxlovid, said a second course of Paxlovid could be used to treat rebound cases.
How and why
Aside from how best to treat rebounds, it’s also unclear how common they occur or why they occur. The CDC notes that resurgent symptoms of COVID-19 are not unique to people taking Paxlovid. “A brief recurrence of symptoms may be part of the natural history of SARS-CoV-2 infection (the virus that causes COVID-19) in some individuals, regardless of treatment with Paxlovid and regardless of vaccination status,” the agency wrote in her health warning.
That’s consistent with Pfizer’s first clinical data on Paxlovid, which found about 1 to 2 percent of them both The treatment and placebo groups had rebounds in studies. However, as more people take Paxlovid, anecdotal reports of post-Paxlovid rebounds are appearing on social media.
Experts are still figuring out why rebounds happen. Last week, researchers at Fauci’s NIAID reported encouraging preliminary data from a small study that suggests rebounds are partly due to immune responses being reignited as the body clears dead human cells and viral debris after a rapidly smothered infection. The study found no evidence of other possible explanations for rebounds, such as B. the possibility of SARS-CoV-2 mutating to thwart Paxlovid or that people’s immune systems are unable to protect themselves against the virus. Additionally, limited data released by the CDC suggests that those who have a rebound are not likely to have more severe COVID-19, which requires hospitalization or emergency care.
