People who test positive for COVID-19 again after taking the drug Paxlovid should self-isolate for an additional five days, the Centers for Disease Control and Prevention said Tuesday.
There’s a chance they’re contagious if they have that rebound effect, said CDC’s Dr. Lauri Hicks.
This is the first time the CDC has issued guidance on what people should do if they test positive again a few days after testing negative for COVID-19. Although orientation is specific to those taking Paxlovid, Hicks, the CDC’s chief medical officer for COVID-19 response, said anyone who tests positive or feels unwell again should stay away from others.
“If you improve and then deteriorate again or decide to test and test positive, particularly after a negative test result, the recommendation is to self-isolate again for at least five more days. and continue to mask up for at least at least 10 more days,” she said.
The rebound has occurred throughout the pandemic, with people seemingly recovering from COVID-19, testing negative again and then either coming back positive or developing new symptoms about five days later, said COVID-19 specialist Dr Daniel Griffin. infectious diseases at Northwell Health in New York.
It is not clear whether a rebound after taking the antiviral Paxlovid is different from rebounding without medication. In the trial that led to the authorization of Paxlovid, 2% of those who took the drug and almost the same percentage of those who did not experience bounces.
There is still little data on whether someone experiencing a rebound from COVID-19 produces enough live virus to infect those around them.
Pfizer, which makes the drug, says the rebounds studied in the real world closely mirror what happened in the trial.
But anecdotal reports and decidedly unscientific Twitter surveys found that up to 47% of respondents who took Paxlovid say they went through a rebound.
The problem is personal to Dr. Robert Wachter, chairman of the Department of Medicine at the University of California, San Francisco, who led one such investigation.
His wife, journalist Katie Hafner, tested positive for COVID for eight days, negative on days 9 through 12 and positive again on day 13, he said.
“She was clearly recovering from the initial infection, was on the mend, and then had a new round of head cold symptoms on day 12,” he said. “She felt crummy again.”
She finally came negative for good just recently, 18 days after the first positive test.
Like most people, Hafner’s second set of symptoms weren’t serious, but it was a pain to have to wear a mask around the house for almost three weeks, said Wachter, who never caught the virus. .
Griffin said he’s not convinced it’s good public policy to recommend a second period of isolation. Some people continue to test positive on rapid antigen tests for more than two weeks after an initial diagnosis, but studies show the vast majority of transmissions occur within the first five days of a COVID-19 infection, a he declared.
“If you ask too much of your patients, there’s a point where they say, ‘You know what, that’s unreasonable,’ and they don’t do anything,” he said. “If we now start saying that everyone who has a few more bad days needs to self-isolate again, it will be difficult at this stage of the pandemic to get people not to just say, ‘I’m not going to listen to everything.'”
the a study cited by the CDC – which has yet to be peer-reviewed and reports a single case of a rebounding patient transmitting the virus – is not enough to justify isolating large numbers of people, Griffin said.
It’s unclear whether a second course of Paxlovid, a longer duration or a higher dose of the antiviral would prevent rebound, but Pfizer spokesperson Kit Longley said the company is considering other options.
“We are looking at how we would conduct studies on different alternative treatment approaches,” he said.
Regardless of the rebound, all the evidence suggests that Paxlovid works well in preventing hospitalizations and deaths among people infected with COVID-19 and at high risk of severe disease, Griffin and Hicks said.
The CDC, along with the Food and Drug Administration and the National Institutes of Health recommend Paxlovid for anyone with COVID-19, vaccinated or not, at high risk of developing a serious infection. This includes older adults and anyone 12 or older (weighing at least 88 pounds) who has a medical condition such as diabetes, asthma, or immune problems.
Wachter is also in favor of taking Paxlovid, although a bit more cautiously. Three weeks ago, he would have said “it’s obvious”. On Tuesday afternoon, he argued his more nuanced support in 23 Tweets.
Contact Karen Weintraub at kweintraub@usatoday.com
Coverage of patient health and safety at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
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