Anthony Fauci MD, has been on the rebound, but not in a good way. During a remote interview with the Foreign Policy Global Health Forum on Tuesday, Fauci indicated that he’s been having a “Paxlovid rebound.” That’s a relapse of Covid-19 positivity and symptoms soon after completing a course of Paxlovid for Covid-19 and testing negative. And apparently the rebound has been worse than the first time around. This has prompted him to take a second course of Paxlovid. But is this something that you should do if the virus catches you on the rebound so to speak?
The following Inside Edition segment included a clip of this interview with Fauci:
In case you haven’t watched the news since early 2020 and are asking, “Who’s Dr. Fauci,” he is the Director of the National Institute of Allergy and Infectious Diseases (NIAID) and the Chief Medical Advisor to U.S. President Joe Biden. Oh, and by the way, our country has been in the midst of a global Covid-19 pandemic since February 2020. It looks like Fauci was able to avoid catching the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) all the way until earlier this month.
On June 15, the National Institutes of Health (NIH) announced that Fauci had tested positive for Covid-19 via a rapid antigen test. Prior to this, Fauci had been quadruply vaccinated against Covid-19, having completed his primary series plus two boosters. Of course, while Covid-19 vaccination can protect you against Covid-19, it’s not like a full-body concrete condom. It doesn’t offer 100% protection. So with many people around Fauci dropping additional Covid-19 precautions like wearing face masks while indoors in public or social distancing as if they were dirty underwear, it hasn’t been surprising that there’s been a Spring 2022 upswing in cases, and that Fauci finally got infected.
The June 15 announcement mentioned that Fauci was “currently experiencing mild symptoms.” The 81-year-old Fauci ended up taking a course of Paxlovid, presumably since his age puts him at higher risk for worse Covid-19. Paxlovid, Pfizer’s oral antiviral medication, is actually two types of medications, nirmatrelvir tablets and ritonavir tablets, co-packaged together.
Following the five-day course of Paxlovid, Fauci did test negative on a rapid antigen test for three consecutive days. However, the fourth day was the opposite of the charm. That day, his test turned out to be positive. During the Foreign Policy Global Health Forum interview, Fauci said, “And then over the next day or so, I started to feel really poorly, much worse than in the first go-around.” In other words, the sequel was even worse than the bad original, sort of like the movie Deuce Bigalow: European Gigolo after the movie Deuce Bigalow: Male Gigalo.
He added, “So I went back on Paxlovid and right now I am on my fourth day of a five-day course.” Fauci continued by saying, “fortunately I feel reasonably good but I’m not completely without symptoms.”
Now, does this mean that you should take a second course of Paxlovid if you are experiencing rebound Covid-19? Well, back on May 3,Riley Griffin, Madison Muller, and Robert Langreth writing for Bloomberg quoted Pfizer CEO Albert Bourla, DVM, PhD, who is not a medical doctor, as saying the following about a Paxlovid rebound, “then you give a second course, like you do with antibiotics, and that’s it.” Umm, is that really it? Before you take medication advice from someone who’s not a medical doctor and who heads the company that makes the medication, keep in mind that the initial Paxlovid emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA) technically did not cover a second course of Paxlovid for rebound Covid-19. Indeed, the FDA Updates on Paxlovid for Health Care Providers website included the following as of May 4: “there is no evidence of benefit at this time for a longer course of treatment (e.g., 10 days rather than the 5 days recommended in the Provider Fact Sheet for Paxlovid) or repeating a treatment course of Paxlovid in patients with recurrent Covid-19 symptoms following completion of a treatment course.” A May 24, 2022, Centers for Disease Control and Prevention (CDC) Health Advisory indicated something similar: “There is currently no evidence that additional treatment for Covid-19 is needed for Covid-19 rebound.”
So before taking a second course of Paxlovid for possible rebound, you may want to wait for it, wait for it, wait for more scientific evidence that it will actually be warranted and useful. It may not even clear why you are experiencing what appears to be a rebound. As I covered for Forbes about a month ago, there are several possible reasons. One is that the medication may not always suppress replication of virus long enough for your immune system and body to clear the virus. Thus, once the five-day course is over, the remaining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in your body may start reproducing itself again. Another possibility is that the virus has developed resistance to the medication. In such a case, resistance is not futile, for the virus that is. It will allow the virus to survive potentially any number of Paxlovid courses. A third possibility is re-infection with the virus. What seems like one stretch of Covid-19 actually is two separate infections. This would have been much less likely had you remained isolated all the time. Remember the SARS-CoV-2 can’t open doors since its spikes are way too small.
Of course, an additional possibility is that the Covid-19 tests aren’t exactly super accurate at ruling out infection. You may turn “negative” on antigen tests even though you are still infected and shedding the virus. So what appears to be a Paxlovid rebound could actually just a continuation of Covid-19 with some false negative tests thrown in the middle.
Add to these, the possibility that the antiviral is not reaching all of the cells in your body that contain the virus. This would allow the virus to hang out until the Paxlovid “storm is over.”
Fauci’s case is more evidence that Paxlovid rebounds are a real concern. When someone tells you that he or she has Covid-19, you may not want to say, “hope you rebound soon” without clarifying that you mean fully recover. At the same time, you should make sure that anyone infected with SARS-CoV-2 does not end isolation prematurely and, in turn, end up spreading the virus to others. Otherwise, this could be like saying, “catch you on the rebound,” to the SARS-CoV-2.