SAN FRANCISCO (KCBS RADIO) – President Joe Biden has COVID-19 again. His doctors said over the weekend that after taking Paxlovid he tested negative for several days.
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But now, he is experiencing rebound positivity, or what's commonly known as "Paxlovid rebound."
Paxlovid rebound happens when someone with COVID-19 takes Paxlovid, gets better, tests negative, then winds up testing positive again.
"Sometimes that can be associated with symptoms, sometimes it may not be," said Dr. Amesh Adalja, Senior Scholar at the Johns Hopkins Center for Health Security on KCBS Radio's "Ask an Expert" with Melissa Culross on Monday.
"We don't quite understand why it's happening, how common it is, and what it actually means biologically," he said.
The main difference between a Paxlovid rebound and reinfection is the timing. A standard COVID-19 reinfection wouldn’t happen days after recovering from the first infection.
"People don't get reinfected for usually several weeks to months after their initial infection – so this is completely distinct from reinfection," he said.
It's the same virus in the rebound cases that caused the initial infection.
This phenomenon didn't show up all that often during clinical trials for Paxlovid, but it seems to be, at least anecdotally, more common in the real world.
While not much is known about why this happens, there are some commonalities. For instance, people who do experience the rebound tend to do well, in that they don’t need hospitalization or suffer from severe disease.
"We also know that this isn't a reason to dissuade someone from taking Paxlovid," said Adalja. "Paxlovid is life-saving for those people who qualify for it."
People who are experiencing a rebound are not advised to take the drug again to treat it, because Paxlovid is meant just to treat severe disease.
"However, the Pfizer CEO has said they should go back on it, Dr. Fauci himself went back on it," he said. "I don’t know that there's any strong data to support it, I don't recommend taking the course of medication again."
The rebound is temporary and tends to go away quickly. While it's not something to get too worried about, it is something that needs to be figured out.
"Maybe we can prevent it from happening because those people do become contagious," said Adalja. "Maybe we can prevent it from happening if you extend the treatment course to seven days, or maybe 10 days."
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