It’s unclear why COVID-19 can rebound. But one hypothesis is that the virus takes advantage of a small window to regain a foothold after the drug leaves the body but before the immune system kicks in.
Rebounding COVID-19 isn’t limited to patients who take Paxlovid. Li recalls that even in the early days of the pandemic, some patients would come to him in the hospital saying that they’d started to feel better but got worse again. It’s hard to know how to interpret such anecdotal reports, he says. Researchers are still learning what an untreated viral infection can look like in the body.
Studies show he’s not alone. When Li and colleagues studied the course of disease in COVID-19 clinical trial participants who received a placebo treatment,, with symptoms coming back for 1 in 4 people. That rebound, however, typically lasted about a day, and few had both high viral loads and returning symptoms, the team reports in a preliminary study posted August 2 at medRxiv.org that hasn’t yet been peer-reviewed by other scientists.
In this case, there’s no disappearing drug. Any returning symptoms without a positive test might be from something else such as allergies or a different respiratory virus, Li says. It’s also possible that the virus is replicating in different parts of the body at different times. Some tests might end up negative when the body eliminates virus from the throat, for example, but it’s still replicating at low levels in the nose.
That latter scenario may have happened with my husband. In a confusing twist, he tested negative on two saliva PCR tests while continuing to test positive on nasal antigen tests. A PCR test is far more sensitive, so we expected the opposite to happen. Since experts say to, he stayed isolated until he finally tested negative on an antigen test two weeks after his first symptoms appeared.
Luckily, he’s fully recovered now, and not at all eager for a repeat experience. That means we’re both still masking in public spaces and taking other precautions. We know we’re not done with this pandemic.
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