With the approach of cold and flu season will we see a resurgence of COVID? How effective are the antiviral pharmaceutical drugs?
Paxlovid has been seen a lot in the news treating well known patients like Dr. Fauci, President Biden and most recently Jill Biden. Paxlovid is an antiviral treatment used to prevent serious illness and death from COVID-19 and may be most effective for adults over 65, new research shows. But the drug may yield little to no benefit for younger populations.
The claim comes from new research, published last week in the New England Journal of Medicine, to assess the effectiveness of Paxlovid in patients during an Omicron surge in Israel in a population that already had some level of prior COVID immunity.
In examining data from more than 109,000 Israeli patients who were at least 40 years old, researchers found that Paxlovid significantly reduced the rates of hospitalization and death from COVID in people ages 65 and older, compared to those who did not take the drug.
Among patients 65 years of age or older, the rates of hospitalization and death due to COVID-19 were significantly lower among those who received the drug," lead study author Ronen Arbel, PhD. "This shows that the drug is an important second line of defense for vaccinated patients, and the first line in the unvaccinated patients
Despite these significant reductions in risk of hospitalizations and deaths for patients over 65, researchers saw little to no benefit for a younger population treated with Paxlovid. The new research showed that people over 65 reaped the most benefits from taking Paxlovid, the study leaves questions about its effectiveness among younger populations—even those for whom the treatment is recommended.
Currently, the CDC still recommends that high-risk individuals, regardless of age, take Paxlovid to prevent mild-to-moderate cases of COVID-19 from progressing into more serious health issues.
Eligible patients at high risk of progression to severe COVID-19 are recommended to be treated with Paxlovid to reduce the likelihood of hospitalization and death.
COVID rebounds have been commonly associated with Paxlovid treatment, research shows that rebound cases, though mild and not associated with severe illness, can occur even in patients who haven't taken the antiviral drug.
Some patients with COVID-19 experience a recurrence of symptoms or a new positive viral test after having previously tested negative. The phenomenon, 'COVID-19 rebound,' occurs independently and regardless of Paxlovid treatment or vaccination status. This brief recurrence of symptoms may be part of the natural progression of SARS-CoV-2 in some patients.
According to the most recent information from the CDC, COVID rebound following a course of Paxlovid does not mean that a patient developed a resistance to Paxlovid.
These COVID rebounds after Paxlovid use also don't negate the drug's effectiveness in reducing hospitalizations and deaths, the CDC said. There's also no data that suggests a longer course of treatment, or a repeat course of treatment, would be more beneficial for COVID rebound cases.
A COVID-19 rebound is a recurrence of COVID-19 symptoms or a new positive viral test (after previously testing negative), within two to eight days after recovery and stopping Paxlovid. This can happen regardless of vaccination status.
"Typically, what people are reporting is that the relapse in symptoms are similar or maybe slightly better than what the original symptoms were that individuals had, but it is a recurrence," infectious disease specialist Prasanna Jagannathan, MD, assistant professor of medicine and of microbiology and immunology at Stanford University,
It's unknown exactly how many people experience a COVID-19 recurrence after Paxlovid. In clinical trials, about 1%–2% of patients experienced a COVID-19 rebound case.
If COVID-19 symptoms recur following Paxlovid treatment, they're typically mild and resolve in about three days, the CDC said.
The CDC confirmed that COVID-19 rebounds were not due to reinfection by the SARS-CoV-2 virus or resistance to Paxlovid—but experts still aren't entirely what's behind relapses after stopping medication.
According to Dr. Jagannathan, one possible explanation is that low levels of the virus may persist in the body, and are able to multiply again once an individual stops treatment. "That is the most likely answer, but we still don't know," said Dr. Jagannathan.
In the CDC's statement, the agency also said that "a brief return of COVID-19 symptoms may be part of the natural history of SARS-CoV-2…infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status.
According to the CDC, there is no evidence that suggests any additional treatment is needed for a COVID-19 recurrence, since the symptoms seem to be short-lasting and self-limiting.
"Based on the data, a single course is enough to get the desired effect namely reducing your chance of severe COVID-19 that causes hospitalization or death. Though some researchers are looking into potentially extending Paxlovid courses, the CDC maintains that there's no data currently that suggests this may be helpful.
But people who experience COVID-19 rebounds should still re-start their isolation period once their symptoms recur or they receive another positive test, according to the CDC.
Despite the possibility of recurrence following Paxlovid treatment, health care providers maintain that the drug is essential in treating people who are at high risk of severe disease from COVID-19, and should continue to be prescribed and used.
Until Next Time: Stay Safe, Stay Healthy and be careful out there
James A Vito, D.M.D