What you need to know about ‘COVID-19 rebound’

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Health Fairview

By Staff Writer

COVID-19 rebound can occur a few days to a week after recovering from the initial illness.

This condition typically occurs within a week of initial recovery from the virus. Here’s what you need to know to keep yourself and your loved ones safe.

“COVID-19 rebound” occurs when a person infected with the COVID-19 virus recovers and tests negative, only to retest positive and/or develop symptoms a few days to a week later.

The Centers for Disease Control and Prevention (CDC) issued an advisory in late May reporting that some patients with a normal immune response who have completed a five-day course of Paxlovid treatment for COVID-19 experience another bout of illness two to eight days afterward.

These patients tested negative for the virus immediately after treatment, then retested positive and had recurring symptoms in the following week.

There are no reports so far of serious illness from COVID-19 rebound, and the CDC isn’t currently recommending any further treatment. It does seem possible to transmit the virus during COVID-19 rebound, however, so re-isolating is important to protect those around you.

Here’s what else you need to know about COVID-19 rebound.

It typically is mild and goes away within a few days.

The CDC reported that both recurring symptoms and positive test results improved or went away shortly without further treatment. The median time it took for COVID-19 rebound to resolve was three days, based on available data.

“There’s currently no evidence that this is a full-blown reinfection with COVID-19, or another illness caused by COVID-19,” said Hospitalist Andrew Olson, MD, director of COVID-19 hospital medicine at M Health Fairview University of Minnesota Medical Center.  “Instead, it appears to potentially be part of the natural course of infection with the virus that causes COVID-19.”

It can occur even if you didn’t initially receive treatment for COVID-19.

COVID-19 rebound may be a natural part of the illness for some people. In a Paxlovid clinical trial, rebound was reported in a small number of participants – including the patients who received Paxlovid and those who didn’t. The CDC reported there was no evidence that COVID-19 rebound was the result of a resistance to Paxlovid. Vaccination status also does not appear to be a factor, according to the CDC.

Paxlovid is still recommended as an effective COVID-19 treatment.

The CDC is still recommending Paxlovid as an effective treatment for COVID-19 in people at high risk for severe illness. The U.S. Food and Drug Administration (FDA) issued an emergency use authorization for Paxlovid late last year, after clinical trials showed it could reduce the risk for hospitalization by nearly 90 percent.

Paxlovid is for symptomatic patients who are at a high risk of progression to severe illness, are 12 years or older, and weigh at least 88 pounds. Treatment must begin within five days of COVID-19 symptom onset. View this FDA fact sheet for more information on Paxlovid.

For more information on Paxlovid eligibility and treatment through M Health Fairview, visit our COVID-19 therapies resource guide.

It’s possible to transmit COVID-19 during rebound, so isolation remains important.

You are likely able to transmit the virus to other people during COVID-19 rebound. The CDC recommends that people with a recurrence of COVID-19 symptoms or a new positive test isolate again for at least five full days. Patients can end isolation after five days if their fever has been gone for 24 hours (without the use of fever-reducing medications) and symptoms are improving.

Individuals with COVID-19 rebound should wear a mask for 10 days after their rebound symptoms started. Some people may continue to test positive after 10 days, but they are less likely to infect others, according to the CDC.

“There are several ways to protect yourself and your loved ones from severe illness,” said Olson. “COVID-19 vaccination and booster shots are critical. If you do become ill, talk to your doctor right away to find out if Paxlovid or other COVID-19 therapies are right for you.”