Paxlovid is a combination of nirmatrelvir, an antiviral drug that blocks replication of COVID-19, and ritonavir, which slows down the breakdown of nirmatrelvir. It must be taken within five days of the onset of symptoms, or it will have little to no effect.
It was originally thought that Paxlovid rebound occurred because it treated the virus so quickly that the body didn’t have a chance for the immune response to kick in, causing COVID to return. However, the data no longer supports this theory.
It’s also still unclear as to what percentage of people experience rebound. Originally, it was 4% to 8%, but a Mass Brigham General study from 2023 suggests it’s as high as 20.8%. We also don’t know why it occurs in some people, but not others. The truth is that when it comes to rebound, we don’t have clear answers at this point in time.
Luckily, the current strains of COVID don’t cause serious disease in the overwhelming majority of people. Healthy people who aren’t elderly and aren’t immunocompromised almost always do well with COVID. Therefore, the majority of people don’t need Paxlovid, and a new study in the New England Journal of Medicine suggests that it probably doesn’t help that much anyway.
For these reasons, Paxlovid should only be given to people who are immunosuppressed, immunocompromised, HIV infected, or who are elderly with comorbidities. Improvement was demonstrated only in people with these risk factors, which increased the chances of them getting very sick or winding up in the hospital if they are infected with COVID.
Because there is so much we’re still learning about COVID, rebound effects shouldn’t be a significant part of the equation as to whether you’re going to take Paxlovid. As a matter of fact, most people don’t realize that rebound can occur in those who don’t take Paxlovid as well.
In addition, many health care professionals question whether rebound is even real. Because of this, it has become a gray area where we’re not sure how to handle it, other than to say that if it occurs, it’s not serious.
Paxlovid rebound has basically become a non-issue, and doctors aren’t very concerned about it. This is especially true as newer COVID drugs are expected to come on the market.
More importantly, everyone should be getting vaccinated because that’s what prevents people from dying.
