What is Paxlovid Rebound?

Alexandra Thompson
Alexandra Thompson23 Aug 2022

As COVID-19 cases are on the rise, nationwide access to antiviral medications, such as paxlovid, is necessary now more than ever. However, after completing the five-day antiviral course, some individuals experience what is known as Paxlovid Rebound: the return of COVID-19 symptoms after initially improving upon treatment completion.   

Paxlovid Rebounding  

The rollout of paxlovid prescriptions started in February 2022 and still remains one of the most effective ways of reducing severity and hospitalization amongst covid-positive populations. However, in May, the Center for Diseases Control and Prevention reported that some individuals treated with paxlovid experience COVID-19 rebound within two to eight days after their initial recovery period — completion of the paxlovid prescription.

COVID-19 rebounding is defined as the return of covid-19 symptoms and/or new positive COVID-19 test after having tested negative and completing the paxlovid treatment. This phenomenon has been seen in both unvaccinated and vaccinated individuals. 

Researchers are currently trying to understand how and why rebounds occur. Still, limitations with the number of people reporting rebounded symptoms or seeking medical attention do not allow for an accurate understanding of COVID-19 rebounding in the general population. Some researchers from the University of California San Diego School of Medicine have deemed the rebounding as a “part of the natural history of the coronavirus” that may lead to lengthening the paxlovid treatment period from 5 days to 10

Paxlovid is Still the Go-To Treatment 

Even in the face of rebound cases, experts urge that the paxlovid treatment is still safe and effective. In the Pfizer clinic trial, paxlovid reduced Covid hospitalizations and risk of severe illness by 90 percent. Additionally, it’s important to note that previous studies and ongoing research have found paxlovid to work exceptionally well at reducing the amount of virus in the body and decreasing symptoms. So while the rebound cases are cause for concern, the importance and effectiveness of paxlovid should still be stressed. 

What To Do If Your Symptoms Rebound 

If your symptoms rebound or come back after completing a course of paxlovid, the first thing you should do is contact your primary care physician and get a COVID-19 antigen test. Additionally, at-home testing kits can also be used to determine if you are still testing positive. Even if your test comes back negative, information on if the virus can still be spread during the rebound period is unknown, so physicians recommend taking extra precautions. People should continue to isolate themselves and wear a mask until symptoms are gone.” Says Dr. Jeffery Klasuner of USC School of Medicine. Furthermore, the CDC recommends that people with COVID Rebound should treat it as an initial infection and follow the agency’s guidelines on isolation: 

  • Isolating for at least five days
  • Wearing a mask around others for at least 10 days following presents of symptoms
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About Paxlovid Antiviral Treatment 

Paxlovid is currently the first choice recommended antiviral treatment for patients ages 12 and older with mild to moderate COVID-19 cases. Paxlovid works by blocking the proteins that the virus uses to multiply and has been shown to be 90 percent effective at reducing the risk of hospitalization and death.  

Paxlovid is free for eligible patients with a positive covid test and is available with a prescription at over 20,000 locations across the United States, including pharmacies, community health centers, urgent care centers, and hospitals.  

Each paxlovid prescription has 30 tablets that are taken by mouth over a 5-day period. Paxlovid consists of 2 different medications, nirmatrelvir, and ritonavir. Each day you will take two nirmatrelvir tablets and one ritonavir tablet in the morning and evening, a total of 6 tablets per day until the prescription is complete. 


Source: Food and Drug Administration 

Paxlovid Frequently Asked Questions ( FAQ)  

Below are some commonly asked questions about paxlovid and rebounding concerns. 

Who is Eligible for Paxlovid?  

According to the FDA, Paxlovid is available for individuals 12 years of age and older who weigh at least 88 pounds or 40kg and present with a positive COVID-19 test. The FDA also emphasizes that paxlovid should be prioritized for individuals who are at high risk for severe illness and have detrimental risk factors such as: 

  • Chronic Lung Disease
  • Chronic Kidney Disease
  • Diabetes
  • Obesity
  • Cancer
  • Other Conditions that Weaken the Immune System

Paxlovid is available for both vaccinated and unvaccinated individuals, but the treatment course must be started within five days of developing symptoms. 

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Are Rebounding Symptoms Different Than The Original COVID-19 Symptoms?  

The symptoms for COVID-19 rebound are almost identical to the initial infection-related symptoms, except much less severe. The CDC also notes that symptoms should last for a short period; In most cases, symptoms clear in about 2-3 days. Common COVID-19 symptoms include:  

  • Cough
  • Fatigue
  • Muscle or Body Aches
  • Shortness of Breath
  • Headache
  • Sore Throat
  • Congestion or Runny Nose
  • Nausea or Vomiting
  • Fever and Chills

Bottom Line 

There is still a lot to research and understand about Paxlovid Rebounding and whether or not it's going to become a nationwide concern. However, as cases are steadily rising again and paxlovid prescription fills are at an all-time high, the return of symptoms after treatment completion is definitely something you should self-monitor and seek out medical attention, if needed. It is important to note that the rebounding does not mean paxlovid is not effective and should still be taken if you are at risk and test positive for COVID-19.  

Although Paxlovid is currently free for all Americans, the possible doctor visits and care as a result of rebounding come at a cost. Even though we are in a much better place than at the beginning of the pandemic, testing positive for COVID-19 can come with its own challenges, including healthcare costs. However, with Mira, you never have to worry about how to access care or hidden costs. At just $45 per month, Mira members get access to low-cost lab testing, urgent care visits, virtual mental health services, and discounts on prescriptions. Sign Up today! 

Alexandra Thompson

Originally from Houston, Texas, Alexandra is currently getting her Master's in Public Health with a health policy certificate at Columbia University. One of her life goals is to own her own art gallery!