Paxlovid Rebound: How Long to Test Negative Again?

So I first tested positive for COVID on 12/19, a Monday morning, and was put on Paxlovid right away (within 12 hours of first symptoms). That was a Monday, and by Friday evening I was testing negative again. Alas, I was not out of the woods yet; the following Thursday I woke up sneezing nonstop and tested positive again. Still positive as of last night.

So far Tom Scud has escaped infection; I have been isolating in one bedroom with a HEPA filter running, leaving only to grab food from the kitchen or use the bathroom, or maybe to throw in a load of laundry or something (although I have only had enough energy to do that in the past day or two). We are both masking in the house unless we are alone in a room with the door shut. So far it’s worked, but it sure would be nice to feel like we could, say, safely sprawl on the couch and watch Netflix. I am definitely getting stir-crazy after not going further than my front door for nearly 2 weeks.

What have other people’s experiences been with testing negative again after a rebound? When will we know that Tom Scud is out of the woods, assuming he continues to test negative?

For my lovely wife, a negative test on day 6, followed by increased symptoms and a positive on 7, then not negative until 15.

I was positive for 7 days on the initial symptoms and 7 days again on the rebound.

Ugh. Sounds like I probably have at least a few more days to go, then. I might build a fire in the fire pit and sit in the backyard, then, just so I don’t go completely stir-crazy. Luckily it’s not 20 degrees below zero here at the moment.

It took me 10 days post-pax to test fully negative. I started it on day 2 of testing positive (day 3 of feeling awful). We, too, stayed fully separate, masked when in common areas, and did not share a common area at the same time. It sucked (although my SO probably loved being able to play XBox without having me on him to get off his butt).

Update: round 2, day 5 post-positive. Tested negative once again this morning. Hopefully it sticks this time! Still exhausted as all hell, but managed to work a full day. We may do something crazy like sprawl on the couch together and watch Netflix (masked, of course).

This is old now – have you fully recovered? Is Tom Scud okay?

Yep, I am finally back among the living! In the end I missed 2 weeks of work and it took about 3.5 weeks total to feel like myself again. The second round of testing positive also ran 5 days in the end.

All in all, it wasn’t nearly as bad as I feared it might be given my crappy lungs. However, it’s still totally worth avoiding (that was the longest absence from work due to illness of my entire career), and I can’t imagine how bad it might have been if I hadn’t had every vaccine I was eligible for. And miraculously, I didn’t infect anyone else!

Good to hear. I am now at the beginning (paxlovid day 2), and of course hope for a shorter process.

While sick, I have been reading a bit about paxlovid rebound. There also can be rebound after going through COVID without paxlovid. And there does not seem to be any randomized controlled study showing a statistically significant increase in rebound rate after paxlovid, although some very good research physicians think it is probably real.

While the benefit to risk ratio for the vaccines is quite high, I read a recent blood cancer presentation suggesting that, at least for people in my boat, the vaccines aren’t working quite as well for post-omnicron variants. What still is working as before is pavlovid. (This of course isn’t medical advice – I’m just saying not to be sacred of pavlovid if your doc advises it.)

I had posted in the more recent Covid thread before I thought to search for “rebound” in this forum.

My experience is exactly mirroring yours, Eva_Luna. I tested positive 12/19/23 and immediately went on Paxlovid. Yesterday I was feeling like I was past it, and was even resuming normal activity, but overnight I started clogging up badly and sneezing uncontrollably. Didn’t test, though - I was going to do that tomorrow.

Now I feel sick again. Hopefully this rebound is brief and mild, as I’m seeing described on Yale medicine. Bleh.

I don’t think there is a randomized controlled study showing that, but real-world data is definitely suggesting that paxlovid increases the risks of rebound.

Annecdotal evidence has suggested that for a while. Among my friends, 100% of people who have complained about rebound took paxlovid. (Not all my friends who took paxlovid had rebound, though.)

Is there any data on whether the other antiviral also has higher rebound? My dad, uncle, aunt, and their friend (who all tend to hang out together) all got redemsivir (as it’s cheaper, I believe), and AFAIK, none of them got rebound. I know dad didn’t.

I wonder if it’s actually about one drug combo, or something more inherent. I could see it being that the initial dose just isn’t enough to knock the bug out completely, and it has a resurgence before your natural immunity kicks in. But I could also see it being specifically something about the Paxlovid cocktail that keeps the immune system from learning to fight it as well, meaning that, when it wears off, it sometimes can’t stop a resurgence. Or, option 3: the resurgence is actually caused by something specific with the antiviral that actually makes it easier for symptoms to occur after it leaves.

I’d also be interested in seeing whether when you actually take it factors in. Perhaps there’s a sweet spot between showing symptoms and the end of that 5 day window where it has the least chance of causing rebound.

I read somewhere that the singer you take it, the greater the chance of rebound.

My friends who are into the science believe that rebound is caused by your immune system not having an adequate time to mount a response before the markers of infection initially go away. Basically, the idea is that the rapid recovery confuses the immune system.

I also heard some people speculating on the radio (talking about this study) that it might be that if you took paxlovid longer, there wouldn’t be enough residual virus to start the rebound. But, the drug as prescribed is highly effective at avoiding death and hospitalization, so they are unlikely to do studies on other ways of administering it.

My husband, who took no Paxlovid and was sick at the same time as me, is feeling fine.

Just took my temperature; I’m back up to 101 degrees. And my sense of taste and smell just disappeared, which I had escaped before.

Back to bed. Godammit.

“[S]ooner,” I presume? That makes sense. That would fit my window hypothesis, since the effectiveness of the antiviral also decreases to negligible amounts after 5 days or so. You need enough time for your immune system to start fighting it before taking it out.

I’ve read that redemsivir is actually less potent than Paxlovid, but perhaps that is why is it used in the less serious cases: less chance of rebound since it lets the immune system do its thing more. (In higher risk cases, stopping the infection is a higher priority. And, in more severe cases, the immune response is already revved up.)

Yes, sooner.

Oh ouch. Best wishes.

I was just reading the CDC’s guidelines on re-isolating after Paxlovid rebound.

“Patients should re-isolate for at least 5 days. Per CDC guidance, they can end their re-isolation period after 5 full days if fever has resolved for 24 hours (without the use of fever-reducing medication) and symptoms are improving. The patient should wear a mask for a total of 10 days after rebound symptoms started.”

The site really doesn’t discuss testing again. Here’s a link if anyone wants to read it more thoroughly.

So in my case I can go out and about again starting tomorrow, as long as I mask up. Bleh, that rebound was awful, and my sense of smell is gone. I do hope it returns.

The CDC needs to give guidance to the least common denominator. Honestly, i think it ought to mention testing as an option, but it doesn’t, presumably because the decision makers felt testing was too expensive or exotic for us dumb Americans.

(sigh) Started my rebound this morning. Hope you are past yours.