Although rare, “rebound” cases following treatment with an anti-viral drug are possible and President Joe Biden is the latest example of that. The President tested positive for COVID-19 again Saturday. This news comes slightly more than three days after he was cleared to exit coronavirus isolation, according to the White House.
According to White House physician Dr. Kevin O'Connor, Biden “has experienced no reemergence of symptoms, and continues to feel quite well.” O'Connor says, “there is no reason to reinitiate treatment at this time.”
Biden tweeted a 12-second video on a White House balcony with his dog, Commander, to let everyone know he was doing fine amid the rebound case.
“I'm feeling fine, everything is good,” says Biden. “But Commander and I got a little work to do.”
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Biden was previously experiencing “mild symptoms”, which included a runny nose, fatigue and an occasional dry cough.
Those symptoms were "completely resolved" after the President completed a five-day course of Paxlovid (an antiviral pill used to treat COVID-19), according to O'Connor, who had been treating Biden.
Why do rebound cases occur?
Due to the chances for "rebound" COVID in some patients taking Paxlovid, Biden continued to be tested as a precaution.
After testing negative, Biden returned to holding in-person indoor events and meetings with staff at the White House while wearing a mask, which is in accordance with CDC guidelines. However, he removed his mask indoors when delivering remarks on Thursday and during a meeting with CEOs on the White House complex.
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Press secretary Karine Jean-Pierre says social distancing was in place when the President did take his mask off.
“They were socially distanced. They were far enough apart. So we made it safe for them to be together, to be on that stage,” she shares.
Regulators are still studying the prevalence and virulence of rebound cases, however, the CDC warned doctors in May that it has been reported to occur within two to eight days after initially testing negative for the virus.
According to White House COVID-19 coordinator, Dr. Ashish Jhadata, data "suggests that between 5 and 8 percent of people have rebound” after Paxlovid treatment. Joe Biden
“Acknowledging the potential for so-called ‘rebound’ COVID positivity observed in a small percentage of patients treated with Paxlovid, the President increased his tested cadence, to protect people around him and to assure early detection of any return of viral replication,” O'Connor wrote in a letter.
Both the Food and Drug Administration and Pfizer have pointed out that 1% to 2% of people in Pfizer’s original study on Paxlovid saw their virus levels rebound after 10 days. However, the rate was about the same among people taking the drug or dummy pills, “so it is unclear at this point if it is related to drug treatment,” according to the FDA. Joe Biden
Most rebound cases are typically mild. In fact, severe disease during a rebound case has not been reported.
In the past patients who have recovered from earlier variants of COVID-19 have typically had high levels of immunity to future reinfection for 90 days, Jha notes. However, the BA.5 subvariant that infected Biden, who is fully vaccinated and boosted, has proven to be more “immune-evasive.”
“We have seen lots of people get reinfected within 90 days,” he says, adding that officials don’t yet have data on how long those who have recovered from the BA.5 strain have protection from reinfection.
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What to do if you get a rebound case
Paxlovid has been proven to significantly reduce severe disease and death among those most vulnerable to COVID-19. Despite the rebound risk, U.S. health officials highly encourage you to consult with your doctors or pharmacists to see if you should be prescribed the treatment if you test positive.
However, because COVID is still contagious when taking Paxlovid, it is important to continue to take precautions. In fact, researchers say people should be aware that the drug may not completely extinguish the infection.
So what should you do if you develop a rebound case?
The CDC says people who test positive again and whose symptoms come back after finishing their antiviral pills should restart their isolation period and isolate for five full days.
You can end your isolation period after those five additional days as long as your fever has been gone for 24 hours without fever-reducing medication and you’re feeling better.
The CDC also recommends wearing a mask for 10 days after your symptoms come back.
In accordance with these guidelines, Biden will reenter isolation for at least five days. He will continue to isolate at the White House until he tests negative.
