Another rare virus mystery: They got sick, treated, and infected with the virus again

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Soon after serving on the jury in March, Greg Cromley developed a sore throat and congestion. The retired molecular biologist took a rapid test on Saturday and saw the emergence of a dark, thick streak – “extremely positive” for the coronavirus.

Cromley, 71, called his doctor two days later. By afternoon, the friends had left a course of Paxlovid, a five-day regimen of antiviral pills designed to prevent people from becoming seriously ill.

On the day he took his last dose, his symptoms were regressing. Test each of the following three days: All are negative.

Then, in the middle of a Zoom community meeting, he started feeling sick again. Cromley, who was vaccinated and boosted, thinks it may be residual effects of his immune response to the virus. But the chills were long-lasting and unpleasant. test. positive. repeatedly.

Cromley, like other patients who have experienced relapses after taking baxlovid, is bewildered and anxious. On Twitter, doctors and patients alike share a Share group ideas in real time About what might happen, with little clues to work with.

It’s the latest development – and the latest puzzle – in the pandemic, and it’s a reminder that two years later, the world is still on a learning curve with the coronavirus.

Infectious disease experts agree that this virus rebound phenomenon after some patients take the drug appears real but is rare. Exactly how often it happens, why it happens and what – if anything – is still a matter of debate.

What is clear is that patients should be warned that this is possible so that they do not panic – and so that they know to get tested again if they start to feel ill. More data is needed to understand what is going on. Paxlovid, made by pharmaceutical giant Pfizer, remains a useful drug, although it has raised a new mystery.

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“I’m not baxiloid negative,” said Cromley, who lives in Philadelphia, whose last test was positive a week after the second wave of the disease began. “I don’t know if it just stops [viral] Replication for five days of time, and it’s back.”

One of the major concerns with antiviral drugs is the risk of resistance, when the virus evolves to evade treatment. An FDA analysis of Pfizer’s clinical trial showed that the virus rebounded in many people about 10 to 14 days after initial symptoms appeared, but found no cause and no evidence that the infection was resistant to treatment.

Michael E. Charnes, chief of staff for the VA Boston Healthcare System, has published a detailed case study of a 71-year-old patient who experienced a relapse. The man, who was vaccinated and bolstered, received baxiloids and felt better quickly. When he developed cold symptoms a week after resolving his condition, researchers sequenced the virus’ genetic code and found that it was the same virus that reappeared. This has ruled out reinfection, a variant re-emergence or the virus becoming resistant.

Charness would like to see more data and other questions answered. Should antivirals be given for a longer period to ensure removal of the virus? Should people be treated again? What are the implications of people returning to their normal lives?

“If you have a relapse of your viral load, and that happens on day 10, when the CDC says you’re back to work, there’s no mask, what are you supposed to do about isolation? Is this a moment when you become contagious again? Al-Ihsan said. “The person we studied, we were advised to isolate until his viral load cleared the second time around.”

Pfizer collects data, both in clinical trials and in real-world monitoring of drug use. The company’s trial data indicates a delayed increase in viral load in a “small number” of people taking the drug, but rates appear to be similar among study participants who took a placebo, according to company spokesperson Kit Longley. People who experienced these increases did not become acutely ill the second time around.

These results suggest that baxlovid is not the cause of people’s relapse, as this also occurs in untreated subjects.

If this turns out to be true, it raises concern that some people – whether they take medication or not – can be contagious long after they think they’re in the clear, and after guidelines suggest they can stop taking precautions.

“Although it is too early to determine the cause, this suggests that the observed increase in viral load is unlikely to be related to baxlovid,” Longley wrote in an email. “We have not seen any resistance to baxlovid, and we remain very confident in its clinical efficacy.”

The limited evidence leaves most doctors in favor of the idea that baxlovid kills the virus, but not completely. It is possible that by suppressing the virus, the immune response does not fully intensify, because it does not see enough viruses. Once treatment is over, the virus can begin to multiply again in some people.

Philip Prietsky, a primary care physician in Santa Monica, Calif., said he encountered two cases among patients, each of whom had been vaccinated and boosted at least once.

A 72-year-old man with chronic medical conditions that increase his risk of acute illness began feeling unwell at the end of March. He tested positive and started a course of baxiloid. Felt better and tested negative. Then, 12 days later, he started to feel bad again – and his test result was positive.

A return of infection seemed unlikely, and Britsky thought resistance was unlikely with a five-day course of treatment.

In well-vaccinated people, re-infection so quickly will be “Like a thunderbolt or winning the lottery,” Pritzky said. “I don’t think this is a re-infection. I think this is a return of the original infection.”

Experts do not know how common this phenomenon is. Many people may not test if they get sick again after the initial infection subsides, making it difficult to keep track of them.

It almost happened to Holly Teliska, 42, of San Francisco. Telesca fell ill shortly after returning home from a trip to New York. She had a risk factor for severe illness and was able to access Paxlovid immediately. When she finished the course of treatment, she did an at-home PCR test that was negative and felt much better, although she remained exhausted.

Four days later, she had a cold and a cough. I assumed she had caught her daughter’s cold and had overcome it. Five days later, with plans to visit an immunocompromised friend, she took a test.

Teliska felt silly testing herself. She was vaccinated and boosted, and then infected.

“We said I’m her safest friend now, that I have COVID-19, so for three months I can safely spend time with her,” Teleska said. That really threw this novel out the window. … This whole experience was a true reminder that there is still much to learn.”

New baxiloid. It only came into use in December, so reports people are sharing on social media of a resurgence of the disease may be the tip of the iceberg — or may simply reflect a desire to learn more about a rare and interesting result.

If it turns out that such cases So very rare These case reports may be an intermittent curiosity – something might happen to warn patients. If it is more common, it may lead to adjustments in treatment regimens.

The growing anecdotes are compelling to many doctors, but it is also possible that the virus may rarely recover. Yonatan Grad, associate professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health, studied the viral loads of NBA players and staff during infection. This data shows that viral loads can bounce back, he said.

The “exceptionally unusual” thing, Grad said, is for the viral load to drop for a few days to a level that indicates negative and then rise again.

Paul Sacks, an infectious disease specialist at Brigham and Women’s Hospital in Boston, recently shared the story of a patient who developed an infection and then relapsed after taking baxlovid. I have heard many colleagues who have similar stories. But the anecdotes raise more questions than they answer.

He points out that even if the virus hasn’t been shown to develop resistance to treatment during a resurgence, that doesn’t mean it won’t. Will the treatment kill the virus so successfully that people don’t generate a strong immune response? This could have implications for understanding whether injury acts as a powerful reinforcer.

This phenomenon is so new that many doctors are not aware of it. Jennifer Charnes, a 31-year-old nurse who lives in Brooklyn, Massachusetts, has benefited from knowing her father’s work in Boston, Virginia.

Charness started sneezing in early April and got a blatantly positive coronavirus test. She has a history of asthma and a prescription for baxolphoid. When she took the drug, she saw her positive test line dwindle and her symptoms fade. She scanned to make sure it was negative before returning to work, as a precaution. Then, two days later, she felt the symptoms came back and she tested positive – again.

“I’m very disappointed,” Charns said. “I don’t think I’m going to get very sick. It’s about what this means for my viral load, how contagious I am? And when will I not be contagious? I’m stuck in my house again.”

Charness’s primary concern is that they do not pose a risk to anyone else. I consulted the doctor remotely on Friday. The clinic had never heard of a case like hers and decided to treat it as an infection again and reset the isolation clock.

She said, “I’m on the fourth day.” “Or am I today 13?”

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