05/24/22 Health Advisory: COVID-19 rebound after Paxlovid treatment

Requested actions

• Be aware, Centers for Disease Control and Prevention (CDC) issued a health advisory about COVID-19 rebound after Paxlovid treatment. Continue to offer Paxlovid for early-stage treatment of mild to moderate COVID-19 in people at high risk of severe disease.
• Be aware, providers have reported COVID-19 rebound—recurring symptoms or a new positive test after a negative test—2–8 days after initial recovery. A brief return of symptoms may be part of SARS-CoV-2 infection in some people, regardless of treatment or vaccination status. Case reports suggest patients with COVID-19 rebound who were treated with Paxlovid have mild illness.
  • Do not offer retreatment. Evidence does not indicate additional treatment is needed.
  • Tell patients with COVID-19 rebound to isolate per CDC guidance and take additional precautions to prevent transmission.
  • Tell patients to stay up to date on COVID-19 vaccine and seek Evusheld therapy if immunocompromised.
  • Continue to prescribe Paxlovid to people who meet treatment criteria.

Questions? Contact the Health Department

• Urgent issues—call (253) 649-1412.
• Non-urgent issues—call (253) 649-1413 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease.

Additional information

• CDC health advisory about COVID-19 rebounding after Paxlovid treatment.
• Paxlovid patient eligibility screening checklist, Food and Drug Administration (FDA).
• Paxlovid fact sheet for healthcare providers, FDA.
• Paxlovid fact sheet for patients, FDA.
• Interim guidance for use of Paxlovid, Washington State Department of Health (DOH).
• Paxlovid drug interactions, Infectious Diseases Society of America.
• COVID-19 drug interactions, University of Liverpool.
• COVID-19 therapeutics locator for providers, Health and Human Services (HHS).
• Therapeutics for providers page, DOH.
• Our COVID-19 treatment information for providers page.
• COVID-19 therapeutics resources, HHS.
• COVID-19 treatment guidelines, National Institutes of Health.