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How 'rebound' COVID-19 happens

President Joe Biden is in isolation again after another round of positive COVID-19 tests. The president's physician says Paxlovid is likely behind the "rebound."

CHARLOTTE, N.C. — President Joe Biden continued to work virtually Tuesday after another round of positive COVID-19 tests over the weekend. The president's physician attributes this second isolation period to the anti-viral Paxlovid, calling the medical situation "rebound COVID positivity."

Paxlovid is the coronavirus treatment doctors may prescribe to a patient considered to be at-risk for severe complications from the virus, and it is administered within a certain window of detecting an infection.

Biden's rebound case is seemingly rare. While the CDC warned months ago that it was a possibility for those taking the coronavirus treatment, Mayo Clinic researchers studied nearly 500 people taking Paxlovid and found less than 1% of them had a rebound infection.

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The president started taking Paxlovid after first testing positive nearly two weeks ago. He then left isolation after several days of negative tests. Biden started testing positive again Saturday, with his physician noting that the president had no symptoms and "felt quite well."

Dr. Raynard Washington, Mecklenburg County's public health director, said Paxlovid works by suppressing COVID-19 replication, and rebound COVID-19 can happen when the person finishes their round of pills.

"That viral replication, when the person is no longer taking Paxlovid, can start to pick back up," Washington said. "Then you might have enough viral particles in the body to be detected on a test, and then that the test will come back positive."

The CDC's fact sheet on the treatment states the rebound can also emerge as resurfacing symptoms.

"In most cases, the person won't become infectious again," Washington said, noting that most of the time, the positive tests subside after several days. 

The CDC says that rebound positivity calls for isolating again for at least five days and in rare cases, a person might continue to test positive after day 10. However, at that point, it is unlikely the person is shedding any infectious virus, the agency notes.

Rebound positivity does not appear to foreshadow any severe outcomes or signal that Paxlovid did not work, the CDC states.

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