Doctor discusses President Biden's rebound COVID-19

President Joe Biden is back in isolation after testing positive again for COVID-19 Saturday, days after finishing a 5-day course of the antiviral Paxlovid.

The president's doctor says the 79-year-old does not have symptoms and is feeling well, but appears to have a case of viral rebound.

So, what does that mean?

Dr. Cecil Bennett, a family practice physician in Newnan, Georgia, says rebound infections with this virus and antiviral treatment are not unexpected.

He likens what happened with the president to what sometimes happens when he prescribes an antibiotic for a patient with a secondary upper respiratory infection like bronchitis.

"They feel good for the first few days when they first start the therapy, and a few days later they start getting symptoms again,"  Dr. Bennett says.  "Basically, this tells us the antibiotic may have initially suppressed the bacteria, but then the bacteria  overwhelmed the antibiotic. So, I switch to another antibiotic." 

Bennett says the same thing can happen with viral therapies like Paxlovid.

"It may be effective initially, help to suppress the virus, but then, lo and behold, a few days later, people have rebound symptoms. "

In Mr. Biden's case, Bennett believes, the antiviral was not very effective, perhaps because of his age.

"So, we shouldn't panic seeing this happen," he says.  "It will happen time and time again, particularly in those who have greater risk, those who are seniors or have comorbidities."

In Paxlovid clinical study about 1-2% of those who took Paxlovid had rebound symptoms within 10 days.

Volunteers in the study placebo group, who received the inactive treatment, reported similar rates of rebound symptoms.

Now, with the highly contagious BA.5 Omicron subvariant making the rounds, and millions taking Paxlovid to try to prevent becoming severely ill, rebound COVID is becoming more common.

US President Joe Biden walks along the colonnade from the residence to speak in the Rose Garden of the White House in Washington, D.C., US, on Wednesday, July 27, 2022. Biden ended his isolation after twice testing negative for Covid-19 capping his f

So, Dr. Bennett says, he's not surprised to the president, who is fully vaccinated and double-boosted, has rebound COVID-19.

"What we're seeing is that individuals who are vaccinated are getting COVID," Bennett says.  "Individuals who are boosted one time are getting COVID.  Individuals who are boosted 2 times are getting COVID.  Individuals who are getting Paxlovid are getting rebound COVID."

He says the news the president is asymptomatic this time around is encouraging.

"For the most part, people recover quickly, and that is what we should always look at: do people recover quickly," Bennett asks.

If you have a rebound infection, stay home and isolate for at least 5 days.

On day 6, you can come out of isolation, the CDC says, if you have been fever-free for 24 hours without fever reducing medication and your symptoms are improving.

For 10 days, Dr. Bennett says, wear a well-fitting high quality mask like a KN95 when you are around other people.

"I think anyone who is recovering from COVID and going back into the public arena should be wearing those masks," he says.