Fauci reports COVID rebound, says his is “much worse” than initial illness

Anthony Fauci, the country's top infectious disease expert, has been struck by a phenomenon that seems to be becoming more common in the latest stage of the Pandemic.

In an interview Tuesday at Foreign Policy's Global Health Forum, Fauci recounted the progression of his infection to his current rebound, which he said has been much worse than his first round with the disease. Fauci—the director of the National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) and chief medical advisor to the president—is 81 years old and has been fully vaccinated against COVID-19 and boosted twice.

He had a positive test on June 15 and had very little symptoms. He started a five-day course of Paxlovid after his symptoms got worse. Fauci said that he just had mild nose congestion and fatigue. He reverted to negative on his tests for three days after finishing the course. On the fourth day, I tested myself again, and I reverted back to positive, but over the next day or so, I started to feel worse than before.

Fauci returned to Paxlovid for a fifth day. He said Tuesday that he was on his fourth day of Paxlovid. I don't feel unwell, but I do have some symptoms.

Conflicting treatment advice

Fauci's second course of treatment is not in line with the stance of the FDA and CDC. There is currently no evidence that additional treatment is needed for the rebound of COVID-19. Patient monitoring is the most appropriate management for patients with a second symptom after completing a Paxlovid treatment course.

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The FDA stated in May that there was no evidence of benefit for a longer course of treatment.

A second Paxlovid course could be used to treat rebound cases, according to Albert Bourla, CEO of Pfizer.

How and why

It's not clear how common they are or why they occur. People taking Paxlovid are not the only ones with COVID-19 symptoms. The agency wrote in its health alert that a brief return of symptoms may be part of the natural history of the disease.

Pfizer's initial data on Paxlovid shows that about 1 percent to 2 percent of both the treatment and placebo groups had a rebound in trials. There are anecdotal reports of post- Paxlovid rebound on social media.

The experts are trying to figure out why the rebound happens. Last week, researchers at Fauci's NIAID reported encouraging preliminary data from a small study suggesting that the body clears dead human cells and viral debris after a quickly smothered infections. There was no evidence to support the idea that people's immune systems fail to protect against the virus. According to limited data published by the CDC, people who have a rebound do not end up with more severe COVID-19.