Symptoms come back even after two days. Doctor: COVID-19 relapse is a new and dangerous phenomenon

Although the COVID-19 pandemic has been going on for its third year, we are still learning the disease and learning new things. More and more is being said about the phenomenon that can appear two to eight days after symptoms have disappeared or a negative test has been taken. What exactly is “COVID-19 rebound”, where does it come from and when can it be dangerous? In an interview with Medonet, Bartosz Fiałek, a physician and promoter of medical knowledge about COVID-19, explained.

1. “COVID-19 rebound” can be defined as COVID-19 relapse, it can be “symptomatic” or “viral”
2. A symptomatic relapse occurs when two to eight days after the relapse has resolved, it reappears
3. A “viral” relapse is when a positive test result for SARS-CoV-2 infection occurs within two to eight days
4. These phenomena can also occur simultaneously
5. Bartosz Fiałek: the phenomenon has not been thoroughly known yet, so we cannot indicate an unequivocal cause. However, it is suspected that it is related to the fact that the organism “did not cope” fully with the pathogen
6. The COVID-19 recurrence was experienced by Dr. Anthony Fauci, medical adviser to the US President, and now Joe Biden himself
7. More information can be found on the Onet homepage

Monika Mikołajska / Medonet: Recurrences of COVID-19 (the so-called COVID-19 rebound) began to be discussed when it affected Dr. Fauci (in June) and now Joe Biden. What are we really talking about? What is “COVID-19 rebound”?

Bow. Bartosz Fiałek: The American Center for Disease Prevention and Control (CDC) presented a good definition of “COVID-19 rebound” in my opinion. They rose to the occasion. We can talk about the recurrence of COVID-19 when, two to eight days after the symptoms have disappeared and / or the test for SARS-CoV-19 infection has been negative, we again record the occurrence of symptoms and / or a positive test for SARS- CoV-2.

We can therefore deal with a “symptomatic” relapse (I recovered, the symptoms have decreased in intensity or have disappeared, and after two to eight days they increase or return) or a «viral» relapse (after a negative SARS-CoV-2 infection test result appears test positive within two to eight days). It may also happen that both of these forms occur simultaneously (symptoms of the disease reappear and the test result is converted from negative to positive).

The time since the last SARS-CoV-19 infection test result or symptoms is important to recognize a COVID-2 recurrence. If the symptoms of the disease return, e.g. after a month or two, it will no longer be a COVID-19 recurrence, but a long covid. “COVID-19 rebound”, as defined, occurs two to eight days after “recovery”.

The phenomenon of relapse is known in some diseases, but that it also happens with COVID-19 has been established relatively recently.

It is known that the phenomenon of disease relapse occurs, inter alia, in in other respiratory infections. It is not unusual. Nevertheless, in the context of COVID-19, this is a phenomenon that has been described relatively recently, which does not mean that it is surprising.

We already know what COVID-19 relapse is. The question now is where does it come from? What is it in an apparently healthy body that makes the disease return?

The phenomenon has not been fully understood yet, so we cannot indicate a clear cause. From a scientific point of view, however, attempts are being made to explain this phenomenon in the case of SARS-CoV-2 infection.

Bow. Bartosz Fiałek

It seems that the recurrence of COVID-19 may be related to the fact that the organism of the person in whom it appeared did not remove, eliminate, “did not cope” fully with the virus. As a result, the so-called remnants, i.e. remnants of the pathogen. They can present a certain replication potential, i.e. they can multiply. As a result, on the one hand, a negative result may turn into a positive result (the number of virus copies increases), and on the other hand, symptoms may develop (more virus copies, the greater the risk of symptoms, severe disease, death). As we said before, these two phenomena can occur simultaneously.

These allegations suggest that the main cause of COVID-19 recurrence is because a person’s immune system does not fully eliminate the new coronavirus from the body. However, we cannot be sure that this is the main or only cause of this phenomenon.

There is another option – antiviral drugs. The recurrence of COVID-19 has recently been mentioned, for example, in the context of the drug Paxlovid, which inhibits the enzyme that allows virions to be “cut” into smaller, capable of multiplication, pieces. The drug is taken for five days. Thanks to the therapy, the number of copies of the virus in the body is normally reduced and symptoms disappear as a result. Some people may experience a situation where SARS-CoV-2 is not completely eliminated from the body by treatment and the remaining remnants of the pathogen begin to multiply after treatment is completed. We already know the effects of this.

Of course, it is not the case that antiviral drugs lead to the relapse of the disease, after all, this phenomenon is also observed in people who are not treated with antiviral drugs. However, it is also not that these substances are without influence on the occurrence of COVID-19 recurrence. Clinical trials conducted by the Pfizer concern during the Paxlovid effectiveness tests have shown that COVID-19 recurrence occurred in 1-2 percent. people in the group taking the drug compared to those in the placebo group. It is very little, but not at all.

And what is known about the COVID-19 relapse rate in general?

In addition to the above estimates, we have access to an uncensored study – the only one widely commented on by the scientific community. The conclusions that can be drawn on the basis of it are as follows: “symptomatic” COVID-19 recurrence affected 27% of patients. patients (recurrence of disease symptoms within two to eight days of their resolution, whether they were taking the drug or not). That’s a lot (approximately one in four).

“Viral” recurrence of COVID-19 occurred in 12 percent. subjects (conversion of the test result for the presence of SARS-CoV-2 infection from negative to positive within two to eight days of obtaining a negative result).

Does the COVID-19 relapse have any risk?

Yes. Especially in the context of 12 percent. people who have changed their test result from negative to positive. Such conversion may mean that these people have most likely ceased to be infectious, but due to the re-multiplication of the virus in them, they could have become infectious again (and probably have become, although we are not 100% sure).

Meanwhile, hardly anyone decides to retest within a few days after contracting COVID-19. Many people think: I just fell ill with COVID-19, I tested negative, the symptoms reappeared, but it can’t be the same disease, I must have been overwhelmed, maybe it’s the air conditioning fault. Meanwhile, symptoms may be due to a recurrence of COVID-19, not air conditioning. Moreover, it could be a “viral” COVID-19 relapse, when we may become unsafe again. Then a situation may arise in which we unconsciously infect other people.

And this is the potential danger of COVID-19 relapse for me. Fortunately, the rate of “viral” relapse is not high – roughly one in nine to ten people, but these people may be the source of another SARS-CoV-2 outbreak.

What would the doctor’s advice in such a situation?

Let’s be careful and watch ourselves. If the symptoms of an infection appear even shortly after a potential recovery, be sure to do a test. If it is negative, we are probably among those 27 percent. people in the study who reported “symptomatic” recurrence of COVID-19. A positive result of the test for the presence of SARS-CoV-2 infection confirms the “viral” recurrence, and hence the real risk of spreading the pathogen – then re-isolation is necessary, for example with President Biden.

We should also remember that COVID-19, but also e.g. influenza, tend to generate late complications, including severe ones. In such situations, we should watch ourselves especially carefully during the entire recovery period.