Paxlovid rebound is not a thing + Covid hurts

• Oct 10, 2023 • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

“Paxlovid rebound” is the idea that taking the anti-viral medication Paxlovid will help with a Covid infection initially, but then — ruh roh — things get worse after a week or so. Nope! That’s just Covid being Covid. Paxlovid rebound was never a thing, still is not a thing, and never will be a thing: people are simply blaming the wrong thing.

I’m paraphrasing Dr. Daniel Griffin, who has immense experience treating COVID patients. In his own words:

“Let’s stop with this misinformation. Let’s call this what we called it early on: it’s the second week, it’s the period of the cytokine storm, the hypoxic phase… no ‘rebound’ here.”

See (or rather hear) This Week In Virology episode #1006 @ 29:45 [Overcast web app].

Covid hurts

As always when I bring up Covid, it’s because long Covid hurts: pain is a common long-term symptom of Covid (see Ebbesen and Cui), and long Covid is common and can occur even after mild cases (but much more so after nasty ones). Vaccination and Paxlovid both reduce the severity of Covid, and therefore the risk of long Covid, and new cases of chronic pain.

Ebbesen et al. was just published, so that’s today’s pain science update. They report some super depressing news in this paper, strongly underlining the “Covid hurts” thing: at least 5% of 130,000 people who had mild Covid (not hospitalized) developed new widespread musculoskeletal pain after their infections … and still had it more than a year later. Ugh. ☹️

That is a lot of hurting: at least 6500 people in that study group all got an ugly, long-term legacy from their Covid infections … and without even going through the deadly wringer of hospitalization. If that’s what mild Covid can do, I shudder to think what severe Covid can do. (Unfortunately, we know exactly what it can do now, and it is indeed shudder-inducing: see Davis et al, also new. They went into freaky detail about the incredible list of post-Covid complications. Full text and tables.)

“This is fine” meme, 2 identical frames showing a cartoon dog seated and drinking a beverage while surrounded by flames and smoke. In the second frame he says, “This is fine.” First frame caption is “2020-2022: COVID.” Second frame caption is “the rest of our lives.”

It will never really be “over” — especially for the people with long Covid.