Have COVID? Request Paxlovid Even if You’re ‘Not High Risk.’ Here’s Why – KQED

California has recently enacted several laws that force insurers to keep covering COVID care even after the state and federal states of emergency wind down, including State Bill 1473, which specifically requires insurers to keep covering the costs of COVID therapeutic treatments like Paxlovid. But this law only keeps the current situation in place until six months after the end of the federal emergency on Nov. 11. Which means that after that date, if you want Paxlovid and you’re insured, you’ll have to make sure you are obtaining these services “in network” — and you could get stung by out-of-pocket costs if you don’t.

As for those without insurance, free Paxlovid consultations and prescriptions are still available in California via the state’s telehealth service, Sesame. But nationally, the White House’s COVID-19 Response Coordinator Dr. Ashish K. Jha has promised that in the longer term, “likely over the summer or early fall,” the country will “transition from US government distributed vaccines and treatments to those purchased through the regular healthcare system,” and that the White House is “committed to ensuring that vaccines and treatments are accessible and not prohibitively expensive for uninsured Americans.” Which does not necessarily mean they will be free.

“Seriously, it’s going to be very complicated,” warns Chin-Hong. The last few years, he says, now feel like “we were living in a fantasy land, where — at least around COVID — it doesn’t matter who you are and what you are: Everything was free.”

But come Nov. 11, as a state “we’re kind of going back to stratified land where the rules are complicated and people have to have different decisions based on how much cost sharing they’re going to have,” he says.

Don’t be put off by ‘Paxlovid rebound’

In a nutshell, the “Paxlovid rebound” is when someone tests positive for COVID and takes Paxlovid, and tests negative on an antigen test for COVID after several days — but then redevelops their COVID symptoms and tests positive again on an antigen test after that.

In 2022, Dr. Bob Wachter told KQED that, in these cases, the negative test comes on average on Day 7 or 8 of a COVID infection, and that the positive “rebound” test and return of symptoms happens around Day 11 or 12. Rebound infections, he said, “tend to be mild,” even though they last roughly another five to seven days — and you should assume you’re infectious again if you test positive that second time.

A lot of folks hear about the “Paxlovid rebound” and get discouraged from seeking out Paxlovid, says Chin-Hong. But he also says that what a lot of people don’t know is that people can sometimes “rebound” with COVID anyway — even without taking Paxlovid.

Chin-Hong says he’s “seen so many studies now” at this stage of the pandemic that show swabs of COVID patients both with and without Paxlovid with “very similar rates of the virus coming back, with and without symptoms.” In short, “we don’t have any evidence at this point that Paxlovid causes more rebound than natural infection, when you study people systematically,” says Chin-Hong.

“Nobody really knows why” COVID rebounds happen, says Chin-Hong. But he says that there’s a good chance that some folks are already getting a COVID rebound, without Paxlovid, and just aren’t realizing it. After a COVID infection, “you’re probably not paying attention beyond the first negative that you got,” he suggests, and “you just dismiss that sniffling nose or whatever … you’re out of the five days and you’re celebrating.”

Ultimately, says Chin-Hong, there’s “this probably biphasic aspect of COVID” that just hasn’t been studied much yet. But all this is to say: Don’t let the idea of a “Paxlovid rebound” dissuade you from taking Paxlovid when you might greatly benefit from it — because a rebound infection could hit you anyway even without the Paxlovid.