Doctor’s Rx: Stop Testing

Stop testing, said the doctor, it will be fine.

In my chronicle of these plague years this may well have been the most memorable, or at least counter-intuitive, medical advice I had been given.

Ten days into my bout with COVID-19, and five days after completing the five-day course of the new antiviral drug, Paxlovid, I was again coming up positive on rapid tests.

My Covid symptoms, if they indeed were symptoms of Covid, were indistinguishable from seasonal allergies or a head cold, sniffles, coughing and a general droopy feeling.

In other words, nothing really alarming except for the alarming idea that this virus that we have been so programmed to fear was succumbing neither to my body’s somewhat compromised immune system or the anti-viral medication that had been introduced as a game changer just a few months ago.

I had actually tested negative once, on day eight, after completing the Paxlovid, but then positive again on days nine and ten. Which is when the doctor told me to stop testing.

This was jarring, given how many times we have been told through the pandemic that we need to test more. Indeed, we do need more testing, even now, to spot the virus and isolate the infected or treat them with drugs like Paxlovid.

Particularly worrisome is the federal government’s cutoff of funds to test the uninsured for free. That’s why there are now fewer of those vans and tents offering testing on the street. Inevitably, now there will be people for whom the cost of the test will be enough of a barrier to skip it.

Which means some infected people won’t isolate themselves or get treatments they need.

Raising Anxiety

But the doctor was making a different point to me. I know I have the virus. I quickly got the anti-viral treatment. I know I should rest and isolate until I feel better.

All the testing is doing now is raising my anxiety. Which, in my own defense, isn’t hard to to do.

“With vaccines, our wall of immunity and new highly effective treatment, especially Paxlovid, we can now likely keep severe disease caused by Omicron variants at or under that caused by flu,” the city’s former health commissioner, Dr. Tom Frieden, said the other day in a thread of tweets. “But Omicron can still be dangerous, especially in people who are older, immunosuppressed or not-up-to date with their vaccinations, as we tragically saw in Hong Kong.”

I am older and immunosuppressed, although my last dose of vaccine was only two months ago.

A key element here is that vaccines and anti-viral treatments are medicine not magic. We need to set our expectations against that.

As a reporter covering the pandemic, I had followed the enthusiastic rollout of Paxlovid, how it reduced by 89 percent the proportion of COVID patients who developed severe illness.

Fine Print

But only after I started taking it did I read some of the fine print in the studies.

“Several subjects appeared to have a rebound in SARS-CoV-2 RNA levels around Day 10 or Day 14,” the manufacturer, Pfizer, reported.

Turns out these “rebound cases” like mine are not uncommon, although how common is still being studied.

Dr. Paul Sax, clinical director of the division of infectious disease at Brigham and Women’s Hospital told the Boston Globe that he is hearing about the issue from patients.

“At the very least, people who take Paxlovid and clinically recover should not ignore their symptoms if they come back,” Sax said. “They should think this is a recurrence of COVID, and then [test] themselves again.”

My friend John took Paxlovid and felt better but by no means “cured.” Ten days on he was napping the day away and hoping he would be well enough for a planned trip to see his grandchildren.

Buying Time

Researchers stress that rebound cases don’t mean the anti-viral treatment is ineffective. It may well be buying time for the immune system to mount its defense.

My wife, who developed COVID at roughly the same time, also took Paxlovid, and has been clear of the virus in rapid tests.

New York City has gone to considerable lengths to make it easy to get Paxlovid, including a program to deliver it to you at home.

Some patients have taken a second course of Paxlovid, although that would seem at odds with the initial guidance to take it within five days of the onset of symptoms.

Once again, we are in the situation we have faced repeatedly since the beginning of the pandemic. We don’t know enough.

Which of course is why I ignored the doctor’s advice and tested myself again Sunday. Still positive.