NIH: “Findings from a small study of eight patients published in Clinical Infectious Diseases suggest that COVID-19 rebound is likely not caused by impaired immune responses. The study, led by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, aimed to define the clinical course and the immunologic and virologic characteristics of COVID-19 rebound in patients who have taken nirmatrelvir/ritonavir (Paxlovid), an antiviral therapeutic developed by Pfizer, Inc. COVID-19 rebound is characterized by a recurrence of COVID-19 symptoms and/or a new positive viral test after having tested negative, according to the Centers for Disease Control and Prevention. According to the study authors, the results do not support the hypothesis that the five-day course of Paxlovid is too short for the body to develop a strong immune response to SARS-CoV-2, the virus that causes COVID-19….The findings suggest that rebound symptoms could be partially driven by the robust cellular immune response to residual viral RNA throughout the respiratory tract, rather than an impaired immune response allowing viral replication, according to the authors. Larger, more detailed epidemiologic studies are needed to further understand the clinical importance and epidemiologic consequences of COVID-19 rebound, the authors write. The authors note that the current data support the need for isolation in symptomatic rebound persons and the need to evaluate, in a clinical trial, longer courses of Paxlovid in immunocompromised individuals where the immune response may be ineffective.” [h/t Pete Weiss]

See also Your Local Epidemiologist – how paxlovid works.