Science
For some COVID patients, ‘Paxlovid rebound’ has nothing to do with Paxlovid

It is a story a couple of COVID-19 treatment, a nasty trick the coronavirus generally performs on its victims, and the way the 2 turned a pandemic couple known as “Paxlovid rebound.”
It’s additionally a narrative about how seems will be deceiving.
People have been fast to embrace the concept that the antiviral drug is in charge for COVID-19 relapses in individuals simply days after they’ve seemingly recovered. President Biden was mentioned to have skilled Paxlovid rebound this summer time, after White Home medical doctors declared him coronavirus-free. The identical factor occurred to Dr. Anthony Fauci and Stephen Colbert, amongst others.
It’s tempting to presume a cause-and-effect relationship between two issues that happen in fast succession. And even when occasions are utterly random, we are likely to see the patterns we anticipate finding.
However researchers should not so positive Paxlovid rebound is actual. Relapses have occurred in COVID-19 sufferers who didn’t take the drug — they only didn’t get as a lot consideration when there wasn’t a brand new medication in charge.
Medical doctors concern some sufferers who may benefit from Paxlovid are skipping it in an effort to keep away from a boomerang bout of COVID-19. That’s troubling as a result of the treatment has been discovered to powerfully cut back the danger of hospitalization or loss of life within the unvaccinated, older individuals and people with compromised immunity. Preliminary analysis hints it might even cut back the danger of lengthy COVID.
Dr. Michael Charness, who led a group that exhaustively studied 13 sufferers whose COVID-19 rebounded, admitted that the phenomenon has scientists “scratching our heads.” He mentioned he’s perplexed that many rebounders’ viral hundreds — and thus, their capacity to contaminate others — will be simply as excessive or increased than it was throughout their preliminary sickness.
“However rebound is not a cause to not take Paxlovid,” he insisted. When utilized by individuals with a great probability of changing into severely unwell or dying, Paxlovid reduces the percentages of both by nearly 90%.
Furthermore, passing on Paxlovid out of concern that it’ll immediate a one-two punch of COVID-19 is unlikely to assist, Charness mentioned.
“It’s clear some individuals will rebound anyway,” he mentioned.
That wasn’t so clear in late Might, when the Facilities for Illness Management and Prevention issued a well being advisory titled “COVID Rebound After Paxlovid Therapy.” It knowledgeable medical doctors and public well being officers of current circumstances by which individuals who had taken the really helpful five-day course of Paxlovid after which examined unfavourable for a coronavirus an infection had “recurrent sickness” two to eight days later.
The alert cautioned that the rebound phenomenon could also be a characteristic of COVID-19 “unbiased of therapy with Paxlovid,” and the CDC confused that it continued to suggest use of the antiviral treatment. But within the public sq., a causal hyperlink was shortly cast. Conversations buzzed with accounts of neighbors and associates who took Paxlovid and skilled the boomerang impact.
By late June, researchers at Harvard Medical College revealed a research within the Journal of Scientific Infectious Ailments that described seven COVID-19 sufferers who relapsed following a course of Paxlovid. In September, Charness and his colleagues on the VA Boston Healthcare System and elsewhere weighed in with their report within the New England Journal of Drugs on the development of sickness, restoration and recurrence in 13 sufferers who took Paxlovid to deal with their COVID-19.
Approved by the Meals and Drug Administration almost a 12 months in the past, Paxlovid has carried the hopes of medical doctors and public well being officers who rely on it as a rescue drug for the unvaccinated and a backup for vaccinated individuals in fragile well being. It’s simpler, and has fewer security considerations, than molnupiravir, one other antiviral made by Merck. And in contrast to antibody remedies and the treatment remdesivir, it’s a tablet meant to be taken at dwelling.
A Pfizer lab technician inspects Paxlovid tablets in Freiburg, Germany.
(Pfizer by way of Related Press)
The Biden administration’s “check to deal with” initiative made Paxlovid simple to seek out at pharmacies, without charge to sufferers. However it hasn’t precisely taken off. In a ballot performed this summer time by a consortium of universities, solely 11% of those that’d had a coronavirus an infection since Jan. 1 mentioned they acquired a prescription for the drug.
“If individuals qualify for Paxlovid, they need to take it. It’s a lifesaver. Interval,” mentioned Dr. David Smith, an infectious illnesses specialist at UC San Diego. “I hate that rebound has been tagged as a Paxlovid impact.”
Certainly, the extra scientists be taught, the extra they’ve come to imagine that relapses have been occurring all through the pandemic.
A preliminary research led by Dr. Jonathan Z. Li, an infectious illness professional at Harvard, was the primary to recommend that rebound may simply be one other of the SARS-CoV-2 virus’ soiled little tips.
Li is a part of a bunch monitoring the scientific development of 1000’s of COVID-19 sufferers. He and his colleagues combed their information to establish 568 mildly unwell COVID-19 sufferers who had not been handled with Paxlovid. Ten % of them reported a return of signs after they thought they’d recovered, and 12% skilled a resurgence of viral hundreds after the coronavirus had change into undetectable, the group reported in a preliminary research posted on-line in August.
In September, a dispatch within the New England Journal of Drugs bolstered the case that rebound occurs even within the absence of Paxlovid. Researchers from Pfizer, which makes the drug, reported that in a scientific trial with 1,970 contaminated members, viral rebound occurred in 2.3% of topics who had been handled with Paxlovid in addition to 1.7% of topics who bought a placebo treatment as a substitute.
Inside weeks, a report in JAMA Community Open provided further proof that rebound has been a characteristic of COVID-19 all alongside. In a bunch of 158 COVID sufferers tracked carefully for 28 days, 30% reported that they suffered a return of signs after feeling nicely for 2 days — and that was in the summertime and fall of 2020, earlier than Paxlovid was out there.
There’s even new analysis suggesting that Paxlovid offers safety towards lengthy COVID, a phenomenon that’s distinct from rebound but in addition options an prolonged run of COVID-19 signs.
The evaluation of greater than 56,000 COVID-19 sufferers handled within the Veterans Affairs well being system discovered that those that took Paxlovid had been 26% much less prone to have lengthy COVID signs after 90 days than those that didn’t. The research was posted on medRxiv this month and has not been reviewed by unbiased scientists.
Regardless that it’s clear COVID-19 can rebound with out the assistance of Paxlovid, scientists nonetheless have good cause to determine whether or not there’s any actual hyperlink.
Antiviral medicines act by gumming up a pathogen’s replication equipment. However viruses hardly ever take that problem mendacity down. They mutate continuously, and are fast to capitalize on any adjustments that assist them overcome a drug’s defenses.
Hundreds of laboratory encounters between Paxlovid and the coronavirus have confirmed that the danger of inducing a Paxlovid-resistant virus is actual. However in circumstances the place sufferers relapsed after taking Paxlovid, scientists have discovered no indicators that the virus has modified, Charness mentioned.
“It wasn’t a brand new an infection or mutation that made virus proof against Paxlovid,” he mentioned. “It was simply ‘Night time of the Residing Lifeless’” — the identical virus coming again.
That’s really excellent news, as a result of it means Paxlovid has not but pushed the coronavirus to include a mutation that enables it to short-circuit a extremely efficient treatment.
However it nonetheless may. A medication that weakens a virus however doesn’t end it off places that virus below super stress to evolve. It might behoove medical doctors to prescribe an extended course of the drug, or to create a extra formidable cocktail by combining it with molnupiravir.
“I’ve discovered by no means to guess towards this virus,” Li mentioned.

Science
Biden is diagnosed with 'aggressive' form of prostate cancer

WASHINGTON — Former President Biden has been diagnosed with an “aggressive form” of prostate cancer, his office said Sunday, a devastating development after having dropped his bid for reelection last summer over widespread concerns over his age and health.
Biden’s personal office said he was examined last week after the president reported a series of concerning symptoms.
“Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms. On Friday, he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone,” the office said in a statement.
“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive, which allows for effective management. The President and his family are reviewing treatment options with his physicians,” the statement added.
The former president, 82, had been making his first public appearances since leaving office in recent weeks, including a public address and a lengthy sit-down on ABC’s “The View,” and also hired a communications strategist to help burnish his legacy amid the publication of a series of books critically examining his time at the White House.
Biden has a tragic personal history with cancer, losing his son, Beau Biden, to glioblastoma in 2015, when he was serving as vice president. At that time, he launched the “cancer moonshot,” a government-wide push for improved cancer treatments that he relaunched during his presidency.
The spread of cancer to the bones will make Biden’s cancer difficult to cure. But its receptiveness to hormone treatments could help his medical team inhibit the cancer’s growth, at least temporarily.
Biden dropped out of the 2024 race in July under immense pressure from leadership in the Democratic Party after a disastrous debate with the Republican presidential nominee, Donald Trump, laid bare concerns over his age and acuity.
Within hours of dropping out of the race, Biden endorsed his vice president, Kamala Harris, to run in his place. She quickly coalesced the party around her nomination and avoided a primary battle, but lost to Trump in November.
In a post on X, Harris said she and her husband, Doug Emhoff, were saddened to learn of Biden’s diagnosis. “We are keeping him, Dr. Biden, and their entire family in our hearts and prayers during this time,” she wrote. “Joe is a fighter — and I know he will face this challenge with the same strength, resilience, and optimism that have always defined his life and leadership. We are hopeful for a full and speedy recovery.”
Last week on “The View,” Biden said he took responsibility for Trump’s return to power, because he was in office at the time. “I do, because, look, I was in charge and he won. So, you know, I take responsibility,” he said.
But he continued to reject criticisms that he and his team worked to conceal the effects of his age on his performance as president, saying he was not surprised by Harris’ loss and suggesting he still believes he could have beaten Trump had he stayed in the race.
“It wasn’t a slam dunk,” he said, referring to President Trump’s victory. “Let me put it this way. He’s had the worst 100 days any president’s ever had. And I would not say honesty has been his strong point.”
Trump expressed concern about Biden’s condition in a Truth Social post Sunday. “Melania and I are saddened to hear about Joe Biden’s recent medical diagnosis. We extend our warmest and best wishes to Jill and the family, and we wish Joe a fast and successful recovery,” he wrote.
California Gov. Gavin Newsom was among the many politicians from both parties who posted their warm wishes and prayers for the former president. “Our hearts are with President Biden and his entire family right now. A man of dignity, strength, and compassion like his deserves to live a long and beautiful life. Sending strength, healing and prayers his way,” Newsom wrote on X.
House Speaker Mike Johnson (R-La.) wrote on X: “This is certainly sad news, and the Johnson family will be joining the countless others who are praying for the former President in the wake of his diagnosis.”
Biden was spending the weekend in Delaware with family, an aide said.
Science
Nearly half of Pasadena Unified schools have contaminated soil, district finds

Eleven of the 23 Pasadena Unified School District schools, where students have been back on campus since January, have contaminated soil after the Eaton fire, the district found.
More than 40% of the schools had lead at levels exceeding the state’s health-based limits for residential soil, and more than 20% had arsenic levels beyond what L.A. County considers acceptable, according to the results released Wednesday.
The district found lead at more than three times the state’s allowable limit of 80 milligrams per kilogram of soil next to Blair High School’s tennis courts and more than double the limit at four elementary schools. Lead, when inhaled through dust or ingested from dirt-covered hands, can cause permanent brain and nerve damage in children, resulting in slowed development and behavioral issues.
Arsenic, a known carcinogen, was found at a concentration of 92 mg/kg at San Rafael Elementary School. The county has used 12 mg/kg as a reference level, based on an estimate of the highest naturally occurring arsenic levels in all of Southern California. The naturally occurring background level of arsenic in Altadena and Pasadena ranges from 4 to 10 mg/kg, according to a 2019 study by the U.S. Geological Survey.
There is no safe exposure level for arsenic or lead.
“I’m worried about her safety,” said Nicole Maccalla of her daughter, a sixth-grader at Octavia E. Butler Magnet, which is located less than a mile from the Eaton fire burn area. “I would really like to have assurances that she’s physically safe while she’s at school.”
Instead, what she got was a map of the school posted by the district showing lead levels 40% and 70% above the allowable limit in soil samples taken next to the school entrance and near the outdoor lunch tables, respectively.
“If, literally, you’ve got to walk by lead to walk up the steps to school, then how many kids are walking through that with their shoes and then walking into the classroom?” Maccalla said. “It’s not like these are inaccessible areas that are gated off.”
Maccalla made the hard decision to let her daughter return to school in January despite early fears — worrying that the trauma of changing schools directly after the fire would be too much.
Along with other concerned parents, Maccalla has been pushing for both soil and indoor testing for months at school board meetings. It was only after the L.A. County Department of Public Health announced in April that it had found 80% of properties had lead levels exceeding the state’s standards in some areas downwind that the district hired the environmental firm Verdantas to conduct testing at schools.
“The school board has been very resistant to any request for testing from parents,” she said. “The superintendent kept saying it’s safe.” The parents’ response: “Prove it.”
The district released test results for 33 properties it owns — some with district schools and children’s centers, others with charter and private schools, some rented to nonprofits — that were all largely unscathed by the fires. On the 22 properties with public schools, students have been back in the classroom since late January. The full results with maps for each school can be seen on the school district’s website.
The district stated on its website there was “no indication that students or staff were exposed to hazardous levels of fire-related substances in the soil,” noting that any contamination found was highly localized. (For example, although seven samples at Blair High School identified elevated lead levels, 21 samples did not.)
Health agencies also advised the district that soil covered with grass or cement was unlikely to pose a health risk.
In response to the results, the district stated it would restrict access to contaminated areas, complete follow-up sampling and work on remediation over the summer. No classroom instruction would be affected.
“We want to be abundantly clear: Safety is not negotiable,” Pasadena Unified School District Supt. Elizabeth Blanco said in a press release. “That’s why we’re moving forward with both urgency and care.”
For Maccalla, it’s too little too late. “I would like to know what their plan is for monitoring the health of the children, given you’ve got kids that have already been playing outside in that soil for four months straight,” she said. “So what’s their health crisis mitigation plan?”
The test results also found high levels of chromium — which, in some chemical configurations, is a carcinogen — on one campus. Another had high levels of a class of contaminants called polycyclic aromatic hydrocarbons, which can cause headaches, coughing, skin irritation and, over long periods of exposure, can come with an increased risk of cancer.
Three of the five properties with the district’s children’s centers also had elevated levels of heavy metals — two with lead, one with arsenic.
When Maccalla — who has spent much of her time after the fire volunteering with the community advocacy group Eaton Fire Residents United — first saw the map of her daughter’s school, she began to formulate a plan to rally volunteers to cover the contaminated areas with mulch and compost before school buses arrive again Monday morning. (That is an expert-approved remediation technique for fire-stricken soil.)
“If the district is not going to do it, the state’s not going to do it, our county’s not going to do it, our city’s not going to do it,” she said, “well, the citizens will. We absolutely will.”
Science
California board voted to nix a controversial hazardous waste proposal
A state environmental oversight board voted unanimously to rescind a controversial proposal that would have permitted California municipal landfills to accept contaminated soil that is currently required to be dumped at sites specifically designated and approved for hazardous waste.
Earlier this year, the California Department of Toxic Substances Control (DTSC) released a draft of its first-ever Hazardous Waste Management Plan, a document intended to guide the state’s strategy on dangerous waste.
The draft plan included a recommendation to weaken California’s disposal rules for contaminated soil — typically the largest segment of hazardous waste produced each year. The potential change would have allowed contaminated soil from heavily polluted sites to be dumped at landfills that were not designed to handle hazardous waste.
Environmental advocates and community members expressed concerns that the rollback could result in toxic dust blowing into communities near local landfills or dangerous chemicals leaching into groundwater. State officials countered by saying that contaminated soil would only go to landfills equipped with liners that would prevent toxic substances from seeping into local aquifers.
At a public meeting on the plan held on Thursday evening, the Board of Environmental Safety — a five-member panel established to provide oversight of DTSC — unanimously voted to remove that recommendation from the state’s draft plan. That followed months of intense scrutiny from residents and environmental groups directed toward the plan. DTSC officials present at the meeting also signaled that they would support the board’s decision to nix the revision.
“I heard you talk about the pollution burdens you already face,” DTSC deputy director Mandi Bane said to the crowd of a few dozen who had gathered at the department’s offices in Cypress. “The worry that DTSC is taking steps that will endanger your community by making that pollution burden worse, and [the] outrage that these steps will be taken without consultation and discussion. As a public health professional, the stress, the fear, the anger that I heard from folks was very concerning … and I do want to apologize that this plan had that impact.”
Heavily polluting industries have tainted soil across California. More than 560,000 tons of hazardous soil are produced each year in California as environmental regulators endeavor to prevent residents from coming in contact with chemical-laced soil and developers build on land in industrial corridors.
However, the vast majority of this soil is not considered hazardous outside of California. The state has hazardous waste regulations that are more stringent than the federal government and most states in the country.
There are only two waste facilities in California that meet the state’s rigorous guidelines for hazardous materials, both in the San Joaquin Valley. Any hazardous dirt in California must be trucked there, or exported to landfills in neighboring states that rely on the more lenient federal standards.
State officials argued the current rules make it difficult and expensive to dispose of contaminated soil, noting that the average distance such waste is trucked right now is about 440 miles, according to the draft plan.
Ahead of the board vote, environmental advocates rallied outside of the DTSC offices in Cypress, calling on state officials to uphold California’s hazardous waste standards for contaminated soil. Angela Johnson Meszaros, an attorney with Earthjustice, said the proposal would effectively forgo California’s regulatory authority and rely on the federal environmental rules — at a time when the Trump administration is repealing environmental policy.
“This plan is a travesty, and I’m calling on DTSC to be better than this,” Johnson Meszaros said at Thursday’s meeting. “If we don’t draw the line with this massive deregulatory effort, there is no line. We will be swept up in the insanity we see at the national level.”
The discussion of hazardous waste disposal has been thrust into the public spotlight recently as the U.S. Army Corps of Engineers continues to remove toxic ash and contaminated soil from properties destroyed in the Eaton and Palisades wildfires. Because disaster debris is traditionally considered not hazardous, federal contractors have been hauling this material to several nonhazardous local landfills without testing it.
In response to the federal cleanup plans, residents in unincorporated Agoura and the Granada Hills neighborhood in Los Angeles staged protests near local landfills.
Melissa Bumstead, an environmental advocate and San Fernando Valley resident, urged the Board of Environmental Safety to consider factoring disaster debris into the hazardous waste plan. With climate change fueling increasingly destructive wildfires, this will continue to be an issue for years to come, she said.
“This is an opportunity, not just with hazardous waste that is manufactured,” Bumstead said, “but also hazardous waste that is created by wildfires on how to create a plan that is going to protect Californians in the future.”
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