ArticleAnnals of internal medicine2023
Symptom and Viral Rebound in Untreated SARS-CoV-2 Infection.
Article in Annals of internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04518410 (Adaptive Platform Treatment Trial for Outpatients With COVID-19), which is not on this map. Cited by 28 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Adaptive Platform Treatment Trial for Outpatients With COVID-19 (Adapt Out COVID)
Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 62 citations in OpenAlex.
- SARS-CoV-2 infection rebound among patients receiving antiviral agents, convalescent plasma, or no treatment: a systematic review with meta-analysis.Blood transfusion = Trasfusione del sangue · 2024Pooled it
- Viral and Symptom Rebound Following Anti-Severe Acute Respiratory Syndrome Coronavirus 2 Monoclonal Antibody Therapy in a Randomized Placebo-Controlled Trial.The Journal of infectious diseases · 2025Trial
- Characterization of Treatment Resistance and Viral Kinetics in the Setting of Single-Active Versus Dual-Active Monoclonal Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2.The Journal of infectious diseases · 2024Trial
- COVID-19 Rebound After VV116 vs Nirmatrelvir-Ritonavir Treatment: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Variant-Specific Viral Kinetics in Acute COVID-19.The Journal of infectious diseases · 2023Trial
- Viral shedding and symptom severity across populations during acute COVID in the ACTIV-2 study.medRxiv : the preprint server for health sciences · 2026Article
- Impact of Sex on Viral Shedding and Symptom Severity During Acute COVID-19.Pathogens & immunity · 2026Article
- Post-steroid rebound in COVID-19 pneumonitis: a case series and review of the literature.BMC pulmonary medicine · 2025Review
- Disparate SARS-CoV-2 Infection Outcomes Abound, but What Makes SARS-CoV-2 Bound for Rebound?The Journal of infectious diseases · 2025Article
- SARS-CoV-2 rebound and post-acute mortality and hospitalization among patients admitted with COVID-19: cohort study.Nature communications · 2025Article
- Incidence of COVID-19 Symptom Rebound After Treatment with Remdesivir.Infectious disease reports · 2025Article
- Modeling suggests SARS-CoV-2 rebound after nirmatrelvir-ritonavir treatment is driven by target cell preservation coupled with incomplete viral clearance.Journal of virology · 2025Article
- Persistence of an Infectious Form of SARS-CoV-2 After Protease Inhibitor Treatment of Permissive Cells In Vitro.The Journal of infectious diseases · 2025Article
- An orally available P1'-5-fluorinated MPNAS nexus · 2025Article
- The kinetics of SARS-CoV-2 infection based on a human challenge study.Proceedings of the National Academy of Sciences of the United States of America · 2024Article
- Modeling suggests SARS-CoV-2 rebound after nirmatrelvir-ritonavir treatment is driven by target cell preservation coupled with incomplete viral clearance.bioRxiv : the preprint server for biology · 2024Article
- Clinical rebound after treatment with nirmatrelvir/ritonavir in COVID-19.BMC infectious diseases · 2024Article
- COVID-19 clinical rebound after treatment with nirmatrelvir/ritonavir.Research square · 2024Article
- Viral SARS-CoV-2 Rebound Rates in Linked Commercial Pharmacy-Based Testing and Health Care Claims.Open forum infectious diseases · 2024Article
- Symptoms, Viral Loads, and Rebound Among COVID-19 Outpatients Treated With Nirmatrelvir/Ritonavir Compared With Propensity Score-Matched Untreated Individuals.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 7 institutions in 1 country.
Funding
Abstract
backgroundAlthough symptom and viral rebound have been reported after nirmatrelvir-ritonavir treatment, the trajectories of symptoms and viral load during the natural course of COVID-19 have not been well described.
objectiveTo characterize symptom and viral rebound in untreated outpatients with mild to moderate COVID-19.
designRetrospective analysis of participants in a randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT04518410).
settingMulticenter trial. PATIENTS: 563 participants receiving placebo in the ACTIV-2/A5401 (Adaptive Platform Treatment Trial for Outpatients With COVID-19) platform trial. MEASUREMENTS: Participants recorded the severity of 13 symptoms daily between days 0 and 28. Nasal swabs were collected for SARS-CoV-2 RNA testing on days 0 to 14, 21, and 28. Symptom rebound was defined as a 4-point increase in total symptom score after improvement any time after study entry. Viral rebound was defined as an increase of at least 0.5 log
resultsSymptom rebound was identified in 26% of participants at a median of 11 days after initial symptom onset. Viral rebound was detected in 31% and high-level viral rebound in 13% of participants. Most symptom and viral rebound events were transient, because 89% of symptom rebound and 95% of viral rebound events occurred at only a single time point before improving. The combination of symptom and high-level viral rebound was observed in 3% of participants. LIMITATION: A largely unvaccinated population infected with pre-Omicron variants was evaluated.
conclusionSymptom or viral relapse in the absence of antiviral treatment is common, but the combination of symptom and viral rebound is rare. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.