Authors: Gupta K, Strymish J, Stack G, Chamess M



Initiation of NM/R treatment on Day 0 in a 71-year-old vaccinated and boosted male resulted in rapid
resolution of COVID-19 symptoms followed one week later by the development of typical cold symptoms.
SARS-CoV-2 viral load fluctuated in parallel with symptoms, with two distinct peaks on Day 1 and Day 9
of illness. No other respiratory pathogens were identified. Viral samples demonstrated sequence identity
for the omicron subvariant BA.1 on Days 1, 7, and 11. Our findings suggest that viral replication and
COVID-19 symptoms may recur after very early treatment with NM/R before natural immunity is sufficient
to fully clear SARS-CoV-2.

Keywords: COVID-19, SARS-CoV-2, Nirmatrelvir