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President Joe Biden tested positive for COVID-19 again Saturday, slightly more than three days after he was cleared to exit coronavirus isolation, the White House said, in a rare case of “rebound” following treatment with an anti-viral drug.

White House physician Dr Kevin O'Connor said in a letter that Biden “has experienced no reemergence of symptoms, and continues to feel quite well.” O'Connor said “there is no reason to reinitiate treatment at this time.”

In accordance with Centres for Disease Control and Prevention guidelines, Biden will reenter isolation for at least five days. He will isolate at the White House until he tests negative. The agency says most rebound cases remain mild and that severe disease during that period has not been reported.

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Just as when Biden first tested positive, the White House sought to show he was still working. The president sent out a picture of himself masked and tieless on Twitter, which showed him signing a declaration that added individual assistance for flood survivors in Kentucky.

The president followed up by tweeting out a 12-second video of him on a White House balcony with his dog, Commander.

“I'm feeling fine, everything is good,” said Biden, a pair of aviator sunglasses in his hand.

“But Commander and I got a little work to do.”

https://twitter.com/POTUS/status/1553479370383171584?ref_src=twsrc%5Etfw

Biden, 79, was treated with the anti-viral drug Paxlovid after he first tested positive on July 21. He tested negative for the virus on this past Tuesday and Wednesday. He was then cleared to leave isolation while wearing a mask indoors. His positive tests puts him among the minority of those prescribed the drug to experience a rebound case of the virus.

White House COVID-19 coordinator Dr Ashish Jha told reporters on Monday that data "suggests that between 5 and 8 per cent of people have rebound” after Paxlovid treatment.

“Acknowledging the potential for so-called ‘rebound’ COVID positivity observed in a small percentage of patients treated with Paxlovid, the President increased his tested cadence, to protect people around him and to assure early detection of any return of viral replication,” O'Connor wrote in his letter.

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O'Connor cited negative tests for Biden from Tuesday evening, Wednesday morning, Thursday morning and Friday morning, before Saturday morning's positive result by antigen testing. “This in fact represents ‘rebound' positivity," he wrote.

According to the CDC, those with rebound COVID-19 should isolate for at least five days, ending that if a fever has resolved itself for 24 hours without medication and symptoms have improved. The patient “should wear a mask for a total of 10 days after rebound symptoms started. Some people continue to test positive after day 10 but are considerably less likely to shed infectious virus.”

Both the Food and Drug Administration and Pfizer point out that 1 per cent to 2 per cent of people in Pfizer’s original study on Paxlovid saw their virus levels rebound after 10 days. The rate was about the same among people taking the drug or dummy pills, “so it is unclear at this point that this is related to drug treatment,” according to the FDA.

While Biden was testing negative, he returned to holding in-person indoor events and meetings with staff at the White House and was wearing a mask, in accordance with CDC guidelines. But the president removed his mask indoors when delivering remarks on Thursday and during a meeting with CEOs on the White House complex.

Asked why Biden appeared to be breaching CDC protocols, press secretary Karine Jean-Pierre said, “They were socially distanced. They were far enough apart. So we made it safe for them to be together, to be on that stage.”

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Regulators are still studying the prevalence and virulence of rebound cases, but the CDC in May warned doctors that it has been reported to occur within two days to eight days after initially testing negative for the virus.

“Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease,” the agency said at the time.

When Biden was initially released from isolation on Wednesday, O’Connor said the president would “increase his testing cadence” to catch any potential rebound of the virus.

Paxlovid has been proven to significantly reduce severe disease and death among those most vulnerable to COVID-19. US health officials have encouraged those who test positive to consult their doctors or pharmacists to see if they should be prescribed the treatment, despite the rebound risk.

Biden is fully vaccinated, after getting two doses of the Pfizer coronavirus vaccine shortly before taking office, a first booster shot in September and an additional dose March 30.

While patients who have recovered from earlier variants of COVID-19 have tended to have high levels of immunity to future reinfection for 90 days, Jha said that the BA.5 subvariant that infected Biden has proven to be more “immune-evasive.”

“We have seen lots of people get reinfected within 90 days,” he said, adding that officials don’t yet have data on how long those who have recovered from the BA.5 strain have protection from reinfection.

Ukrainian and Russian officials blamed each other Saturday for the deaths of dozens of Ukrainian prisoners of war in an attack on a prison in a separatist-controlled area.

The International Red Cross asked to visit the prison to make sure the scores of wounded POWs had proper treatment, but said its request had not been granted so far.

Meanwhile, Russia kept launching attacks on several Ukrainian cities, hitting a school and a bus station.

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Ukrainian President Volodymyr Zelenskyy said the ICRC and the United Nations have a duty to react to the shelling of the prison complex in Ukraine's eastern Donetsk province, and he called again for Russia to be declared a terrorist state.

"Condemnation at the level of political rhetoric is not enough for this mass murder," he said.

Separatist authorities and Russian officials said the attack Friday killed 53 Ukrainian POWs and wounded another 75.

Russia's Defense Ministry on Saturday issued a list naming 48 Ukrainian fighters, aged 20 to 62, who died in the attack; it was not clear if the ministry had revised its fatality count.

Satellite photos taken before and after the attack show that a small, squarish building in the middle of the Olenivka prison complex was demolished, its roof in splinters.

Both Ukraine and Russia alleged the attack on the prison was premeditated and intended to silence the Ukrainian prisoners and destroy evidence.

The ICRC, which has organized civilian evacuations and worked to monitor the treatment of POWs held by Russia and Ukraine, said it requested access to the prison "to determine the health and condition of all the people present on-site at the time of the attack."

"Our priority right now is making sure that the wounded receive lifesaving treatment and that the bodies of those who lost their lives are dealt with in a dignified manner," the Red Cross said.

But the organization said late Saturday that its request to access the prison had not been granted yet.

"Granting ICRC access to POWs is an obligation of parties to conflict under the Geneva Conventions," the ICRC said on Twitter.

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Russia claimed Ukraine's military used US-supplied precision rocket launchers to target the prison in Olenivka, a settlement controlled by the Moscow-backed Donetsk People's Republic.

The Ukrainian military accused the Russians of shelling the prison to cover up the alleged torture and execution of Ukrainians there.

The Institute for the Study of War, a think tank based in Washington, said the competing claims and limited information prevented assigning full responsibility for the attack but the "available visual evidence appears to support the Ukrainian claim more than the Russian."

Moscow has opened a probe into the attack and the UN said it also was prepared to send investigators.

UN deputy spokesman Farhan Haq said "we stand ready to send a group of experts able to conduct an investigation, requiring the consent of the parties, and we fully support the initiatives" of the Red Cross.

Elsewhere in eastern Ukraine, Russian rockets hit a school in Kharkiv and a bus station in Sloviansk, among other strikes. In southern Ukraine, one person was reported killed and six injured in shelling in a residential area in Mykolaiv, local officials said.

Russian and separatist forces are trying to take full control of the Donetsk region, one of two eastern provinces that Russia has recognised as sovereign states.

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Deputy Prime Minister Iryna Vereshchuk warned Saturday that Ukrainian-controlled parts of Donetsk will face severe heating problems this winter because of the destruction of gas mains. She called for a mandatory evacuation of residents before the cold weather sets in.

The prison attack reportedly killed Ukrainian soldiers captured in May after the fall of Mariupol, a Black Sea port city where troops and the Azov Regiment of the national guard famously held out against a months-long Russian siege.

On Saturday, an association of Azov fighters' relatives dressed in black demonstrated outside Kyiv's St Sophia Cathedral and called for Russia to be designated a terrorist state for violating the Geneva Convention's rules for the treatment of war prisoners.

A woman wearing dark glasses who gave only her first name, Iryna, was waiting for news of her 23-year-old son.

"I don't know how is he, where is he, if he is alive or nto. I don't know. It's a horror, only horror," she said.

On the energy front, Russia's state-owned natural gas corporation said Saturday it has halted shipments to Latvia because of contract violations. Gas giant Gazprom said the shipments were stopped because Latvia broke "terms for extraction of gas".

The statement likely referred to a refusal to meet Russia's demand for gas payments in rubles rather than other currencies. Gazprom has previously suspended gas shipments to other EU countries, including the Netherlands, Poland and Bulgaria, because they would not pay in rubles.

EU nations have been scrambling to secure other energy sources, fearing that Russia will cut off more gas supplies as winter approaches.

An investigation is underway after an inmate who died in his cell had allegedly been complaining of breathing difficulties and asking for medical help. The prisoner died in his cell at Christchurch Men’s Prison on Thursday. …

The federal opposition has called for more details to be released about the government's proposal to enshrine an Indigenous Voice to Parliament by altering the constitution through a referendum.

The Coalition says it is keeping an "open mind" but has raised questions about how the proposed Voice to Parliament would work.

Nationals Leader and Shadow Agriculture Minister David Littleproud said the opposition "respects the intent" of the movement but is concerned about a lack of detail.

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"This issue has been littered with good intentions for many decades and we haven't necessarily got the outcome," he told Today on Sunday morning.

"Now is the time for the government to tell us the detail of what they're picking out of that report, how this is going to operate, who's going to be on it, how will that go to building trust, and not just across Australia but also with Indigenous communities."

"It would be a lost of opportunity if the government doesn't get this right," Littleproud said.

However, Labor's Northern Territory Senator Malarndirri McCarthy encouraged the opposition to go through the "15 years" of documentation surrounding Indigenous constitutional recognition for the answers to their questions.

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"Constitutional recognition has been talked about for over 15 years and there's been many parliamentary committees, First Nation committees," she told Today.

"Those reports are there and so the opposition and others in the parliament are very welcome to go and read them."

Prime Minister Anthony Albanese announced yesterday a suggested wording for a referendum question to be put to Australians:

"Do you support an alteration to the Constitution that establishes an Aboriginal and Torres Strait Islander Voice?"

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Albanese also outlined three sentences which would drive discussion around the proposed constitutional amendment:

1. There shall be a body, to be called the Aboriginal and Torres Strait Islander Voice.
2. The Aboriginal and Torres Strait Islander Voice make representations to Parliament and the Executive Government on matters relating to Aboriginal and Torres Strait Islander Peoples.
3. The Parliament shall, subject to this Constitution, have power to make laws with respect to the composition, functions, powers and procedures of the Aboriginal and Torres Strait Islander Voice.

In order to create the Voice to Parliament, Australia's constitution must be changed through a referendum.

A referendum requires the majority of people and the majority of states to vote in favour of a yes/no proposal.

Of the 44 referendums in Australian history, only eight have been successful, and none have carried since 1977.

The last referendum was in 1999, when Australians voted against becoming a republic.

A single ticket bought in a Chicago suburb beat the odds and won a $US1.337 billion ($1.91 billion) Mega Millions jackpot.

According to megamillions.com, there was one jackpot-winning ticket in the draw on Friday night, and it was bought at a Speedway gas station and convenience store in Des Plaines.

The winning numbers were: 13-36-45-57-67, Mega Ball: 14.

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"We are thrilled to have witnessed one of the biggest jackpot wins in Mega Millions history," Ohio Lottery Director Pat McDonald, the current lead director for the Mega Millions Consortium, said in a statement on the lottery's website.

"We're eager to find out who won and look forward to congratulating the winner soon!"

The jackpot was the nation's third-largest lottery prize.

It grew so large because no one had matched the game's six selected numbers since April 15. That's 29 consecutive draws without a jackpot winner.

Lottery officials had estimated the winning take at $US1.28 billion, but revised the number up to $1.337 billion on Saturday.

The total prize is for winners who choose the annuity option, paid annually over 29 years.

Most winners opt for the cash option, which for Friday night's drawing was an estimated $780.5 million.

The odds of winning the jackpot are 1 in 302.5 million.

A clerk at the Speedway store who answered the phone but declined to give his name said the store had not been officially notified that it sold the winning ticket and that he learned about it from reporters calling for comment.

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Mega Millions is played in 45 states as well as Washington, DC, and the US Virgin Islands. The game is coordinated by state lotteries.

Illinois is among the states where winners of more than $250,000 can choose to not reveal their names and Illinois Lottery spokeswoman Emilia Mazur said the vast majority of those winners do just that.

Even lottery officials may not know for a while who won because winners don't have to come forward straight away. And the winning ticket may have been bought by a group of people.

"We won't know whether it's an individual or it's a lottery pool until the winner comes forward to claim their prize," National Mega Millions spokeswoman Danielle Frizzi-Babb said.

As of Saturday afternoon, no winner had come forward, according to Mazur.

Emily Irwin, managing director, Advice & Planning, at Wells Fargo's Wealth & Investment Management, said Friday that the winner should consider keeping a low profile and resist going on an eyebrow-raising spending spree that everyone knows the winner cannot afford.

"This is not the time to start calling everybody you know, saying, 'Hey, I have a big secret. Can you keep it?'" Irwin said.

This is necessary to avoid being inundated with requests for money.

"There are scammers and others who follow big winners," she said, admitting that sudden wealth can put a lottery winner in physical danger.

"Privacy equals safety," she said.

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One thing the winner must do immediately is sign the ticket. That's because if the ticket hasn't been signed then it really isn't yours.

If the winner loses an unsigned ticket and another person finds it and signs it, the ticket now belongs to them.

Irwin suggests a step further to survive a legal battle over ownership.

"Take a Polaroid of you holding it and (put) it in a safe deposit box or somewhere else safe," she said.

Pratik Patel, the head of Family Wealth Strategies at BMO Family Office in Chicago, said the winner should work with a financial planner to map out their future.

"I would run a Monte Carlo market simulation," Patel said, explaining that this is an analysis of what a winner's annual income might be and what the proceeds from various investments might be.

"What you're doing is using analytics to inform your spending."

Frizzi-Babb agrees that talking to a financial planner is a good idea.

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"I would suggest that you do that before you even set foot in a lottery office," she said.

One expert who has worked with past lottery winners says the winners should avoid going to the lottery office altogether, instead sending an attorney or financial adviser to preserve their anonymity — if lottery officials allow.

"There are going to be people doing everything they can to figure out who the winner is," said Kim Kamin, who was a trusts and estates attorney for 17 years and now teaches estate planning at Northwestern University's law school.

"There are going to be many eyes watching."

There is also a question nobody wants to answer at that particular time: What happens to the money when you die?

Irwin said don't leave this unanswered; you must take action to ensure the bulk of your estate goes to your beneficiaries rather than the government.

"You need a manager who specializes in this and understands this world," said Patel.

"Someone making $60,000 a year might need a certain type of professional manager and they may want to switch to someone who does ultra wealth."

Whatever the winner does, it is important to do it slowly.

"You can absolutely indulge but let's be smart about it," Patel said. "It's a lot of money but until you figure out what you can afford, there are still limitations."

For example, he said, consider chartering a private jet before diving in and buying one.

"You may be interested in owning your favourite basketball team," he warned, "but maybe that isn't a good idea if it uses up all your money."

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