According to one model of infected nerve cells, the dsRNA state will immediately separate into two ssRNA strands whenever the infected nerve cell activates. Thus, any neurological activity caused by physical or mental exertion will cause the dsRNA to separate, triggering renewed viral replication. If someone is taking a direct-acting antiviral drug (DAA) while physically or mentally exerting their self, then the drug has an opportunity to act on the virus, ideally preventing re-formation of the dsRNA state. This model remains theoretical pending experimental validation.
I‘m thinking about PEM when I read this. Would the ssRNA cause an immune reaction?