Respiratory Viruses and Infections: Making the Right Diagnosis
Thursday, May 04, 2023
by Aaron Medaris, Physician Office Resource
The last couple of years as we hunkered down, masked up, social distanced, and used gallons of hand sanitizer to avoid the dreaded results of COVID-19, we also avoided the flu the and a variety of other respiratory infections. Talk to any parent with young children and they’ll most likely tell you that 2020 was the healthiest their kids had been in a long time.
Now that we’ve been vaccinated, eliminated social distancing, shed the masks, toned down the use of hand sanitizer, and even had the leader of the free world declare the pandemic is “over” (I personally don’t agree with that last one), multiple questions linger in my mind:
- With a public that became accustomed to being tested for COVID seek medical care to be tested for other respiratory infections?
- Will HCPs be willing to test for multiple respiratory viruses (ex: Flu vs. COVID)?
- What can HCPs do to prepare themselves for this coming COVID and Flu season?
To Test, or Not to Test, That is the Question
While no forecast is perfect, initial reports from states across the country are showing an increase in influenza. Some experts even estimate that the flu will outpace COVID this winter season. Assessing our current situation and looking at the forecast, what can you do to be better prepared for the increase of patients respiratory infections that will soon be entering your exam rooms? The first and one of the most important is to test for respiratory infections. That may seem simple, but this important step is often skipped because well, if it looks like a duck, and it talks like a duck, well then it’s probably a duck…right? But what if there’s more to it? A couple of years ago, I got really sick. Cough, fever, chills, body aches that came on hard and fast. I went to the doctor and after his examination, he told me he has seen this a lot lately and it was just a virus. I then asked if he thought it was the flu. He quickly replied, “I highly doubt it. I haven’t seen any flu cases this year.” This illness just felt different to me, and so I asked, “Is it ok if you test me for the flu?” He again stated he was quite certain it wasn’t the flu, but that if I wanted the test he would have the nurse administer one. And wouldn’t you know it, when I got the test results back, I had the flu. My good doctor prescribed an antiviral which helped immensely! A treatment I would have never received if I hadn’t been tested. Could it be that all those that my physician had been seeing with similar symptoms as I had the flu as well, but were never tested for it?
Why Should You Test
Some physicians like in the example above choose not to test. Whether that’s because doubts regarding the accuracy of tests or feel that empirical treatment will be effective in most cases. Despite these concerns there are multiple reasons why you should test:
- Empirical treatment can lead to more patients receiving antiviral treatment than actually need to receive it. This could possibly give rise to an antiviral shortage and delaying the correct care for another patient that actually needs it.
- Testing frequently will provide the physician with valuable “market intelligence.” It will help the physician understand what viruses are currently spreading through the community and will allow them to provide a better treatment path.
- Better patient experience. That might seem odd because what patient wants a stick shoved up their nose. The truth is, testing shows the patient that you want to provide the best possible care and it can bring peace of mind to the patient, even if they do test positive. They will know that they are being treated the correct way.
What to Know When Purchasing Tests
I’m sure that many of you are testing for respiratory infections. If you’ve talked to your distributor lately, you’ve probably noticed a lot of different respiratory tests out there. When it comes to testing for flu, COVID, RSV, rhinovirus, etc. which test is best for you and your practice? Here are some things to consider when evaluating which ones are best for you:
CLIA Complexity – A test is only good if you are able to administer it. Make sure that you are equipped with the correct CLIA certificate of perform the test. Check to see if the test is a Waived (most simple) or Moderately complex (requires additional certification). If you’re a waived facility and are interested in purchasing a moderately complex test, that’s fine, but make sure you take the steps before hand to become a certified compliance facility with CLIA.
Ease of Use – Is the test simple to perform? Difficult? Require additional equipment? Training? Will the additional equipment help me in the long run?
Performance – Sensitivity and specificity are essential. I would even be sensitive to the brand of test that I am purchasing. Especially when it comes to different COVID tests. Due to the EUA that the FDA has granted, there are many counterfeit and poor quality COVID tests that are being pushed on doctors.
Volume – How many tests are you planning on running? What’s the average you use during a flu season? Will you need more this season?
Time to Results – How long does it take to run and receive test results? Is it important to get results back quickly to your patients?
Sample Type – is it a single sample type or does it allow for multiple sample types (nasal, nasopharyngeal, saliva, etc.)?
Connectivity – Is it important to have the results transmitted electronically?
Cost – Brand is important when it comes to getting accurate results. But brand can also be expensive. Be sure to check with different brand reps, distributors, websites, publications, and promo emails for discounts and specials. They’re out there.
What Types of Tests are Available?
Rapid Lateral Flow Immunochemical Tests:
There are different varieties of these test which have been on the market for decades and are used to confirm the presence or absence of a specific antigen. Results of these types of tests can either be viewed visually or with the use of an instrument. May of these tests are CLIA Waived and can be completed in less than 15 minutes.
Many flu and other respiratory infections can be run on molecular devices. These tests detect the presence of the genetic material of the virus and generally produce results in 30 minutes or less. Molecular results are the gold standard in testing. Be sure to verify the CLIA compliance that is needed for molecular tests, some are CLIA Waived and some require a moderate complexity license. CLIA Waived molecular test typically use rapid PCR detection and the device can be moved closer to the point of care. CLIA Waived molecular devices usually cost less than traditional molecular devices, but still offer the same reimbursement.
One important thing to note is that no respiratory test provides 100% accuracy. Results depend on a few different criteria: type of test used, virus strain, and integrity of the sample. For best results please review test instructions and be aware of any test limitations.
No one can predict the future, but we can look at where we’ve been and current trends. Now whether those trends will hold true is yet to play out, but I do know we can do our best to be prepared for this COVID and flu season. Physicians Office Resource offers valuable insights on a variety of different respiratory infection tests and testing devices. Look for them in this issue or visit our website and learn more. Have questions feel free to reach out and we’ll be sure to put you in contact with the right people.