Respiratory virus season varies from year to year, but it typically occurs between early fall and spring, with peaks between December and February.1 When it comes around this year, bringing high incidences of the usual culprits — colds, flu, streptococcal throat (strep) and respiratory syncytial virus (RSV) — it may be complicated by an increased risk of co-infection with COVID-19.
Flu, COVID-19 and RSV, in particular, all share similar symptoms, but patients who contract these infections need different treatments. "This presents challenges for physicians to identify the infection and decide if it is one infection or several at once," says Patrick Bowman, McKesson Medical-Surgical's director of lab instrument specialists, East. "The consequences of having undiagnosed co-infection can be significant for the patient," he adds.
Last year, there weren't many flu cases, because COVID-19 preventive measures (e.g., isolating, social distancing, hand sanitizing and wearing masks) were being taken.2 However, in most places, children are now returning to school and workers are going back to their offices. "This year we may see more cases of flu because a lot of the COVID-19 mitigation strategies have been lifted. In the United States, we are definitely bracing for a flu season to coincide with the current COVID-19 pandemic," adds Bowman.
Here are some strategies to proactively prepare for and offer the appropriate diagnostic testing during the upcoming respiratory virus season.
Implement syndromic, multiplex testing
Multiplex testing, the process of using one test and one collection sample to analyze multiple targets with overlapping or similar symptoms, is especially important this year. With multiple viruses that have similar symptoms in the community, these tests allow you to reach a definitive and more complete diagnosis quickly.3
A multiplex test will provide multiple results in a single test run that would otherwise require several separate test cartridges, multiple patient samples and more time to perform.4 This is essential because although the various infections may have a similar clinical presentation, treatment protocols differ.
"If a physician were to just test for COVID-19, there is a very real possibility that they could miss a co-infection diagnosis with flu, which would be more common, especially in season. That could evolve into worsening conditions such as pneumonia and could further complicate their COVID-19 infection and treatment efficacy," says Bowman.
From the patient perspective, multiplex testing saves time and money, requires only a single collection sample and increases the chance of an optimal outcome by receiving the right treatment protocol quickly. Healthcare providers benefit from more precise results as well as saved time and money.5
Transition to the most up-to-date assay
The CDC has announced that, as of December 31, 2021, it will withdraw its request to the U.S. Food and Drug Administration (FDA) for Emergency Use Authorization (EUA) of the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel.6
In anticipation of this change, the CDC recommends transitioning to other multiplex tests that can detect and differentiate between SARS-CoV-2 and the various flu strains. The FDA website carries a list of approved COVID-19 tests. The multiplex tests can process more samples (what is called higher throughput) and detect more than one pathogen at the same time, thus saving time and resources.
EUA for the tests mentioned above will expire at the end of the calendar year 2021 and transition to the multiplex options. The CDC is providing this advance notice for clinical laboratories so they have adequate time to select and implement one of the many FDA-authorized alternatives.
Encourage earlier vaccinations
It takes about two weeks after a flu vaccination for the protective antibodies to develop. Patients should not get vaccinated for flu in summer, as the protection wears off.7 Instead, early fall is the key time to do it, before the flu virus becomes widely spread. However, even if patients miss this window, counsel them to still get the flu and COVID-19 vaccines to protect them for the rest of the season. Currently, there are no vaccines for strep or RSV. The CDC recommends getting the flu vaccine in September or October.8
Consider drive-through or curbside clinics
In our current environment, patients may opt to postpone routine, recommended vaccinations because they want to limit their exposure to possible pathogens; ironically, this leaves them more vulnerable to preventable infections.
The CDC recommends, where possible, curbside or drive-through vaccination clinics as the safest option for staff and patients during the COVID-19 pandemic, especially in communities with high infection rates.9
The National Adult and Influenza Immunization Summit offers a toolkit to assist in off-site, temporary and satellite vaccination clinics.10
Refresh staff training
Retrain and refresh your staff on policies, requirements and procedures for performing tests, to make sure you are accounting for best practices and best results. "We would especially recommend staff training for respiratory testing. Even in normal years uncomplicated by COVID-19, providers can sometimes go many months between doing a flu test. Even the most veteran, seasoned staff may be a little rusty when they get that first flu case present," cautions Bowman.
Educate your patients
Make sure your patients have the most up-to-date information and help them distinguish between fact and falsehood. There is a lot of dangerous misinformation floating around that may lead patients to make uneducated choices.
As an example, a recent Harris poll found that "more than a third (36%) of Americans are not planning to get the flu shot this year. When asked why, one in 12 of those who don't plan to get a flu shot (8%) said it was because they had gotten the COVID-19 vaccine and believe it will also protect them from the flu."11
Patients may be skeptical when recommendations change, which occurs as experts learn more. For example: It was originally thought that providers should not give the flu and COVID-19 vaccines at the same time. Upon further research, the CDC has changed that recommendation to "COVID-19 vaccines may be administered without regard to timing of other vaccines."12
These reversals may confuse patients, who may think, "How do I know experts aren't just going to change their minds again?" Explain to your patients how science evolves as researchers learn more and treatment options and delivery methods continue to be refined and enhanced.
This respiratory virus season will be a challenging one for healthcare providers and patients alike. However, with diligent planning, implementation of the latest diagnostic testing options and good communication, you can make sure it's as healthy as possible for your patients and your staff.
Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.
© 2021 McKesson Medical-Surgical Inc.