Advantages and Limitations of Available Testing Modalities for Respiratory Infections

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Priya Nori, MD, comments on the use of at-home tests for respiratory disease, including for COVID-19 and influenza.

Tina Tan, MD: Priya, do you think the available tests are keeping up with new viruses that are emerging?

Priya Nori, MD: Patients are much better off if they present to a health care setting—their doctor’s office, an urgent care, or the ED. But the options at home remain limited. We’ve made remarkable progress during the COVID-19 pandemic with at-home testing specific to that illness. It’s truly amazing what the world of science and biotech can do when pushed to deliver in an emergency. I don’t want to lose momentum. I’d like to see that continue and apply the lessons from the current respiratory viral season.

It’s clear that we need to level up and develop these technologies to test any number of viruses at home, starting with the big 3: COVID-19, influenza, and RSV [respiratory syncytial virus]. Imagine the implications if you have a positive test and then you have a series of instructions on how to isolate, how to supportively care for yourself, and how to get those treatments without stopping in urgent care, without stopping in the ED, and without utilizing all those health care resources. That would be truly revolutionary. I know I’m not the only one. There are a lot of very smart people working on these things. But think of the implications for the economy, the patient, and infection control. You don’t want these infectious human beings circulating around society, taking the bus, sitting in the waiting rooms of these offices. That’s where we need to be in the next couple of years.

Tina Tan, MD: Kevin, what are you using in your urgent care centers? Do you think your ability to test for these viruses is decreasing the number of antibiotics and other agents prescribed because of testing results?

Kevin Michael Reiter, MD, PA: I have a couple of points. That’s a great question. The first thing I think about with the ability to test rapidly and diagnose is that there are treatment windows. With influenza, if we can start treatment within 48 hours of diagnosis, we’re in a better place. With COVID-19 and Paxlovid and the oral antivirals, there is a 5-day window. The quicker we get results back, depending on where we’re seeing that patient in their disease course and illness, is important. In terms of getting that test in time for us to intervene, there are rapid diagnostic tests. As Priya mentioned, if we could do this at home and have the patient complete a virtual visit, receive the guidance, and get what they need without being in the community, that’s where infection prevention needs to be looking in the future.

In terms of antibiotics, at GoHealth urgent care, we’re national leaders in the stewardship of antibiotics. We’ve put programs in place, whether it’s in our EMR [electronic medical record] system or in the education of our providers. We provide scorecards to our providers, and we let them know how many antibiotics they prescribe and how much relative to their peers. We’ve taken it a step further to let them know when they’re inappropriately prescribing antibiotics. We give directed feedback toward acute bronchitis, nonstreptococcal pharyngitis, and viral rhinosinusitis, with the indications and implications of inappropriate use.

To your point, if we know for sure that these are viral infections because we have an otherwise healthy person or even a compromised individual who’s presenting with, let’s say, acute bronchitis, and we test and know it’s coming from RSV, we’re more reassured. We can tell them that 80%, 90% of these infections are viral, but when they see the result—they know if their grandchildren just had a cold and were in the pediatrician’s office and on a nebulizer, and we have that otherwise healthy individual who presents with bronchitis—we can say, “This is RSV. This is a viral infection. Here’s the result.” That carries more weight.

Transcript edited for clarity

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