3 key considerations for COVID-19 testing during flu season
2) We can expect an urgent need for multiplex SARS-CoV-2 testing
The ongoing approach to COVID-19 management is identification of the source of infection, early diagnosis, quarantine and supportive treatments. However, the similar clinical presentations of influenza-like illnesses make it difficult for clinicians to differentiate SARS-CoV-2 from other respiratory pathogens without a laboratory diagnosis. Using multiplex PCR testing for influenza A&B, SARS-CoV-2 and other respiratory pathogens will be important to distinguish the cause of ILI and determine appropriate clinical management.
3) We can prepare by supporting public health measures with multiplex testing
Rapid and accurate diagnoses are critical not only for the patient and their family, but also for public health measures such as contact tracing, quarantine or isolation, and appropriate use of personal protective equipment. Although single-plex testing for influenza or SARS-CoV-2 may be more cost-effective and accessible, multiplex PCR testing for SARS-CoV-2, influenza and other respiratory pathogens may ultimately conserve resources by providing a thorough differential diagnosis in a relatively short time. Infection control programs may also benefit from the ability to track epidemiological trends.
Differentiating SARS-CoV-2 from other respiratory pathogens is critical because of the increased risk of transmission and actions needed for COVID-19 management. A patient diagnosed with COVID-19 must isolate themselves with resource-intensive public health measures needed to identify all individuals in contact with them. By contrast, a patient diagnosed with a bacterial pathogen such as Mycoplasma pneumoniae or Bordetella pertussis would warrant antimicrobial therapy or patients positive for influenza A or B may be prescribed an antiviral agent to help shorten the course of symptoms. During a pandemic when demand is high and resources are low, proper allocation of resources is crucial.
In summary, the potential advantages of multiplex PCR testing for SARS-CoV-2 plus other respiratory pathogens include:
- Determining the cause of respiratory illness
- Surveillance and monitoring of seasonal respiratory pathogens
- Clinical management
- Treatment decisions (antivirals vs. antibiotics vs. supportive care)
- Quarantine recommendations (droplet or isolation measures)
- Public health measures (infection control, epidemiology and hospital-acquired infections)
The new reality of COVID-19 will only complicate the upcoming flu season. Experts from the World Health Organization have stated that the typical epidemiology of viruses such as influenza shows seasonal patterns in the absence of control measures. However, COVID-19 has demonstrated no seasonal pattern thus far and will persist until there is a vaccine or herd immunity (8). Measures to reduce the overall burden of respiratory viral infection—including social distancing, wearing of masks, increased vaccination rates, and availability of diagnostics to detect co-infections such as multiplex PCR tests—will be paramount in planning for the months ahead.
- Bchetnia, M., Girard, C., Duchaine, C., Laprise, C. (2020) The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A review of the current global status. Infect. Public Health.
- Kim, D. et al. (2020) Rates of co-infection between SARS-CoV-2 and other respiratory pathogens. JAMA 323, 2085–2086.
- Jain, S. et al. (2015) Community-acquired pneumonia requiring hospitalization among U.S. adults. Engl. J. Med. 3737, 415—427.
- Joseph, C., Togawa, Y., Shindo, N. (2013) Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses 7, 105—113.
- Wu, Q. et al. (2020) Co-infection and other clinical characteristics of COVID-19 in children. Pediatrics 146, e20200961.
- (2020) Overview of Testing for SARS-CoV-2 July 17, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Fclinical-criteria.html
- Academy of Medical Sciences. (2020) Preparing for a challenging winter 2020/21 July 14, 2020. https://acmedsci.ac.uk/file-download/51353957
- World Health Organization. (2020) COVID-19 Virtual Press Conference August 10, 2020. https://www.who.int/docs/default-source/coronaviruse/covid-19-virtual-press-conference—10-august-at-12-pm-cest.pdf