Staying informed on the latest developments this respiratory season will be key – for you and your customers.
By Jim Poggi
Respiratory testing at the point of care has been a common practice in the U.S. since the early 1980s when the first lateral flow tests for Group A strep were introduced. Their speed made a difference in initiating treatment, but most clinicians agreed that plated media had better sensitivity. Nonetheless, rapid strep tests, now including molecular platform options, have improved in performance and have become the standard of initial diagnosis.
Additional rapid respiratory tests followed. A multitude of influenza tests followed in various formats from visually read lateral flow to reader based lateral flow and finally a number of molecular assays. From a diagnosis viewpoint, it all seemed to be coming together to rapidly and effectively diagnose respiratory infections, select the proper treatment program and manage the patient back to health.
That is, until the COVID pandemic came along. Suddenly, the emergence of this novel pathogen in 2019 changed everything. It spread rapidly, creating a worldwide pandemic and healthcare crisis that continues to some extent to the present day. This summer, after COVID case trends had been flat in the U.S. for a few months, a new omicron subvariant, BA.5, has emerged and cases and hospitalizations are on the rise again. New COVID cases are now at the same level they were in September of 2021, with the only higher peak in the last 12 months taking place in February of 2022.
With all the changes in the number and type of respiratory infectious agents increasing, dramatic changes in public health response via vaccination and testing, emergence of new test and treatment options and locations and the increase in virtual visits changing the face of the practice of medicine in the physician office, how do you stay informed to be the very best consultant you can be? My answer is straightforward: understand the current environment, leverage your knowledge to advise your customers and stay informed as changes rapidly take place.
What we know
What do we know as we prepare for the fall of 2022, when respiratory infections typically peak in the U.S.? From the public heath perspective, we are in a very different place than just three years ago. COVID vaccinations are free to U.S. citizens and the U.S. government is providing the third wave of COVID antigen tests, with eight tests available to any U.S. family at no charge. Follow the link to learn more COVID.gov/tests – Free at-home COVID-19 tests. The Biden administration has announced a six-point plan, largely based on earlier test-and-treat initiatives to combat the current wave of BA.5 infections. It includes continuing to work with communities to provide wide availability of vaccines and tests as well as assuring that COVID vaccines continue to be widely available to young children, who were not subject to vaccine availability earlier in the pandemic. It does not include mask mandates or social distancing requirements at this time.
Over the past three years, virtual visits have become far more available and acceptable to the U.S. public, largely due to “shelter in place” mandates early in the pandemic. In 2019, virtual visits averaged 75,000 per month; by the end of 2020, they rose to over 225,000 visits per month. Even the CDC has changed its influenza surveillance methods. In addition to other changes the CDC now tracks influenza all year, rather than tracking it seasonally as they have done before. See the new FluView for detail: Weekly U.S. Influenza Surveillance Report, CDC.
From a disease incidence perspective, the information is particularly interesting. Influenza incidence peaked in December and January as it has done typically, but the number of positive tests remained below 1% during that time, while it rose to nearly 10% in May and June. Both cases and positive test results have continued to drop since the May-June time frame. Flu testing peaked at about 150,000 tests per week in December and January and has dropped to fewer than 18,000 tests per week in July.
The incidence of COVID infections and hospitalizations appears to follow the emergence of new variants and subvariants. With the emergence of COVID subvariant BA.5, cases again are approaching 125,000 per day, an increase of 15% over the previous week. The trend continues upward. So, it appears COVID and flu have been cycling in opposite directions; as COVID has risen, influenza has fallen.
From a vaccine and test kit supply perspective, we have probably not been better prepared. Vaccines are in good supply and I am not aware of any critical shortage of test kits for any respiratory pathogens.
On the other hand, the public is clearly weary of COVID prevention, and social distancing and use of masks has slipped since it is largely no longer mandated and social distancing is largely a thing of the past. So, we may not be as prepared to avoid a surge of COVID BA.4 or 5 as we were in past surges.
What we don’t know
What don’t we know? More than anything else, we don’t know the incidence level of COVID, influenza, RSV and other respiratory pathogens this fall and winter. We can speculate the BA.5 will drive COVID infections up for a while and that flu may revert to its typical seasonal incidence. There is no better data to be confident now that I know of. We also do not know exactly when the non-mRNA vaccines will be available in the U.S.; one manufacturer is already cleared for use in Canada. The CDC approved the use of non-mRNA COVID vaccines in July, but roll-out timing is uncertain at this time. Coordination of vaccination, public awareness, diagnosis and treatment of COVID has become a community activity. You need to know how your key practices fit into and leverage community resources. Are they testing in house? Where do they send patients for vaccination? Are they recommending boosters and conservative social practices? You need this information to consult effectively and offer the proper range of lab and other medical surgical products and services. Deep customer discussions are important to get the questions on the table and plan for this fall.
To get the most out of the opportunities presenting themselves for your business this fall and winter, stay informed. Leverage what you know, share the information with your customers, understand their perspective and plans, acknowledge what we do not know and pay active attention to the trends expected to make this respiratory season different from any we have previously experienced. It’s worth your time.