Public Health

COVID-19, RSV, flu: When to get tested and how

Jennifer Lubell , Contributing News Writer

Pathologists are at the center of helping to diagnose diseases such as respiratory syncytial virus (RSV), influenza and COVID.

“These diseases may be off the front pages now—but they're very much still with us,” said Donald Karcher, MD, president of the College of American Pathologists.

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At this article’s deadline, COVID-19 test positivity stood at 9.5%, according to the Centers for Disease Control and Prevention.

“That's down a bit, but still high,” said Dr. Karcher, professor of pathology at George Washington University. Hospitalizations have also declined but are still lingering at over 16,000 a week.

At a College of American Pathologists media briefing in October, Dr. Karcher joined two other pathologists to discuss test positivity in COVID-19 and other winter viruses, and how patients should approach tests and vaccines.

In a Leadership Viewpoints column, AMA President Jesse M. Ehrenfeld, MD, MPH, outlines the new prevention tools, including vaccines and monoclonal antibodies, that are available this respiratory virus season.

Expressing concerns about the potential for COVID-19 rates this winter, Dr. Karcher asked the panelists about trends in their own communities.

Leilani Valdes, MD, medical director at Regional Pathology Associates and chair of pathology and laboratory medicine at Citizens Medical Center in Victoria, Texas, saw a slight increase in COVID-19 cases over the summer.

This was a bit surprising, given some experts’ predictions that COVID-19 would become more seasonal, said Dr. Valdes.

“We worry that we're going to see an increase once we do get into that cold and flu season again,” she said. Monitoring positive COVID-19 tests gives her infection-control team an idea of how much virus is circulating in the community.

“We want to be ready when it does increase for those patients to come in and be treated in our hospital,” she added.

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The federal government has reinstated its policy to provide four at-home COVID tests to each U.S. household at no charge.

At-home tests are a useful way for individuals to identify a current infection and take the precautions necessary to keep it from spreading, said Dr. Valdes. The patients who use them aren’t medical technologists or pathologists with years of training, however.

For that reason, “it’s really important when you do these at-home tests that you really pay attention to the instructions,” she urged. Users need to look at all the steps the test asks them to do to ensure an accurate result.

While they can be easy to use and provide quick answers, the at-home tests have limitations, said Diana Cardona, MD, associate professor of pathology at Duke University School of Medicine.

Polymerase chain reaction (PCR) tests, which look at the genetic material of the virus, are the most sensitive, meaning they are most likely to detect the virus if a person has it, she said.

At-home tests aren’t as good as detecting this material, which means someone could get a false negative result.

For all the viruses that cause the common cold, COVID-19 or the flu, basic symptoms present with runny nose, sore throat, cough, congestion and possibly some fatigue.

As symptoms progress, the source of the illness may become clearer. Difficulty breathing or losing sense of smell or taste are signs it may be COVID as opposed to flu, RSV or a cold, said Dr. Cardona.

“If you have any suspicion that maybe you actually do have COVID-19 and your home test was negative, go into a clinic and get a PCR test just to make sure,” advised Dr. Cardona.

The Food and Drug Administration published a list on its website that extends expiration dates for some of the at-home test kits. If a kit is not on the list and is expired, people should either throw it away or approach the results with caution, said Dr. Cardona.

Stay updated with the AMA COVID-19 resource center for physicians.