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WASHINGTON – Got a runny nose and cough? If you go to urgent care or the ER, you may be able to find out exactly what germs are making you sick, thanks to new tests that don’t just look for one pathogen at a time, but sometimes screen for 18. About 20 viruses and bacteria.
The use of these multiple tests has become more common in recent years. Last fall and winter in particular, the US was simultaneously battling at least three respiratory infections: Covid-19, respiratory syncytial virus, and the flu.
Doctors in busy situations can help make quick diagnoses, but experts say they can be a mixed blessing. On the one hand, you may be able to figure out exactly which virus or viruses are making you sick. On the other hand, most viruses have no specific treatment, so it may not be of much use to you or your doctor.
And it can increase the patient’s anger. If it’s not just the flu, it’s adenovirus or bocavirus – what exactly does it mean?
New challenges, new worries
Dr. Sara Nosal, a primary care physician in the Bronx, New York, said she is seeing more of the phenomenon in her practice.
In a recent case, a woman brought her 2-year-old son, who had runny nose and cough but was still feeling well, for examination by sniffing his nose.
At the end of the week, the family went to the urgent care clinic and the child was tested for 18 viruses at the same time. The results were positive for three: adenovirus, metapneumovirus and enterovirus.
“And the parents are like, ‘Why? Why does my child have so many viruses?’ said Nose.
Research shows that co-infections are not that rare, especially in the fall and winter months. For example, in one study of nearly 2,400 children with respiratory illness in Australia, one in four of those with viral illness had more than one virus. The study authors concluded that often having two or more viruses at the same time does not make a child sick.
But three viruses at the same time can seem bad for worried parents.
“Well, that’s not crazy, but we don’t normally test children. So we don’t always know that information,” Nosal said.
What’s more, there’s no specific treatment for her young patient’s viruses, so despite the grim diagnosis, her advice probably remains the same: rest, hydration and hugs.
Diagnosis may not change treatment
Because testing for Covid makes your sneeze normal, many patients want to know what’s wrong.
“We now have the ability to put names on things, so I think it’s changed,” said Dr. Priti Milani, an infectious disease specialist at the University of Michigan. “I feel like Covid has changed that paradigm a little bit.”
Multiplex tests are not available everywhere. Physicians are more likely to prescribe in settings such as emergency rooms or urgent care clinics that attempt to obtain information quickly to guide care.
Labcorp and Quest Diagnostics, two of the largest commercial laboratory testing companies in the United States, confirmed that they are getting more orders from doctors for the multi-time test starting in 2019, although neither has released exact numbers.
I feel the covid test is important, because we handle it differently. We have treatments and those treatments are not being used by people who could use them.
– Dr. Preeti Milani, University of Michigan
Testing for certain infections, especially the flu and Covid-19, is still warranted in many cases, Milani says, especially when those viruses are known to be circulating in your environment.
“I feel the covid test is important, because we treat it differently. We have treatments and those treatments are not being used by people who could benefit from them,” she said.
Covid is not particularly serious for children, but knowing they have it can help you protect other family members, such as grandparents, who may be more vulnerable.
And certain people with underlying health conditions that affect their immune function may benefit from multi-specialty testing, she says. In these cases, the results of the test can change how doctors manage the disease.
Studies have shown that multiplex testing may otherwise have limited utility.
Because they can test for both viruses and bacteria, proponents of the tests say they can help prevent unnecessary treatments, such as prescribing antibiotics — which kill bacteria — for viral illnesses.
A recent study at Children’s Hospital Colorado found that not to be the case. Among 931 children who underwent rapid respiratory testing in the emergency department, half of the physicians whose patients were given test results were more likely to prescribe antibiotics than those who did not. Children whose doctors know their respiratory panel results also experience longer ER stays and are more likely to be hospitalized.
“For most people, it doesn’t change your management. And, frankly, it’s probably a waste of a visit,” Milani said.
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