Diagnostics


Future-proofing respiratory triage with POC testing


In this article, Helen Peat and James Cottam highlight a crucial need for fast and efficient diagnostic tests to accurately differentiate between respiratory illnesses. Point of care (POC) PCR testing could play a central role in enabling healthcare providers to respond quickly to unpredictable surges in respiratory cases, aiding infection control and contributing to better patient outcomes.


Massive surges in cases of respiratory viruses – such as SARS-CoV-2, influenza A and B, and RSV – have threatened to overwhelm healthcare systems worldwide in recent years. Despite novel vaccines and extensive public health initiatives, these viruses continue to be significant threats to public health the world over, particularly during the winter season. For instance, SARS-CoV-2 was responsible for 53.3 % of the total 2,051 acute respiratory infections (ARIs) between week 40 of 2023 and week 14 of 2024, where virology testing was available.1


In addition, 193 SARS-CoV-2 deaths


were reported in the UK, up to the 8 August 2024, and 2,695 people were hospitalised before the 29 July, showing that the pathogen still poses a significant threat several years after the beginning of the COVID-19 pandemic.2 The resumption of domestic and international


travel, as well as the return of social gatherings, following the COVID-19 pandemic also led to a resurgence of influenza and RSV strains that had been temporarily kept in check. The measures implemented to combat COVID-19 initially led to a decline in influenza rates, but those numbers quickly rebounded once social activities resumed. However, more recent influenza outbreaks have been markedly more unpredictable in both timing and severity. Most surveillance systems in the UK indicated lower influenza activity and deaths in the 2023/24 season than in the previous winter period – 2,776 deaths down from 15,465 in 2022/23.1 Vaccination initiatives contribute to keeping influenza incidence numbers somewhat under control, but their effectiveness in preventing hospitalisation among those aged 65 and older is only around 30 %.1


Viral activity in 2023/24 also


lasted longer than the previous season, showing variations in the timing of outbreaks that have put further strain on healthcare providers, with most centres now needing to continue testing and treatment well beyond the typical


winter season window. In addition, uptake of the influenza vaccine in the UK has declined compared to the previous season, potentially creating concerns for the upcoming winter.1 RSV has historically been the most


predictable of the four major winter viruses, with sharp peaks that vary little in timing and magnitude, but the easing of restrictions after the COVID-19 pandemic skewed these peaks and spread the RSV caseload throughout the year.1


RSV substantially impacts babies,


with nine out of 10 infants contracting RSV before the age of two.3


Navigating pressures from multiple directions The majority of SARS-CoV-2, influenza A/B and RSV infections affect the most vulnerable people in society. For instance, in England, 81 % of the total 2,051 ARIs between week 40 of 2023 and week 14 of 2024 were reported by care homes, while just 5.1 % came from educational settings, and 10.5 % from hospitals.1


The risk for those


Since then, the virus has followed a more typical seasonal pattern with a conserved winter peak.1


However, it can still have


devastating impacts in adults, accounting for approximately 600,000 GP visits, 460,000 NHS 111 calls and 24,000 hospital admissions in the UK every year.4


Fortunately, in September 2024, the


NHS rolled out an RSV vaccine across the UK for the first time, which will help to protect higher risk groups, including pregnant women and the elderly, and hopefully combat much of the seasonal burden caused by this virus.3


20 www.clinicalservicesjournal.com I December 2024


with compromised immune systems – such as the elderly – emphasises the urgent need for rapid intervention through fast diagnostics, patient isolation and timely treatment. This is especially key in emergency departments, where the prompt and accurate identification of SARS-CoV-2, influenza A/B and RSV is crucial for determining the right treatment plans and aiding the implementation of timely isolation measures as necessary. For COVID-19,5


rapid antigen tests are


adequate in symptomatic patients who have high viral loads, but lose accuracy when a patient is further from peak replication.6 Misdiagnosis can have serious consequences,


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