CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Karen Titus
September 2020—The twinned challenge of testing for SARS-CoV-2 and the upcoming influenza season has a bit of The Cat in the Hat energy running through it. How does one manage to keep Thing One and Thing Two from creating unmitigated chaos?
Maybe one doesn’t, not completely. A pandemic-based flu season will by its very nature be protean. So as she eyes the uncertainties that could lie ahead, Beverly Rogers, MD, offers only one clear prediction. “Until you get to coinfection time, it’s all speculation,” says Dr. Rogers, chief of pathology, Children’s Healthcare of Atlanta, and adjunct professor of pathology and pediatrics, Emory University School of Medicine.
Dr. Rogers and her colleagues are looking ahead and planning, plainly. They’ve been doing so for months. As far back as April, Dr. Rogers, in an earlier interview with CAP TODAY, spoke about learning from the unfolding pandemic in anticipation of a second wave of SARS-CoV-2 infections in the fall.
Now, from a position of relative calm at Children’s in early August, here’s how Dr. Rogers is taking stock of what might lie ahead.
All was quiet on the flu front, unsurprisingly. “We aren’t seeing flu right now—just a bit of rhinovirus,” she says, because the respiratory season—with its large number of rhinovirus infections and influenza, as well as respiratory syncytial virus—hadn’t started.
“When those begin to hit, however, there’s overlap in symptomatology with SARS-CoV-2 infection. To ferret that out, you’re going to need to test for multiple pathogens,” says Dr. Rogers.
At Children’s, the laboratory typically runs two platforms that test for influenza type A and type B during the respiratory season. “One platform offers a flu A/B duplex and another offers multiplex testing for multiple respiratory pathogens. Both platforms are available based on patient condition and clinical decision.”
SARS-CoV-2 testing is being added to both platforms, she says, “because clearly you’re going to want to test for that as well in the symptomatic patient.”
Symptoms aren’t necessarily going to offer the best guidance for testing, however. Despite their similarities with flu, SARS-CoV-2 symptoms are frustratingly variable. “What a bizarre virus,” as Dr. Rogers puts it. A child presenting with diarrhea could be infected with SARS-CoV-2, but that symptom wouldn’t necessarily prompt a respiratory panel. “And it’s not on the GI panel,” Dr. Rogers says. It’s not yet clear to her how laboratories and clinicians will negotiate their way through that testing maze, though her lab intends to offer respiratory panels with SARS-CoV-2 as well as standalone SARS-CoV-2 tests.
One ongoing practice might ease some pressure as she and her colleagues try to plan for the flu season: Children’s focuses tightly on what she calls symptomatic isolation—any child exhibiting flu- or COVID-like symptoms will be somewhat isolated if admitted to the hospital, even before test results are available.
Clinical colleagues are asking for rapid tests for SARS-CoV-2, which “is a bit of a challenge,” Dr. Rogers concedes. The false-negative rates of the currently available antigen assays have been problematic, to put it mildly. “We need more point-of-care testing with high sensitivity to detect the virus.”
“We suffer in the outpatient arena,” she adds. “Urgent care laboratories need a solution, but the current waived testing platforms tend to lack sensitivity.”