It's not practical or necessary to test everyone who has a runny nose, cough or fever. But there are specific circumstances that warrant it.
The spread of respiratory illnesses is well underway, as US Centers for Disease Control and Prevention director Dr. Mandy Cohen told Congress recently. She noted the rise of three particular viruses: flu, the coronavirus and respiratory syncytial virus, better known as RSV.
Hospitalizations for these three viruses continue to increase, according to CDC data. As more people have symptoms such as cough, sneezing and fever, they may wonder if they should get tested to find out exactly which virus is causing their symptoms. What symptoms can be treated at home, and what should prompt someone to seek medical care? Does it matter if you go to the doctor’s office versus urgent care or the emergency room? And if people have not gotten vaccinated yet, is it too late?
To assist us with answering these questions, I spoke with CNN wellness medical expert Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.
CNN: Is it important for everyone who has a runny nose, cough or fever to get tested to find out exactly what is causing their symptoms?
Dr. Leana Wen: No. This is not practical, nor is it necessary. In addition to the “big three” that’s often referenced of influenza, the coronavirus and RSV, there are also many other viruses that cause respiratory illnesses, such as adenovirus, rhinovirus and parainfluenza. By some estimates, there are more than 200 viruses that cause the common cold and produce the symptoms mentioned of runny nose, cough or fever. Most people do not need testing to figure out exactly which virus is causing their symptoms.
There are three circumstances under which virus testing may be recommended. First, someone who is vulnerable to severe illness may wish to get tested for influenza and Covid-19. There are several antiviral therapies approved for individuals with influenza, including Tamiflu. According to the CDC, people in priority groups for influenza treatment include those who have severe illness or are at higher risk for influenza complications.
Similarly, Paxlovid is an antiviral oral treatment approved to treat individuals early in their course of illness from Covid-19 and who meet eligibility criteria. Other treatments for Covid-19 include the pill molnupiravir and the injection or infusion remdesivir. Individuals at risk for severe disease from the coronavirus should get tested if they have viral symptoms so that they can begin antiviral treatment as soon as their diagnosis is confirmed.
Second, someone may wish to get tested to find out if they have influenza or Covid-19 if they live in a household with an individual who is vulnerable to severe disease from these two pathogens. For instance, a healthy child in day care probably doesn’t need to get tested for every sniffle. However, if they live in a household with a grandparent who is on immunosuppressing medications after a kidney transplant, they should get tested more often if they exhibit viral symptoms.
That’s because if the child has influenza, the grandparent may be eligible to take prophylactic antiviral medications that reduce their chance of contracting the flu. There are no such prophylactic options for Covid-19, but the grandparent should be on the lookout for symptoms and take antiviral treatments if they contracted the coronavirus. And, of course, the child with viral symptoms should isolate from the grandparent to reduce the chance of spreading the infection.
Third, a person may get tested for influenza, Covid-19, RSV and other viruses if they are severely ill or have been ill for a while. This would be part of an evaluation to find out what is causing these prolonged, severe and/or progressive symptoms. For instance, someone who is ill enough to require hospitalization probably would receive a full viral panel as part of their inpatient evaluation.
CNN: Is it possible for someone to test positive for more than one virus?
Wen: Yes. In a 2019 study, researchers examined more than 44,000 cases of respiratory illnesses in Scotland and tested for 11 viruses, including rhinovirus, coronaviruses, influenza and RSV. Of all patients who tested positive for one virus, 11% had a coinfection with one or more other viruses. Some patients harbored as many as five viruses at the same time.
Again, for most people, it’s not important to know exactly what is causing their symptoms. The treatment is generally the same and is referred to as supportive treatment. That means there is no specific antiviral therapy, but rather, symptoms are addressed to help the patient feel better. So, if someone has a fever, they can take fever-reducing agents like Tylenol or ibuprofen. They can drink lots of fluids to prevent dehydration. They can get rest to help with their fatigue. That’s different in the case of influenza and Covid-19 for specific patients who are eligible for antiviral treatment; those are the people for whom testing is most crucial.
CNN: What symptoms can be treated at home, and what should prompt someone to seek medical care?
Wen: Most people will recover fully with supportive treatment at home. Note that this may take some time; cold symptoms can last more than a week and a cough could linger for months.
Symptoms that should prompt seeking medical care include difficulty breathing, severe chest pain, severe vomiting and inability to keep down fluids, and sustained fever. Parents of young children should be on the lookout for struggled breathing as evidenced by signs like nose flaring, wheezing, increased breathing rate and bluish tinged lips. Babies are especially prone to dehydration, and parents and caregivers should contact a medical professional if the child is not making enough wet diapers.
Other individuals who should contact their physician earlier in the course of illness are those who are elderly and who have severe underlying medical conditions like heart and lung disease. For these patients, a viral illness that may be mild for most can exacerbate existing conditions and result in hospitalization or worse, and early, proactive monitoring is essential.
CNN: When should someone go to the doctor’s office versus urgent care or the emergency room?
Wen: Emergency symptoms require emergency care in the ER. These include sudden and severe symptoms like chest pain, struggling to breathe and seizures. On the other hand, symptoms that are continuing over days can generally begin with an evaluation in the doctor’s office. In these situations, you could begin with a call to your physician’s office. They could advise as to whether you could be seen on an urgent basis in the office or via a telehealth visit. They could also advise as to whether you should, instead, go urgent care or the ER.
CNN: Can you remind us what steps people can take to prevent from contracting viruses? Also, if they have not gotten vaccinated yet, is it too late?
Wen: It’s not too late to get vaccinated. People who have not had this year’s flu vaccine or the latest Covid-19 vaccine can still get it now, as can those eligible for the RSV vaccine. These vaccines reduce your chance of contracting the virus and, most importantly, decrease your chance of severe illness even if you were to get infected.
Other steps to prevent infection include frequent handwashing, staying away from those with cold-like symptoms and mask-wearing in indoor, crowded spaces.
The-CNN-Wire
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