12-Utility of Testing for Respiratory Viral Co-Infections With SARS-CoV-2 at Time of Initial Diagnosis
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Infection, Crisis Management, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Matthew Norris, MD

Introduction/Hypothesis: Over 4.8 million cases of COVID-19 have been diagnosed in the United States as of 8/2/2020, with >50,000 new cases diagnosed per day since 6/24/2020. The question arises at the point of care of whether to test patients initially diagnosed with SARS-CoV-2 for a secondary respiratory co-infection. The CDC has endorsed testing for respiratory pathogens other than SARS-CoV-2 to date. However, there is little evidence to support, or recommend against, additional respiratory pathogen testing.

Methods: The following is a retrospective cohort study of all adult patients with nasal swabs positive for SARS-CoV-2 by PCR from 3/16/2020 to 4/20/2020 at a 500-bed community teaching hospital in Northern New Jersey. Decisions regarding test selection for secondary respiratory pathogens were performed by emergency department providers per individual clinical judgement. Both a 12-25 target respiratory PCR panel and 3-target PCR were available at our institution. Being unable to measure direct costs, 2020 Medicare clinical laboratory fee schedules were used to estimate cost. Approval to perform this study (IRB #1597737, decision 4/29/2020) was obtained through the Atlantic Health System Institutional Review Board.

Results: 1,676 adult patients without a prior SARS-CoV-2 diagnosis were identified as having the virus at time of emergency department presentation. 572 patients were tested with a 12-25 target respiratory PCR while 195 patients were tested with a 3-target viral PCR. Seven 12-25 target PCRs were positive for a co-infection (1 Influenza B, 1 Human Metapneumovirus, 2 Rhinovirus/enterovirus, 3 non-COVID coronaviruses) while all 3-target PCRs were negative. Positive viral testing changed management in one case (patient who tested positive for Influenza B received oseltamivir).

Conclusions: Data supports emerging literature showing respiratory viral co-infection during the initial outbreak was rare. Testing at our hospital cost an estimated $326,425.45 but had minimal impact on patient care. As most respiratory viral co-infections are unlikely to change management in patients with SARS-CoV-2 infection, minimizing use of high-target respiratory viral PCRs will free up laboratories to perform more targeted viral testing and allow better resource allocation during our current pandemic.


Meta Tag
Content Type Presentation
Knowledge Area Crisis Management
Knowledge Area Infection
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag COVID-19
Tag Resource Allocation
Year 2021
viral respiratory co-infections
patient management
high-target respiratory PCR
healthcare resources


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