INTRODUCTION: Over 4 8 million cases of COVID-19 have been diagnosed in the United States as of 8/2/2020, with &gt;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 SARSCoV- 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 SARSCoV- 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
Utility of testing for respiratory viral co-infections with sars-cov-2 at time of initial diagnosis