Respiratory Virus Testing and Treatment for Healthcare Professionals
In individuals who are at high risk for severe disease, prescription COVID-19 and influenza treatments can prevent serious illness when started early.
While respiratory infections have unique characteristics, it is often difficult to identify respiratory viruses based on symptoms alone. Only testing for these viruses can confirm the diagnosis. In patients with signs and symptoms of respiratory virus illness, especially those that are at high-risk for severe disease, act fast to test for flu, RSV, and COVID-19 and discuss treatment options.
Testing
Clinical Testing when multiple respiratory viruses are in Co-Circulation
While COVID-19 is common during the summer and winter, influenza and RSV activity typically starts increasing in the fall and peaks during winter months. When respiratory viruses are co-circulating, clinicians should test using multiplex panels for COVID-19, flu, and RSV. There are various panels available for testing of multiple viruses. If patients test negative for flu, RSV, and COVID-19, further testing with a respiratory pathogen panel can be performed if clinically indicated.
Rapid antigen tests for influenza and COVID-19 are FDA approved and available for over-the-counter purchase. Patients reporting influenza A positive results from at-home tests who are severely ill (hospitalized/ICU) should be re-tested with an influenza rRT-PCR test and influenza A positive samples should be sent for subtyping.
In addition, influenza testing by rRT-PCR should be encouraged in situations where sequencing or subtyping may be needed, including:
- Severe cases, such as hospitalized, intensive care unit (ICU), and/or fatal cases
- Acute respiratory illness outbreaks of public health concern
- Persons with recent close contact or exposures within 10 days of symptom onset that are concerning for avian, variant, or novel influenza infection (e.g., variant influenza A (H3N2)v, (H1N2)v, or (H1N1)v, or avian influenza H5N1 or H7N9).
Treatment
There are various types of treatments for COVID-19 and influenza. In individuals who are at high-risk for severe disease, prescription COVID-19 and influenza treatments can prevent serious illness when started early.
For COVID-19:
- CDPH recommends that providers prescribe nirmatrelvir/ritonavir (Paxlovid) to non-hospitalized, symptomatic, and eligible patients.
- Remdesivir (Veklury) should be considered when nirmatrelvir/ritonavir (Paxlovid) is clinically contraindicated, and molnupiravir (Lagevrio) may be considered if remdesivir is impractical and Paxlovid is clinically contraindicated.
- In addition, providers should consider additional preventative therapeutics in higher-risk patients, such as pemivibart (Pemgarda) for COVID-19 prevention, an authorized monoclonal antibody for pre-exposure prophylaxis (PrEP) in moderately-to-severely immunocompromised individuals who may not mount an adequate immune response to COVID-19 vaccination. PrEP with Pemgarda is not a substitute for vaccination and all individuals who can receive vaccination should do so. For more information, see the FDA’s Frequently Asked Questions on the Emergency Use Authorization for Pemgarda (pemivibart) for Pre-exposure Prophylaxis (PrEP) of COVID-19.
- For more information, see COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC.
For Influenza:
- CDPH recommends antiviral therapy as early as possible for any patient with confirmed or suspected influenza who:
- Is hospitalized
- Has severe, complicated or progressive illness
- Is at higher risk for influenza complications
- Antiviral options may include oral oseltamivir, inhaled zanamivir, intravenous peramivir or oral baloxavir depending on age and other factors.
- In addition, providers should consider additional preventative therapeutics in higher-risk patients, such as: oseltamivir (Tamiflu) and zanamivir (Relenza), which can be used as both seasonal PrEP and post-exposure prophylaxis (PEP) for influenza in institutional and household contacts who are at higher risk of severe infection.
- For more information, visit the Influenza Antiviral Medications: Summary for Clinicians | CDC.
For RSV:
Cost and Coverage
For patients without insurance or those whose insurance plan does not cover the cost of antivirals for COVID-19 or flu, there may be patient assistance programs, discount programs, and other plans to help support access to medications at low cost or no cost.
Offer your patients support programs for covering costs of treatment for:
For more information on Infection control and prevention in various healthcare settings and healthcare provider return to work guidance, visit: