NFID Board Members: We Need More Accessible, Less Expensive RSV Testing

William Schaffner, MD, medical director at the National Foundation for Infectious Diseases (NFID), and Patsy Stinchfield, RN, MS, CPNP, president-elect of NFID, explain how COVID-19 testing developments have opened doors for developments in respiratory syncytial virus (RSV) testing.

Transcript

The COVID-19 pandemic has demonstrated the necessity for vaccines, antibodies, and other treatments, and the timeliness of their developments. What can be learned from this to take the next steps toward treatments and preventions for RSV?

Stinchfield: I think we have a bit of a Catch-22 with RSV. First of all, again, understanding that virus—the magnitude of its impact—and the way you do that is you have a good diagnostic test for it. We do have a good PCR [polymerase chain reacton] panel that we use in intensive care to say this child or this adult has a severe respiratory illness. What is it? Is it flu? Is it RSV? Is it adenovirus? There's a whole host of severe viruses. We also need that kind of diagnostic testing to be more accessible—much like we're seeing with COVID testing being done in our own homes so that parents could be able to say, "Can I send my child to daycare today? He's coughing, he's wheezing"—and the RSV rapid home tests, which I envision that doesn't exist at this point, but would be wonderful.

Some of the things we can learn from COVID-19 will be getting those rapid tests. I think what we did in health care was we'd say, "Well, there is no treatment. If there's no treatment, then why are you testing? What does it matter? We should just do symptomatic management." That's where the Catch-22 is. So we need better diagnostics, which can lead to better understanding of our impact, what ages are impacted, to what degree, and have the kind of data that we have right now of COVID-19 in disease in different age groups. Then we can also say, "This age group is most impacted. Let's target our vaccines to pregnant women or to people over 65 and then have that ongoing surveillance.." You can see these things are all related. Unless you have, really, a good understanding of your current epidemiology of it and that public health surveillance, it's hard then to get us into a place where we're using antivirals and, even more so, preventative things like vaccines and monoclonal antibodies.

Schaffner: Doctors respond best when they know what's causing an illness. So to say that a patient does not have flu, negative tests, does not have COVID, something else, doctors don't respond to that very well. They respond better if you can define the illness, right? "Yes, it's RSV." And I would emphasize that we need better, more accessible diagnostic testing. I think the tests ought to be, first of all, accurate; second of all, available; third, quick so we can get a rapid answer; and fourth, inexpensive. At the moment, we have those multiplex tests at our institutions, just as Patsy was describing. But they're generally discouraged for use except in seriously ill patients—very seriously ill patients, intensive care unit patients and the like—because they're rather expensive. What we need is more accessible, less expensive testing. When these new modalities of treatment and prevention come along, then we will be able to focus and see what the impact is, clinically and from a public health point of view.