Respiratory illness test turnaround time ‘critical’

Simultaneously test for both Covid-19 or influenza symptoms once circulating influenza levels exceed ECDC-specified threshold

One of the challenges faced in the coming winter, when patients present with respiratory symptoms, is whether they should be tested for Covid-19, influenza, or both, as per the Health Protection Surveillance Centre (HPSC).

In its “Guidance for Covid-19 and influenza testing — Winter 2020/21”, just published (Monday, September 7), it advised that a subgroup of the National Covid-19 Testing Strategy Group, had been convened to consider the options for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing/influenza testing for this coming winter, in settings to include nursing homes, residential care facilities, work places, hospital settings and primary care.

The group has now issued a set of recommendations for appropriate testing approaches in each of these sites.

These include: if a patient presents in the community, or to hospital, with respiratory symptoms they should be tested for Covid-19, irrespective of circulating Covid-19 levels in the community.

When circulating influenza levels remain below the European Centre for Disease Prevention and Control (ECDC) specified threshold, as evidenced by the results from the sentinel general practitioner (GP) practices, a test for influenza in these patients is not required.

When the circulating influenza levels have risen above the ECDC-specified threshold, the following applies: in nursing homes, residential care facilities and other work places, where the workers work in close proximity, patients or workers who present with respiratory symptoms compatible with Covid-19 or influenza should be tested for both Covid-19 and influenza, simultaneously.

Under the latest recommendations, in primary care a GP will make a clinical diagnosis of respiratory illness. All these patients with a diagnosis compatible with Covid-19 symptoms should have a test for Covid-19 performed.

“The turnaround time for these tests is critical,” underlines the group’s recommendations. If SARS-CoV-2 is not detected, and the patient remains unwell after several days, the laboratory should be asked to repeat the test on the sample, and to test for Covid-19 and influenza.

Four further recommendations on the approach to patients with respiratory symptoms have been drawn up for the hospital setting.

In addition to the recommendations on options for SARS-CoV-2 and influenza testing approaches, the HPSC has updated its “Guidance for surveillance to detect clusters/outbreaks of influenza or influenza- like illness [ILI]or respiratory illness”.

Published yesterday by the HPSC, the guidance advised that surveillance to detect outbreaks of influenza or ILI or respiratory illness was currently in place.

The purpose of the surveillance was to detect outbreaks of ILI, influenza A and influenza B and other respiratory pathogens e.g. respiratory syncytial virus, human metapneumovirus etc. in the community.

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