Respiratory viruses have become a global concern, with a never ending flow of headlines and news reports causing widespread panic and confusion among the general population.
We see buzz words and catch phrases intended to raise alarm among the masses. Terms like “tripledemic” and viral “co-infections” may grab headlines but they are misleading and create a false sense of heightened risk. While conspiracy theorists might have their notions about why this happens, the reality is that much of the misinformation arises from the uncertainty in how we diagnose these respiratory viruses.
With the emergence of distrust during the COVID-19 pandemic, it has become more important than ever for individual patients to understand key symptoms that differentiate respiratory viruses, such as COVID-19, influenza, and respiratory syncytial virus (RSV). By being able to identify these symptoms, individuals can seek appropriate medical attention and take necessary precautions to protect themselves and others. More importantly, individuals can avoid making clinical decisions out of fear.
COVID-19, caused by the novel coronavirus SARS-CoV-2, has made a global impact in terms of both its spread and severity. But recent cases appear to be more mild than in the past. The most common symptoms of COVID-19 include fever, cough, and shortness of breath. However, what sets COVID-19 apart from other respiratory viruses is the loss of taste and smell. Additionally, some COVID-19 patients may experience gastrointestinal symptoms such as diarrhea and vomiting. It is important to note that asymptomatic cases, where individuals show no symptoms, can also occur in COVID-19.
Influenza, commonly known as the flu, is mostly commonly caused by the influenza type B virus. But there are other viral strains of influenza and other viral species like rhinovirus and adenovirus that lead to symptoms that we traditionally label as flu as well. While fever, cough, and shortness of breath are also common symptoms of the flu, it is characterized by the abrupt onset of these symptoms. Influenza may be accompanied by fatigue, muscle aches, headache, sore throat, and a runny or stuffy nose. Although loss of taste and smell is not typically associated with the flu, gastrointestinal symptoms can still occur, especially in children.
RSV is a respiratory virus that primarily affects young children and infants. Symptoms of RSV infection include cough, runny nose, fever, and wheezing. However, RSV differs from COVID-19 and the flu in that it is often accompanied by nasal congestion, which can cause difficulty in breathing. While loss of taste and smell are not associated with RSV, vomiting and diarrhea may occur in some cases, particularly in infants.
Differentiating these respiratory viruses based on symptoms alone can be challenging, as they can overlap to some extent. This is why health policy experts rely on diagnostic tests to accurately identify the virus causing the illness. These tests include a PCR test or antigen test, which can detect specific viral genetic material or protein markers, respectively.
However, there is a limit to the efficacy of these tests. Often the decision to get tested is based on the severity of the symptoms. More mild symptoms create less concern and therefore, such an affected patient might be less likely to get tested.
However, the value of these tests depends on the number of people who get tested. This might seem odd, but in clinical medicine, a test is never just a test. Every clinical test has a certain error. And the type of error varies based on the test. To get a sense of how expansive this problem is, just know there is an entire field of science dedicated to studying testing accuracy in clinical medicine.
Most people know the basic concepts. A clinical test’s sensitivity is the ability to correctly rule out a disease if the patient being tested does not have it. A test’s specificity is the ability to correctly rule in a disease if the patient being tested has it. That is easy enough. But the problem comes when the sensitivity and specificity change based on the number of people tested.
A lesser known concept, called pretest probability, is the likelihood that a patient being tested has the disease before the test is conducted: The higher the prevalence of a disease, the higher the pretest probability. But here is the kicker. The higher the pretest probability, the more sensitive a test becomes. This means the more people who get tested for viral infections, the more accurately these tests become in ruling out a disease.
It gets very confusing very quickly. This is when the uncertainty comes in. While it is important to get tested, testing for the individual may create unnecessary concern or alarm. But testing is important for population level statistics to show the prevalence of a disease and to accurately diagnose it. There is a tension between what is good for the individual and what is good for society. This is not unlike the debate on vaccines. In fact, it is a fundamental concept in healthcare that the headlines always seem to miss. So instead, we see a slew of headlines scaring people into getting tested regardless of whether or not a test is needed.
Buzz words like “co-infection” and “tripledemic” inadvertently mislead the public about the severity of these infections. While it is important to raise awareness about the risks and complications associated with respiratory viruses, it is equally important to provide accurate information to avoid unnecessary fear and panic.
Firstly, the term “co-infection” refers to the presence of two or more infections in an individual at the same time. It is mostly seen in individuals with weakened immune systems. However, using this term in the context of respiratory viruses gives the impression that these viruses are more dangerous or more likely to cause severe illness when occurring alongside other viral infections. This can lead to a heightened sense of panic and anxiety among the public, without providing a realistic understanding of the actual risk posed by respiratory viruses.
Similarly, the term “tripledemic” refers to the possibility of a simultaneous outbreak of three different respiratory viruses. While this scenario is theoretically possible, it is important to note that such occurrences are extremely rare – and not likely to automatically happen just because we have multiple viruses in the atmosphere. In fact, during the acute phases of the COVID-19 pandemic, we saw less of other respiratory viral diseases. Presenting this possibility as a prominent concern can create unnecessary fear and anxiety among the public, potentially leading to misinformation or misunderstanding.
Instead of using sensationalistic terminology, it would be more helpful to focus on accurate and evidence-based information when discussing respiratory viruses. This includes providing information on the symptoms, transmission, and prevention of these infections. From there, the public can make informed decisions about getting tested.
By educating the public about the importance of seeking medical attention only when clinically warranted, we can promote a more informed and rational response to respiratory viruses. Individuals would be better informed on when it is necessary to get tested and make better clinical decisions.
