Provider News

Viral Season Update: Illness and Volume Trends, and Helpful Resources for Our Community

November 6, 2024

As with past viral seasons, our goal is to share information and resources with our larger community as we all work together to care for patients during this busy time.

Important Information for Viral Respiratory Testing

During the COVID-19 pandemic, viral respiratory testing saw a significant increase. However, a large portion of these tests do not impact clinical management and are often unnecessary. Third-party payers have now stopped reimbursing for viral panels that test for more than seven pathogens, which are costly (around $700). When reimbursement is denied, either the patient will be billed, or Seattle Children’s must absorb the cost. In contrast, shorter panels that test only for RSV, influenza, and COVID-19 are still covered by insurance. Some patients are referred to SCH specifically for viral testing, and when this testing is not necessary, addressing patient and family expectations can be time-consuming, especially if they believe they are there for viral testing. Families should be prepared that, if viral testing is deemed clinically appropriate, it will typically be performed using a panel that identifies only influenza, RSV, and COVID-19.

Viral Trends and Hospital Volumes

  • ED Volumes: Our ED volumes have been stable since the start of the school year, with low respiratory illness volumes.
  • Influenza: Influenza activity continues to be low nationally and locally. Routine testing is not indicated. Influenza in the Pacific Northwest typically starts between Thanksgiving and January and lasts 10-12 weeks. We continue to monitor national Highly Pathogenic Avian Influenza A(H5N1) news.
  • RSV: We are seeing sporadic RSV positives, which may be an early signal that numbers are starting to increase slightly. This year, we are over a month later than last year. If true, best estimate is that RSV will peak in January, with the steep part of the curve starting in December. Latest data is that nirsevimab reduces RSV-associated medical visits by more than 90%.
  • SARS-CoV-2: National and local COVID numbers are nearing recent nadirs. Wastewater activity across the country is down.
  • Mpox: The ongoing outbreak in Central and East Africa is caused by the more virulent Clade Ia subvariant. There have been 42,000 reported cases and 1,100 deaths. The majority of cases and deaths are in pediatric patients. Clade 1b is also circulating and has spread to several countries in Africa and has been detected in Sweden and Thailand in travelers. As of October 23, 2024, there have been not reported cases of clade 1 Mpox in the US. Clade II Mpox is still being diagnosed across the world at low levels. Mpox testing is available at Seattle Children’s – if you feel your patient may have Mpox and want them tested, please call Mission Control at 206-987-8899.
  • Other Respiratory Viruses: Rhino/enterovirus positives remain the most common positive at Seattle Children’s. Rhino/entero positives happen all year but tend to spike at the start of the school year. After our initial spike associated with the start of school, positivity has dropped slightly. Adenovirus, HMPV and parainfluenza are low but parainfluenza may be starting its annual fall rise. Fall parainfluenza activity is associated with croup and laryngitis and is mostly caused by parainfluenza 1 and 2.
  • Measles: Measles continues to be active nationally and internationally. We ceased active screening in August but remain vigilant to any new outbreaks.
  • Other Respiratory Pathogens: The CDC has recognized that Mycoplasma pneumoniae respiratory infections have increased in the United States in 2024, especially among young children. Per CDC guidance,
    • Have increased suspicion of pneumoniae among patients with community-acquired pneumonia who aren't clinically improving on antibiotics that are known to be ineffective against M. pneumoniae, such as beta-lactams.
    • Perform laboratory testing when pneumoniae infection is suspected to ensure appropriate antibiotic therapy is administered, especially among hospitalized children.

How You Can Help

  • Families should be prepared that, if viral testing is deemed clinically appropriate, it will typically be performed using a panel that identifies only influenza, RSV, and COVID-19.
  • Before sending your patient to the ED, contact our Mission Control team with as much notice as possible at 206-987-8899. This helps us plan for your patient’s arrival. In appropriate instances, we may be able to directly admit your patient to the hospital or arrange an urgent ambulatory clinic visit in lieu of an ED visit.

Resources