RSV Diagnosis: Why Specific Testing Matters for RSV Management

In this episode, the panel challenges the commonly held belief among clinicians that RSV testing is unnecessary because it does not alter treatment. Dr. Creech pushes back forcefully, describing this attitude as a misapplication of the Hippocratic principle — "first do no harm" morphing into "first do no tests." He argues that knowing the specific virus responsible for a child's illness serves multiple important purposes: it allows providers to counsel families on the characteristic course of that infection, identify children who qualify for second-season prophylaxis, and reinforce public awareness about RSV.

Dr. Simões reinforces this perspective, noting that a specific RSV diagnosis carries prognostic value — particularly the risk of recurrent wheezing, which differs depending on the virus identified and the child's family history of asthma. He reviews the current diagnostic landscape: nucleic acid-based tests (including rapid point-of-care tests) are available and highly accurate. However, reimbursement gaps are a real barrier — RSV testing is not reimbursed in the outpatient setting the way flu and COVID testing are, discouraging its use. In emergency departments and inpatient settings, multiplex flu/RSV/COVID panels are increasingly deployed, but single-agent RSV testing is underutilized, even in ICU patients. Both panelists agree that understanding which pathogen is present — whether RSV, rhinovirus, HMPV, parainfluenza, or adenovirus — matters for prognosis, counseling, and appropriate follow-up.

In the next episode, "RSV Prevention Overview: Maternal Vaccines and Monoclonal Antibodies," Dr. Simões provides a comprehensive overview of the currently available immunization and prophylaxis strategies for RSV, including how and when they should be administered.