Most regions of the world continue to grapple — nearly three years into the COVID-19 pandemic — with how best to manage and reduce the ongoing threat of a lingering SARS-COV-2, as well as other agents responsible for respiratory infections.
European health systems are looking for tools to help them improve pandemic preparedness and prevent the next outbreak — something that will require closer cooperation between the public and private sector, greater foresight and a joined-up approach to planning.
In addition to the ongoing concerns about COVID-19, two years of intermittent lockdowns and lack of exposure to other communicable viruses means Europe is seeing worse-than- usual epidemics of influenza and respiratory syncytial virus.1 At the same time, the region is facing a concerning avian flu that has jumped to mammals and thus threatens to spread to humans.2, 3
The Delphi study, a multidisciplinary panel of experts representing academia, health, non-governmental organizations and government from 112 countries and territories convened in 2022, developed a set of recommendations for ending the COVID-19 public threat. Chief among these was the suggestion that the EU adopt a “whole-of-society” (including multiple disciplines, sectors and actors) and “whole-of-government” (including multi-ministry coordination) approach. Maintaining evidence-based prevention measures that include vaccination and a range of complementary public health and financial support measures — including strategies that identify, review and address resilience in health systems and the removal of economic barriers to COVID-19 tests, personal protective equipment, treatment and care — are equally crucial.
A focus on coordinated, consistent policies will help EU member states to be successful at managing health risks that lie ahead and enable health systems to become more resilient, the study concluded.
The European Commission also advised EU member states in December 2022 to adapt their surveillance strategies toward sustainable testing for COVID-19, flu and RSV in preparation for the winter season.
The value of high-performance diagnosis and testing
Ensuring more accurate detection of respiratory illness is critical to slowing the rate of infection in EU countries and alleviating the burden on health systems.
The European Centre for Disease Prevention and Control, on its website, observes that a universal testing strategy for all those with COVID-19 symptoms is a “resource-intensive endeavour,” and notes that “well-designed, representative, sentinel surveillance systems in primary and secondary care should remain the main surveillance method for acute respiratory infections,” including RSV.1
The recent creation of the Health Emergency Preparedness and Response Authority is part of this process, enabling European countries to work together to address cross-border health threats and increase health security through monitoring and surveillance of pathogens within the EU and outside its border.
One single tool that could be most beneficial to physicians and other healthcare providers during the winter virus season is a more simplified workflow that is highly accurate, rapid and can test for multiple viruses at the same time. Many symptoms of flu, RSV and COVID-19 are similar, so accurate and fast diagnoses are critical to patient care. The ECDC has said that diagnostic testing should aim to use PCR tests that can simultaneously test for influenza, COVID-19 and RSV when possible.
Simplifying and improving detection
PCR tests provide the most rapid and accurate detection and can be designed with multiple targets to continue to provide detection even in the event of mutating strains.
Cepheid, a molecular diagnostics company, has focused on the importance of pandemic preparedness planning to lower the risk of emerging infectious diseases, not only of COVID-19, but also influenza and RSV.
The company has been collaborating with the U.S. Department of Health and Human Services’ Biomedical Advanced Research and Development Authority to develop diagnostic tests — including the Xpert Pan-Coronavirus that detects and differentiates the seven known coronaviruses that infect humans, and the Xpert Xpress SARS-CoV-2/Flu/RSV test.
With evolving strains of influenza currently in circulation, the need for “multi-target” diagnostic tests is increasing. Mutations can affect the performance of molecular diagnostic tests, sometimes leading to an increase in false negative results.4 This is particularly likely in tests that focus on only one genetic target of the influenza genome. To counteract this problem, Cepheid offers a simplified four-pathogens test that can detect COVID-19, RSV and two types of influenza simultaneously, using a multiple target technology for each virus.
Moreover, scaling-up testing capacities has been an essential pillar in tackling the pandemic, but still it remains a struggle for many hospitals across Europe today. Cepheid offers testing technology that lends itself to different healthcare settings and improves the workflow of hospitals. The testing platform can be transported within departments and can relieve pressure on centralized laboratories in case of an increased co-circulation of respiratory viruses.
The COVID-19 pandemic highlighted the weaknesses in existing European public health systems. It is essential to improve the resilience of the region’s health systems through cooperation and joined-up COVID-19, influenza and RSV programs that offer combined solutions. These include vaccinations and diagnostic tests that ensure early disease detection, accuracy and agility.
1 Operational considerations for respiratory virus surveillance in Europe. (2022, July 18). European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/publications-data/operational-considerations-respiratory-virus-surveillance-europe
2 Agüero M, Monne I, Sánchez A, Zecchin B, Fusaro A, Ruano MJ, Del Valle Arrojo M, Fernández-Antonio R, Souto AM, Tordable P, Cañás J, Bonfante F, Giussani E, Terregino C, Orejas JJ. Highly pathogenic avian influenza A(H5N1) virus infection in farmed minks, Spain, October 2022. Euro Surveill. 2023 Jan;28(3):2300001. doi: 10.2807/1560-7917.ES.2023.28.3.2300001. PMID: 36695488; PMCID: PMC9853945.
3 Sidik SM. Bird flu outbreak in mink sparks concern about spread in people. Nature. 2023 Feb;614(7946):17. doi: 10.1038/d41586-023-00201-2. PMID: 36697730.
4 Jørgensen RL, Lerche CJ, et al. Emergence of Circulating Influenza A H3N2 Viruses with Genetic Drift in the Matrix Gene: be Alert of False-negative Test Results. APMIS. 2022 Oct;130(10):612-617.