Five joint tests for respiratory diseases

The five-joint examination for respiratory diseases is a joint screening project for five high-risk respiratory pathogens, covering influenza A virus, influenza B virus, respiratory syncytial virus, adenovirus, and Mycoplasma pneumoniae. The results can be obtained in about an hour. During the high-incidence period of respiratory infections, the outpatient and emergency triage efficiency is more than 40% higher than that of a single examination. For patients with persistent high fever and suspected mixed infection, the cost-effectiveness is much higher than that of item-by-item screening. For ordinary people with mild symptoms, there is no need to do it routinely.

What particularly impressed me was when I was working in the pediatric emergency department in December last year when respiratory infections were at their peak. A mother came in late at night holding her baby and crying anxiously. The baby had been feverish for 3 days, with the temperature reaching as high as 39.8°C. I had only tested negative for influenza A at the community clinic, so I was prescribed anti-fever medicine for a common cold. As a result, I was still coughing and wheezing when I got home, and I couldn't get rid of it even after taking medicine. At that time, I was prescribed five joint tests and took a nasopharyngeal swab. The result came out in more than 40 minutes. It was Mycoplasma pneumoniae combined with respiratory syncytial virus infection. The medication plan was adjusted. Three days later, my mother came over to express her gratitude and said that the baby could run on the ground. Don't tell me, there were really many cases of this kind at that time. During the peak period, patients with mixed infections in our department accounted for nearly 30%. If we tested these five types one by one, it would not only cost more, but also take a long time to wait for the results, which could easily delay treatment.

But to be honest, there is a lot of controversy over this project in clinical practice now, and not everyone thinks it is easy to use. A classmate of mine who works at a community health service center said that most of the patients they receive here are patients with colds and very mild symptoms. Most of them have runny nose and low-grade fever. They are self-limiting and can be treated for a few days. If they come up, they will order five joint tests and spend more than 100 yuan. In the end, the results are all negative. The patients must feel that they have been cheated. This is a typical example of excessive medical treatment. Moreover, there are still many people who have a low acceptance of nasopharyngeal swabs, especially children. They will burst into tears after being swabbed, and parents will feel uncomfortable watching it. If the symptoms are not severe, there is really no need to suffer this crime.

However, most emergency and pediatric doctors in tertiary hospitals still recommend it for high-risk groups, especially the elderly with underlying diseases, pregnant women, and children under three years old. Once the fever lasts for more than 2 days, and there are symptoms of severe coughing and chest tightness, you really should not save this money. There used to be an old man in his 60s who had COPD. He took azithromycin at home for two days after he had a fever, but it didn't work for three days before he came back. The five-unit test showed B flow, which had turned into mild pneumonia. If he had been tested a few days earlier and used oseltamivir, he would not have suffered this problem at all. To put it bluntly, this project is like a rapid security checker for respiratory pathogens. You don’t have to open the boxes one by one and look through them. You can scan them to see if there are any “dangerous elements that have sneaked in.” It is much more reliable than just gambling on your luck by taking medicine.

Many people also confuse the five-component test with the previous new crown test and ask whether it includes the new crown test. In fact, the current regular five-component test does not include it. If there is a need, you can add the test separately, and it is not much more expensive. Some people think that venous blood must be drawn. In fact, most of them now use nasopharyngeal swabs or oropharyngeal swabs, which are similar to the previous COVID-19 antigen tests. If it is quick, the sample can be collected in half a minute, and it is not as painful as everyone thinks.

As for whether you should do it or not, there is really no standard answer. Pricing varies from place to place, ranging from early 100s to more than 300. If your symptoms are very mild, just a sore throat and runny nose, your fever does not exceed 38.5°C, and you are usually in good physical condition, you can observe it at home. There is no need to spend this money. But if you have a fever that doesn’t go away after two or three days, you have a cough that makes you unable to sleep at night, and you have elderly and children to take care of at home, then it is really recommended to make one. It is much better to know the pathogen and then use the medicine than to take antibiotics and antiviral medicines blindly. After all, taking the wrong medicine is not only useless, but also easy to develop drug resistance, which is not worth the gain.