FDA approves at-home rapid combo tests for Covid-19 and flu.

That and other stories in "Five on Friday" for October 18, 2024...

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Getty Images/CandyRetriever.

Item 1: FDA approves at-home rapid combination tests for Covid-19 and flu.

Prior to late 2021 or 2022, had you ever swabbed yourself for a virus in your own home? Think about it. The Covid-19 pandemic mainstreamed the idea of testing for a virus at home. But at-home testing has long been used for another reason: pregnancy tests. There’s no reason why similar technology couldn’t extend to other uses. In fact, the reasons that at-home testing for things other than Covid-19 remain uncommon are complex.

One of them is demand, however. And people now are interested in this, thanks for Covid-19 rapid antigen tests. Well, there’s good news. The FDA just approved marketing of the first at-home rapid flu and Covid-19 combination test. The tests are relatively expensive ($10-$12 each) but could be very useful.

Because flu is so seasonal, I would not recommend using combination tests in the US except from November through March. The rest of the time, I’d just use the relatively cheaper Covid-19 tests. While Covid-19 clearly has some seasonality to it, unlike flu, it does not vanish in the spring and summer.

Of course, there are other viruses worth checking for, especially if you’re protecting high-risk people. So, we’d like to see combo tests that include RSV and other usual suspects that can cause everything from missed days of school/work to severe disease, depending on the person. The FDA’s decision on an at-home combination rapid test for Covid and flu is a step in the right direction.

Item 2: Marburg Virus response in Rwanda going well.

There are very few viruses that are as deadly as Ebola. Marburg Virus is one of them, and it may in fact be deadlier. The two viruses have a lot in common. They come from the same family of viruses (Filoviridae). They probably circulate in the same types of animals (fruit bats). They both cause terrible fevers with hemorrhagic complications (internal and external bleeding). They have similar incubation periods (days to weeks). They can both spread by human-to-human transmission and spread late in the course of the illness (which is one reason why they are easier to control). In case it is not obvious: you don’t want it.

There’s currently an outbreak in Rwanda. While there have been 15 deaths among 62 cases, things are going remarkably well, considering. The current case fatality rate is lower than in many past outbreaks (20%-30% versus 88% in the last big outbreak in 2023 in Equatorial Guinea). This likely reflects increased testing, which picks up milder cases, and better and earlier medical care.

Also, vaccines are being given. While there is debate as to whether proceeding without a randomized clinical trial is wise (which is what is happening, despite the WHO’s advice), I share my friend Dr. Craig Spencer’s view that it’s just impressive that in a very short window, health officials went from detecting an outbreak to having vaccines in arms. It shows that when public health officials have a plan, are alert, and act quickly, much can be accomplished.

The good news is that there have been no new cases in recent days, a sign that the outbreak may be under control.

Item 3: IV fluid shortage causing major care disruptions in US hospitals.

When Hurricane Helene hit, it disrupted production of the largest manufacturer of intravenous (IV) fluids in the United States. It caused a national shortage in IV fluids. The impact was so severe and sudden that hospitals started rationing their supplies. Eventually, elective surgeries were canceled, including at my hospital in Boston.

Since the hurricane, the Biden administration has been working with Baxter (which is apparently, responsible for around 60% of IV fluid supplies in the US) to try to improve the situation. According to the White House, as of today, hospitals now have 50% more supply than they did a week ago, a sign that things are improving .

On Twitter/X, one well-known intensive care doctor posted an interesting and disturbing thread. In it, he described strategies for ICUs trying to keep patients alive during this shortage. The big thing is this: oral hydration is underutilized in hospitals. People (clinicians, patients) who think IV fluids are superior to oral hydration are wrong. IV fluids are useful for people who can’t keep up their fluid intake needs (for a variety of reasons), or who need a very specific type of fluid. In the ER, we see a lot of people who seem to think IV fluids will help them more than, say, Ensure or Pedialyte, when that’s often not the case. One source of misconception on this are doctors and other clinicians who offer IV fluids for rich people who are hung over from drinking too much alcohol. It doesn’t help patients. It does help enterprising clinicians make money, though—which I’m not sure is an outcome we’re so interested in, in isolation.

The IV fluid shortage from Hurricane Helene, however, is a stark reminder that we need a more diverse pipeline of medical supplies, especially given the unpredictability of climate change.

Item 4: US hospitals resisting the return of capacity reporting.

During the Covid-19 emergency period, hospitals were required to report their capacity and other key metrics. This allowed public health authorities and experts to monitor what was going on and where patients were at risk. When the emergency phase ended, many of those requirements were sunset. As a result, we know a lot less about our systemic readiness at any given time than we did.

However, a new rule enacted by Health and Human Services in August is bringing the requirements back. Hospitals will also have to report information about how many of their patients have Covid, flu, and RSV.

For a number of reasons, I think this is very good. We need this information, regardless of what the next threat or emergency is. That said, some hospital groups think the requirements are too onerous, as per excellent reporting in MedPage Today by Joyce Frieden. While I am sympathetic to the notion that the government should not ask hospitals to complete overly administrative tasks, these requirements clearly serve the national interest, especially during unexpected emergencies. That said, if the Feds can make this process less time-intensive without losing the information needed, that should happen.

Item 5: Poll of the Week.

Here are the results from the last poll. Thanks for your votes! Wyoming was the correct answer. No human H5N1 cases there, so far.

Item 5a: Poll of the Week for this week!

Last weekend, the New York Times published an essay I wrote entitled “It’s OK if You Haven’t Gotten Your Flu Shot Yet.” In the piece, I also advocated that researchers test a two-dose flu series for high-risk/immunocompromised people. If it works, it could save many lives and decrease hospitalizations.

That’s it. Your “Friday Five!” Questions? Comments? Please chime in!

Feedback! Have any ideas for next week’s Poll of the Week? Any great articles you have read elsewhere that you want to share with the Inside Medicine community?