Changes in Respiratory Viral Testing Before and After the COVID-19 Pandemic

As an intern during the winter of 2008, I presented a full service of children admitted overnight with bronchiolitis.It had been 2 years since the initial publication of the American Academy of Pediatrics' "Diagnosis and Management of Bronchiolitis" guideline, which recommended against routine viral pathogen testing. 1 As I reported that the final child on the service had a positive respiratory syncytial virus test, my bewildered attending asked, "Why do they continue to send these tests on children when they don't change management?"At the time, we were amid a massive deimplementation effort to reduce respiratory pathogen testing.Now, 17 years later, I am the attending in the emergency department working with a family who is demanding to know exactly which virus is causing their otherwise healthy child's fever of 4 hours' duration after their rapid COVID-19 test returned negative.Like many clinicians, I am left wondering how we moved from telling most families that their child had a virus in need of only good supportive care to needing to know exactly which virus is responsible for their symptoms?And importantly, can and should we ever go back?This change in approach to respiratory pathogen testing, as experienced by author T.W.L., is likely familiar to many frontline clinicians and is described in the article by Molloy et al. 2 In this study, the authors leveraged data from the Pediatric Health Information System database and examined trends in respiratory pathogen testing for over 5 million encounters for respiratory illnesses at 39 children's hospitals before and after the COVID-19 pandemic.They found that between 2016 and 2023, children and adolescents presenting to the emergency department or hospitalized with a respiratory illness had a 4.6-fold increase (from 13.6% in 2016 to a peak of 62.2% in 2022) in respiratory