Managing Back-to-School Respiratory Infections

In late summer, tens of millions of children throughout the United States return to school, sharing tales of their summer adventures and, inevitably, new germs. Many will develop a cough, sore throat, or runny nose in the coming weeks, as part of a well-documented “summer wave” of respiratory infections.

In 2025, COVID-19 cases are already on the rise. As of August 5, the Centers for Disease Control and Prevention (CDC)reported increased infection rates in 45 states.¹ But that’s not to say a runny nose couldn’t be an early case of influenza, respiratory syncytial virus (RSV), or even seasonal allergies. In the U.S., ragweed pollen peaks in the late summer, and mold spores increase as leaves accumulate on the ground. With so many potential culprits, the only way to reliably identify and manage respiratory symptoms is with proven diagnostic tests. Accurate results can then guide appropriate treatment decisions and recommendations for preventing further spread.

The Case for Definitive Diagnostics

With children, ongoing respiratory issues and illnesses may feel par for the course and not always worthy of a doctor’s visit. While it’s true that many cases do not require treatment, it is still essential to test and identify the specific cause.

Due to the overlapping symptoms of influenza, RSV, and SARS-CoV-2, obtaining a definitive diagnosis requires targeted tests. A 2018 analysis of emergency department decision-making found that only 36% of influenza cases were correctly identified based on clinical symptoms alone, compared to over 98% accuracy with rapid polymerase chain reaction (PCR) testing.² The pandemic further emphasized the need to efficiently differentiate between respiratory pathogens as SARS-CoV-2 became an endemic.

While many different technologies are available, real-time PCR remains the gold standard for providing rapid and accurate results, and its capabilities continue to advance, making them more accessible than ever. In 2025, testing for different pathogens can be performed in parallel and at the point of care. For example, Roche Diagnostics’ four-in-one cobas® liat SARS-CoV-2, Influenza A/B & RSV nucleic acid testcan simultaneously detect and differentiate between influenza A and B, RSV, and SARS-CoV-2 with a single nasal swab.³ Creating a streamlined process for the clinician and a positive experience for the patient, results are returned in just 20 minutes, empowering clinicians to make informed treatment decisions within the same visit. Beyond the benefits for individual health, testing to identify specific respiratory illnesses is important for public health surveillance and to reduce further spread.

Optimizing Care for Children

Identifying the underlying cause of a respiratory illness can have dual benefits: It helps inform what treatments will work and, at the same time, what treatments will have no effect. This is particularly important for antibiotic stewardship, as the medical community strives to limit the unnecessary use of antibiotics. Research has connected early childhood antibiotic use (particularly repeat prescriptions) with an increased risk of everything from early-onset asthma to celiac disease, metabolic conditions, and attention deficit hyperactivity disorder.⁴ As it stands, the CDC estimates that 28% of antibiotic prescriptions in an outpatient setting are not required.⁵

For conditions that do require an antibiotic treatment, timely diagnosis is key. Right now, we’re seeing an alarming rise in pertussis (whooping cough), a bacterial infection caused by Bordetella pertussis. CDC data indicate there was a six-fold increase in cases in the United States in 2024 compared to the prior year.⁶ Streptococcal pharyngitis (strep throat) is also bacterial and often strikes school-age children (most commonly ages 3–9). Early treatment is crucial to achieving the best outcomes and minimizing further spread.

With an accurate diagnosis, caretakers can appropriately assess risk and take measures to protect those most vulnerable to severe illnesses. For example, RSV can be particularly dangerous for young children and infants and causes an estimated 58,000-80,000 hospitalizations of children under the age of 5 each year.⁷ COVID-19, by comparison, is typically very mild or asymptomatic in children, but poses a greater risk to pregnant women and the elderly.⁸

Supporting Public Health

Recent advances in diagnostic tests, alongside shifting healthcare delivery models, are improving access to care for routine respiratory infections. We’re seeing a shift towards more decentralized sites of care, including urgent cares, specialty clinics, physician offices, or freestanding emergency departments. These locations are often more accessible and convenient for busy families with school-aged children. However, they are still capable of providing quality care and timely results, with many facilities now using point-of-care instrumentation. Along with supporting the individual patient, timely testing and reporting at these locations provide public health officials with a richer understanding of how diseases are moving across the country and where additional resources may be needed.

Innovating for the Future

It’s difficult to fully protect children from respiratory infections, especially as the late-summer heat pushes kids to stay inside with air conditioning during their breaks. What we can control is how we respond to those infections, ensuring steps are taken to secure a definitive diagnosis. This is a necessary first step to establish an informed treatment plan for the individual—whether that’s antivirals, antibiotics, or a wait-and-see approach. Timely diagnoses are also critical for preventing further spread of pathogens at school, at home, and in society more broadly.

At Roche, we are dedicated to advancing the fight against respiratory infections by developing innovative solutions and expanding testing options. Our mission is to provide healthcare providers with the highest quality testing, enabling them to deliver exceptional care. Together with our communities, we remain united in this critical effort, knowing that collaboration is key to making a meaningful impact.

In March 2020, we were the first to receive emergency use authorization (EUA) for a commercially developed PCR test for SARS-CoV-2, the virus that causes COVID-19.⁹ This year, as with countless years prior, we’re ready to support clinicians and families as they brace for the back-to-school surge in respiratory infections. As we look to the future, we must remain vigilant, leveraging new innovations and standing ready to combat respiratory infections through fast and accurate diagnosis. Roche will remain at the forefront of the field, evolving to address new pathogens, different patient and clinician needs, and shifting models of care.

References

1. Centers for Disease Control and Prevention (CDC). Current Epidemic Trends (Based on R_t) for States. August 15, 2025. Available from: https://www.cdc.gov/cfa-modeling-and-forecasting/rt-estimates/index.html.

2. Hansen G, Moore J, Herding E, et al. Clinical decision making in the emergency department setting using rapid PCR: Results of the CLADE study group. Journal of Clinical Virology. 2018 May:102:42-49. doi: 10.1016/j.jcv.2018.02.013. Epub 2018 Feb 21. Available from: https://pubmed.ncbi.nlm.nih.gov/29494950/

3. Roche Diagnostics, North America. One visit. One Test. Multiple Results. August 15, 2025. Available from: https://diagnostics.roche.com/us/en/products/lab/cobas-liat-sars-cov-2-influenza-a-b-and-rsv-pid00000730.html?programName=US-RDS-NPC-XPI-Liat+CFRA-2410.

4. Aversa Z, Atkinson E, Schafer M, et al. Association of Infant Antibiotic Exposure With Childhood Health Outcomes. January 2021. Available from: https://www.mayoclinicproceedings.org/article/S0025-6196(20)30785-0/fulltext.

5. Centers for Disease Control and Prevention (CDC). Outpatient Antibiotic Prescribing in the United States. December 5, 2024. Available from: https://www.cdc.gov/antibiotic-use/hcp/data-research/antibiotic-prescribing.html.

6. Centers for Disease Control and Prevention (CDC). Pertussis Surveillance and Trends. June 11, 2025. Available from: https://www.cdc.gov/pertussis/php/surveillance/index.html.

7. Centers for Disease Control and Prevention (CDC). Respiratory Viruses and Young Children. June 5, 2025. Available from: https://www.cdc.gov/respiratory-viruses/risk-factors/young-children.html.

8. Centers for Disease Control and Prevention (CDC). Similarities and Differences between Flu and COVID-19. September 17, 2024. Available from: https://www.cdc.gov/flu/about/flu-vs-covid19.html.

9. Roche Diagnostics. Roche’s cobas SARS-CoV-2 Test to detect novel coronavirus receives FDA Emergency Use Authorization and is available in markets accepting the CE mark. March 12, 2020. Available from: https://www.roche.com/media/releases/med-cor-2020-03-13.

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