397 - Respiratory Coinfections with COVID-19 in Veterans Health Administration (VA), 2020

Background: The first US cases occurred in the COVID-19 pandemic in Jan. 2020.  Initially, some states required patients be screened for other respiratory pathogens before COVID-19. Information on COVID-19 coinfections with other respiratory pathogens is limited. We investigated prevalence of COVID-19 coinfections with other respiratory pathogens in VA.

Methods: Molecular and viral culture test results from 9/29/2019-5/31/2020 for respiratory pathogens (Adenovirus, Bordetella pertussis/parapertussis, Chlamydia pneumoniae, COVID-19 and other Coronaviruses, Influenza, human Metapneumovirus (hMPV), human parainfluenza viruses (HPIV), Mycoplasma pneumoniae, Rhino-Enterovirus, and Respiratory Syncytial Virus (RSV)) were identified from VA data sources.  COVID-19 tested patients were evaluated within 7 days for respiratory pathogen coinfections from 2/1/2020-5/31/2020.  Patient demographics were obtained for patients with coinfections.

Results: A total of 825,282 respiratory pathogen tests (including COVID-19) were performed from Sept. 2019 with percent positive shown in Figure 1.  Of these, 617,541 tests were performed starting in Feb. 2020 (Table 1).  There were 14,839 (6.5%) positive COVID-19 tests (10,223 unique patients) of 227,111 tests performed (174,747 unique patients).  30,066/174,747 (17%) of patients with COVID-19 were tested for another respiratory pathogen.  Fifty-six (0.55%) unique COVID-19 patients were detected with coinfection including 3 COVID-19 positive patients with > 1 other respiratory pathogen (2 with Coronavirus and Adenovirus and 1 with Coronavirus and Rhino-Enterovirus).  Other coinfections included 18 Rhino-Enterovirus, 15 Influenza, 10 with another Coronavirus, 4 RSV, 3 hMPV, 2 HPIV, and 1 C. pneumoniae.  Demographics of coinfected patients are shown in Table 2.Figure 1: Percent Positive of Respiratory Pathogens in VA, 9/29/2020-5/31/2020
Table 1: Respiratory Pathogens in VA, 2/1/2020-5/31/2020
Table 2: Co-infection patients with COVID-19 and other Respiratory Pathogens, 2/1/2020-5/31/2020


Conclusion: In VA, coinfection with COVID-19 and other respiratory pathogens was rare.  Detection was limited since not all COVID-19 patients were tested for other respiratory pathogens and respiratory pathogens were declining when COVID-19 emerged.  Coinfections were detected with different respiratory pathogens.  Further comparisons of coinfected vs. non-coinfected patients to assess outcome or actionable results will be important as we enter the next influenza season.