1/10 Wrote my thesis about use of upper respiratory swabs to diagnose RTI in the community. Imagine if GPs could use a swab and point of care test to tell you if your cough needed antibiotics or not!

2/10Peer reviewers of grants we submitted were rightly sceptical that upper respiratory swabs (same as those used for covid testing) could ever be a reliable indicator of aetiology. Ie the bugs found on nose/throat/ pharyngeal swabs might not be the same bugs causing the disease.

3/10 We knew from previous work (eg the @capcbristol TARGET study led by @drniamhr ) that swabs taken by trained clinicians result in zero pathogen detection in up to 28% of RTI symptomatic people.

4/10 In a small study in 2011, we detected potentially pathogenic respiratory viruses in the upper respiratory tracts of 26% of asymptomatic children.

5/10 There is no perfect gold standard test for RTI in primary care. Our strategy was to examine whether results of swabs taken from the upper respiratory tract were related to prognosis, and whether using them to direct antibiotic prescribing resulted in better, safer outcomes.

6/10 Several years, two unsuccessful fellowship applications and two children later, @NIHRSPCR funded my first pilot study into upper respiratory point of care testing: the first U.K. study of rapid multiplex point of care testing to direct RTI treatment in primary care.

7/10 Recruitment to the pilot finished just before covid arrived.

8/10 NOBODY has done a definitive study looking at whether testing samples from the upper respiratory tract adds any diagnostic or prognostic value over and above the clinical examination. This urgently needs doing to support GPs drive down high antibiotic prescribing rate.

9/10 In absence of evidence that upper respiratory tract swabs are related to actual cause of RTI (remember 28% of ill people found to have zero pathogen detection from upper respiratory tract!), should we be funding mass testing as part of our pandemic response?

10/10 Here is my former boss talking about the future of point of care testing for@RTI in general practice. Thanks for reading! https://www.bristol.ac.uk/primaryhealthcare/news/2020/rapid-point-of-care-testing-during-and-after-covid-19.html @drniamhr @NIHRSPCR @capcbristol @JochenCals @ChristieCabral @gemmalasseter @BJGPjournal @bmj_latest