Winter Respiratory Testing Pathways: Choosing the Right Test for the Right Patient
As winter respiratory pressures continue to intensify across the NHS, laboratories and point-of-care teams are once again being asked the same critical question:
Which respiratory testing strategy delivers the right balance of speed, governance, operational efficiency and clinical appropriateness?
The answer is increasingly nuanced.
Today’s respiratory pathways are no longer built around a single testing modality. Instead, pathology teams, microbiology leads and POCT services are designing layered approaches that combine rapid antigen testing, digital reporting tools and targeted molecular diagnostics – each deployed where they add the greatest clinical value.
With respiratory infections accounting for almost 22.8% of unplanned acute medical admissions, and winter respiratory admissions rising by approximately 80% compared with spring, the pressure on testing pathways remains substantial1,2.
At the same time, the scale of the burden is reflected in national influenza modelling, which estimated the 2024/25 vaccination programme prevented between 96,000 and 120,200 flu-related hospital admissions in England alone, indicating the true scale of seasonal flu pressure on the NHS.3
Against that backdrop, selecting the right respiratory diagnostic pathway is no longer simply a procurement exercise — it is a clinical governance and diagnostic stewardship decision.
Why respiratory testing decisions now sit firmly with laboratories
For microbiology and virology teams, rapid respiratory diagnostics require careful validation within local governance frameworks before implementation into clinical pathways.
Whether introducing lateral flow antigen testing into emergency departments, scaling ward-based outbreak testing, or deploying point-of-care molecular platforms for high-risk patients, laboratories remain responsible for ensuring:
- Appropriate clinical application
- Understanding of assay limitations
- Governance and traceability
- Integration into existing patient pathways
- Compliance with POCT oversight requirements
This is particularly important as respiratory testing expands beyond the traditional laboratory environment and into urgent care, admissions, IPC workflows and community-facing services.
Increasingly, forward-looking trusts are recognising that winter resilience is not simply about testing more patients — it is about deploying the right diagnostic approach in the right setting, with clear escalation pathways and operational consistency.
The challenge for many trusts is not deciding between lateral flow or molecular testing. It is deciding where each belongs.
Matching respiratory diagnostics to clinical need
One of the biggest misconceptions in respiratory diagnostics is that “more sensitive” always means “better”.
In reality, the clinical usefulness of a test depends heavily on the patient population and intended use case and operational setting.
The most effective respiratory pathways are increasingly those that align testing technology with the clinical question being asked.
Where rapid antigen testing adds value
Lateral flow antigen tests detect viral proteins directly from the sample without amplification.
This means they perform best when viral loads are highest — typically during the period when symptomatic patients are most infectious.4
That characteristic makes antigen testing particularly valuable for:
- Rapid triage
- Cohorting decisions
- Infection prevention and control
- High-volume symptomatic testing
- Operationally fast decision-making
Importantly, antigen tests are less likely to remain positive after recovery because they are not detecting residual viral RNA fragments.
For many acute respiratory workflows, that distinction matters.
A positive antigen result is often more reflective of current infectiousness rather than historical infection.
For healthcare systems managing significant winter pressure, this can support faster operational decisions while helping avoid unnecessary escalation or prolonged isolation linked to residual molecular positivity5.
Where molecular testing remains essential
Molecular assays, including PCR and nucleic acid amplification technologies, detect viral RNA by amplifying extremely small quantities of genetic material.
This allows detection at much lower viral loads and earlier stages of infection5.
For higher-risk patient groups, this level of analytical sensitivity is clinically important.
Particularly important use cases include:
- ICU or high-consequence clinical decisions
- Oncology and haematology patients
- Transplant recipients
- Immunosuppressed populations
- Patients with strong clinical suspicion despite negative antigen results
However, molecular sensitivity also introduces a well-recognised operational challenge: RNA can remain detectable long after viable virus has cleared.
This means molecular positivity does not always correlate with ongoing infectiousness.
For laboratories and IPC teams, understanding this distinction is essential when designing balanced winter respiratory pathways that support both patient safety and operational flow.
Designing smarter respiratory pathways for winter
One of the biggest shifts happening across respiratory diagnostics is that organisations are moving away from “one-test-for-all” strategies.
Instead, leading pathology and POCT teams are building layered respiratory pathways that match the diagnostic approach to the patient cohort, clinical risk and operational setting.
That matters because the challenge facing services this winter is not simply increasing testing capacity — it is ensuring diagnostic resources are used appropriately, sustainably and with clear clinical intent.
In practice, that means recognising that different technologies answer different clinical questions.
A rapid antigen test may be the most operationally effective tool for cohorting symptomatic patients in an emergency department. A molecular assay may be essential for an immunosuppressed oncology patient where low viral loads cannot be missed.
The most resilient respiratory pathways are increasingly those that understand where each modality adds the greatest value.
Which test, for which patient?
There is no single answer – but there is a right answer for your pathways.
Symptomatic patient
For frontline respiratory triage, speed and workflow integration are often the priority.
Rapid antigen testing combined with digital reporting can support faster cohorting decisions, improved documentation and EPR integration without delaying patient flow.
In operationally pressured environments, this type of pathway can help services maintain throughput while improving governance and result traceability.
- Lateral flow antigen testing or molecular testing solutions – these options are suitable here depending on your preference between low cost and speed vs. premium and high sensitivity.
Immunosuppressed patient
Patients with compromised immune systems may carry lower viral burdens even during active infection, making molecular sensitivity clinically important.
In these settings, rapid molecular confirmation closer to the patient can support safer clinical decision-making and reduce delays associated with central laboratory workflows.
- Molecular testing solutions – where PCR sensitivity is required
Negative LFT but strong clinical suspicion
Where symptoms and clinical presentation remain highly suggestive despite a negative antigen result, targeted molecular testing can provide additional diagnostic confidence without relying on central laboratory turnaround times.
This type of escalation pathway is becoming increasingly important in organisations seeking to balance rapid screening with appropriate clinical certainty.
- Molecular testing solutions – when molecular confirmation is required at POCT
Recovering patient – assessing ongoing infectiousness
Because antigen tests are less likely to detect residual non-viable viral material, they can often provide a more practical indication of current infectiousness during recovery phases.
For IPC teams, this distinction may help support more proportionate isolation and discharge decision-making.
- Lateral flow antigen testing preferred – turns negative when antigen cleared; PCR may stay positive from dead RNA
High-volume ward outbreak/IPC cohorting
For operationally pressured environments, scalable antigen testing combined with digital result capture can support faster cohorting decisions, improved governance and reduced administrative burden during periods of peak respiratory demand.
Increasingly, organisations are recognising that digital workflow integration is becoming just as important as analytical performance in large-scale POCT deployment.
- Lateral flow antigen testing or molecular testing solutions – these options are suitable here depending on your preference between low cost and speed vs. premium and high sensitivity.
Option 1 – Lateral flow antigen testing
Beright COVID-19 / Influenza A+B / RSV Antigen Combo Lateral Flow Test
| Analyte | Sensitivity | Specificity | Accuracy |
| SARS-CoV-2 | 97.0% | 99.0% | 98.0% |
| Influenza A | 95.0% | 99.1% | 98.4% |
| Influenza B | 92.9% | 99.1% | 98.1% |
| RSV | 94.3% | 96.2% | 95.9% |
Lateral flow antigen testing – Digital reading and governance
ClearScreen powered by TestCard
Option 2 – Point of Care Molecular Testing Solutions
Credo VitaSIRO solo™
The future of respiratory diagnostics is pathway-led
Perhaps the most important shift happening across respiratory diagnostics is this:
The conversation is no longer simply about individual tests. It is about pathway design.
The most effective winter respiratory strategies increasingly combine:
- Rapid antigen testing for scalable frontline decisions
- Digital reporting and governance tools
- Targeted molecular diagnostics for high-risk patients
- Clear escalation criteria between modalities
- Operational workflows aligned to clinical risk
For laboratories, POCT teams and operational leaders, the focus is becoming less about choosing a “best” technology — and more about deploying the right technology in the right clinical context.
As respiratory demand continues to place pressure on NHS services, organisations that align diagnostic speed, governance, operational workflow and clinical appropriateness are likely to be best positioned to build sustainable winter respiratory pathways.
References
- UK Health Security Agency (2025) Influenza in the UK, annual epidemiological report: winter 2024 to 2025. GOV.UK, published 22 May 2025. Available at: gov.uk [Accessed: 14 May 2026].
- National Institute for Health and Care Research (NIHR). Winter respiratory infections place significant pressure on hospitals.
https://evidence.nihr.ac.uk/alert/winter-respiratory-infections-place-significant-pressure-on-hospitals/ - UK Health Security Agency. Flu vaccine prevented around 100,000 hospital admissions.
https://www.gov.uk/government/news/flu-vaccine-prevented-around-100000-hospital-admissions - UKHSA. Lateral flow validation prioritisation criteria for rapid diagnostic assays.
https://www.gov.uk/guidance/lateral-flow-validation-prioritisation-criteria-for-rapid-diagnostic-assays-for-specific-sars-cov-2-antigens - CDC. Overview of Testing for SARS-CoV-2.
https://www.cdc.gov/covid/hcp/clinical-care/overview-testing-sars-cov-2.html - Beright SARS-CoV-2 / Influenza A+B / RSV Antigen Combo IFU.
- eClinicalMedicine.Evaluation of lateral flow device sensitivity and CTDA relevance.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00014-3/fulltext - TestCard ClearScreen.
https://www.testcard.com/clearscreen - NHS England. Digital reader evaluation for lateral flow testing.
https://www.england.nhs.uk/ - UK Department of Health and Social Care. Point of care testing guidance and governance principles.
https://www.gov.uk/government/publications/point-of-care-testing-guidance-for-community-pharmacies - Peer-reviewed evaluation of the Credo VitaSIRO solo™ respiratory assay platform.