All of us become sick every now and then, whether we like or not. In today’s world, you don’t have to be an infectious disease specialist or microbiologist to know that what makes us sick are small microbes that we call viruses and bacteria. Although the answer is thus straightforward, the question ‘Is it bacterial or is it viral?’ remains of the utmost importance as it is the foundation for the consideration to prescribe antibiotics for a patient, or not.

To answer that question, traditionally we would adventure on a quest to find the particular virus or bacteria that makes us sick. However, more than year ago I learned that we can ask the patient’s own defensive mechanism, called the ‘immune response’, for general directions to get to our destination more quickly. Thus, my professional career has since been focused (quite literally) on asking the question ‘is it bacterial or is it viral’ to a broad range of people to figure out what drives us to ask that question, to determine whether the question is relevant and if so, under what circumstances.

There are 5 key learnings I have obtained in the last year from asking the ‘Is it bacterial or is it viral?’ question. Some answers I anticipated, some I didn’t. Although this story will further unfold in 2023, here is what I learned so far:

1. It’s all about antimicrobial resistance, but not really…

When we give antibiotics to people that don’t need them, we create circumstances where bacteria learn to become resistant to our antibiotic treatments. Preventing these unnecessary antibiotics is thus of the utmost important to safeguard our antibiotics for the future.
Rapidly determining whether the infection of a patient is ‘bacterial’ or ‘viral’ helps prevent the unnecessary use of antibiotics. However, in many cases, physicians will know the likely cause of the patient’s infection without the need for any diagnostic test. The problem of unnecessary antibiotic use is however an issue of not knowing with certainty the cause of an infection. This uncertainty may result in prescribing antibiotics ‘just in case’ as a safety measure.

Thus, ‘Is it bacterial or viral’ doesn’t necessarily deal directly with ‘antimicrobial resistance’ or the decision to give or withhold antibiotics. Rather, it deals with the uncertainty surrounding the use of antibiotics, taking away the fog that hides the path to make the right clinical decision.

2.  A shield against outside pressures

Healthcare delivery has been under tremendous pressure, a situation which only deteriorated further since COVID-19 came along. This pressure translates itself to longer waiting times to get access to a primary care physician, an increased amount of emergency department visits and subsequently, longer waiting times in the emergency department. Increased patient numbers not only create increased work pressure, it indirectly increases clinical uncertainty as it’s up to the emergency medicine staff to figure out quickly which patient might end up deteriorating clinically in next hour. If there are more patients, the likelihood that it could happen increases.

The long waiting times and high burden on our healthcare workforce creates a stressful environment which indirectly impacts the way we prescribe antibiotics. Add to that increased public awareness of ongoing epidemic situations regarding certain microbes through the many media outlets in existence, and the usual patient-physician encounter may change dramatically and lower the threshold to prescribe.

Under these circumstances, ‘is it bacterial or viral’ can raise a barrier to withstand the external pressure. It could aid in standardizing the way we look at infections, irrespective of the circumstances. Furthermore, it aids in identifying more quickly the right care pathway for the patient which could reduce waiting times. In that sense, providing an answer to the question ‘is it bacterial or viral’ is like asking for directions, although we generally don’t like to ask for directions; it may actually make our life easier.

3. Tackling the ‘we have always done it like this’ view

Although change is what drives us forward, it is by no means easy. Changing the way we look at patients with an infection requires effort and one could ask, do we need another tool to figure out whether ‘it is bacterial or viral’? Perhaps not, but just maybe, we do need it. However, you can only learn that if you give yourself that individual experience to figure things out. Whether it is curiosity, a view to do better or the disbelieve that a quick answer to the ‘is it bacterial or viral’ question will actually have an impact, any excuse is a good excuse to figure out whether change is actually needed.

4. Who you talk with matters

‘Is it bacterial or viral’ is a simple question but the challenge is that there are multiple clinical settings in which you encounter patients with infections. Depending on the setting, the clinical specialty of the physician in that setting and their overall experience, the ‘is it bacterial or viral’ question may have a completely different meaning. Therefore, there is no right or wrong answer, only many different perspectives of what the ‘is it bacterial or viral’ question could mean. The clinical challenge is merge different viewpoints in a simple message or story that everyone can relate to.

Throughout 2022, I learned the perspectives of physicians in emergency medicine, pediatric medicine, infectious diseases, microbiology, infection prevention & control, intensive care medicine, acute medicine, and primary care medicine. Although the ‘is it bacterial or viral’ question has a different impact on these people, at the end of the day all of them aim to improve care delivery for a specific subset of patients. However, to close the circle I still miss some key perspectives, in particular from nursing staff and the patients themselves.

5. Your personal perspective matters

Before asking the question ‘is it bacterial or viral’ to anyone else, you need to understand your own perspective and personal viewpoint. Knowing what it means to you helps you deliver the question to someone else and have a genuine in-depth conversation with them. In the end, we prefer to connect with something that we can relate to and that’s where your own viewpoint helps you deliver the right story.

My personal view behind addressing the ‘is it bacterial or viral’ question has all to the do with the life we may live in the future which in itself, is a future story.