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November 17, 2022 — The overlapping symptoms of respiratory viruses with familiar names — COVID-19, influenza, the common cold, and RSV (respiratory syncytial virus) — can make them difficult to tell apart.
But how quickly symptoms appear, how long they last, and even which symptom(s) you have can be important clues. Some treatments are available, and are most effective when taken early, so it’s helpful to know what infection you or a friend or family member has.
The American Academy of Pediatrics has Helpful page explaining What symptoms are most likely with respiratory disease. “I think this is a really good scheme. Patricia (Patsy) A. Stinchfield, RN and president of the National Foundation for Infectious Diseases (NFID) says:
One exception I made is that children with COVID-19 experience less loss of taste and smell, compared to adults.
“It’s very difficult to distinguish our symptoms from influenza, RSV, and COVID-19…for parents and clinicians, for that matter,” says Moopen Rathore, MD, a member of the American Academy of Pediatrics’ Committee on Infectious Diseases.
Stinchfield agrees that these viruses cause many of the same symptoms, such as congestion, cough, and possibly a fever. But this does not mean that it is impossible to distinguish between them.
The Fast and the Furious
“After 44 years as an infectious disease nurse practitioner, it was one of the things I would ask people to try to figure out how sick they were from the start.” For children and adults, the flu often comes on very quickly. “It’s like a minute when a child is playing or an adult is working – And the next minute… that feeling like you were hit by a Mack truck. “
In contrast, other viral diseases tend to come on more slowly, she says. “People will say they feel like they’re off with something, have chills, have a sore throat, or just feel groggy.”
Gastrointestinal symptoms could be another clue. Vomiting and diarrhea are more common with COVID-19, and to some extent the flu, than with RSV. This happens in part because the COVID-19 virus binds to ACE2 receptors that are found in both the lungs and the intestines, so it can affect both parts of the body.
In addition, it is well accepted that loss of taste and smell is a unique sign of COVID-19 infection. So that can help you tell COVID-19 to other viral diseases.
Symptoms that indicate RSV
More sneezing, “copious amounts” of nasal mucus – snot – A runny nose and wheezing are some of the characteristic symptoms of RSV. Wheezing is when a child or adult makes a whistling sound while breathing. Stinchfield says, “You don’t see wheezing in COVID or the flu as much as you do with RSV.”
“With respiratory syncytial virus (RSV) it’s a type of upper respiratory tract infection, and people tend to get more of what we call bronchiolitis,” Rathore says. Bronchiolitis is inflammation and congestion in the small airways of the lungs, which in turn can cause a wheezing sound.
In addition, some people infected with RSV have such difficulty breathing normally that they enlist other muscles to help, including the muscles just above and below the breastbone.
The common cold is still there
“People talk a lot about RSV right now – And rightly so – “At least what we see is very different,” says Rathore. The latest internal numbers from the American Academy of Pediatrics’ Committee on Infectious Diseases indicate that the common cold is the dominant virus at the moment, followed by influenza, RSV, and the COVID-19 virus.
Rator estimates that about 35% of patients with a viral illness test positive for the rhinovirus, which causes the common cold.
“So it’s probably more common than any other infection we’re talking about,” he says. And yes, a cold is more common, “but it’s also relatively less likely to cause more serious illness.”
Testing is still necessary
Stinchfield shared two main messages. The test is the only reliable way to diagnose a viral disease. “So if someone says, ‘That’s definitely RSV’ and your child hasn’t been tested, you really don’t know.”
Testing very young children is important because they can’t describe their aches and pains, says Rathore, who is also chief of pediatric infectious disease and immunology at the University of Florida in Jacksonville.
Tests can also confirm the flu or COVID. “The nice thing is there are some rapid tests that we use in clinics that can screen for COVID-19, influenza and RSV in one device,” says Stinchfield. She hopes that a similar set of home tests will be available in the future.
Another reason to get tested is, “There is a cure for COVID-19 and there is a cure for the flu, so it’s important to know what you have so you can benefit from early treatment.”
Stinchfield also says there are effective vaccines for COVID-19 and influenza, and a vaccine to protect against RSV is in development.
Don’t hesitate to get help
Trust your instincts if you feel like a viral illness is getting worse, Stinchfield says. “Just listen to your gut. If you’re afraid, if you’re like, ‘This isn’t right,’ ‘My husband doesn’t look good,’ ‘My baby doesn’t look good,’ get medical help.
“This is what we are here for,” she says.
Stinchfield acknowledges that there can be a longer-than-usual wait to see a pediatrician or infectious disease doctor because of an RSV outbreak. Also, consider a virtual appointment if you’re concerned about exposure to other people in a medical setting, she says.
Are we in for a worrying winter?
With multiple viruses spreading noteworthy, some experts are warning of a “twin epidemic” or “triple epidemic” in the coming winter. Rator took a step forward. “I am actually invoking the possibility of a Dimick tetrad.” In addition to COVID-19, RSV, and influenza, the common cold virus also circulates.
In fact, in his Northeast Florida area, RSV rates appear to be declining, influenza is on the rise, and with COVID-19, “there’s a concern that it might come back as it was in previous seasons.” At the same time, the incidence of the common cold remains constant.
“There’s nothing you can say for sure” about which viruses will dominate over the coming winter, says Rathore. But flu season in the Southern Hemisphere has been relatively severe, and that often predicts what happens in the United States and other parts of the Northern Hemisphere, he says.
On the plus side, last season’s flu vaccine was a good match for protection against the flu strain that has been circulating in Australia and elsewhere, which may be reassuring here. This is another reason why everyone who is eligible to get a flu shot should get it. “
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