Is it RSV, the Flu, or COVID-19? 5 Common Questions Answered

We know that viruses spread more easily in winter; that’s partly because we spend more time indoors. We see an increase in cases of the common cold, flu, and RSV. COVID-19 is another variable to consider, as it is still present and increasing in frequency in our communities.

Because RSV, COVID-19, and the flu share many symptoms, such as fever, cough, and runny nose, it can be difficult to tell viruses apart based on symptoms alone. Here are some answers to common questions to help you understand how to protect yourself and others, including when to test or seek medical help.

With the symptoms being so similar, how can I tell these viruses apart?

Without testing, diagnosing the flu, COVID-19, or RSV can be difficult. In some cases, younger kids and adults may have more than one condition at once, such as flu and RSV or flu and COVID-19. The most effective way to determine what’s causing your symptoms is to get tested. Testing also helps inform your treatment options and whether you need to isolate or wear a mask to protect others.

Which should I be most concerned about, the flu, RSV, or COVID-19?

All three viruses may lead to complications. This is particularly true for babies under age 1 and older adults with diabetes, asthma, heart failure, or COPD. Contact your primary care physician or advanced practice provider, and seek medical help immediately if you or a loved one fall into these groups and have flu, RSV, or COVID-19 symptoms. 

Are there treatments available for any of these viral infections?

Some antiviral medications can help fight flu and COVID-19 infections. In cases of flu infections, your health care provider may prescribe Tamiflu to children and adults within the first 48 hours. For COVID-19, patients 12 or older with a high risk of complications may take Paxlovid within the first five days of the onset of symptoms. Both drugs are available by prescription only.

How can I protect young children and older adults from RSV?

Two monoclonal antibody therapies– nirsevimab (Beyfortus) and palivizumab (Synagis) – can help protect babies and young children from RSV complications. Monoclonal antibodies are not vaccines or treatments for children who already have RSV. They provide an extra layer of defense that helps fight RSV infections and protect children from getting very sick. The protection these antibodies provide wanes over time. 

Nirsevimab is recommended for all infants younger than 8 months born during – or entering – their first RSV season (typically fall through spring). One dose of nirsevimab can protect infants for 5 months, the length of an average RSV season. A dose of nirsevimab is also recommended for some children between the ages of 8 and 19 months at increased risk of severe RSV and who are entering their second RSV season. Palivizumab (Synagis); on the other hand, is limited to children under 24 months of age with certain conditions that place them at high risk for severe RSV disease. It must be given once a month during RSV season.

When should I go to the doctor or the emergency room?

In general, you can schedule a virtual or in-office visit if your symptoms are mild, like those of the common cold. Other symptoms, such as feeling tired for no reason or difficulty breathing, may warrant a trip to the emergency room. Contact your physician or advanced practice provider for guidance on where to go for care, or head to the nearest ER immediately if:

• You can't breathe
• A child with uncontrolled  fever, vomiting, or struggling to eat or drink
• Your or someone you know has chest pain, persistent vomiting, or sudden dizziness (common in severe flu cases)
• Your or a loved one is confused, disoriented, or has discolored lips or hands (common in severe COVID-19 cases)

Do older adults need a different type of flu vaccine for better protection?

The CDC recommends that adults 65 or older get a high-dose flu vaccine, after new research suggests that they're more effective for people in this age group. That extra protection is crucial for older adults whose immune systems don’t respond as strongly to vaccines as younger populations. People 65 and older also have an increased risk of complications and hospitalization. Any of the following high-dose vaccines are recommended for adults 65 or older: 

• Fluzone High-Dose Quadrivalent vaccine
• Flublok Quadrivalent recombinant  flu vaccine
• Fluad Quadrivalent adjuvanted flu vaccine

If you haven’t gotten your annual flu vaccine, now is the time. Talk to your health care provider if you are allergic to eggs or any vaccine ingredients other than eggs. You can find information about vaccine ingredients in the package inserts.

What else can I do to protect myself and my family?

Wash your hands often with soap and water for at least 20 seconds, and help young children do the same. Cover your coughs and sneezes with a tissue, stay home if you’re sick, and clean and disinfect surfaces and objects you frequently touch.  In cases of RSV, keep infants younger than 12 months away from people with cold-like symptoms. 

Staying up to date with vaccines is an effective preventive measure. Most children and adults are eligible to receive the flu and COVID-19 vaccines. Everyone 5 years and older should get one updated Pfizer-BioNTech or Moderna COVID-19 vaccine, even if they received any original COVID-19 vaccines. Adults 60 and older have the option to receive RSV vaccination after a discussion with their health care provider. Talk to your health care provider if you have questions about the COVID-19, RSV, or flu vaccines. It’s never too late to get vaccinated to help prevent complications.

The takeaway

While some antiviral medications can help fight the flu and COVID-19, vaccination and healthy habits are your best line of defense. Schedule your annual flu shot and get the updated COVID-19 vaccine to protect yourself and your loved ones. If you're 60 or older, speak with your CHI Memorial primary care physician or provider about whether the RSV vaccine is appropriate for you.  

Sources:

GRADE: Higher Dose and Adjuvanted Influenza Vaccines for Adults Aged ≥65 Years | CDC
Quadrivalent Influenza Vaccine | CDC
Who Should and Who Should NOT Get a Flu Vaccine | CDC
RSV Vaccine Information Statement | CDC
Stay Up to Date with COVID-19 Vaccines | CDC