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Jan. 29, 2023

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Do you have the flu, a cold or COVID? Here’s how to spot the differences

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The season of sniffles and shivers is underway.

As temperatures dip into the 30s and 40s and boxes of tissue become common household items again, doctors and health experts are worried many Washingtonians may have forgotten our immune systems are likely underprepared.

“Even though we’ve seen a lighter flu season in the past couple of years because of all the masking and distancing that were related to COVID, we anticipate this is going to be a particularly bad year based on predictions from Australia and the Southern Hemisphere,” said Dr. Elizabeth Meade, a pediatric hospitalist and medical director of education, outreach and quality at Providence Swedish.

State COVID trends were still relatively low around the end of October, though cases of RSV, a virus that can cause coldlike symptoms, have been skyrocketing for weeks, filling pediatric hospitals. Because RSV, or respiratory syncytial virus, infections are pouring into the region months earlier than usual, they’re beginning to overlap with the beginning of influenza season.

The state’s rate of flu infections has also begun to increase in the past few weeks. At least three Washingtonians have died from the flu since the beginning of October.

In King County, about 5.4% of lab tests are returning positive for influenza, compared to about 0.7% in mid-October.

This week, Meade answered our top questions about these respiratory infections and how to stay safe.

This conversation has been edited for clarity and brevity.

How can I tell the difference between flu, RSV and COVID symptoms?

Many of those symptoms overlap, unfortunately, so it can be really difficult for people to tell what’s what without testing. Some things are more specific — if someone has the acute loss of taste or smell, then that would be very suspicious for COVID.

If you have COVID, you can also have lots of nonspecific symptoms, like aches, congestion, cough, sore throat. Those are things that tend to overlap with the other viruses.

Flu is one of those illnesses like COVID where people tend to feel like they got hit by a truck — feeling really exhausted, really sore, really achey and with a high fever. It’s sort of the all-encompassing one here. With the exception of loss of taste or smell, many of the symptoms of flu will overlap with all of these other illnesses.

RSV is not something that typically comes with high fevers, but can cause fevers in children. It often tends to cause sneezing and lots of congestion. In older children and adults, RSV typically looks like a common cold. In younger children with underlying health conditions or older people with underlying health conditions, we tend to see more of the lower respiratory symptoms, like difficulty breathing, fast breathing or use of different muscles (like retractions in between ribs or flaring of the nostrils).

In really young children, it can cause inability to feed, severe respiratory distress and color change (like turning blue or pale).

There’s really no way to differentiate between RSV and other cold viruses without a test.

If I think I have one of these illnesses, at what point should I seek medical attention?

A lot depends on the person. If you’re not someone who’s at high risk of developing severe disease — if you’re an older child or adolescent, or a relatively young adult or middle-aged person who doesn’t have underlying health conditions — then unless you’re experiencing severe symptoms (difficulty breathing, dehydration, confusion, changing color, chest pain), we’d suggest you try to do some self-care at home or have a phone call or virtual visit with your physician.

For those in high-risk groups, it’s best to call a doctor or health professional to see if you need to be evaluated. Those more vulnerable to developing severe respiratory symptoms include children under the age of 5 for some things like flu; children under the age of 2 for other things like RSV or COVID; anyone with underlying health conditions, specifically heart or lung disease; people over 65; or anyone who has a decreased immune system (like those on immune-suppressing medications, those who have had transplants or those who are pregnant).

If you’re having severe symptoms, then you really do need to see a provider, whether that’s your own, or going to urgent care or the emergency room.

What does self-care at home look like if my symptoms aren’t too severe?

For cold and RSV, make sure you’re able to breathe comfortably and that you’re able to stay hydrated. Suctioning (getting mucus out from your nose) and using medications to control fever are also recommended for most kids and adults. (Note: Tylenol and ibuprofen are good options, though babies under 6 months old shouldn’t take ibuprofen.)

Typical over-the-counter cold and cough medications are not recommended for young children, and parents and caretakers should instead opt for fluids and fever-reducers.

Honey can also be useful for adults and older kids for soothing sore throats or coughing, but children under 1 years old shouldn’t have honey.

For flu, it’s all about supportive care as well, but there are antiviral medications we will use at times, typically for higher risk patients (young children, pregnant people, people with underlying health conditions). Tamiflu, for example, is an option that’s most useful if given within the first 48 hours of illness.

What if I’m infected with multiple viruses at once?

It’s not that the viruses are merging or even that they’re interacting with each other, but it’s more that having more than one illness that can cause similar symptoms at the same time can certainly cause more severe symptoms and give people a more significant risk of severe illness, hospitalization, ICU care and death. What we particularly worry about is really nasty viruses like the flu in combination with something like COVID. That could be very dangerous for people of any age or underlying health status.

This year, as we’re seeing this giant surge of RSV, and frankly many other viruses, we’re starting to see flu-positive patients in Washington state. And we always anticipate there will be a likely COVID surge with holidays and travel and all that, so I think this is shaping up to be potentially a very difficult winter when it comes to respiratory diseases.

How do I test for these viruses?

COVID tests remain fairly accessible to most Washingtonians, who can either pick one up at a pharmacy or drug store or order free kits from the state’s home testing program.

There’s no home testing options for the flu or most other cold viruses, but most hospitals and clinics have access to both rapid tests and more sensitive tests, which test for several different viruses and take a little longer to return results.

What are your top recommendations for avoiding these viruses?

If you have any respiratory symptoms, stay home from day care, work or school. Lots of hand washing. Wearing masks when appropriate — in school for some people, in large gatherings, etc. Avoid anyone else who has respiratory symptoms. And stay up-to-date on routine vaccines, including flu and COVID shots.

We know RSV is highly contagious and we know kids spread it very easily. So this is a time for parents to be really vigilant about not sending your child to day care or school if they have any cold symptoms. There’s no way for most people to know if that’s RSV or not, and while the other children that are around your child may not be at high risk, they may have young siblings, newborns or other immunocompromised people at home.

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