RSV, flu and COVID-19: How to tell the difference? Here’s when to see a doctor, stay home amid tripledemic warnings

RSV, flu and COVID-19: How to tell the difference? Here’s when to see a doctor, stay home amid tripledemic warnings

SAN FRANCISCO — Doctors are seeing more and more different viruses circulating in the community at ever-increasing rates.

The triple threat — or “triple epidemic” — of influenza (flu), COVID-19, and respiratory syncytial virus (RSV) share many of the same symptoms, and it’s hard to tell which one you’ve contracted.

We spoke with Dr. David Hoffman, a pediatrician at MarinHealth Medical Center, to share his insights on how to tell the difference and when you should and shouldn’t worry.

“Although it is impossible to know for sure which of these viruses you have without testing, there are some characteristic symptoms for each virus,” said Dr. Hoffman.

Here are some symptoms of each and a guide on what to do if you or a family member gets sick.



The flu usually appears very suddenly with an incubation period of one to four days, unlike COVID-19, which tends to have a gradual onset of symptoms. People usually feel worse with the flu than with other types of virus, and it often comes with a sore throat, nausea, body aches, vomiting, or even diarrhea. A telltale sign of the flu can be a very high temperature — as high as 103 or 104 Fahrenheit. A fever is just the body’s way of fighting infection and is not dangerous in itself.

dr. Rochelle Walensky, director of the CDC, said, “Flu hospitalizations remain the highest we’ve seen for this time of year in a decade. If you get sick, see your doctor for early care. There are good antiviral drugs to treat the flu as well and COVID-19.”

The CDC is again suggesting people voluntarily wear masks indoors to reduce their chances of getting sick in the next few weeks.

It’s not too late to get both vaccines – experts say that with a booster shot, you start getting protection within a week.

A special feature

The most obvious sign of the flu can be a very high temperature in the 103 to 104 range.

Flu symptoms include:

  • Fever
  • Chills
  • Headache
  • Nose leak
  • Nausea
  • Fatigue
  • Loss of appetite
  • Sore throat



“Coronavirus has become familiar to most of us, and the symptoms are similar to flu and RSV. To further complicate the situation, some people get very sick, while others have very mild symptoms, and still others show no symptoms at all. While most people develop symptoms within in the first week after exposure, symptoms may appear two to 14 days after exposure to the virus.”

A special feature

“Unlike other viruses, COVID-19 can affect other areas of the body outside of the lungs and, in some cases, cause long-term consequences,” says Dr. Hoffman.

Symptoms of COVID-19 include:

  • Cough
  • Short fever
  • Shortness of breath
  • Abdominal pains
  • Loss of taste or smell
  • Congestion
  • Fatigue
  • Sore throat
  • Nausea or vomiting
  • Diarrhea
  • Muscle or body aches
  • Headache



RSV is a virus that many adults would have already contracted and generally causes cold symptoms in adults. “If you remember that cold you had that just wouldn’t go away, you continued to have congestion and maybe a cough that lasted longer than usual, there’s a good chance it was RSV. Again, flu symptoms can include fever, chills, headache , runny or stuffy nose, nausea, fatigue, loss of appetite and sore throat,” said Dr. Hoffman.

In most people, RSV causes a runny nose, congestion, and cough. According to Dr. Hoffman, RSV is more likely to cause severe illness in very young children, especially those born prematurely or those who have lung or heart disease. The most prominent symptom that some children infected with RSV will show is wheezing. Wheezing is a high-pitched sound with each exhalation.

“In most people, and even in most children, RSV does not cause serious illness. But it does in a subset of children. Even children with severe illness that require hospitalization will usually be just fine. They may need some oxygen, they may just should be watched carefully. RSV is most likely to cause significant or, you know, more worrisome disease in very young children and very old adults,” Dr. Hoffman said.

A characteristic symptom

The most obvious symptom that some children infected with RSV will show is wheezing, a high-pitched sound with each exhalation.

Symptoms of RSV include:

  • Nose leak
  • Decreased appetite
  • Cough
  • Sneezing
  • Fever
  • Wheezing

When to see a doctor

dr. Hoffman says to seek immediate medical attention if these symptoms occur:

  • Difficulty breathing
  • Chest pain or pressure
  • New confusion
  • Inability to wake up or stay awake
  • Bluish lips or face
  • Severe stomach pain
  • Refusal to eat and drink

When should I keep my child at home?

If your child shows any symptoms of RSV, the flu, or COVID-19, health experts advise keeping your child at home to avoid spreading the virus to other people. It doesn’t matter which virus is the culprit. Care should be taken to prevent spread.

Prevention: How to prevent a child from getting sick

Prevention is the best medicine, especially with these viruses. These suggestions are good ideas for avoiding seasonal viruses:

  • Vaccinate your child against influenza, COVID-19, pneumococcal and pertussis.
  • Wash your hands regularly or use hand sanitizer.
  • Disinfect high-touch surfaces, such as tables, desks and doorknobs, if someone in your household is sick.
  • If your child is sick, keep them at home to avoid spreading the disease.

“Everyone talks about RSV, but we see other viruses in the community, like metapneumovirus, which can cause bronchitis or a significant respiratory infection or viral pneumonia. There are thousands of viruses that we don’t have tests for, so we don’t know exactly which virus it is, but we’re definitely seeing more and more different respiratory infections,” Dr. Hoffman said.

He says the most important message he wants to convey to parents is that you can do yourself a lot more harm if you worry excessively.

“Because you worry and increase stress, you become more susceptible to all kinds of illnesses, chronic diseases, and infections,” says Dr. Hoffman.

“Regardless, I think everyone should do what they can to protect themselves from all respiratory and other vaccine-preventable diseases. He encouraged all pregnant women to get pertussis shots during pregnancy to ‘cocoon’ their unborn child, and preventing them from getting whooping cough themselves,” he says.

Similarly, he urged children to get the pneumococcal (whooping cough) vaccine.

“Get the COVID-19 and flu vaccine for children and adults. The flu vaccine will make you feel like you may have a very mild cold, but that’s much better than getting seriously ill or even dying from the flu. So many people choose not to get the flu shot because they don’t like it. But actually the benefits far outweigh the very small risks of the flu shot or the inconvenience of the flu shot,” Dr. Hoffman said.

“I don’t think it’s a good idea to rush to your pediatrician’s office or your doctor’s office just to get tested, to try to find out what you have, other than maybe testing for COVID-19 because most people who get RSV and flu and COVID-19 will be completely okay. And so it’s really just about determining whether or not you should self-isolate and for how long,” he said.

The fact is that these respiratory viruses usually present with similar symptoms, such as cough, runny nose and fever. Fortunately for most children, it doesn’t matter which of these, or the thousands of other viruses that cause respiratory illnesses or colds, your child has. Most children will recover from all these viruses on their own, without treatment and without serious complications. If your child is sick, consider getting tested for COVID-19 first to find out if and for how long you should isolate your child at home.

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