Is it Covid, flu or RSV? A few hallmarks can help distinguish between the illnesses

Covid, influenza, and respiratory syncytial virus (RSV) together are driving a national wave of respiratory illnesses.

According to data from the Department of Health and Human Services, approximately 76% of beds in US hospitals are occupied. According to an NBC News analysis of HHS data, pediatric beds in six states are similar, even though 90% or more of pediatric beds are occupied.

It can be difficult to distinguish between Covid, flu, and RSV, as they share many common symptoms. However, it is useful to know which virus you have, as it determines the treatments you should receive and how long you should self-isolate.

Specific signs – symptoms or how the disease progresses – can help distinguish each virus. Here are five factors to consider.

Some symptoms are specific to certain viruses

A runny nose, cough, congestion or sore throat can occur due to any of the three viruses or the common cold. However, loss of taste and smell is more associated with Covid than with influenza or RSV. And wheezing is a tell-tale sign of a serious RSV infection, often found in children or older adults.

The only way to know for sure is to get tested.

Pediatric infectious disease specialist Dr. “I don’t think anyone can say ‘Hey, listen, based on your symptoms, I think you have a virus,’ and say with confidence what it is,” said Frank Esper. At the Cleveland Clinic.

Do the symptoms come on gradually or suddenly?

Flu symptoms tend to develop more suddenly than COVID or RSV symptoms.

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“The flu classically presents with a sudden fever that is fairly rapid first. This contrasts somewhat with RSV and Covid, which we think is a slow increase in symptoms,” said Yale Medicine infectious disease specialist Dr. Scott Roberts.

How long has it been since exposure?

Diseases have different incubation periods – the time between exposure and symptoms. On average, flu symptoms tend to develop two days after exposure to the virus, while RSV symptoms take about four to six days to appear, and the typical incubation period for Covid for the omicron variant is three to four days.

“If I go to a party and have symptoms the next day, it’s probably flu because that can be as short as the 24-hour incubation period,” Roberts said.

Age makes a big difference in the symptoms and severity of a disease.

RSV is unlikely to make a healthy adult feel very sick, whereas Covid and the flu certainly can.

“In general, if you’re a young, healthy adult or not at an extreme age and have a fairly serious illness, it’s probably not RSV,” Roberts said.

The most vulnerable groups to severe RSV infections are infants, children with lung disease, adults aged 65 and over, and people with compromised immune systems.

Symptoms may also appear different depending on your age and immune status. Many children encounter respiratory viruses for the first time this year when they return to regular school and socialize, so their bodies may have a harder time clearing the infection, which can lead to more far-reaching symptoms.

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According to Esper, nearly a quarter of children have gastrointestinal symptoms (such as diarrhea, stomach pain or vomiting) caused by viral infections. This is less common in adults with seasonal flu or RSV.

Meanwhile, people with weakened immune systems are more likely to develop severe symptoms or pneumonia from any of the three viruses.

Consider which virus is circulating the most in your community

Disease experts predict that cases of Kovid will increase during the holidays as more people travel and congregate indoors. Average daily cases reported to the Centers for Disease Control and Prevention have increased by nearly 11% in the past two weeks, according to NBC News’ tally.

However, as many people use home tests, it is difficult to determine local levels of Covid transmission. In contrast, RSV and flu tests are done in a doctor’s office or ordered by prescription.

RSV infections appear to have passed their peak nationally. While the CDC does not keep a national count of RSV cases, the number of positive weekly tests has dropped from 17,000 in the week ending November 5 to nearly 9,000 in the week ending Saturday.

In contrast, cases of flu are increasing rapidly. The national share of positive flu tests rose from about 8% in the week ending October 30 to about 15% in the week ending November 13. more than ten years.

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Esper said he expected the Cleveland Clinic to “swim in the flu” two weeks from now.

However, the picture varies by region. In the Northeast, “we’ve seen increases in RSV over the last one to two months, and it actually flattened out – which is great news – and then flu, we’ve only seen an exponential increase in the last few weeks,” Roberts said.

“The southeastern United States – Georgia, Alabama, Mississippi – they saw the opposite. They saw an increase in the flu initially, and then now you see RSV starting to catch up,” he added.

Available treatments and vaccines

Unlike Covid and flu, there is no vaccine or universally prescribed treatment for RSV.

“It’s probably RSV that scares me the most because you can’t do anything about it and a lot of young children haven’t seen it. We’re seeing really record increases in our children’s hospitals,” Roberts said.

But to reduce the duration of flu symptoms, doctors often prescribe Tamiflu or one of three other approved treatments. For some people with Covid, doctors may prescribe Paxlovid.

White House Covid-19 Response Coordinator Dr. Ashish Jha highlighted the benefits of getting a flu shot and Covid boosters.

“At this moment when there’s so much flu, there’s still a fair amount of RSV, there’s still a good amount of Covid, the most important thing people have to do is get vaccinated,” Jha said in a briefing on Tuesday. “It keeps you out of the hospital.”


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