Is it Covid, flu or RSV? Several characteristics can help distinguish the disease
Covid, influenza and respiratory syncytial virus (RSV) together are driving a national wave of respiratory illness.
According to data, about 76% of hospital beds in the US are filled data from the Ministry of Health and Human Services. Pediatric beds are at a similar level, although six states have 90% or more of their pediatric beds filled, according to an NBC News analysis of HHS data.
Covid, flu and RSV can be difficult to tell apart, as they share many common symptoms. But it is useful to know which virus you have, because it determines the treatments you should receive and how long you should isolate yourself.
Certain signs – either symptoms or how the disease progresses – can help distinguish between each virus. Here are five factors to consider.
Some symptoms are unique to certain viruses
A runny nose, cough, congestion or sore throat can be caused by any of the three viruses or the common cold. But loss of taste and smell is more common linked to covid than with flu or RSV. And wheezing is often a sign of a serious RSV infection, usually found in children or older adults.
The only way to know for sure is to get tested.
“I don’t think anyone would ever say, ‘Hey, listen, I think you have a virus based on your symptoms,’ and say for sure which virus it is,” said Dr. Frank Esper, a specialist in pediatric infectious diseases at the Cleveland Clinic.
Do the symptoms come on gradually or suddenly?
Flu symptoms develop more often than those of Covid or RSV.
“The flu usually comes with a sudden high fever that comes on quite quickly. This is somewhat in contrast to RSV and Covid, where we mean a slow escalation of symptoms,” said Dr. Scott Roberts, an infectious disease specialist at Yale Medicine.
How long has it been since the presentation?
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 usually appear four to six days to appear, and the typical incubation of Covid is three to four days for the omicron variant.
“If I go to a party and have symptoms the next day, it’s probably the flu because the incubation period can only be 24 hours,” Roberts said.
Age makes a big difference in the symptoms and severity of the disease
A healthy adult is unlikely to feel very ill from RSV, while Covid and the flu certainly can.
“Generally speaking, if you’re a young, healthy adult or not at the extremes of age, and you get a pretty severe illness, it’s probably not RSV,” Roberts said.
The groups most susceptible to severe RSV infections are infants, children with lung disease, adults 65 and older, and people with weakened immune systems.
Symptoms may also look different depending on your age and immune status. Many children encounter respiratory viruses for the first time this year as they return to regular schooling and socializing, so it can be harder for their bodies to clear the infection, which can lead to more widespread symptoms.
According to Esper, nearly a quarter of children have gastrointestinal symptoms (such as diarrhea, stomach pain, or vomiting) due to viral infections. It is less common in adults with seasonal flu or RSV.
People with weakened immune systems, meanwhile, are more likely to develop severe symptoms or pneumonia from any of the three viruses.
Think about which virus is circulating the most in your community
Disease experts predict that the number of Covid cases will increase during the holidays as more people travel and gather indoors. Average daily cases reported to the Centers for Disease Control and Prevention have already risen by nearly 11% over the past two weeks, according to Data from NBC News.
But local levels of Covid transmission are difficult to determine, as many people use tests at home. In contrast, RSV and flu tests are done in the doctor’s office or by prescription.
RSV infections appear to have passed their peak nationally. Although the CDC does not keep a national count of RSV cases, number of positive weekly tests it fell from more than 17,000 in the week ending Nov. 5 to about 9,000 in the week ending Saturday.
In contrast, the number of flu cases is skyrocketing. The national proportion of influenza tests which returned positive rose from about 8% in the week ending October 30 to nearly 15% in the week ending November 13. Hospitalizations against the flu are the most they were at this time of year for over a decade.
Esper said he expects the Cleveland Clinic to be “swimming in flu” in two weeks.
However, the picture varies from region to region. In the Northeast, Roberts said, “we’ve seen an increase in RSV over the last one to two months and it’s actually plateaued — which is great news — and then the flu, just the last few weeks we’re seeing an exponential increase.”
“The southeastern United States — Georgia, Alabama, Mississippi — saw the opposite. At first they saw an increase in influenza, and then now you see RSV starting to catch up,” he added.
Treatments and vaccines available
Unlike Covid and the flu, there are no vaccines or universally prescribed treatments for RSV.
“RSV probably scares me the most because there’s nothing you can do about it, and so many young kids haven’t seen it. We’re really seeing record increases in our pediatric hospitals,” Roberts said.
However, to reduce the duration of flu symptoms, doctors usually prescribe Tamiflu or one of them three other approved treatments. For some people with Covid, doctors may prescribe Paxlovid.
dr. Ashish Jha, the White House’s co-ordinator for the Covid-19 response, highlighted the benefits of the flu shot and the Covid-19 booster.
“At this point where we have a lot of flu, we still have a decent amount of RSV, we still have a good amount of Covid, the single most important thing that people need to do is get vaccinated,” Jha said at a briefing on Tuesday. “It keeps you out of the hospital.”
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