RSV vs. Flu vs. COVID-19: How to Tell the Difference

<blockquote> <h3>Fast Facts: </h3> <ul> <li>RSV is a result of the respiratory syncytial virus and just as the name suggests, it affects the respiratory system.</li> <li>The Centers for Disease Control (CDC) estimates that RSV causes about 58,000 hospitalizations and 100 to 300 deaths among children under 5 each year. In adults 65 and older, an estimated 177,000 are infected with RSV, resulting in 14,000 deaths annually.</li> <li>According to the CDC, it is estimated that 39 to 56 million Americans came down with the flu last season. </li> <li>Since the beginning of the pandemic, COVID-19 has caused over 6 million fatalities worldwide, according to the CDC. </li> </ul> </blockquote> <p>Naturally, it’s easy to blame the coronavirus if your child suddenly wakes up with a cough, runny nose, and a fever. But there’s another virus back in town – called respiratory syncytial virus (RSV). And there’s still the influenza virus that causes the flu that could be to the culprit, too. </p> <p>With the cold and flu season colliding with COVID-19 spikes, all three are possibilities because RSV, the flu, and COVID-19 all have similar symptoms. While the cause of your child’s infection might not always be clear, there are a few differences between COVID, the flu, and RSV that can help you settle some of the confusion on which one it is. </p> <p>Read on to find out what those differences are. </p> <h2>Eeny meeny miny moe, is it RSV, the flu, or COVID-19 that got your child sick from head to toe?</h2> <p>If you’re a parent, you already know that having a sick child is hard enough. But now throw cold and flu season into the mix with COVID-19, and it makes things even more confusing. Is it just a cold or the flu, is it COVID, or is it something else like RSV? Can I use the same over-the-counter (OTC) medications for all three? How long will it last if it’s COVID, the flu, or RSV? And so on and so forth. </p> <p>All three are viruses that affect the respiratory system, which is the network of tissues and organs that help you breathe. And all three of these respiratory viruses can spread from person-to-person by droplets traveling through the air when you talk, cough, sneeze, or sing. Each virus typically begins as a respiratory infection with similar early symptoms in most children, including: </p> <ul> <li>congestion</li> <li>cough</li> <li>runny nose</li> <li>body aches and pains</li> <li>fever</li> <li>headache</li> </ul> <p>This makes it hard for you to know which virus your child is dealing with – especially early on. However, the good news is that the treatment for each of these viruses is largely the same: get lots of rest, drink plenty of fluids, and treat symptoms such as fever and body aches with over-the-counter (OTC) medicine.  </p> <p>But if you’re still wondering about which one it is that your child is infected with, there are some subtle differences between RSV, the flu, and COVID-19.</p> <h2>Respiratory Syncytial Virus (RSV)</h2> <p>RSV is a result of the respiratory syncytial virus and just as the name suggests, it affects the respiratory system. It can affect people of all ages, but RSV infection is more common among children. In fact, almost all children get RSV at least once before they’re 2 years old. </p> <p>The reason RSV is more dangerous for infants and young children comes down to anatomy. Babies and toddlers have much smaller airways than older children and adults. That means when they get sick with RSV, their airways can fill up with mucus more quickly, leading to breathing problems. And because they’re babies and toddlers, they don’t yet know how to clear their throats or blow their noses to get rid of the mucus. </p> <p>RSV typically occurs in the late fall through early spring, peaking between the months of December and March. However, with mask-wearing and physical distancing during the COVID-19 pandemic, RSV was nearly non-existent in 2020. But since safety measures for COVID-19 have relaxed with the arrival of the vaccines, there has been a resurgence of RSV in children. </p> <figure><img alt="Protect Your Child from RSV" src="https://cdn.storymd.com/optimized/JdPYEmcjq3/thumbnail.jpg" /> <figcaption>Protect Your Child from RSV. <em>Source: CDC</em></figcaption> </figure> <h3>Wheezing, a symptom unique to RSV</h3> <p>For adults and healthy children, RSV is like getting the common cold with symptoms typically appearing within 4 to 6 days of infection – symptoms like fever, congestion, cough, runny nose, and sneezing. But a unique symptom of RSV is wheezing, which is caused by a buildup of mucus in the upper respiratory tract (i.e., nose, nasal cavity, mouth, throat, vocal cords). And this buildup can lead to difficult, short, or fast breathing. </p> <p>So, if it sounds like a whistle or rattle when your child breathes, your child is wheezing – which in most cases of RSV, resolves on its own. However, in infants and young children, where RSV can be more serious, the wheezing and breathing difficulties can persist and it can cause your child’s mouth, lips, and fingernails to turn a bluish tinge due to the lack of oxygen, which can sometimes lead to other infections and more severe illnesses such as: </p> <ul> <li><b>sinus and/or ear infections</b></li> <li><b>croup, </b>which is an inflammation and swelling of the vocal cords that causes a loud, barking sound when coughing</li> <li><b>bronchiolitis</b>, which is swelling of the small airways, called the bronchioles, in the lungs</li> <li><b>pneumonia</b>, which is an infection of the lungs</li> </ul> <h3>When mild RSV becomes severe</h3> <p>In severe cases of RSV where bronchiolitis or pneumonia develop, your child may need to be hospitalized and may require extra oxygen, which means they would need to be put on a mechanical ventilator. The CDC estimates that RSV causes about 58,000 hospitalizations and 100 to 300 deaths among children under 5 each year. </p> <p>Children who are at higher risk of developing a serious RSV infection include: </p> <ul> <li>premature babies</li> <li>children with heart or lung diseases</li> <li>those with weakened immune systems </li> <li>babies born with low birth weight</li> <li>babies with allergies or eczema</li> <li>having a mother who smokes or smoked during pregnancy</li> <li>children attending day care </li> <li>children living in crowded living conditions</li> </ul> <h3>What can you do to treat RSV? </h3> <p>To help your child feel better, you can treat their symptoms by:</p> <ul> <li>giving them lots of fluids to prevent dehydration</li> <li>using a cool-mist humidifier to help break up mucus and allow for easier breathing</li> <li>removing mucus using nasal saline drops or a gentle nasal suction to help them breathe easier</li> <li>giving them acetaminophen or ibuprofen to bring down low-grade fevers </li> </ul> <p>Additionally, there is an injection called palivizumab, which is a monoclonal antibody that is specifically targeted against the virus to prevent serious RSV-induced lung infections. While palivizumab is effective at treating RSV, it is quite costly and only certain young children are eligible for it – such as those who are born prematurely, those that have lung or heart diseases, or those with a weakened immune system. </p> <p>While severe RSV can cause serious health problems, it’s important to keep in mind that most children with RSV have few, if any, complications, and the infection usually only takes 1 or 2 weeks to run its course. </p> <h2>Influenza, the flu </h2> <p>The flu is caused by the influenza virus and the CDC estimated that 39 to 56 million Americans came down with the flu last season. The flu typically starts in the fall, lasting through the spring, and peaking between the months of December and February.</p> <h3>Fever, how high is too high? </h3> <p>A distinctive sign of the flu is a rapid onset of a very high fever. Not just your run-of-the-mill fever, the flu often causes high fevers of 103- or 104-degrees Fahrenheit (39 or 40 degrees Celsius) that can induce nausea and vomiting, which – though not unique to the flu – is often worse than with other viruses. And because of the combination of a high fever with the nausea and vomiting, it tends to make children feel miserable – and adults who catch influenza aren’t excluded from the misery either. </p> <p>Along with the high fever, the flu can cause other common respiratory symptoms, such as:</p> <ul> <li>chills</li> <li>cough</li> <li>congestion</li> <li>stuffy and/or runny nose</li> <li>body aches and pains</li> <li>fatigue</li> <li>headaches </li> <li>sore throat</li> <li>nausea and diarrhea</li> </ul> <h3>Treating the flu</h3> <p>Most cases of the flu are mild enough that you can treat your child’s symptoms at home without any prescription medications. You could help alleviate symptoms by: </p> <ul> <li>giving your child plenty of fluids, in the form of water, soup, and low-sugar flavored drinks. </li> <li>treating symptoms like a headache or mild fever with OTC medications, such acetaminophen or ibuprofen. </li> <li>making honey tea or simply giving your child a teaspoon of honey to help suppress their cough. Honey is a demulcent, meaning that it can help relieve irritation of the mucus membranes in your throat, and studies have shown honey to be as effective as a common OTC cough suppressant ingredient, called dextromethorphan. </li> </ul> <p>For more severe cases or for people who are at high risk for severe complications (e.g., the elderly or immunocompromised adults), there is an antiviral drug, called Xofluza^® (baloxavir marboxil), that was approved by the Food and Drug Administration (FDA) to treat the flu. It works by killing or preventing the influenza virus from replicating and thus, it can help reduce the duration of symptoms and possibly prevent complications associated with the flu. However, this antiviral drug is only indicated for people ages 12 years and older who have had flu symptoms for less than 48 hours.</p> <h3>Severe flu can be dangerous</h3> <p>There are some cases of the flu that are more severe, which may require more than rest and OTC drugs. In fact, children under the age of 5, but especially under the age of 2, are at higher risk of complications from the flu. The CDC estimates that among children younger than 5, about 6,000 to 27,000 with the flu are hospitalized each season for complications such as dehydration, sinus and/or ear infections, pneumonia, and inflammation of the heart, brain, or muscle tissues. </p> <p>The good news is that most children who are infected with influenza recover fully in about 5 to 7 days. In some cases, cough and fatigue may linger for about 2 weeks or longer. </p> <p>The better news is that there is a yearly flu vaccine that children older than 6 months can get that is effective at helping avoid the flu. And the best time to get the flu shot is in October or November because it gives the body time to develop antibodies against the flu virus before the peak of the flu season hits in December.</p> <figure><img alt="Anyone Can Get the Flu" src="https://cdn.storymd.com/optimized/Roev99cadv/thumbnail.gif" /> <figcaption>Get the Flu Shot. <em>Source: CDC</em></figcaption> </figure> <h2>COVID-19</h2> <p>During the pandemic, COVID-19 was practically the only illness everyone focused on and for good reason. According to the CDC, the coronavirus – the virus that causes COVID-19 – seems to spread more easily than the flu and RSV. And compared to the flu and RSV, COVID can take longer to show symptoms, be contagious for longer, and cause more serious illnesses in some people. </p> <h3>The silver-lining of COVID-19, it’s not as severe in babies and kids </h3> <p>Since the beginning of the pandemic, COVID has caused over 6 million fatalities worldwide. But one of the enduring mysteries of COVID is that children have been spared by the virus – for the most part – and have not experienced anywhere near the severity of illness that adults have. For most other viruses, including influenza and RSV, young children are typically the most vulnerable with the risk of bad outcomes being higher in infants and young children. </p> <p>Although the COVID infection rate in children is similar to that of adults, many children do not have any symptoms. For those who do show symptoms, they are typically not as severe. Similar to the flu and RSV, symptoms of COVID in children usually include: </p> <ul> <li>fever and chills</li> <li>headache</li> <li>sore throat</li> <li>fatigue</li> <li>body aches and muscle pain</li> <li>cough</li> <li>shortness of breath</li> </ul> <p>But unlike the other viruses, symptoms that are unique to COVID include the loss of smell and/or taste, croup – which is inflammation of the airways that causes a barking-like cough, stridor (high-pitched, coarse sound when breathing), and distressed breathing. COVID can also have a serious effect on other body systems outside of your lungs – which is more commonly seen in adults but can happen in children too. An infection with the coronavirus that leads to severe COVID, can cause long-term effects on the heart, and sometimes, the brain. </p> <h3>COVID-19 in children can lead to MIS-C</h3> <p>Even though children are mostly spared from severe COVID, one serious risk COVID-19 poses is the potential to develop multisystem inflammatory syndrome in children (MIS-C) after they have been exposed to the coronavirus. And just like the name suggests, MIS-C is an inflammatory reaction that affects different parts of the body, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal system. It usually appears between 2 to 6 weeks (4 weeks on average) after a coronavirus infection. While MIS-C is uncommon, it can be serious. </p> <p>It may be more difficult to identify COVID based on its symptoms, but MIS-C symptoms are a little more distinctive and include: </p> <ul> <li>fever that lasts 24 hours or longer</li> <li>bloodshot eyes</li> <li>enlarged lymph nodes </li> <li>vomiting and diarrhea</li> <li>rapid heartbeat</li> <li>rapid and difficulty breathing</li> <li>redness or swelling of the lips, tongue, hands, and feet</li> <li>severe pain in the abdomen</li> <li>pale, gray or blue-colored skin, lips, or nail beds</li> <li>inability to wake up or stay wake</li> </ul> <p>MIS-C usually affects school-age children, most commonly 8- and 9-year-olds, but it has been seen in infants and teens. While most cases of MIS-C are easily treated and most children recover fully, it can cause lasting organ damage if not treated immediately. </p> <h3>What should you do if your child has COVID-19 symptoms?</h3> <p>The first thing to do is get them tested. There are at-home antigen tests, but you can also take your child to a health clinic for an RT-PCR test. </p> <p>The next thing to do is keep your child at home from day care or school to reduce the risk of spreading the virus to other children. </p> <p>In terms of treatment, there’s only one antiviral drug specifically indicated for COVID-19 that is approved by the FDA for use in babies and children under the age of 12, called remdesivir (Veklury^®). While it is effective at reducing COVID-19 symptoms and preventing severe COVID, it is only administered intravenously and only children who are at an increased risk of developing severe COVID are eligible for the drug. Another caveat is that the drug must be given early after infection, meaning that it is most effective if remdesivir is administered 1 or 2 days after the onset of symptoms. </p> <h3>COVID-19 is mild in children, but prevention is always best</h3> <p>According to the American Academy of Pediatrics, there have been a total of 14.7 million (18.4%) cases of COVID-19 reported in children across the United States – that’s out of a total of 79.4 million total cases, including adults. </p> <p>While it may be true that children are far less likely to get the virus and more likely to experience mild COVID-19 symptoms, it’s not always the case. Anyone can contract the coronavirus and develop severe COVID-19 and your child might not be one of the lucky ones who gets a mild case of it. </p> <p>So, the best way to avoid getting severe COVID is to prevent it altogether by getting vaccinated. That means that if your child is of an approved age to get any of the COVID-19 vaccines, it is recommended that they do so. </p> <p>To date, COVID-19 vaccines have been proven to be safe and effective for babies, children, and adults at preventing severe infections that could lead to hospitalization or death. They do not, however, prevent contracting the virus itself. </p> <figure><img alt="Help stop the spread of COVID-19" src="https://cdn.storymd.com/optimized/vAQ3WyS7d8/thumbnail.png" /> <figcaption>Help Stop the Spread of COVID-19. <em>Source: CDC</em></figcaption> </figure> <h2>The bottom line</h2> <p>Symptoms of RSV, the flu, and COVID-19 can overlap and look similar. So, if your child has a runny nose, cough, and fever – the telltale signs of many respiratory viruses – testing is a good first step to figuring out what has infected your child.</p> <p>The good news is that many healthcare clinics now use a triple test that can detect RSV, the flu, and COVID-19 – it’s a one-stop shop to confirm your child’s diagnosis. </p> <h2>More on RSV, the Flu, and COVID-19</h2><ul><li><a href="https://soulivity.storymd.com/journal/vj6kkz2tzm-respiratory-syncytial-virus-infection" target="_blank">Respiratory Syncytial Virus (RSV): Symptoms, Treatment, Prevention</a></li><li><a href="https://soulivity.storymd.com/journal/qjo8d3ohnm-flu" target="_blank">The Flu (Influenza): Symptoms, Complications, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/wdo272os4j-coronavirus-disease-2019-covid-19" target="_blank">Coronavirus Disease 2019 (COVID-19): What You Need to Know</a></li></ul>