Respiratory infections occur year-round, but more occur during the colder months. Flu and Respiratory Syncytial Virus Infection (RSV)– which is currently plaguing US health systems–are both highly contagious respiratory viruses that cause cold-like symptoms.
With COVID-19 cases continuing to emerge, it’s important to distinguish between what might be COVID-19, from what might be the flu or RSV.
The pandemic’s influence on respiratory virus spread
During the pandemic, children essentially got a reprieve from the flu and RSV, and outbreaks that did occur were much smaller. Because of stay-at-home orders, masking, and other COVID-19 prevention efforts, children were not as vulnerable to catching these two viruses.
Now, with the combination of returning to normal activities and reduced masking plus lowered immunity, these viruses are back in full force and with a vengeance. Health systems are strained with an influx of children with RSV, and flu cases are spiking, with public health officials reporting the highest incidence of the flu in a decade.
To prevent illness, it’s essential to understand the differences between these respiratory illnesses and what to do if symptoms arise.
Influenza, more commonly known as the flu, is a contagious respiratory illness that affects the nose, throat, and lungs (in most cases). The flu virus is spread from one individual to another through coughing, talking, or sneezing; symptoms range from mild to severe. In rare instances, the flu can spread when a person touches a contaminated surface or object and then touches their mouth, nose, or eyes.
Kids are more severely affected by this virus than adults and experience higher fevers and digestive issues (vomiting, diarrhea, and nausea). Unlike the common cold, the flu tends to come on suddenly with additional intense symptoms, including:
- Body and/or muscle aches
- Chills and sweats
- Shortness of breath
- Runny or stuffy nose
- Sore throat
Seasonal influenza activity is currently elevated across the country. The CDC estimates that roughly 11,000+ patients were admitted to hospitals with influenza during the last week of November, which is high for this early in a typical flu season.
Respiratory syncytial virus (RSV)
Respiratory syncytial virus (RSV) infects the lungs and respiratory tract causing mild, cold-like symptoms within 4 to 6 days after exposure to the virus. Though most people recover quickly, RSV can cause serious health complications for children and infants including bronchiolitis or pneumonia.
The CDC estimates that between 58,000-80,000 children younger than five years old are hospitalized annually due to RSV infection. According to the CDC, those at most significant risk for severe RSV illness include:
- Premature infants
- Infants, especially those six months and younger
- Children younger than two years old with chronic lung disease or congenital (present from birth) heart disease
- Children with weakened immune systems
- Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions
As COVID-19 restrictions have relaxed, the rates of RSV-related hospitalizations are spiking. The pandemic significantly reduced RSV infections due to social distancing and other safety measures. However, as children return to everyday life without masks and other COVID-19 precautions, they’re at greater risk and more vulnerable than ever. With children’s hospitals being at capacity with cases across the country, experts are worried. Like most viruses, RSV is highly contagious and can spread quickly through schools or childcare centers. Symptoms of RSV infection usually include:
- Runny or stuffy nose
- Sore throat
- Decrease in appetite
Coronavirus disease (COVID-19) is a respiratory disease caused by the SARS-CoV-2 virus. COVID-19 can be critical and has caused millions of deaths worldwide and lasting health problems in many who have survived the illness. Depending on your location, at-home COVID-19 diagnostic tests are available at drugstores or can be provided through your healthcare provider. Symptoms typically appear 2-14 days after a COVID-19 exposure. Since the pandemic's start, nearly 50% of children and infants with COVID-19 have shown little to no symptoms. Nonetheless, possible signs and symptoms to look out for include:
- Fever or chills
- Difficulty breathing
- Loss of taste or smell
- Sore throat
- Chest pain
- Body and/or muscle aches
Differences between respiratory infections
The flu, RSV, and COVID-19 are all highly contagious respiratory illnesses caused by different viruses: the flu by the influenza virus, RSV by the respiratory syncytial virus, and COVID-19 by the SARS-CoV-2 virus.
No symptom or sign can tell you what virus your child is having. However there are some that can help you navigate your child’s infection and help you determine when to see your doctor.
One distinctive sign of the flu is a very high fever of 103 or 104 degrees Fahrenheit.
What you can do: You can treat fever with acetaminophen (TylenolTM) or ibuprofen (MotrinTM, AdvilTM). If symptoms worsen and it is within 72 hours of onset, your child may benefit from additional medications, such as Tamiflu.
What to look out for: dehydration. With high fevers a child can lose water. Keeping your child hydrated is important during this time.
One sign can be breathing issues. For those with breathing issues (ex Asthma) or in the very young, RSV can cause breathing issues.
What you can do: hydrate as increased breathing results in increased water loss. Give asthma medications early (if your child has asthma). Provide comfort with honey (for cough) and humidified air (although there is no definitive proof they help).
What to look for: trouble breathing (breathing fast, trouble talking), dehydration, and/or increased fatigue from working so hard to breathe.
This one is the trickiest as symptoms can mimic either of the above.
What you can do: get tested to confirm or rule out COVID-19 so you can keep others who may be at risk (unvaccinated, elderly) safe. Treat fever and keep hydrated.
What to look for: besides breathing issues, in rare cases children can get a multi inflammatory syndrome (MIS-C). Symptoms can be stomach pain, bloodshot eyes, diarrhea, dizziness or lightheadedness (signs of low blood pressure), skin rash or vomiting. This can occur several days or weeks after the COVID infection.
Reach out to your PCP for additional information on the differences between the 3 viruses and how to distinguish between them.
The role of seasonality
In the US, flu, and RSV are present year-round but circulate widely in the fall and winter months. Recent studies show that COVID-19 cases increase seasonally, specifically between January and March. In the winter, most people prefer spending time indoors.
Breathing the same air for extended periods combined with little ventilation increases the risk of catching a respiratory virus. The pandemic and the strict two-year lockdown weakened most immune systems, thus increasing the chances of catching any illness.
How to prevent infections
COVID-19 prevention strategies implemented over the past few years have also been effective at preventing the flu and RSV.
- Vaccinations (https://www.vaccines.gov/): If eligible, consider making an appointment and ensuring your child is up-to-date on all vaccines. In regards to the flu, the CDC recommends that everyone age six months and older get vaccinated annually. The flu vaccine is the best prevention, and health officials are feeling very confident about the efficacy of the vaccine against this year’s flu strain.
- Social distancing techniques: wearing a mask and keeping appropriate physical distance reduces risk of any respiratory infection
- Hygiene: Washing or sanitizing hands regularly keeps bodies healthy and prevents spreading respiratory infections. Also, it’s important to always cover your mouth if you cough or sneeze.
- Sanitation: Miniscule droplets of any virus are often in high-contact surfaces or objects, so it’s crucial to sanitize areas of potential contamination.
Sharing similar symptoms, it’s often quite difficult to tell the difference between the flu, RSV, and COVID-19. The good news is your healthcare provider can do a swab test or additional testing to determine which virus your child has.
Hydration and ample rest are the best forms of treatment for these illnesses. Be sure to ask your healthcare provider for additional information or treatment recommendations for your family.