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Flu, cough, and COVID-19: Key things to watch out for as the winter approaches

There’s been a steady increase in respiratory illnesses as winter approaches, causing some VCU Health doctors and nurses to watch out for a “tridemic” or “triple epidemic.” We posed some questions to a member of VCU Health's infectious diseases department to learn what you can do to keep yourself and loved ones safe in the coming months.

Woman holding a thermometer in one hand and coughing into her elbow Getty Images

There’s been a steady increase in respiratory illnesses as winter approaches, causing some VCU Health doctors and nurses to watch out for a “tridemic” or “triple epidemic.” The term refers to three viruses popping up at the same time. This season, health care professionals are keeping their eyes on COVID-19, influenza (flu) and respiratory syncytial virus (RSV).

We posed some questions to Dr. Barry Rittmann, who is part of VCU Health's infectious diseases department, to learn what you can do to keep yourself and loved ones safe in the coming months.

How serious is this rise in respiratory illnesses?

It is understandable that people have become fatigued over the past several years, but it is important to protect yourself and your loved ones from the impending respiratory season. Every year we see a rise in respiratory illnesses in the winter months, as well as an increase in the risk of serious disease, particularly in our immunocompromised, chronically ill and older populations.

What are the symptoms of COVID-19, the flu, and RSV? How can I tell if I have one virus vs. another?

This is a tricky question, as there is much overlap between the three illnesses and they can all start with very similar symptoms. All can cause fevers, cough, shortness of breath, decreased energy, sore throat, headaches, or runny nose. Flu and COVID-19 are more likely to cause body aches or muscle pain. Less commonly, stomach issues such as nausea or diarrhea can occur. COVID-19 is more likely to cause a loss of taste or smell, although this can be seen in other illnesses as well.

Overall, the best way to tell the difference is to get tested.

How can people best protect themselves?

As we have experienced, there is much uncertainty in these pandemics and changes can occur quickly. Please be on the lookout for any changes in recommendations from medical professionals locally or federally. If you have any questions or concerns, do not hesitate to reach out to your local providers.

Here are some quick tips:

  • Make sure you are up to date on all your vaccinations, including flu and COVID-19.
  • Wash your hands often with soap and water for at least 20 to 30 seconds. Avoid touching your eyes and mouth as much as possible. Routinely clean frequently touched surfaces such as doorknobs, cell phones, and countertops.
  • Close contact with others -- such as shaking hands, sharing drinks or utensils, or kissing -- can spread the viruses as well.
  • If you are sick: stay home. Try to avoid contact with others as much as possible.
  • Use tissue paper or your upper sleeve to cover your cough and sneeze.
  • Consider wearing masks, particularly if you are in a crowded public place (like a public bus or train) or if you’re around others who may be sick or at high risk for getting really sick.

Who is most at risk?

Children, older people and immunocompromised patients are at the highest risk of getting severely sick with all of these diseases.

Particularly for COVID-19 and flu, infants, those over 65 years old, or people with chronic conditions are at higher risk (such as cancer, heart disease, or diabetes to name a few). Despite this, COVID-19 and flu can cause young healthy patients to get seriously sick too.

RSV can cause severe disease in particularly babies under 6 months and the elderly. Most young healthy adults do not get severely sick.

When should someone consider going to their family or primary care doctor?

If you have mild symptoms, it is best to stay home. You should still get tested and should contact your doctor, especially if you are high risk.

At what point should someone go to urgent care or an emergency department?

You should seek urgent medical care if you are:

  • Having difficulty breathing or persistent chest pain
  • Increased confusion or decreased consciousness
  • If your lips/nails/skin becomes pale/blue/gray (which can be a sign that you are not getting enough oxygen)

For additional guidance on how to decide if you or someone you know should go to a hospital or primary care doctor, the Children’s Hospital of Richmond at VCU has some tips.

What kind of things will medical professionals track to monitor the spread of these illnesses?

We track the number of positive cases and patients being tested in the ICUs, emergency departments, and on inpatient units as well as patients who need to use a ventilator. These data points help us to quantify the current rates of infection in our healthcare systems, as well as to measure the severity of illness.