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Flu, cough and COVID-19: Know the differences

As cases of respiratory illnesses rise across the country, a VCU Health infectious disease expert shares how to best protect you and your loved ones from getting severely sick.

Woman holding a thermometer in one hand and coughing into her elbow Three different respiratory illnesses are being tracked across the United States. (Getty Images)

This story was originally published Nov. 10, 2022 and has since been updated to include new information about the 2023 – 2024 respiratory illness season. Stay up to date on all health news by visiting VCU Health News. (Updated Oct. 10, 2023)

By Sara McCloskey

Respiratory illnesses tend to spread more often during the colder months. Similar to last year, VCU Health doctors and nurses are watching out for another “tridemic” or “triple epidemic," a term referring to three viruses popping up at the same time. Health care professionals are keeping their eyes on COVID-19, influenza (flu) and respiratory syncytial virus (RSV).

“These illnesses all have very similar symptoms at the beginning, so it may be difficult to know what virus you or a member of your household may have contracted,” said Gonzalo Bearman, M.D., VCU Health infectious disease expert. “This is the first year that vaccines and medications are available for COVID-19, flu and RSV. Talk to your primary care provider to see if you’re eligible for these voluntary shots.”

As we head into respiratory illness season, Bearman shared with VCU Health News the differences between these viruses and tips for keeping yourself healthy.

How serious is this rise in respiratory illnesses?

It is understandable that people have become fatigued hearing about these illnesses 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 people getting severely sick, 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, since 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. You can go to the doctor’s office to get tested for all three of these illnesses or buy COVID-19 tests at your local pharmacy. As of Sept. 25, every household in the U.S. can apply to receive four free COVID-19 tests in the mail from the federal government.

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.

This is also the first year several different RSV vaccines and medications are available for specific populations. RSV vaccines are being recommended to adults 60 years old and older as well as pregnant people, who can pass immunity to the virus to their newborns. Another medication was developed specifically for babies and toddlers which provides temporary immunity for several months.

If you have any questions or concerns, do not hesitate to reach out to your primary care provider.

Here are some quick tips:

  • Getting vaccinated is still the best proven way to prevent yourself from getting severely sick. This is the first year that vaccines and medications are available for the three main respiratory illnesses seen between fall and winter. Talk to your primary care provider about your eligibility for these voluntary vaccinations and medications.
  • 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 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 getting severely sick from these viruses?

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 60 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 illness particularly for babies under 6 months and older adults. Most young healthy adults do not get severely sick.

When should I consider going to my 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 at high risk of getting severely sick.

At what point should I 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.

How do medical professionals 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.

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