Experts are warning that cases of respiratory syncytial virus, COVID-19 and the flu are rising rapidly already, which could set the scene for what some are calling a "tripledemic." And because these illnesses — along with the common cold — can look very similar to each other, now is the time to learn the differences.
"The concerning thing is that these things typically don't peak until the December to February timeframe, and we're not in December yet," Dr. John Torres, NBC News senior medical correspondent, said in a Nov. 14 segment. "So we're seeing this trajectory go really high, and we don't know what's going to happen," he said. Cases may start to come down, or they may continue to rise through February, Torres explained.
And this early surge in cases is already stressing hospital systems, TODAY reported previously. So far, 11 states are reporting that more than 80% of their hospitals are filled, according to an NBC News analysis.
What's more, because RSV, COVID-19 and the flu cause similar symptoms, it can be challenging for parents to figure out which illness their child has — and when they should consider taking their kid to the doctor or even the hospital.
"The hardest thing is distinguishing the three apart," Torres said. In general, flu symptoms come on more quickly than those of RSV or COVID-19, he explained, while COVID-19 may come with a sore throat and loss of taste or smell. And RSV is characterized by respiratory symptoms, like wheezing and rapid breathing in children, Torres said.
So, with at least three respiratory viruses that cause similar symptoms circulating this fall and winter, it may be difficult to know which one you or your child have been infected by. Here are experts' tips for figuring out whether it's the flu, COVID-19, the common cold or RSV as well as when to take a COVID-19 test and when it's time to call the doctor.
How to tell the difference between RSV, flu and COVID symptoms
Many symptoms can arise with RSV, flu and COVID-19, such as cough, fatigue, fever and runny nose. But some are more common with certain viruses than others. For example, muscle and body aches are most common with flu, and sore throat is most common with COVID, but it can occur with RSV and flu.
How quickly the symptoms arise can provide more clear direction on what your child is sick with, especially if the symptoms start abruptly with a fever, which is usually a sign of flu, NBC News reported. RSV and COVID usually escalate slowly.
The length of time between exposure and symptoms appearing can also indicated one illness over another. Influenza's incubation period can be as short as 24 hours (but is usually about two days), so if you feel under the weather the next day after a gathering, that's likely the flu. RSV symptoms usually take about four to six days, and the omicron variant of COVID takes three to four days.
Historically, children older than 6 months who are not immunocompromised have been less likely to get severely ill from RSV, but the current surge has been sending toddlers and older children to the hospital. Some experts have theorized that this is because they haven't been exposed to the virus before, as pandemic precautions kept infections at bay over the past two years. In these cases, RSV can lead to a wider-range of symptoms, such as diarrhea.
Checking which viruses are spreading most frequently in your community can also help determine which virus your child is sick with. Your local health department may have this data. Nationally, RSV cases are trending downward, COVID-19 cases have risen 11% over the past two weeks, and flu cases are skyrocketing.
How will I know if my child gets COVID-19?
According to the CDC, hospitalization rates due to COVID-19 are significantly lower in children than rates in adults with the illness. Children may have many symptoms or could be asymptomatic. Either way, if a child tests positive for COVID-19, they must still be cautious, said Dr. Dane Snyder, the chief of primary care pediatrics at Nationwide Children’s Hospital in Columbus, Ohio, as one of the biggest “risk factors is that it could spread to someone else who has much higher risk.”
The CDC stresses that it is still possible for kids to contract a severe case of COVID-19 and become hospitalized. Snyder also warned parents to monitor symptoms, as “there is a unique syndrome with children called MIS that happens typically a few weeks after a child contracts COVID.”
MIS-C, short for multisystem inflammatory syndrome in children, is a condition that has the potential of causing “very severe illnesses in children later on.” Snyder notes that this condition is one that is unique to COVID-19, and to look out for it as it is not something that doctors and medical experts “see very frequently in other illnesses.”
Dr. Flor Munoz, associate professor of pediatrics and infectious diseases at Texas Children’s Hospital, recommends that children get tested if they demonstrate any sort of COVID-19 symptoms. Getting tested is critical “especially because it is difficult to tell the differences between RSV, the flu and COVID-19."
Children as young as 6 months can now receive a COVID-19 vaccine, and kids ages 5 years and up can also get an updated bivalent COVID-19 booster dose after their primary series is complete.
The flu and the coronavirus share many symptoms. Below is a list of the hallmark COVID-19 symptoms specifically in children, according to the CDC.
Symptoms of COVID-19 in kids:
- Sore throat
- Shortness of breath
- Runny nose
- Gastrointestinal issues such as vomiting, nausea and diarrhea
When to call a doctor:
If your child has been in close contact with an individual who has tested positive for the virus, it is important to notify their doctor. If your child has tested positive for COVID-19, Snyder recommends that they remain isolated for the entire quarantine period, as specified by the CDC, and “follow health department and CDC guidelines and policies.”
What is RSV disease?
Respiratory syncytial virus, more commonly known as RSV, is a virus that spreads through respiratory droplets and direct contact, the CDC explains. When an infected person coughs or sneezes into someone else's eyes, nose or mouth, they may spread the virus. Those droplets can also land on surfaces, like a counter or doorknob, where someone else might pick them up, the CDC says.
It is a seasonal virus that typically circulates in the winter, although doctors are seeing a spike in RSV cases this year much earlier than usual.
Like many other viruses, RSV runs its course and goes away on its own in adults.
“All of us adults have probably gotten it at some point or another, and it’s just like a cold. We will get over it within a couple of days,” Dr. John Torres, NBC News medical correspondent told TODAY.
What is RSV in children?
When it comes to young children, however, medical experts are more concerned. “For babies who are vulnerable, those less than 6 months old, premature babies, those with any kind of respiratory or immune system issues it can be serious, even deadly,” Torres added.
Munoz told TODAY that “the problem is that you have young infants being at greater risk because they are going to be having more problems with the lower respiratory tract.”
In other words, babies can be at greater risk when contracting RSV because it is more likely for them to develop bronchiolitis, which “is caused by the virus causing inflammation and narrowing of the airways,” Munoz said.
Is there an RSV vaccine?
There are no vaccines available currently to prevent the spread of RSV. If someone in your household gets RSV, experts say that the most effective ways to prevent any further spread of the virus is to wash hands frequently, disinfect all toys and avoid crowds to the best of your ability. Munoz also recommends parents prevent other adults from kissing their children (but hugs are OK!).
“The best way to prevent getting RSV is really to do what you normally would do to prevent other respiratory viruses, which is hand-washing,'' said Munoz.
Symptoms of RSV:
RSV shares many of the same symptoms as the common cold, COVID-19 and the flu: sniffles, a cough and a low-grade fever are common. These are the most common symptoms of RSV, according to the CDC.
- Runny nose
- Decreased appetite
RSV in infants
Young infants and young children may show different signs of RSV. The CDC says that young infants can get fatigued, show little interest in activity, become more irritable and may show signs of difficulty breathing. Older children may also experience similar issues, although experts say that it is common for their lips to turn blue if they have had extensive breathing troubles. If any of these symptoms occur, take your child to the emergency room immediately.
When to call a doctor:
If you notice that your child has any skin discoloration or has shown any kind of respiratory troubles including, though not limited to, difficulty breathing or wheezing, Torres said that you should notify a doctor right away, as severe cases of RSV can further develop into bronchiolitis or pneumonia.
If your child has a mild case, it is important to remain hydrated, clear any nasal congestion and continue monitoring for more severe symptoms.
What to know about the common cold:
When children get sick, Snyder said that most of the time, the culprit is the common cold.
“Most likely, common colds caused by non-COVID-19 viruses are still the most common thing that we see,” he said. During this time of the year, experts say that it is not unusual for kids to contract a cold from school, large crowds or simply from being run down. “Colds are one of the more frequent things that we see children for in both primary care offices and urgent care emergency departments,” said Snyder.
Once children contract a cold, there's no definite timeline of when the illness will go away. In general, Snyder said that colds can linger for around three to five days, and a cough could persist for another few weeks.
There is no cure or specific way to treat the common cold in children. Experts say colds are “extremely common the first few years of life,” and that “the average child can have six to eight colds over the course of a year.”
Symptoms of the common cold:
- Nasal congestion
- Sore throat
- Mild or low-grade fever
- Body aches, including headache
- Loss of appetite
Snyder warns parents to monitor children closely to see if symptoms progress.
When to call a doctor:
If you start to notice that a more severe symptom continues to persist, such as difficulty breathing, the inability to stay hydrated or urinating less frequently, Snyder recommends contacting your primary care provider immediately.
What will this flu season be like?
Influenza, or the flu, is a common virus that affects the nasal passages, the throat and sometimes the lungs. It is a contagious respiratory illness which mainly spreads when infected individuals sneeze, cough or talk. It is unlikely, but the flu can also be transmitted via surfaces, if an infected person touches something and then another person touches it and proceeds to touch their eyes, nose or mouth.
Flu season, which usually peaks between December and February, is expected to look a little different this year. For the past two years, we've seen dramatically fewer flu cases than in pre-pandemic times. And experts attribute that to a combination of coronavirus-related precautions (like avoiding crowds and wearing masks), as well as an increase in people getting flu vaccines.
This year, however, experts caution that case numbers in some areas of the country are already much higher than they've been previously during the pandemic. This flu season is expected to be a severe one, as was the case for Australia's most recent flu season, normally a harbinger of what will come in the U.S. To make matters more concerning, fewer flu shots have been administered in the U.S. at this point in the season than compared to the same time of year the last two seasons.
In order to protect yourself and your children, experts stress that the most effective tool is to have your child get the influenza vaccine. Snyder stressed to parents that, “flu shots are safe for all children” over 6 months old. Some children might also need two flu shots this year.
If your child contracts the flu, Munoz recommends calling a primary care physician, as “there are many different types of antiviral medicines that pertain specifically to the flu.”
Symptoms of the flu:
Flu symptoms vary from person to person, but the most common signs include:
- Sore throat
- Nasal congestion
- Body aches
- Diarrhea or vomiting, especially in children
Munoz said to be wary of further complications, as the flu “can certainly lead to secondary infections like pneumonia.”
When to call a doctor:
Similar to the common cold, if your child’s symptoms continue to persist for more than five days, Snyder recommends that you contact your doctor. Be sure to watch if “they aren't able to take fluids, or if they're having difficulty breathing,” Snyder noted. He reminded parents that the younger the child, the greater need there is to contact your primary care provider.
Munoz stressed that parents should feel comfortable calling physicians anytime they have concerns or when something does not feel right, especially because the flu is “very, very contagious.”