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RSV vs. Flu vs. COVID-19. Which is it?

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Marin Health
By: David Hoffman, MD, Pediatric Hospitalist at MarinHealth Medical Center  |   December 2, 2022


Now that Fall has come, many families in the North Bay are concerned about falling sick with one or more of the three most common virus strains swirling around our community currently. This is prime time for the “TripleDemic,” the coexistence of the flu, COVID-19, and Respiratory syncytial virus (RSV). How are we to know which symptom goes with what virus? Or when it’s time to stay home or call the doctor?

The fact is that these respiratory viruses tend to crop up with similar symptoms, such as cough, runny nose, and fever. Fortunately for most children, it doesn’t matter which of these, or the thousands of other viruses causing respiratory illnesses or “colds,” your child has. Most children will recover from all of these viruses on their own, without receiving medical treatment and without serious complications. If your child is sick, consider testing for COVID-19 first to inform if and how long you need to isolate your child at home. Below are some characteristics of RSV, flu, and COVID-19. 

Symptoms of RSV

RSV causes a runny nose, congestion, and cough for most people. RSV has a greater likelihood of causing severe illness in very young children, especially those born premature or who have lung disease or heart disease. The most distinctive symptom that some children infected with RSV will exhibit is wheezing. Wheezing is a high-pitched sound with each exhalation.

Symptoms of RSV include:

  • Runny nose
  • Decreased appetite
  • Coughing
  • Sneezing
  • Fever
  • Wheezing

Symptoms of Influenza (Flu)

The dreaded seasonal flu (influenza) can manifest with various symptoms from very mild to severe. The flu typically comes on very suddenly with an incubation period of one to four days, unlike COVID-19, which tends to have a gradual onset of symptoms. Typically, people feel more miserable with the flu than with other types of viruses, and it often comes with a sore throat, nausea, body aches, vomiting, or even diarrhea. A distinctive sign of the flu can be a very high fever-- as high as 103 or 104 Fahrenheit (39.44 or 40 degrees Celsius). Fever is just the body’s way of fighting the infection and is not dangerous in and of itself. 

Symptoms of the flu may include:

  • Fever
  • Chills
  • Headache
  • Runny nose
  • Nausea
  • Fatigue
  • Loss of appetite
  • Sore throat

Symptoms of COVID-19

The coronavirus has become familiar to most of us, and the signs are similar to flu and RSV. To complicate it further, some people become very ill, while others have very mild symptoms, and others show no symptoms at all. While most people develop symptoms within the first week after exposure, symptoms can occur from two up to 14 days after exposure to the virus. Unlike other viruses, COVID-19 can affect other areas of the body outside of the lungs and, in some instances, cause long-term effects.

Symptoms of COVID-19 may include:

  • Cough
  • Brief fever
  • Shortness of breath
  • Abdominal pain
  • Loss of taste or smell
  • Congestion
  • Fatigue
  • Sore Throat
  • Nausea or vomiting
  • Diarrhea
  • Muscle or body aches
  • Headache

When should I keep my child home?

If your child is exhibiting any symptoms of RSV, flu, or COVID-19, health experts advise you to keep your child home from school to avoid spreading the virus to other people. It doesn’t matter which of the viruses is the culprit. Caution should be taken to prevent the spread.

When should I go to see a doctor?

If your child is exhibiting these symptoms, you should seek medical care right away:

  • Trouble breathing (fast or hard breathing)
  • Pain or pressure in the chest
  • New confusion
  • Inability to wake up or stay awake
  • Bluish lips or face
  • Severe abdominal pain
  • Refusing to eat and drink

How to keep your child from getting sick

Prevention is the best medicine, particularly with these viruses. These suggestions are good ideas to avoid seasonal viruses:

  • Get your child vaccinated for flu, COVID-19, pneumococcus, and pertussis.
  • Wash your hands regularly or use hand sanitizer.
  • Sanitize high-contact surfaces, such as desks, tables, and doorknobs, if someone in your household is sick.
  • If your child is sick, have them stay home to avoid spreading the illness.

If your child is sick and you seek a pediatrician, please call 1-888-627-4642.

Dr. David Hoffman completed his undergraduate and medical degrees at the University of California, San Diego. During medical school, he helped sustain the student-run free clinic and worked as a pediatric intern in a government hospital in the underserved Amazon city of Iquitos, Peru. Dr. Hoffman moved to the Bay Area for his residency at UCSF Benioff Children’s Hospital of Oakland in 2000. After completing his residency, he began his career as a pediatric hospitalist in the East Bay, employed by Lucille Packard Children’s Hospital where he practiced for 8 years.

In 2011, Dr. Hoffman came to MarinHealth Medical Center where he continues to provide care across the pediatric spectrum. His work includes attendance at deliveries, caring for both well babies as well as infants requiring intensive care. He also consults on pediatric patients in the emergency department and cares for children that require admission to MHMC. In 2020, Dr. Hoffman accepted the leadership role of Medical Director of the Pediatric Hospitalist Program at MHMC. Dr. Hoffman is passionate about ensuring that children, and their families at MHMC from all socioeconomic backgrounds, receive the most thoughtful, personalized, and culturally-informed expert care. 

When not at work, Dr. Hoffman can be found surfing, sailing, skiing, hiking or running with his wife, 2 teenage kids, or friends.
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