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Is It a Cold? The Flu? COVID? Or RSV?

Many symptoms overlap, but a few warning signs set the common illnesses apart

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It starts with a sniffle, then it moves to a cough. Maybe you get a sore throat or achy muscles, even a fever. Is it just a cold? Or something else?

It’s been nearly four years since COVID-19 burst onto the scene, adding yet another virus-causing illness that could be to blame for why you’re feeling crummy. After all, the common cold, the flu, RSV (respiratory syncytial virus) and COVID-19 all share a similar list of symptoms.

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As we face the cold-weather season, when people head inside and respiratory viruses come out in full force, experts share some tips on how to distinguish among the different diseases and how to recover from each of them. Plus, they have some advice on what you can do to help avoid getting sick in the first place.

COVID-19 has a few distinguishing symptoms

The truth of the matter is that several symptoms for a cold, the flu, RSV and COVID-19 overlap. Chief among them are sore throat, runny nose, cough and headache.

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There are some more specific symptoms, though, that could signal your sickness is caused by COVID-19. Loss of taste or smell, for example, is a common warning sign of a coronavirus infection.

“Especially if you don’t really have a runny or stuffy nose and you have this symptom, that probably is something that’s more specific for COVID,” says Albert Shaw, M.D., an infectious disease expert and professor of medicine at Yale School of Medicine. “And it’s one we would see less so in someone with a common cold or someone with influenza.”

Another symptom that’s more typical with COVID-19 than with the others is diarrhea, Shaw says. It may not be as prevalent as some of the other COVID symptoms, but people still get it with a coronavirus infection. Diarrhea is not a common sign of the flu in adults (it is in kids, though), nor does it usually accompany a cold or RSV.

“That said, there are other viral and bacterial illnesses that can give you diarrhea, so that alone doesn’t mean it can only be COVID. But if you’re trying to differentiate, I would say that those elements, if they’re present, might be of help,” Shaw says.

Disorientation could point to COVID-19, especially in older adults, says Kenneth Koncilja, M.D., a geriatrician at the Cleveland Clinic. “I’ve seen more of my older patients present with symptoms of confusion [and test positive for COVID-19], where you might think it’s a urinary tract infection,” he says.

Sneezing a lot? That’s typically a symptom that’s more common with a cold or RSV than with the flu or COVID. And chances are, if you have a cold, you won’t experience the body aches and fever that accompany an influenza or coronavirus infection. (RSV can cause a low-grade fever, though.)


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Keep a COVID test — or two — on hand

Even though they’re not as readily available as they used to be, it’s still important to keep an at-home COVID test (or two) on hand — especially during the fall and winter seasons. That way, if you start to feel sick, you can check to see if your symptoms are due to COVID-19 in a matter of minutes.

“Particularly given the nonspecific nature of a lot of COVID symptoms and the fact that there can be a diminished fever response and other kinds of atypical symptoms, I think the safest thing would be to definitely test,” Shaw says.

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If you’re positive for COVID-19, your doctor may prescribe an antiviral pill, like Paxlovid (nirmatrelvir/ritonavir) or Lagevrio (molnupiravir), both of which can significantly lessen your chances of severe illness.

However, it’s important to start these treatments, which are currently still free, early in the disease course. So talk to your doctor right away if you find out you have COVID-19. Some pharmacists can also prescribe the pills, or you can find them at one-stop test-to-treat centers.

If you test negative for COVID but symptoms persist, your health care provider may conduct a flu test. As with COVID-19, prescription antiviral treatments taken early on can help you feel better if you have the flu.

Antivirals usually aren’t prescribed for RSV, although some bad cases may require hospitalization. Often with RSV, care calls for fluids, rest and symptom management with over-the-counter medications, according to the Centers for Disease Control and Prevention (CDC). The same goes for a cold.

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Stay up to date on your vaccines

One way to lower your likelihood of getting the flu, COVID-19 and RSV in the first place is to get vaccinated against each disease. Not everyone who gets vaccinated will be able to completely avoid an infection, but the separate shots can blunt the severity of symptoms and help to keep you out of the hospital.

When it comes to COVID-19, health experts recommend that adults stay up to date on their shots. For older adults, that means you should have at least one dose of the bivalent booster, which became available last fall; health officials recently said people 65 and older can get a second one, too.

A new COVID booster that better targets the latest version of the virus is expected this fall, as are recommendations on who needs that and when.  

For the flu, adults 65 and older should ask for a high-dose vaccine, CDC recommendations say. There are three options to choose from, but experts say the differences among them are minimal. For most people, the best one to get is the one your doctor or pharmacist has available — and try to get it by the end of October. There’s no need to space out your flu and COVID-19 shots, so if it’s more convenient to get them at the same visit, the CDC says that can be done.

And for the first time ever, there’s an RSV vaccine available to adults 60 and older. Like with the flu and COVID, older adults are at highest risk for severe illness from RSV. (It can turn into a deep lung infection, such as pneumonia.) The vaccine — there are two options available — was shown in clinical trials to help lessen the severity of symptoms in this population. The advice from health officials: Talk to your doctor to see if the RSV vaccine is right for you.

While there is no vaccine to help prevent a cold, there are several steps you can do to avoid one: Wash your hands often, stay away from people who are sick, and disinfect frequently touched surfaces. These measures can also help you avoid many other illnesses swirling about this cold-weather season.

Editor’s note: This story, first published Sept. 27, 2022, has been updated to include new information.

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