You—or your child—have a runny nose, fever, and cough. Is it RSV or COVID? And does it even matter anymore?
Unfortunately, it’s impossible to tell the two apart without testing—even by cough, experts tell Fortune. But the answer still matters in order to determine the best treatment plan.
What is the difference between COVID and RSV?
Both COVID and RSV are highly contagious respiratory viruses. RSV, or respiratory syncytial virus infection, is a common illness that usually presents as a mild cold. Almost everyone has been infected with it by age 2, according to the CDC. But RSV isn’t mild for everyone. The virus hospitalizes tens of thousands of infants, young children, and elderly adults each year in the U.S. And it kills between 6,000 and 10,000 elderly adults in the U.S. annually, according to the national public health agency.
Cases of RSV are regulating after a spike late last year. Levels of RSV, COVID, and flu rose dramatically at the same time—part of what some public health officials called a “tripledemic” that conceded with the lifting of pandemic restrictions.
RSV symptoms can range from cold-like ailments like sneezing, sore throat, fever, and stuffy nose, to bronchiolitis and pneumonia, the latter of which can prove fatal. As with COVID, the young, elderly, and those with preexisting health conditions may be more vulnerable. And both are spread in the same manner.
There are distinct differences between the two, to be sure, including fatality rates. But it’s easy to see why it’s impossible to tell the two apart without testing.
Are RSV and COVID coughs different?
Unfortunately, both COVID and RSV can result in different types of cough, including dry, wet, wheezing, and the like, Dr. Dan Olson, associate professor of infectious diseases and epidemiology in the Colorado School of Public Health at the CU Anschutz Medical Campus, tells Fortune.
While children with a lower respiratory infection like RSV tend to wheeze, such noises may only be apparent to medical providers. The typical non-clinician parent usually won’t be able to detect it, Dr. Ishminder Kaur, an assistant professor of pediatric infectious diseases at UCLA Health, tells Fortune.
How do RSV and COVID symptoms differ?
Both conditions have a possible overlap of runny nose/congestion, fever, and cough.
But “in general, there are no distinctive clinical characteristics that can conclusively distinguish RSV from COVID-19 based on symptoms alone and without diagnostic testing,” Kaur says.
While there is no surefire way to differentiate the two conditions without testing, there are some potential tells, experts say:
- Symptoms like headache, loss of taste or smell, or sore throat “can point away from RSV,” Dr. Ali Alhassani, head of clinical at Summer Health, tells Fortune.
- GI symptoms like nausea, vomiting, and diarrhea can occur in COVID, sometimes in absence of respiratory symptoms, Kaur says. They usually don’t occur with RSV.
- Children with COVID usually have a fever, while children with RSV may not, she adds.
- Sore throat is more common with COVID, according to Kaur.
- Those with COVID sometimes get conjunctivitis (redness of the eyes) and skin rashes—symptoms not generally seen in RSV, she says.
Does it matter which one I have?
With society functioning as if the COVID-19 pandemic is over, does it even matter any more which you, or a loved one, has?
Yes, experts say. That’s because if treatment is required, a precise plan will need to be formulated. Antivirals like Paxlovid are available to children and adults with COVID ages 12 and older. While no specific treatment is available for RSV, supportive care at a hospital may be needed in either case. (And by the way, it’s possible to have both at the same time.)
If a child is at high risk for a severe outcome from COVID—because they’re obese or have an underlying medical condition—it’s all the more important to determine if they have COVID, Kaur cautions.
Can I test for COVID or RSV at home?
At-home testing kits are available for COVID, of course. But while at-home collection kits exist for RSV, none will give you results in home, Alhassani says. A trip to your doctor or urgent care will be necessary.
When should I worry about my sick child?
Parents should seek care for their children if they witness any of the following, experts tell Fortune:
- Fast breathing or difficulty breathing, which may look like chest wall retractions and/or nasal flaring
- Head bobbing or pauses in breathing in young infants
- Dehydration (reduced urine output)
For non-emergency cases of RSV and COVID, “parents might be more hesitant to go to the doctor’s office with long waiting periods—and the chance that you might get sicker from the waiting room,” Alhassani says.
But if your child’s symptoms aren’t resolving on their own after a few days, “it might be time to consult with a pediatrician,” he advises.
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