September 14, 2023

What’s the Difference Between RSV, the Flu and COVID-19?

It comes down to a wheeze, a fever and long-term effects

Person taking electronic temperature of sick child in bed.

As if parenting wasn’t hard enough, COVID-19 has made the “sick kid questions” even more confusing: Is it just a cold or something else? Can I send my child to school? When should I call their healthcare provider?

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“Every child runs a gauntlet of infections during the first five years of their life,” says pediatric infectious disease specialist Frank Esper, MD. “Navigating childhood illnesses can be challenging for parents.”

Dr. Esper explains how RSV, the flu and COVID-19 symptoms are similar and how they differ.

Separate, but sometimes similar conditions

RSV, flu and COVID-19 are respiratory viruses. These viruses affect your respiratory system — the network of tissues and organs that help you breathe.

“Cough, runny nose and fever are common to all respiratory viruses,” says Dr. Esper. “When I see a child with these symptoms, I usually rely on a laboratory test to make an accurate diagnosis.”

Common symptoms

When it comes to RSV vs. the flu vs. COVID-19, what should you look for? Dr. Esper says there are some subtle differences between RSV, the flu and COVID-19.

Symptoms
Sore throat
RSV
Flu
Common
Cough
RSV
Common
Flu
Common
Sneezing
RSV
Common
Flu
Sometimes
Fever
RSV
Sometimes
Flu
Common
Body aches
RSV
Sometimes
Flu
Common
Tiredness
RSV
Sometimes
Flu
Common
Headache
RSV
Sometimes
Flu
Common
Runny/stuffy nose
RSV
Common
Flu
Sometimes
Shortness of breath
RSV
Sometimes
Flu
Sometimes
Loss of taste and/smell
RSV
Flu

Symptoms unique to RSV

RSV, or respiratory syncytial virus, is a virus nearly all children get by age 2. In addition to a cough, runny nose and fever, a unique symptom of RSV is wheezing. A wheeze sounds like a whistle or rattle when your child breathes.

Most children recover from RSV on their own, but sometimes, it can lead to severe illnesses such as:

  • Bronchiolitis, swelling of the small airways in your child’s lungs.
  • Pneumonia, an infection of your child’s lungs.

RSV can infect people of any age, but is most serious for young children and older adults. According to the Centers for Disease Control and Prevention (CDC), U.S. hospitals admits an estimated 58,000-80,000 children under age 5 for RSV every year.

Symptoms unique to the flu

A distinctive sign of the flu is a very high fever. Along with other respiratory symptoms, the flu causes high fevers of 103 or 104 degrees Fahrenheit (39.44 or 40 degrees Celsius). People usually feel miserable, more so than with other viruses, says Dr. Esper. This can include nausea and vomiting as well, which, though not unique to the flu, is also often worse than with other viruses.

Children under age 5, and especially under age 2, are at higher risk of complications from the flu. These include:

Advertisement

Each year, between 6,000 and 27,000 children younger than 5 years old develop symptoms serious enough to require hospitalization.

Symptoms unique to COVID-19

The signs of COVID-19 are similar to flu and RSV. But unlike the other viruses, COVID-19 can have a serious effect on body systems outside the lungs.

“Flu can do this, too, but the symptoms usually go away once the virus leaves your lungs,” states Dr. Esper. “COVID can cause long-term effects, such as brain fog.”

Several symptoms you may think are unique to COVID-19 are actually common among respiratory viruses. For example:

  • Loss of taste and smell: Many viruses, including those that cause the common cold and flu, can affect your sense of taste and smell.
  • Vomiting and diarrhea: Up to 30% of children with respiratory viruses have gastrointestinal symptoms, says Dr. Esper.

Testing and treatment

If your child has a runny nose, cough and fever — the telltale signs of a respiratory virus — a COVID-19 test is a good first step. Knowing if your kid has COVID-19 can help you protect other family members and prevent the spread outside of your household.

Many clinics use a triple test that can detect RSV, the flu and COVID-19. And you can also buy an at-home PCR test that includes testing for RSV, flu and COVID-19. But Dr. Esper notes you won’t get immediate results because you have to send the sample to a lab for processing.

“The processing time is 24 to 48 hours after they receive the test,” he explains. “Therefore, it can be several days before you find the results.”

Home testing for RSV and flu has many benefits:

  • A diagnosis of RSV at home could help you know when to keep your baby out of daycare. This could protect other children from RSV, which spreads rapidly in childcare settings.
  • An RSV diagnosis is also helpful to isolate your child from family members who are prone to getting bad lung infections.
  • Early identification of flu could help people get the treatment they need quicker. Early treatment with a medications called Tamiflu® (more commonly used) or Xofluza® (less common) significantly reduces how long you’re sick with the flu.

Can you have a co-infection?

Co-infection — when you have multiple viruses at once — is common in children. In any childcare or preschool room, you’ll find children sick with a range of viruses.

“When they’re all coughing, it’s not surprising that a child can catch two or even three viruses at the same time,” notes Dr. Esper. “We saw co-infections before the pandemic, and we’re seeing them now with RSV, flu and COVID-19.”

Advertisement

But he hasn’t seen any evidence that having more than one virus leads to worse symptoms or outcomes. Providers treat infections the same way, whether there are one or three.

In addition to wearing a mask and physical distancing, these steps can reduce your risk of respiratory infections:

  • Get your child vaccinated for RSV, flu and COVID-19 (if your child is eligible).
  • Sanitize high-contact surfaces, such as desks, tables and doorknobs if someone in your household is sick.
  • Wash your hands regularly or use hand sanitizer.

Additionally, it’s helpful to keep your child home if they’re sick. This minimizes the risk of spreading illness to other children at school.

Bottom line?

Children usually recover from respiratory viruses on their own with rest and fluids. Dr. Esper recommends reaching out to your child’s healthcare provider if they have:

  • Trouble breathing.
  • Severe vomiting and diarrhea to a point where they’re not eating or drinking.
  • Symptoms that aren’t improving or are getting worse after five days.

If your child has a high fever and you suspect it’s the flu, get in touch with their provider right away. Early treatment with Tamiflu within the first two days of symptoms can help your child get better faster.

Also check with your provider sooner if your child has any underlying health conditions, such as:

Respiratory infections are common in childhood. While you can take steps to reduce your child’s risk, you can’t avoid them entirely. If your child is sick, keep them home to reduce the spread of infection to others in your community. As they recover, your child will develop immunity that will help protect them from future infections.

Related Articles

Baby receiving a shot in their leg by healthcare worker in pink
December 7, 2023
COVID-19 Vaccines for Kids: What To Know and Why It’s Important

Children as young as 6 months should get vaccinated

Pregnant person with yellow glow emanating from them.
December 6, 2023
Is Pregnancy Glow a Real Thing?

More radiant skin may appear due to physiological responses to pregnancy

Natural antibiotics, pills and herbs, displayed on bamboo spoons on wooden table.
December 5, 2023
Why You Shouldn’t Self-Treat With ‘Natural Antibiotics’

Natural doesn’t mean they’re safe or effective

Female swimmer in the water at edge of a pool
December 1, 2023
Can Exercise Reduce Your Risk of Breast Cancer?

Physical activity and weight management can minimize your chances of getting the disease

Two people standing in the cold.
November 29, 2023
10 Colds Not To Catch This Winter

The flu, RSV, COVID-19, pneumonia and more typically circulate during cold weather months

Parent breastfeeding baby on bed, against the headboard.
November 27, 2023
Looking for Foods To Increase Your Milk Supply? Think Big Picture

No single food will increase your milk, but an overall healthy diet will help

Parent uses manual baby aspirator to open up nasal passages of baby.
November 22, 2023
Prevent Phlegm in Your Baby’s Throat With a Nasal Aspirator

Keeping your baby’s airways clear of mucus helps with breathing and feeding

Two different vaccines and needles displayed in foreground.
November 22, 2023
Which Vaccines Can You Get at the Same Time?

Getting routine vaccinations together can save you time and may be more effective

Trending Topics

group of hands holding different beverages
November 14, 2023
10 Myths About Drinking Alcohol You Should Stop Repeating

Coffee won’t cure a hangover and you definitely shouldn’t mix your cocktail with an energy drink

Person applies moisturizer as part of their skin care routine after a shower.
November 10, 2023
Korean Skin Care Routines: What You Need To Know

Focus on the philosophy — replenishing and respecting your skin — not necessarily the steps

glass of cherry juice with cherries on table
November 8, 2023
Sleepy Girl Mocktail: What’s in It and Does It Really Make You Sleep Better?

This social media sleep hack with tart cherry juice and magnesium could be worth a try

Ad