Cold, Flu or RSV? How to Tell Which Virus You Might Have, From … – KQED

Dec 1

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Bottles of vaccine for influenza, Respiratory Syncytial Virus (RSV) and COVID-19.(Getty Images)

The 2023-2024 winter respiratory virus season is here. And alongside the latest COVID-19 variant and the return of flu season, RSV is once again on the rise around the Bay Area.

RSV which stands for Respiratory Syncytial (pronounced sin-SISH-uhl) Virus usually causes mild, cold-like symptoms, according to the U.S. Centers for Disease Control and Prevention. But in infants, young children and adults over 60, this respiratory virus can attack a weakened immune system to cause severe sickness, leading to hospitalization and even in serious cases death.

People in these age groups and the people who care for them are often warned by their health care providers about the dangers of RSV transmission and offered vaccination against the virus. However, there are a lot of people who may not even know RSV exists, let alone how dangerous it can be to spread it to others accidentally even if getting infected themselves only means mild symptoms.

Keep reading for what to know about RSV testing, how to spot an RSV infection, incubation periods, and whos eligible for the new RSV vaccine.

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In its weekly report, on Nov. 27, the CDC said that the U.S. is experiencing elevated RSV activity, particularly among young children and that there is currently high overall respiratory illness activity in California.

The WastewaterSCAN project monitors the presence of viruses including RSV, COVID-19 and the flu in wastewater across the U.S. Alexandria Boehm, a Stanford professor of civil and environmental engineering, who helps lead the project, provided KQED with the latest snapshot data on Nov. 30, that found RSV levels are trending up and high, and that all sites in the Bay Area are categorized as in the high wastewater category for the virus. This upward trend indicates that the Bay Area is headed towards the levels we saw last year.

In Santa Clara County, health officials recently warned of a dramatic increase in winter viruses in the countys wastewater and an especially sharp rise in RSV levels, which the countys Deputy Health Officer Dr. Sarah Rudman said had doubled in the month leading up to Thanksgiving.

That worries me, Rudman told KQED on Monday, that especially after this holiday weekend with everyones travel and gathering there, were going to see even higher levels this week.

Dr. Peter Chin-Hong, an infectious disease specialist at UCSF, said that when it comes to lab testing at his hospital right now, more tests are coming back positive for RSV than for the flu or COVID-19.

At-home testing for RSV isnt available in the way it is for COVID-19. The only places youd typically have access to a formal RSV test are at an urgent care center, the emergency room, or elsewhere in a hospital, Chin-Hong said.

I think in the future itd be great to have a home test for COVID, flu and RSV, he said. But right now, we just have COVID [testing] at home.

Chin-Hong acknowledges the downsides of being unable to access an RSV test outside of these clinical settings. Its good to know so that you dont infect the very young and very old, who can have more serious consequences, he said.

And on that note

RSV, Chin-Hong said, seems like a cold for most people. But that cold infecting somebody under two, or older than 60, can land them in the hospital.

According to the CDC, the symptoms of RSV infection usually appear in stages and not all at once, and can include:

One big exception to this list: In some very young infants with RSV, the CDC said that the only symptoms may be irritability, decreased activity, and breathing difficulties.

Wheezing could be the particular symptom that might indicate youve got RSV rather than another respiratory virus, Chin-Hong said although wheezing can still be a symptom of those other viruses, too.

So, if youre unlikely to get access to an RSV test, how can you tell if what feels like a bad cold is actually RSV or the flu? Chin-Hong said there are a few things that might help you tell the difference:

The speed and severity of symptoms

Chin-Hong said the onset of symptoms for the flu will be sudden and severe, with fever and muscle pain. You feel like a garbage truck hits you very suddenly, he said.

Influenza, which, like RSV (and COVID-19), is already spreading throughout the Bay Area this winter, can cause serious problems even in healthy people of any age. Some people are also at higher risk of developing serious flu-related complications if they get sick, including those aged 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant people and children younger than 5 years.

The CDC estimates that last years flu season resulted in as many as 58,000 deaths from flu and up to 650,000 flu hospitalizations. WastewaterSCANs Boehm noted, in her teams latest snapshot, that wastewater levels for influenza are starting to trend up, which suggests influenza infections are starting to rise in our region, and that based on last years records, we fully expect the levels to keep increasing.

If you havent already, consider getting your flu shot as soon as possible. Read more from the CDC about what to do if you get the flu.

If your cold symptoms are more progressive, but youre repeatedly testing negative for COVID-19, seriously consider the possibility that you have RSV.

Or, as Chin-Hong puts it: If you dont feel like your whole body is on fire, and it feels like a cold these days, chances are that its going to be RSV.

The incubation period

RSV has a longer incubation period than COVID-19 or a cold the amount of time between exposure to the virus and getting sick.

Right now, the latest COVID-19 subvariants have an incubation period of three to five days, and a cold will take 24 to 72 hours to incubate after exposure. But RSV has a longer incubation period of four to six days, Chin-Hong said. So, if you know youve been exposed to RSV but havent gotten sick after a few days, unfortunately, its unwise to presume youve escaped infection.

While people infected with RSV are usually contagious for 3 to 8 days, according to the CDC, they can also become contagious a day or two before they start showing signs of illness similar to those infected with COVID-19.

If youre not at higher risk for severe RSV but youre pretty sure youve got it, what now?

Manage your symptoms

The CDC said that antiviral medication is not routinely recommended to fight an RSV infection in contrast to COVID-19, for which the antiviral drug Paxlovid is often prescribed, or for the flu, for which antiviral drugs like Tamiflu can be taken.

Most RSV infections, the agency said, go away on their own in a week or two.

So, if youre an adult whos not at higher risk for severe RSV, the CDC recommends managing fever and pain symptoms with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. Its also important to drink fluids to prevent getting dehydrated.

Stay home as much as you can

Remember, the big difference between having just a cold and having RSV is that if you spread RSV, youre potentially endangering infants and older people who are at much higher risk from it. The best thing to do is keep away from others as much as possible while youre sick especially infants and people aged 60 and older. And definitely dont go out if you have a fever, Chin-Hong said thats probably the highest risk.

What if you really cant stay indoors away from others? Then its time to wear a well-fitted face covering like an N95 or KN95 mask, Chin-Hong said. By masking, youll reduce the risks of spreading the virus to those around you.

There are two age groups at the highest risk for severe disease, hospitalization and death from RSV:

Infants and young children

Every year, as many as 80,000 children under 5 years old are hospitalized in the U.S. because of RSV, according to an estimate from the CDC. Children at the greatest risk from RSV include:

Part of the danger of RSV is how it can bring on more severe infections, including:

The CDC said that RSV is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age.

These statistics can seem scary and RSV does undoubtedly pose a threat to many younger children. But for context, the CDC notes that almost all children will have had an RSV infection by their second birthday.

If an infant or young child gets infected with RSV, parents and caregivers can always call their providers advice line, added Chin-Hong, who said to watch for red flags, including when a young child is having difficulty feeding or breathing, or is wheezing and lethargic. Infants with quote-unquote colds who have any of those [symptoms] should be brought into the hospital or urgent care or the emergency room for advice, he said.

People age 60 and older

RSV poses a particular risk to older people because of how our immune systems weaken with age. Every year, between 60,000 and 160,000 older adults in the U.S. are hospitalized with RSV, and as many as 10,000 die from it, The CDC estimates.

In addition to causing more severe infections like bronchiolitis and pneumonia, the virus can also exacerbate existing health conditions including asthma, chronic obstructive pulmonary disease and congestive heart failure.

Some younger adults are also at higher risk from RSV. These groups include folks with chronic heart or lung disease, weakened immune systems or certain other underlying medical conditions.

When should older adults or their caregivers seek medical attention due to a potential RSV infection? Chin-Hong said that one of the main concerns for this age group is developing pneumonia, of which a new shortness of breath can be a symptom. Oxygen levels can also be monitored with an at-home pulse oximeter if a persons levels drop below 93%, Chin-Hong said thats a sign to head to the emergency room.

What does hospitalization actually mean for infants and older adults with severe RSV?

Hospitalization often occurs if the patient is having trouble breathing or has become dehydrated and once in the hospital, they may require extra oxygen or fluids given through an IV if they cant eat or drink enough on their own.

A patient might also need to be intubated with a breathing tube inserted through the mouth, and be given mechanical ventilation to help them breathe again. While this sounds scary, hospitalization usually lasts for only a few days in most of these cases, according to the CDC.

In addition to the general benefits of vaccination against the virus, Chin-Hong notes that there isnt any good therapy for RSV currently making a preventative vaccine even more important.

In May, the U.S. Food and Drug Administration approved the first RSV vaccine for older adults, and, several months later, approved another one for pregnant people, as well asa separate preventative antibody treatment for infants.

RSV vaccines for these groups are available through health care providers and pharmacies, with the shots covered partly or fully by most health insurance plans.

Adults age 60 and older

The CDC recommends this group should talk with their health care provider about whether RSV vaccination is right for them. There is no upper age limit for getting an RSV vaccination, which is given as a single shot. Read more about older adults and the RSV vaccine, and about health insurance coverage for this vaccine.

People between 32 and 36 weeks of pregnancy

Vaccinations for pregnant people are one of two ways that infants can be immunized against RSV in this case, to pass on the benefits to the fetus. The CDC said that a baby born to a mother who got the RSV vaccine at least two weeks before delivery will have protection and in most cases, that baby then wont require a later RSV immunization. Read more about pregnant people and the RSV vaccine, and about health insurance coverage for this maternal vaccine.

Infants

A preventive antibody not a vaccine can also be given directly to a baby after birth if a maternal vaccine isnt an option. This form of immunization is recommended for children younger than 8 months of age during their first RSV season. In some cases, this immunization is extended to children under 24 months of age with certain conditions that place them at increased risk for severe RSV disease, the CDC said. Read more about RSV immunization for infants and young children and about health insurance coverage for this immunization.

KQEDs Sara Hossaini contributed reporting to this story.

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Cold, Flu or RSV? How to Tell Which Virus You Might Have, From ... - KQED