The Difference Between COVID-19, Cold, Flu and Other Illnesses You May Hear About This Season

COVID-19 affects people differently. Coronavirus symptoms range from mild to severe and may include:

• Fever/chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Runny or stuffy nose
• Nausea or vomiting
• Diarrhea

How is the coronavirus different from the flu?

One symptom that sets COVID-19 apart from the flu or other viruses is loss of taste and smell. But only a small portion of people have that symptom, says Dr. Dominguez, so you can’t rely on that alone.

Another key difference is that there’s a vaccine for the flu, whereas there isn’t a vaccine yet for COVID-19.

“That’s really important for parents to keep in mind,” says Dr. Dominguez. “Everyone should get a flu shot every year, but especially this year. Not only does it reduce your chances of getting the flu, but if you do get it, your symptoms will likely be less severe.”

If less people get the flu and their symptoms are less severe, that means there will be more resources available to care for patients with COVID-19.

“We’re also concerned about coinfection, which is when a patient has the flu and COVID-19 at the same time,” says Dr. Dominguez. “We think outcomes may be worse if that happens, and a flu shot can decrease that risk.”

Common colds are normal. In fact, healthy children get about six colds a year. According to the NIH, there are more than 200 different viruses, such as rhinoviruses, that can cause common cold symptoms including:

• Runny or stuffy nose
• Sneezing
• Sore throat
• Gray, yellow or green nasal discharge
• Cough
• Scratchy voice

How is a common cold different from the coronavirus?

A fever is common with COVID-19, but rare if you have a cold. Alternately, sneezing is rare with COVID-19, but common if you have a cold.

How is a common cold different from the flu?

A cold is generally milder than the flu, and symptoms appear gradually. Flu symptoms are sudden and severe. With the flu, your child will likely have a high fever, a headache, severe tiredness, achy muscles and chills. For a common cold, they may have a low fever to start, but they won’t have a headache or muscle aches, and they won’t have chills. Learn more about how to tell the difference between a cold and the flu.

Some conditions of the ear, nose and throat are often the result of a respiratory illness like a cold or the flu. Interestingly, during the COVID-19 pandemic, doctors are diagnosing less ear and sinus infections in children than expected.

“We think this might be related to public health measures like social distancing and school closures, which have resulted in less transmission of the bacteria and viruses that commonly cause these infections,” says Children’s Colorado pediatric otolaryngologist Sarah Gitomer, MD.

Ear infections

Ear infections are common, and about 85% of children experience at least one during childhood. Some ear infections can resolve without antibiotics. But Dr. Gitomer says parents should call their child’s primary care provider if they see a combination of the following symptoms:

• Ear pain
• Drainage of fluid from the ear
• Tugging or pull at an ear
• Fussiness or crying more than usual
• Trouble hearing sounds
• Loss of balance
• Headache

When kids have multiple ear infections in a matter of months, it may be time to meet with one of our ear, nose and throat specialists to discuss surgery.

Sinus infections

The sinuses are the system of nasal cavities in the skull. These cavities are usually empty, but they can become blocked with fluid and germs when you have a viral infection like a common cold. The blockage causes the tissue along these cavities to become inflamed, and that’s when a sinus infection can occur.

Sinus infection symptoms are similar to a cold but may also include pain and tenderness in the face and a fever. A sinus infection typically resolves on its own with over the counter medications and does not require parents to seek medical care for their child.

“In rare cases, it can progress to a bacterial infection that spreads to areas around the sinuses,” says Dr. Gitomer. “When this happens, symptoms can include a red, puffy or bulging eye; decreased or painful movement of the eye; or vision loss.”

That’s when it’s time to call your primary care provider, she says. Your child will likely need antibiotics and may need to be seen by an otolaryngologist — an ear, nose and throat surgeon.

Strep throat

“A sore throat is a common symptom of the flu and a cold, so there’s always a question of how to tell when it’s something more,” says Dr. Gitomer. “A sore throat with a cough, runny nose or raspy voice, indicates that your child likely has a viral infection, not a bacterial infection like strep throat.”

Strep throat symptoms can include:

• A sore throat that comes on rapidly
• Painful swallowing
• Fever
• Headache
• Swollen tonsils
• Red spots on the roof of the mouth or tonsils
• Swollen lymph nodes in the neck
• White streaks of pus on the tonsils

If your child is experiencing these symptoms, you should call your child’s primary care provider and tell them you suspect your child may have strep throat.

COVID-19 is caused by a virus called SARS-CoV-2. When infected with this virus, most children are asymptomatic, meaning they don’t have any symptoms of COVID-19, or they have mild symptoms. In rare cases, though, there are two reasons some children get very sick. 

“One is just a really bad COVID-19 infection that occurs during what we call an acute — or sudden — infection,” says Dr. Dominguez. “The other is a new condition called MIS-C, which usually occurs 3 to 6 weeks after becoming infected with SARS-CoV-2.” 

MIS-C stands for multisystem inflammatory syndrome in children. Doctors suspect a connection between MIS-C and COVID-19, but there are also some children who are diagnosed with MIS-C who do not test positive for COVID-19.  

Much remains unknown about MIS-C, and Children’s Colorado is involved in several national research studies to learn more. Led by pediatric cardiologist Pei-Ni Jone, MD, Children’s Colorado developed comprehensive guidelines to effectively diagnose and treat children with MIS-C, including more than 14 children who’ve been diagnosed within the last few months at Children’s Colorado. The guidelines are now nationally recognized and shared with hospitals across the country. 

Symptoms of MIS-C can include: 

• Fever 
• Severe abdominal pain 
• Vomiting 
• Diarrhea 
• Rash 
• Red eyes, red lips 
• Trouble breathing
• Seeming confused/sleepy 

If your child is showing these symptoms, you should call your primary care provider. In a life-threatening emergency, you should always call 911.

Acute flaccid myelitis, or AFM, is a neurological condition that can cause permanent paralysis and breathing problems in children. Clusters of AFM cases have popped up every other year since 2014. The disease is rare, but parents should be aware and keep an eye out for it. According to the Centers for Disease Control and Prevention, more than 90% of patients with AFM had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.

AFM symptoms include sudden onset of:

• Arm or leg weakness
• Loss of muscle tone and reflexes
• Difficulty moving the eyes or drooping eyelids
• Facial droop or weakness
• Difficulty swallowing or slurred speech
• Pain in arms legs, neck or back

If your child struggles with breathing or is showing any of these symptoms, you should immediately seek medical care.