Children's Hospital Colorado

Differences Between COVID-19, RSV, Flu and Other Bugs Affecting Kids

This page was updated Nov. 8, 2022. Please reference CDC and CDPHE for updates during the pandemic and follow all health and safety guidelines set by your local authorities.

Cough, cough. Sniff, sniff. “I don’t feel well,” your kid says. Uh-oh, you think. As a parent, you never want your kids to get sick. But it happens — and probably more often than you'd like — especially during the fall and winter seasons. This is the time of year when illnesses like the common cold, influenza (flu), respiratory syncytial virus (RSV), and other viruses are widely circulating. Add the ongoing COVID-19 pandemic, and you’re probably wondering what bug your kid picked up this time.

The U.S. is experiencing an unexpected early surge of RSV cases, and in Colorado pediatric hospitalizations for RSV are the highest they’ve ever been. This influx coincides with the beginning of flu season and an increase in COVID-19 transmission — what some have dubbed a “tridemic” or “tripledemic”  — so there are plenty of viruses for you or your child to bring home.

Despite common misconceptions, COVID-19 is still a serious concern. Children’s Hospital Colorado pediatric infectious disease specialist Samuel Dominguez, MD, PhD, points out that COVID spreads more easily than other viruses and can cause more severe illness than the flu in some people. It can also take longer for symptoms of COVID to appear, which means you can spread the virus before you even know you're sick.

How to protect your family from respiratory viruses

The best way to prevent getting sick with COVID-19, RSV, flu or any other respiratory illness is to follow these healthy habits:

  • Wear a mask in indoor, crowded spaces when viruses are circulating
  • Stay home when you’re sick
  • Frequently wash your hands
  • Cover your cough
  • Stay up to date on your COVID-19 and flu vaccines
  • If you’re sick, stay away from infants and young children until you feel better. Likewise, if you have a child 6 months or younger – or one with underlying heart or lung conditions – remain cautious about close contact with others who have cold or flu symptoms.

Even with precautions, it’s likely that your family will catch a virus during cold and flu season, so it’s important to be prepared and understand the subtle differences between these common illnesses.

Symptoms quick chart

With the help of our experts, we created a symptoms chart for quickly comparing symptoms of COVID-19, the flu, RSV, common colds and allergies.

Why testing is important

While reported cases of COVID-19 are down significantly from their peak, the virus is still circulating throughout Colorado and across the country. Testing is the most accurate way to tell the difference between COVID-19 and other respiratory viruses and an important first step in slowing community spread.

Tests for the flu and RSV are also available, as is a single test that detects the flu, COVID-19 and RSV all at once. Dr. Dominguez says that flu testing is also important, as treatments exist to help those who are at high risk for developing severe disease or are seriously ill. Testing for RSV alone is less common, as there are no specific treatments for this virus (yet).  Your pediatrician can recommend the type of tests your child needs based on their symptoms and risk factors, and those results can help guide you in what to do.

COVID-19 vs. the flu

Influenza (commonly known as the flu) is a highly contagious respiratory virus that is present year-round, but circulates widely in the fall and winter months, or flu season. The flu causes cold-like symptoms that often come on suddenly and can range from mild to severe. Children under the age of 2, adults over age 65, pregnant and post-partum women, people taking certain medications and those with chronic medical conditions, including lung or heart conditions, can develop severe or life-threatening complications.

Some of the primary symptoms of the flu overlap with symptoms of COVID-19, making it difficult to distinguish between the two illnesses. Fortunately, the accessibility of at-home COVID-19 tests can make it easy to determine if an individual is infected with COVID. If an individual is at high-risk for severe disease or would qualify for treatment, a flu test may also be recommended.

COVID-19 vs. RSV

The respiratory syncytial virus (RSV) is a common, cold-like infection that hits most kids before they turn 2. Though RSV typically circulates only in the winter months, it’s made some unseasonal comebacks during the pandemic. And in fall 2022, children’s hospitals around the country have seen a surge in RSV, straining emergency rooms and hospitals. Here's what parents should know about RSV.

COVID-19 vs. a common cold

Common colds are normal. In fact, healthy children get about six colds a year. According to the National Institutes of Health, there are more than 200 different viruses, such as rhinoviruses, that can cause symptoms.

COVID-19 vs. ear, nose and throat infections

Some conditions of the ear, nose and throat are often the result of a respiratory illness like a cold or the flu. In the early stages of the pandemic, doctors were seeing fewer ear and sinus infections due to public health measures like social distancing and masking.

Now that many of the public health precautions have been eased, we’re seeing an increase in bacterial and viral infections in kids. This, in turn, is causing an uptick in ear, nose and throat conditions like ear infections, sinus infections and strep throat.

“With the comeback of common respiratory illnesses and viruses like RSV, we’ve again seen an increase in strep throat and ear infections,” says Children’s Colorado pediatric otolaryngologist Sarah Gitomer, MD. “In fact, we’re seeing more complicated infections now than in the past several years.”

Enterovirus D68 and acute flaccid myelitis

Acute flaccid myelitis (AFM) is an uncommon but serious neurological condition that has been linked to a respiratory virus called enterovirus D68, abbreviated as EV-D68. AFM primarily causes limb weakness and paralysis, as well as loss of muscle tone, but other symptoms can also occur.

AFM first emerged in 2014, and experts at Children’s Colorado and the University of Colorado School of Medicine were the first to link an outbreak of AFM to the outbreak of the respiratory virus EV-D68. This virus tends to circulate every other year, and Colorado has seen an increase in cases of EV-D68 this fall. In rare cases, getting sick with this enterovirus can lead to AFM.

“Although AFM is rare, parents should know the symptoms and keep an eye out for them,” says Dr. Dominguez. “If your child is exhibiting signs of AFM, or any signs of paralysis, seek medical attention immediately.”

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