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Is it a Cold? The Flu? COVID? How to tell the difference

The world is swirling with respiratory viruses right now, and this year has been especially bad. Likely a combination of :

  • Everyone deciding the pandemic is over (ha!) and engaging in less mask-wearing

  • Colder temperatures that tend to be breeding grounds for respiratory viruses

  • Closer contact with family gatherings and holiday travel

Every day, primary care offices, urgent cares and ERs are dealing with the onslaught of patients seeking help for their symptoms. Many times, patients have a strong suspicion for what type of bug they caught, even if they haven't gotten any official tests. And many time, patients are totally wrong!

Here are some examples of common assumptions:

  • If the symptoms are mild, it's most likely a cold and definitely not COVID

  • If there is a fever, it's definitely the flu

  • If there is a lot of nasal or sinus congestion involved, it's definitely not COVID or the flu

Sorry to be the bearer of bad news, but none of these assumptions are accurate! As a doctor, I've seen COVID that literally only presents as mild congestion, I've seen influenza without a fever, I've seen severe symptoms that are from a virus that is neither influenza or COVID....the list goes on and on!

Here's why it's dangerous to make assumptions about your viral respiratory infection:

  • If you assume you don't have COVID without testing, you may be spreading it to others by not isolating per CDC guidelines, and also might miss out on life-saving treatment if you are high-risk for COVID complications

  • If you have the flu (influenza) you might miss the 48-72 hr window to benefit from antiviral treatment, or you might be spreading it to high-risk individuals

The basic summary is this: you can't 100% tell the difference and cannot use symptoms as a definitive way to diagnose yourself. You can have a high suspicion based on symptoms, exposure etc but honestly the only way to know for sure is to get tested. There are tests available for influenza and COVID. Now, the caveat is....these tests aren't 100% sensitive (meaning, sometimes you can have flu or COVID but the tests show up negative).

So, you should have a high index of suspicion -for example, if a family member or close contact is diagnosed with COVID, and you develop symptoms a few days later, it's best to assume you may have COVID and act accordingly. For COVID testing specifically, the home tests are most accurate by day 5 of symptoms (so if you test earlier and it's negative, try testing again in a few days) .

If you have any specific questions about your respiratory virus, talk to you doctor!

Here's wishing you a virus-free Christmas

Kim Rogers, MD

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