RSV vs. COVID-19: Symptoms to Watch For, According to Doctors

It can be hard to tell the difference between these two viruses

It's easy to assume that if you or your child suddenly develop a cough and fever, COVID-19 is to blame. But another virus, called respiratory syncytial virus (RSV), is also a possibility, and it can be hard to know for sure which one you might have.

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The Centers for Disease Control and Prevention (CDC) notes that RSV can cause severe disease in children and the elderly, so it's important to identify it as soon as possible.

So how can you tell RSV from COVID-19? Here's what you need to know.

What Is RSV?

RSV is a common respiratory virus that usually causes mild, cold-like symptoms in most people, according to the CDC. It spreads a few different ways:

  • When an infected person coughs or sneezes
  • When virus droplets from a cough or sneeze get in your eyes, nose, or mouth
  • When you touch a surface that has the virus on it, like a countertop, and then touch your face before washing your hands
  • When you have direct contact with RSV, for example, by kissing the face of someone who has the virus

While RSV cases are usually mild, they can be serious sometimes. The virus is the most common cause of complications like bronchiolitis (an inflammation of the small airways in the lung) and pneumonia (an infection of the lungs), especially in children under the age of 1 year old, the CDC says.

Every year, RSV causes about 58,000 hospitalizations and up to 500 deaths in children under 5 years old. It also causes 177,000 hospitalizations and 14,000 deaths in adults aged 65 years or older, the CDC says.

What Are The Symptoms of RSV?

According to the CDC, symptoms can include:

  • Runny nose
  • Decrease in appetite
  • Coughing
  • Sneezing
  • Fever
  • Wheezing

What Are the Symptoms of COVID-19?

You're probably a COVID-19 armchair expert at this point, but it never hurts to recap, just for comparison's sake. COVID-19 is an infectious disease caused by the novel coronavirus, SARS-CoV-2, according to the Food and Drug Administration (FDA). COVID-19 is mostly a respiratory infection but it can impact other organs.

COVID-19 can cause serious complications, like pneumonia, and also a range of illnesses known as post-COVID conditions. Post-COVID conditions, aka long COVID, can include things like difficulty breathing, fatigue, headache, diarrhea, and persistent loss of taste and smell.

The CDC says that symptoms of COVID-19 can include:

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

Can You Get COVID-19 and RSV at the Same Time?

Unfortunately, yes. "Double infections can occur," infectious disease expert Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Health. Daniel Ganjian, MD, a pediatrician at Providence Saint John's Health Center in Santa Monica, California, agreed. "It's not so common, but it's definitely not impossible," Dr. Ganjian told Health.

There isn't a lot of data to show how often double infections occur, but some research backs up the possibility. A 2021 study in Medical Science Monitor of 78 patients in China found that 11 of them had a so-called co-infection. Of those 11, four had RSV in addition to COVID-19.

A retrospective study published in a 2020 issue of Infection Control and Hospital Epidemiology analyzed data from 862 patients at two medical centers in Chicago who tested positive for COVID-19 from March 9, 2020, through April 30, 2020. Of those, two tested positive for COVID-19 and RSV or the flu.

How does someone end up with RSV and COVID-19? You have to be unlucky enough to be exposed to both around the same time. "It just depends upon exposure," Dr. Adalja said.

Overall, though, this is not a common thing. "It would be unusual to be infected with RSV and COVID-19 simultaneously," infectious disease expert Richard Watkins, MD, professor of internal medicine at Northeast Ohio Medical University, told Health. However, he added, people who are immunocompromised or not vaccinated against COVID-19 are at an increased risk.

RSV vs. COVID-19: How to Tell the Difference

If you or your child develops symptoms, it's more than understandable to want to know what, exactly, is behind them. Unfortunately, even your doctor is unlikely to know just by doing an exam. "The acute illnesses for both are very similar clinically," Dr. Watkins explained.

But there are a few clues that may crop up. "COVID-19 can sometimes cause vomiting, diarrhea, and a rash, which you don't see with RSV," Dr. Ganjian said.

Dr. Adalja agreed that it can be tough to parse these out, though. "There's no way to really distinguish the two conditions without a test." If you or a family member develops suspicious symptoms, call your healthcare provider. It's likely they'll want to test you for both infections.

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