Here’s what you need to know about flu, COVID-19, RSV this holiday: Doctor weighs in on masks, tests, symptoms

With holiday gatherings around the corner and viral illnesses, including the flu and COVID-19 on the rise again, a Northwestern Medicine doctor offers tips to managing symptoms, identifying what you have and mitigating transmission risk.

Dr. Jeremy Silver, medical director for Northwestern Medicine Kishwaukee Hospital’s emergency department in DeKalb, said said it’s not dramatic to think of the current illness trends as a “tripledemic,” a term used to highlight the severity of ongoing seasonal illnesses. And another tricky aspect: How to tell the often respiratory-riddled symptoms apart.

Throughout Illinois, cases of flu and COVID-19 are on the rise, preempted by a fall surge of respiratory syncytial virus. According to the U.S. Centers for Disease Control and Prevention, Illinois reports “very high” influenza rates as of Dec. 10.

“It’s probably the equivalent to the peak of omicron, which hit us a bit later [in 2021],” Silver said. “So I think just generally speaking, when it’s cold, the viruses tend to transmit more readily. People are inside congregating and also viruses do better in the cold than they do in the heat.”

A year ago, as then-new coronavirus variant omicron hit the country, a post-holiday surge swept the region, rendering already overburdened hospitals overflowed. Doctors then asked patients to stay away from the ER unless absolutely necessary.

Now space remains an issue, and while numbers haven’t quite reached crisis levels, Silver said area residents seeking treatment should prepare themselves for longer than usual wait times.

“The current situation in the region is challenging, that many hospitals including our own are holding admitted patients in the ER for extended periods of time because the burden of illnesses,” Silver said. “So if you have a condition that could potentially be treated at an urgent care or primary care that might be advisable given the current situation.”

In 2021, DeKalb County reported 78 flu-like illnesses at Kishwaukee Hospital’s emergency department from Oct, 31 through Nov. 13, according to the DeKalb County Health Department. This year, that’s more than doubled so far, with 181 reports during that same time frame in DeKalb. High rates of flu are also reported in DuPage and Kane counties, according to the respective county health departments.

As of Friday, the Illinois Department of Public Health reported 43 counties across the state were at high community transmission levels for COVID-19. That includes DeKalb, Lee, Whiteside, Winnebago and Kankakee counties in northern Illinois. Lake, McHenry, DuPage, Kane, Kendall, Ogle, Carroll are reported at medium risk. And Will, Grundy, LaSalle, Putnam and Bureau remain at low risk.

As of late Thursday, Illinois had 1,704 COVID-19 patients in the hospital, the most since Feb. 14. Of those, 223 were in intensive care units, the most since Feb. 23, and 60 were on ventilators.

The IDPH recommends indoor masking for all regardless of vaccination status in counties reporting high community transmission rates. Self-testing before socializing with a person who’s immunocompromised, staying up-to-date on vaccinations and boosters, maintaining good ventilation and using precautionary measures such as discretion when in large crowds, hand-washing and staying away from others if you feel ill is also recommended.

“I think what you’re starting to see now with COVID is flareups, with surges regionally as opposed to these broad based, national or continental sweeps of disease,” Silver said. “You may have a COVID surge in the Midwest, but the South is seeing flu, as an example.”

It’s been only months since a “massive influx of RSV,” as Silver called it, swept through the region. With it came more strain on the already strained health care systems, as pediatric nurse shortages or shortages of patient space in hospitals meant a bottleneck of cases. Kishwaukee Hospital, for example, doesn’t often admit pediatric patients, Silver said.

How to tell the difference between viruses

The flu, COVID-19 and RSV are all contagious respiratory viruses, with many of the same symptoms that can be hard to distinguish.

According to the CDC, COVID-19 spreads more easily than the flu.

Distinguishing between the two must be a matter of testing, as RSV symptoms and flu symptoms such as fever, cough, fatigue, sore throat, runny or stuffy nose and headache can be found in both infections. And with omicron and its subvariants still the primary strain in the country, COVID-19 might not often show up with a loss of taste or smell, the CDC reports.

“Flu tends to be rapid onset, high fever, you were fine when you woke up, by 3 p.m. it’s over,” Silver said. “COVID tends to be slow, subtle flu-like with cough or sore throat versus sometimes diarrhea or nausea.”

COVID-19 tests can be found in pharmacies and retail stores throughout the area. Health care professionals can provide a flu test.

[ Here’s how to order another round of free COVID-19 tests from federal government ]

Of the three, most people can recover from RSV in a week or two, although infections in infants and older adults can be especially serious. RSV also is the most common cause of bronchiolitis, inflammation of the small airways in the lung, and pneumonia, or lung infections, in children younger than 1, the CDC reports.

“RSV is more of an illness of very young children, fewer than 2 years, with wheezing, difficulty breathing, ow grade fevers and clear runny nose,” Silver said.

According to the CDC, RSV upticks are still reported in several regions throughout the country, with some nearing seasonal peak levels.

“We’re seeing a lot of flu or flu-adjacent illnesses,” Silver said. “In my opinion, the nature of the viruses is dominance so the idea of a tripledemic as an onslaught of all three viruses at once is not reality. I think what’s more realistic, which is what we’ve seen, is this scenario: COVID surges, then dips. Then the RSV epidemic, and that kind of wains, and then flu comes to the foreground.”

Those who seem to suffer are often the ones who do annually, Silver said. In children especially, Silver says he’s noted leapfrogging from one illness to the next.

“The very young and the very old, so the extremes of age,” Silver said. “And vulnerable populations who can’t really, they require society to help lift them up in order to make it through times like this.”

Although it’s possible to be infected with both COVID-19 and the flu at the same time, it’s uncommon, according to the CDC.

Silvers said flu cases he’s seeing now are fairly severe.

How to mitigate risk

Does vaccination seem to be playing a role in those who are getting this year’s strain of flu, like the bivalent COVID-19 booster?

Yes, Silver said.

Similar to the COVID-19 vaccine’s primary function, the role of vaccination against both the flu and the coronavirus is meant to stave off severity: severe symptoms, infections, risk of hospitalization and death.

“Vaccines work,” Silver said. “The risks of vaccines are far outweighed than getting sick and having long-term complications such as baring fog, loss of function, loss of job, chronic fatigue, blood clots, strokes and heart attacks. Don’t forget the flu was the big boogie man just a few years ago prior to COVID. You can’t take your eye off the ball there. Vaccination not only protects you but protects the grandbaby next door. There’s a safety net component there that maybe gets lost.”

That also means additional steps exist to mitigate viral control, Silver said. As has been preached by health care professionals since the beginning of the pandemic almost three years ago, behavioral risk mitigation is paramount, especially as indoor gatherings are likely to abound this holiday season.

For all illnesses, Silver recommends taking the we-before-me approach, using masks, isolation and testing as a way to keep yourself and those around you healthy. Even if at first it feels like just a cold. Wash your hands, too.

“Early [upper respiratory infection] symptoms – ear ache, headache, sinus congestion, runny nose, post nasal drip, dry cough, sore through, body aches, nausea, fatigue – should prompt mask wearing at minimum,” Silver said.

Those with confirmed COVID-19 should isolate until symptom are gone, Silver said. Those with the flu or RSV are likely to experience infectiousness for about 10 to 14 days, Silver said.

“Because of overlap of symptoms, if you feel bad, get tested at home, frequently,” Silver said.

That goes especially for those with who are older, higher risk or have chronic disease like high blood pressure, kidney problems, heart or lung disease such as asthma or COPD, cancer or autoimmune disease, Silver said.

Masking up is about protecting those around you, too, to prevent RSV, flu and COVID-19, Silver said.

“If you don’t feel well, please wear a mask so that you don’t make the person next to you sick,” Silver said. “If you have a fever or you’re very symptomatic, I’d strongly advice not going to work and spreading it around. I’d advise people that are managers in workspaces be sensitive to this. You want your employees to come to work but not be sick at the same time.”

At a glance – symptom checks and treatment

RSV

• No vaccine available.
• Recommended treatment includes fever and pain management medicine, drinking fluids and consulting a doctor.
• Symptoms generally show up four to six days post-exposure, according to the CDC.
• Symptoms include runny nose, decreased appetite, coughing, sneezing, a fever or wheezing. Often appear in stages, not all at once
• Young infants might also experience irritability, decreased activity or trouble breathing.
• Almost all children will have had an RSV infection by their second birthday, according to the CDC.
• Most infections clear within a week or two.
• Seek medical care if patient experiences difficult breathing, loss of fluid intake, or worsening symptoms.

Flu

• Vaccine is available, can be received as most pharmacies, doctor’s offices, etc.
• Symptoms start to appear between one to four days post-exposure, usually come on suddenly.
• Symptoms: fever (though not always), chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue, vomiting and diarrhea (latter is more common in children).
• Recovery often within a few days or less than two weeks.
• moderate complications could include sinus or ear infections. Severe could include heart, brain or muscle tissue inflammation, sepsis.
• Treatment can include antiviral drugs, recommended to start early.
• Contagious from a day prior to showing symptoms to about three to four days after, according to the CDC.

COVID-19

• Vaccine still available, can be received as most pharmacies, doctor’s offices, etc. Latest vaccine will be the bivalent booster, specifically made to target omicron strains of coronavirus.
• Symptoms might not show up for between two to five days post-exposure, and can last up to 14 days after infection or longer if complications arise, according to the CDC.
• Symptoms: Fever, chills, cough, shortness of breath, fatigue, muscle or body aches, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea.
• Test to determine diagnosis.
• Isolate until symptoms disappear once positive.
• Treatment can also include antiviral drugs, including Paxlovid, available through health care provider.
• Can often remain contagious longer than those with the flu.
• Can begin spreading virus two to three days prior to symptoms onset, and remain contagious on average for about eight days after symptoms began, the CDC reports.