Is it a cold, flu or COVID-19? A doctor helps sort it out

By Katia Hetter, CNN

(CNN) — Autumn is here, school is back in session, and along with the recent uptick in COVID-19 cases, people are experiencing sniffles, coughs and other cold-like symptoms.

What should people do if they have these symptoms? At what point should they get tested for COVID-19, flu and other viruses? What can they take to feel better, and when should they seek medical help? And what precautions should they take at school, work and home?

To help us with these questions, I spoke with our CNN wellness medical expert, Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.

CNN: What should people do if they develop cold-like symptoms?

Dr. Leana Wen: Respiratory infections are very common, especially in winter. There are over 200 viruses that cause the common cold. It’s estimated that children go through six bouts of respiratory illnesses every year, while adults develop two to four episodes. Cold-like symptoms generally go away without specific treatment.

What people should do if they have these symptoms depends on their medical conditions and the vulnerability of those in their household. There are some individuals who are very vulnerable to severe outcomes from viral diseases such as COVID-19 and influenza. Those individuals should take antiviral treatment if they test positive to reduce their risk of hospitalization and death.

I’d urge anyone to take a home test for COVID-19 if they develop cold-like symptoms if they are 65 and over, 50 and over with underlying medical conditions, or are immunocompromised or have serious pre-existing illnesses affecting their heart and lungs. If it’s positive, they could take Paxlovid if eligible, and if not, they could ask their health care provider for the other oral antiviral treatment, molnupiravir, or the antiviral injection remdesivir.

These individuals should also consider testing for influenza, especially if they develop fevers and body aches. If they have the flu, they should take the antiviral that targets influenza, Tamiflu.

It’s also important for people who are living in the same household as someone who is vulnerable to test for COVID-19 early and often. The coronavirus is highly contagious, and if you are positive, you could take proactive steps to isolate from the high-risk people living with you.

CNN: What about other viruses? At what point should people get tested for the respiratory syncytial virus (RSV), for example?

Wen: Some doctors’ offices will routinely test for RSV as part of a viral panel. Since there is no targeted antiviral treatment for RSV, a positive test does not change management.

Most people with cold-like symptoms do not need a viral panel for this reason. There are some circumstances where physicians may advise full viral testing—for instance if an immunocompromised patient is very ill. However, most people will not need to find out exactly what virus is causing their symptoms, since it won’t change what treatment they receive.

CNN: What precautions should people with cold-like symptoms take at school, work and home?

Wen: Let’s take each of these situations separately. Schools generally have policies around such illnesses. Most do not allow kids to return to school if they have a fever or severe viral symptoms such as vomiting. Some require a doctor’s note, and there may also be requirements for testing.

Workplaces may also have these protocols. When in doubt, stay home when you have a fever and active or new symptoms. If you must return to work, wear a well-fitting, high-quality mask when around others, including in conference rooms and while riding public transportation, to prevent infecting others.

What precautions to take at home depends on the vulnerability of those living with you. If everyone is generally healthy, it’s not unreasonable to do what you did before COVID-19. Parents might decide that keeping away from sick children or keeping a symptomatic child away from an asymptomatic one, is not worth the extra effort. On the other hand, if someone in the household is very vulnerable—for instance, an elderly grandparent with severe lung disease—then that person should not be in the same room as the sick individual.

CNN: What can people take to feel better?

Wen: If someone has COVID-19 or influenza and is eligible for antivirals, they should take those early in the course of their illness. Otherwise, it’s symptomatic treatment.

That means drinking lots of fluids to keep hydrated and getting plenty of rest. If someone develops a fever or muscle aches, they could take Tylenol or ibuprofen. Other over-the-counter medications can provide some relief for specific symptoms, too, such as nasal congestion and coughing.

CNN: When should people seek medical help?

Wen: Most people will not need to see their health care provider for cold-like viral illnesses. Those who should be more concerned are those who are elderly or are very young, and people with high-risk conditions. These people and their caregivers should be ready to seek medical help if they are concerned or if something does not seem right—for instance, if an elderly person seems confused, a baby is more fussy or drowsy than usual, or someone who has an underlying condition that seems to be getting worse.

Otherwise, reasons to seek medical help include not being able to keep down fluids — and in little children, decrease in wet diapers — shortness of breath and difficulty breathing and persistent fever for more than a few days. Intense and worsening symptoms such as sore throat and headache could prompt a call to the doctor as well.

Finally, people who vulnerable to severe illness due to COVID-19 and their household members should test for the coronavirus. Those vulnerable should have a plan in advance about accessing antiviral treatment to both COVID-19 and influenza.

CNN: Finally, can you remind us of how people protect themselves from picking up these viruses?

Wen: I want to underscore that viral infections are extremely common and difficult to avoid. However, there are steps people can take to reduce their chance of infection.

These steps include careful handwashing. Viruses can be transmitted through high-touch surfaces. People who are out and about should wash their hands or use hand sanitizer before touching their face or eating.

Depending on how important it is to avoid viral infections, individuals can take additional steps, including avoiding indoor crowded spaces and wearing a high-quality mask around others. Of course, I would urge people to be up-to-date on their vaccines, including the new COVID-19 vaccine, the flu shot and, if eligible, the new RSV vaccines.

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