Cold, flu, hay fever, or COVID - Which one do I have?

Maybe you’ve developed a mild cough and runny nose, and it’s causing you to go into a full-blown panic attack. That’s understandable, especially now, when COVID-19, the disease caused by the SARS-CoV-2 virus, is a constant worry. It’s important to remember that as concerning as COVID-19 is, roughly 80% of people recover from the disease without needing special treatment. Some people never even have symptoms.

Many of the most common COVID-19 symptoms are commonly seen in other illnesses, like the flu, the common cold or seasonal allergies such as hay fever (see Table 1).

Around many parts of the world, the cough and cold, flu and allergy seasons are all happening now -- all at the same time -- which can make deciphering your symptoms even more challenging. You may also end up with mixed symptoms (such as allergy and COVID-19 symptoms at the same time), so it can get complicated. Comparing the most common features of COVID-19 with other viruses and allergies that circulate throughout the year might be a helpful start.

Since the coronavirus is new, many of the signs and symptoms of this virus are still surfacing. It appears the initial coronavirus symptoms appear within the first 2 to 14 days. The most common ones -- fever, cough and shortness of breath -- are well-known and expected features, and also occur with other respiratory coronaviruses such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

Symptoms of COVID-19 are usually mild and start gradually. Although fever, cough, shortness of breath and fatigue are frequent symptoms, not everyone is painting the same picture. Some features, like diarrhea and headache, may occur less frequently. Children may exhibit a different set of symptoms or no symptoms at all. Other hints, like loss of smell, taste changes, or pink eye, are newly described features in case reports. Additional information seems to surface daily of previously unreported COVID-19 symptoms, too.

Table 1: Symptoms of COVID-19, the Flu, a Cold and Allergies

Does everyone show COVID-19 symptoms if they have this virus?

No, it seems not everyone who is infected with coronavirus is exhibiting symptoms, which might make it hard to control this outbreak. In children, the symptoms may be so mild that no one knows they are infectious at all. Those without symptoms may be able to transmit COVID-19 disease to others, and that’s another reason why staying at home, keeping at least 6 feet of social distancing, using a cloth face mask in public (if you must go out), and frequent and thorough hand washing are so important. This can’t be overstated enough.

Which medicines can protect me?

COVID-19

On Dec. 11, 2020 the FDA issued an Emergency Use Authorization for Pfizer's COVID-19 vaccine in people 16 years and older. The full vaccine dose requires two injections, with the second dose given 3 weeks after the first. Roll-out of the vaccine is expected to continue in the U.S, based on priority, with vaccine availability for the general population expected in spring of 2020.

Symptomatic treatments, like acetaminophen (Tylenol) or ibuprofen (an NSAID like Motrin or Advil) can be used to relieve COVID-19 symptoms such as fever, headache and body aches.

• However, the use of ibuprofen has been somewhat controversial and a letter published in Lancet suggested ibuprofen might worsen COVID-19 symptoms.
• The FDA is not aware of scientific evidence that links NSAID use with worsening COVID-19 symptoms but is investigating this issue further.
• If you have questions about OTC medications to treat COVID-19 symptoms, speak to your doctor or pharmacist.

The Flu

For the flu, a yearly influenza vaccine is the number one way to prevent this virus. You’ll need a vaccine each fall as the strains of the flu tend to change from year-to-year. Antiviral medications, such as Tamiflu (oseltamivir) or Xofluza (baloxavir marboxil) are also approved for flu treatment. Other common sense measures, such as washing your hands, disinfecting surfaces regularly and covering your cough can also help to prevent the spread of the flu virus.

The Common Cold

The common cold can occur from many different viruses, including a coronavirus. It is usually a mild illness and requires only symptomatic treatment, such as over-the-counter pain relievers like acetaminophen or ibuprofen, decongestants, or cough suppressants. There is no vaccine for the common cold, as many different viral strains can cause the common cold. Covering your cough, sneeze and handwashing can also make sense with a cold.

Allergies

For seasonal allergies like hay fever, learn what triggers your symptoms and try to avoid them. Stay inside when pollen count levels are high. When this isn’t possible, see your doctor who can recommend proven allergy medications like nasal corticosteroids or oral antihistamines. If your allergies are severe or you aren’t helped with other treatments, your doctor might recommend allergy shots (desensitization).

Bottom Line

The symptoms for COVID-19 can range from mild to severe. It’s important to note that while these are common or reported signs and symptoms of COVID-19, new information or studies may find other symptoms of the novel coronavirus that are not well described yet. So, this list is not all-inclusive and you should contact your health care provider for any symptoms that are severe or concerning to you.

When to seek emergency care

It’s important to know your symptoms and seek advice when needed. If you develop emergency warning signs for COVID-19, contact emergency care immediately. Severe cases can lead to pneumonia and acute respiratory distress syndrome and can be fatal. Emergency warning signs include:

• trouble breathing
• persistent pain or pressure in the chest
• new confusion or inability to arouse
• bluish lips or face

Call your doctor

If you think you have been exposed to COVID-19 and develop a fever and symptoms like a cough or difficulty breathing, call your health care provider for medical advice. You may need to shelter in place, undergo testing, and seek medical care.

Those at high risk for COVID-19 complications

About 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing, according to WHO. Older adults and people who have severe underlying medical conditions are especially vulnerable and should take special precautions to avoid contact with the virus. These higher risk groups include those with chronic conditions such as:

• heart disease
• high blood pressure
• lung diseases such as asthma or chronic obstructive pulmonary disease (COPD)
• diabetes.