RSV, Flu and COVID-19: Symptoms and When to See a Doctor

Kaitlin Cockerell, M.D., a general pediatrician at Arkansas Children's Hospital in Little Rock and assistant professor of Pediatrics at the University of Arkansas for Medical Sciences (UAMS), explained a respiratory illness is any illness caused by a virus that can affect the respiratory tract — lungs, upper and lower airways. Even the common cold can turn into a respiratory virus.

"Viruses' are spread by secretions, like if a person coughs or sneezes on someone or out into the air. It can also be spread by saliva, for example, if someone shares a drink or kiss," Cockerell said. "Someone must be in close contact with another person to spread it. It is not spread by just touching someone who has the virus."

However, Cockerell noted if a person with a virus sneezes or coughs, it can linger in the air or on a surface for hours.

Respiratory illnesses can be contracted throughout the year but are most common during late fall and winter.

"People typically spend more time indoors during the colder months, which can lead to the spread of germs," Cockerell said. "Some viruses like the flu are thought to survive better in colder, drier conditions like winter."

Breaking it down: RSV, Flu and COVID

No medication can treat a virus. Some medicines control symptoms caused by a virus, like coughing or fever, and can lessen the length of symptoms. For example, Tamiflu or Xofluza (for ages 12 and up), if taken within the first 48 hours of flu symptoms, can help shorten flu symptoms. A person who starts the medication in that window may experience symptoms for five days instead of seven.

The most common respiratory illnesses are RSV, flu and COVID:

• RSV, Respiratory Syncytial Virus. It causes common cold symptoms in older children and adults. Infants and children under two are at risk for severe wheezing and respiratory distress, requiring oxygen and hospitalization. A hallmark symptom is trouble breathing. Dehydration can also occur. RSV is the most common cause of pneumonia and bronchiolitis in children under 1.
• Flu, caused by the influenza virus. The most common strands are Influenza A and Influenza B. People can experience fever, muscle aches, congestion, coughing and vomiting.
• COVID-19, caused by the SARS-CoV-2 virus. Subtypes cause various symptoms, including cough, congestion, a runny nose, fever, body aches, sore throat and loss of taste and smell. Most children who contract COVID-19 experience cold symptoms, but children with underlying conditions are most at risk.

Children who contract a respiratory illness can see a primary care doctor if they have the following symptoms:

• Mild cough
• Runny nose
• Sore throat
• Fever at or less than 100.4
• Mild fatigue

If a child has a fever of 100.4 for more than 24 to 48 hours or their symptoms are not improving within five to seven days, parents should make an appointment with their primary care doctor.

Emergency care is vital if a child has:

• Trouble breathing
• Changes in alertness
• Bluish lips or face
• Persistent chest pain/pressure
  
  

When to see a doctor or go to ER

"The biggest reason you'd want to go to the ER is for a child's respiratory status. They need a more critical evaluation if they're visibly struggling to breathe or saying their chest hurts," Cockerell said.

Parents may notice fast or hard breathing when a child sleeps, indicating they're struggling to breathe. Lethargy is different from fatigue. Cockerell explained fatigue can be if a child has low energy "and just wants to lay around on the couch" but is still eating and drinking.

"If a parent is having a hard time waking their child up, it's lethargy. They need to go to the emergency room," she said.

Parents need to immediately take a baby under six weeks with a fever to an emergency room because their immune systems are weak.

Comfort at home & prevention

There are many ways a parent can keep their child comfortable at home as they recuperate from a respiratory illness.

• Lots of rest
• Alternate Tylenol and Ibuprofen for pain relief, even if a child does not have a fever.
• Drink fluids to stay hydrated. If a child won't drink, popsicles help with hydration.
  
  

Several things can prevent or lessen the chance a child will contract a respiratory virus. There are vaccines available for children and adults for flu, COVID-19 and RSV.

"A vaccine is a substance used to help the body develop an immune response to a certain disease," Cockerell said. "Vaccines help your body fight off those diseases faster and better."

Medical experts recommend receiving the flu, COVID-19 and RSV vaccines before it's too late into the respiratory illness season. All three vaccines can be given at the same time. Because immunity from the flu vaccine does decline slightly over time, it's important not to receive it too early. The flu shot should be received by the end of October.

"RSV season is also typically from October to April, and it will be important for eligible infants to receive the RSV vaccine once it's available, or after birth if they are born during those months," Cockerell said. "However, you can receive these vaccines anytime during the respiratory illness season. COVID-19 vaccines can be given at any time and would be beneficial before the upcoming fall and winter months."

• Flu vaccine: The 2023-2024 flu vaccines are all quadrivalent, meaning they have four strands of inactivated virus. The flu vaccine is recommended for those over 6 months old.
• COVID-19 vaccine: The newest COVID-19 vaccine is an updated formula that contains components specific to the omicron variant and more current variants. It is also recommended for those over 6 months.
• RSV vaccines: This year, the FDA approved two RSV vaccines for adults 60 and older, one of which can be given to pregnant women. Monoclonal antibody therapy Nersevimab boosts the immune system to protect against severe RSV and is approved for newborns and children up to 24 months old.

"RSV has long been a leading cause of illness, hospitalization and infant death. Thousands of children are hospitalized each year for RSV. Pediatricians and families of those affected know all too well the stress when a baby has RSV," Cockerell said. "There is no treatment for RSV, but we support children through it with oxygen, fluids, etc., until they get better. That's why the new vaccines and antibody therapy are so promising. We can now decrease the likelihood of catching RSV and ending up with severe illness."

Cockerell said every relative in close contact with children younger than 6 months should ensure their vaccines are up to date. Other tips include:

• Good hand hygiene, like scrubbing hands for at least 20 seconds. Children can sing or hum “Happy Birthday” twice to remember how long it takes to wash their hands.
• Cough into their elbow instead of their hand.
• Wear a mask in crowded public places.
• If one child has a virus in the home and another is healthy, using Lysol in their sitting areas and hand-washing can limit the spread.
• Do not allow sick relatives in contact with infants. Relatives need to wash their hands and avoid touching a baby's face.
  
  

"It's up to the parent and their discretion, but it's a good conversation to have with your family members. Ask them if they're coughing, have a runny nose or any respiratory illness symptoms," Cockerell said.

Where to find vaccines, treatment

Arkansas Children’s hospitals and clinics provide COVID-19 and flu vaccines, along with other immunizations. Arkansas Children’s Hospital in Little Rock and Arkansas Children’s Northwest in Springdale deliver high-quality care in their emergency departments.

Primary care services are available at the following:

• General Pediatric Clinic, ACH
• Primary Care Clinic, ACNW
• ACH Southwest Little Rock Clinic
• ACH Pine Bluff Clinic
• Arkansas Children's Hospital - After-Hours Clinic
• Harvey Pediatrics, Operated by Arkansas Children's