Can you tell the difference between RSV and the flu? Here’s what you need to know.

After several weeks of a brutal respiratory virus season, parents of young children may finally get a reprieve: RSV cases appear to be declining in the state.

Still, with the holidays around the corner, doctors worry about potential surges of influenza and COVID-19. Influenza activity is already deemed “very high” in North Carolina by the Centers for Disease Control and Prevention.

“Flu is the highest it’s been since before COVID,” said Dr. Mike Smith, a Duke pediatric infectious disease expert.

Here is what parents need to know about the simultaneous respiratory viruses:

Telling the difference between RSV, flu and COVID-19

At the onset of a virus, it’s very difficult to tell the difference between the three respiratory viruses, which all typically present like a cold in the first few days, said Dr. Sameer Kamath, a Duke pediatrician. However, as the sickness progresses, there are some symptoms that can help differentiate between the viruses.

The flu is generally accompanied by body aches and muscle pains, which are rare in RSV cases. Difficulty breathing is much more common in RSV and COVID cases than in flu cases.

Ultimately, there’s no definitive way to distinguish between the viruses without a test.

“I would not expect a layperson to tell the difference,” he said.

If you seek out a test, go to a primary care provider rather than the emergency room, which are likely overwhelmed with respiratory virus patients, said Dr. Charlene Wong, assistant secretary for Children and Families at the N.C. Department of Health and Human Services.

How to prevent and treat the viruses

The best way to prevent severe illness from a respiratory virus is to stay up to date with vaccinations.

Children should get a flu shot every year, starting when they are 6 months old, the CDC recommends. Children older than 6 months are also eligible for a COVID-19 shot. There is no vaccine to prevent RSV, though certain high-risk infants and children can qualify for monoclonal antibody shots that can prevent severe disease.

Children who become sick with a respiratory virus will likely be able to recover at home.

“For the vast majority of children that we’re talking about, it’s going to be a little cough and fever for a couple days and you’re going to be fine,” Smith said.

Kamath said he recommends using a humidifier and nasal aspirator (which can be purchased at most drug stores) to keep infants’ nostrils clear during their illness. Tylenol (acetaminophen) can also be used to manage symptoms of young children, he said.

For parents of young children, the most important thing to monitor is breathing, he said. Medical help should be sought immediately if a parent sees nostril flaring or rib retractions, which are both potential signs of difficultly breathing (regardless of which virus is causing it).

Kamath said he does not recommend using an at-home pulse oximeter, which can be unreliable for children and can delay professional care.

Teddy Rosenbluth covers science and healthcare for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.