RSV vs. COVID-19: Symptoms To Watch For

It's easy to assume if you suddenly develop a cough and fever, COVID-19 is to blame. But another virus, called respiratory syncytial virus (RSV), is also possible. Because the symptoms of RSV and COVID-19 are so similar, it can be difficult to tell what virus you might have.

The Centers for Disease Control and Prevention (CDC) notes that RSV can cause severe disease in children and older adults, so it's important to identify it as soon as possible. Additionally, COVID-19 can cause severe symptoms in older adults and people with weakened immune systems.

So, how can you tell the difference between RSV and COVID-19? Here's what you need to know about the symptoms and differences between those contagious viruses and when to seek help from a healthcare provider.

What Is RSV?

RSV is a common respiratory virus that usually causes mild, cold-like symptoms in most people. It spreads in a few different ways, which include:

• When an infected person coughs or sneezes near you
• When virus droplets from a cough or sneeze get in your eyes, nose, or mouth
• When you touch a surface that has the virus on it, like a countertop, and later touch your face before washing your hands
• When you have direct contact with RSV—for example, by kissing the face or mouth of someone who has the virus

While RSV cases are usually mild, they can sometimes become serious. In children under 1 year old, some of the most common complications of RSV include bronchiolitis (inflammation of the small airways in the lung) and pneumonia (an infection of the lungs).

RSV causes about 58,000 hospitalizations and up to 500 deaths yearly in children under 5 years old. The illness also causes 60,000 to 120,000 hospitalizations and 6,000 to 10,000 deaths in adults aged 65 years or older.

RSV Symptoms

Symptoms of RSV are very similar to the common cold, flu, and COVID-19 and commonly include:

• Coughing
• Decrease in appetite
• Fever
• Runny nose
• Sneezing
• Wheezing

COVID-19 Symptoms

COVID-19 is an infectious disease caused by the novel coronavirus, SARS-CoV-2. COVID-19 is mostly a respiratory infection but can impact other organs.

Some of the most common symptoms of COVID-19 may include the following:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Swollen tongue
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

COVID-19 can cause serious complications, like pneumonia, and a range of illnesses known as post-COVID conditions. Post-COVID conditions, also known as long COVID, can include difficulty breathing, fatigue, headache, diarrhea, and persistent loss of taste and smell.

Can You Get COVID-19 and RSV at the Same Time?

Unfortunately, yes, you can get RSV and COVID-19 simultaneously. 

"Double infections can occur," Amesh A. Adalja, MD, infectious disease expert and a senior scholar at the Johns Hopkins Center for Health Security, told Health. 

There isn't a lot of data to show how often double infections occur, but some evidence suggests that it's possible. For example, a study published in 2021 in the Medical Science Monitor examined 78 people in China and found that 11 had a so-called co-infection. Of those 11 people, four had RSV in addition to COVID-19.

"It's not so common, but it's definitely not impossible," Daniel Ganjian, MD, a pediatrician at Providence Saint John's Health Center in Santa Monica, Calif., told Health.

Additionally, a retrospective study published in 2020 in Infection Control and Hospital Epidemiology analyzed data from 862 people at two medical centers in Chicago who tested positive for COVID-19 from March 9, 2020, to April 30, 2020. Two of those people tested positive for COVID-19 and RSV or the flu.

So, how does someone end up with RSV and COVID-19? 

"It just depends upon exposure," noted Dr. Adalja. Essentially, it comes down to being unlucky enough to be exposed to both viruses around the same time. 

But overall, co-infection is not a common occurrence. 

"It would be unusual to be infected with RSV and COVID-19 simultaneously," Richard Watkins, MD, an infectious disease expert, and professor of internal medicine at Northeast Ohio Medical University, told Health. However, Dr. Watkins added that people who are immunocompromised or not vaccinated against COVID-19 are at a higher risk than others.

RSV vs. COVID-19: How To Tell the Difference

If you or your child develops symptoms, it's more than understandable to want to know what is causing them. Unfortunately, even a healthcare provider is unlikely to know just by doing an exam. 

"The acute illnesses for both are very similar clinically," explained Dr. Watkins. Still, clues may crop up to help you distinguish between the two viruses. 

"COVID-19 can sometimes cause vomiting, diarrhea, and a rash, which you don't see with RSV," noted Dr. Ganjian.

However, Dr. Adalja agreed that it could be challenging to parse those symptoms out. 

"There's no way to really distinguish the two conditions without a test," noted Dr. Adalja. 

It may be helpful to consult a healthcare provider if you or a family member develops suspicious symptoms. They'll likely want to test you for both infections.

A Quick Review

It can be challenging to tell the difference between COVID-19 and RSV. However, the presentation and symptoms of the diseases are relatively similar. If you suspect you have been exposed to RSV or COVID-19, or are having symptoms of either disease, contact a healthcare provider to receive tests.