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COVID-19 or Influenza - How to Tell


  • COVID-19 infections are widespread in most communities.
  • During the winter, influenza (flu) infections also become widespread.
  • Here is some advice on what to do when both viruses are in town.
  • Updated: May 4, 2021

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About This Topic

COVID-19 and Flu - How They are Similar

  • Presenting Symptoms. They are nearly the same. You will not be able to tell them apart when you are sick. Fever and cough are the most common symptoms for both. Other respiratory symptoms such as sore throat and runny nose are common for both. Muscle aches and feeling very tired are seen with both. The only helpful symptom is loss of taste or smell. It points to COVID-19, but it only occurs in 15% of patients. It also occurs rarely with flu.
  • Viral Tests. Tests are available for both viruses. Both are done with nose or throat swabs. Testing is the only way to tell the right diagnosis. It's the only way to know for sure what someone has.
  • Types of Complications. These are nearly the same. The most common serious symptom is trouble breathing (shortness of breath). It usually means the patient has developed pneumonia. Other complications in young children are croup or wheezing (tight breathing). They are due to a smaller airway and can occur with either virus. The rate of complications, however, is higher with COVID-19.
  • High-Risk Factors for Complications. The most common high-risk factors are lung disease, heart disease, diabetes and obesity. The CDC high-risk patient list for influenza is similar to the evolving list for patients with COVID-19.
  • How it Spreads. Both are spread person-to-person by respiratory droplets. Droplets are produced by coughing, sneezing, shouting or singing. They get inhaled by a nearby person or quickly fall to the floor or ground. COVID-19 is more contagious than flu and can sometimes spread through the air when people are close together indoors.
  • Infections without Symptoms. Both infections can occur without causing any symptoms (asymptomatic people). This occurs around 30% or more of the time for both. These people can transmit the disease to others (spreaders). But, spread is at a much lower rate than for people with symptoms. This is one reason why well people should wear masks.
  • Home Treatment. It's the same. Treat the symptoms that bother you the most. Provide symptom relief as needed for the cough, sore throat and fever. Drink extra fluids and stay well hydrated. When tired, get extra rest. See the COVID-19 Diagnosed or Suspected handout for details.
  • Prevention. Getting the vaccines can help prevent both diseases. Wearing face masks, extra hand washing and social distancing have been proven to help prevent both diseases.

COVID-19 and Flu - How They Differ

  • Antiviral Medication. Prescription antivirals given by mouth (such as Tamiflu) are only available for influenza. They are mainly prescribed for sick patients who also are high-risk for complications. Healthy people don't need antiviral medication if they get flu. An antiviral for COVID-19 is sometimes given by vein (IV) to very ill patients in the hospital.
  • Home Quarantine for Exposed People without Symptoms. Following close contact with someone who is sick with COVID-19, staying home is required. This is usually for 10 days. Following close contact with someone who is sick with flu, staying home is not required, unless symptoms occur. Home quarantine means avoiding other people.
  • Home Isolation for Sick People with Symptoms. Home isolation for COVID-19 is required for 10 days or longer. Home isolation for flu is only recommended until the fever has been gone for at least 24 hours. Reason: COVID-19 is far more dangerous than flu.
  • Symptom Onset after Exposure. The incubation period is how many days after close contact with a sick person the symptoms start. Flu starts faster. Flu symptoms start on the average 2 or 3 days after exposure to a sick person. COVID-19 symptoms start on the average 5-7 days after exposure.
  • Time of Year. Influenza is seasonal, usually October to April. It peaks December through February. COVID-19 is not seasonal. It will not go away in the spring like influenza.
  • Severity and Death Rate. COVID-19 is far more dangerous than flu. Up to 20% of adult patients develop trouble breathing. This is less common in children. COVID-19 has a higher complication rate and ICU admission rate than flu. The death rate for adults is around 6 per 1000 cases. COVID-19 causes about 10 times more deaths than seasonal flu in those who get it.

Trusted Sources for Accurate COVID-19 Information - CDC and AAP

  • To meet the high demand for COVID-19 information, when possible, find your answers online. Here are the most reliable websites:
  • CDC website: https://www.cdc.gov/coronavirus
  • American Academy of Pediatrics parent website: www.healthychildren.org
  • Always follow the most current CDC recommendations if they are different than those in this document.

After Care Advice

  • Do everything in your power not to get either of these infections.
  • Getting both infections at the same time could cause more severe complications.
  • Getting them close together is also risky. The first one could weaken your body for when the second one starts.
  • Become an expert on prevention. Trust the science.
  • Here is some advice to help you get through this flu season.
Influenza Vaccine - Be Smart and Get Your Flu Shot:
  • Getting your annual flu shot is the best way to protect your family from flu.
  • This year is more important than ever. Reason: Getting COVID-19 while you also have the flu or are recovering from it may increase the chances of getting severe complications.
  • Flu vaccines are strongly advised for all children over 6 months of age. (AAP)
  • All adults should get a flu shot, not just those at higher risk for complications.
  • Most often, the flu shot prevents getting any flu infection. If the vaccine does not cover a new flu virus and you get it, the shot still helps to reduce your symptoms.
  • Getting the flu shot will turn on and rev up your immune system. Research shows that it might even reduce your chances of getting COVID-19.
COVID-19 Vaccine - Get Your COVID-19 Shot:
  • Vaccines have saved more lives than any other public health measure. They are the most powerful weapon we have against deadly infectious diseases. Follow the science.
  • Safe and highly effective vaccines are available. Some vaccines are 2 doses, given 3-4 weeks apart. Others are a single dose. Similar to flu shots, they will probably provide protection for 6 to 9 months. At this time, vaccines have been tested and are FDA approved for 12 years and older. Trials on children younger than 12 years have started (May 2021).
  • Get a COVID-19 vaccine. It could save your life and prevent chronic "long hauler" symptoms.
  • Find a nearby vaccine site at vaccines.gov or call your doctor's office.
Protect Your Family from Catching COVID-19 and Flu:
  • Wash your hands often with soap and water. Always wash before eating.
  • Use an alcohol-based hand sanitizer, if water is not available. Note: Soap and water works even better.
  • Don't touch your eyes, nose or mouth unless your hands are clean. Germs on your hands can get into your body this way.
  • Try to avoid contact with sick people.
  • Face masks. Wear a mask when you go outside your home. Face masks reduce the spread of both infections. Even after you get the vaccine, face masks offer additional protection.
  • Social (Safe) Distancing. Try to stay at least 6 feet (2 meters) away from anyone who is sick. Avoid crowds because you can't tell who might be sick.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2021 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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