Respiratory Viruses

Flu, COVID-19 and RSV

Influenza (flu), COVID-19, and Respiratory Syncytial Virus (RSV) are common respiratory illnesses caused by viruses. They affect your lungs, airways, nose and throat, making it hard to breathe. You can catch these viruses any time of year, but respiratory virus illness activity peaks in the fall and winter months. The best way to protect yourself is to receive your seasonal vaccinations.

Flu, COVID-19, and RSV spread the same way

A person who has flu, COVID-19, or RSV coughs or sneezes near you and droplets from a cough or sneeze that contain the virus get in your eyes, nose, or mouth.
You have direct contact with someone with flu, COVID-19 or RSV, like kissing the face of a child with who is sick.
You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands.

Anyone can get sick with a respiratory illness, but some are more likely to get very sick including:

children under 5.
adults over 65 or people with certain medical conditions, such as chronic lung disease, heart disease or a weakened immune system.
people with certain medical conditions.
people who are unvaccinated or not up to date vaccinations.

Flu, COVID-19, and RSV can cause many of the same symptoms. Cough, headache, congested or runny nose, sneezing, fatigue, and fever are all common symptoms of viral respiratory illness. You may also experience shortness of breath or loss of taste and smell with COVID-19.

Go to the emergency room if you start to have any of these symptoms:

Difficulty breathing or shortness of breath
Persistent pain or pressure in the chest or abdomen
Persistent dizziness, confusion, inability to arouse
Seizures
Not urinating
Severe muscle pain
Severe weakness or unsteadiness
Fever or cough that improve but then return or worsen
Worsening of chronic medical conditions

Take your child to the emergency room if they show any of these symptoms:

Fast breathing or trouble breathing
Bluish lips or face
Ribs pulling in with each breath
Chest pain
Severe muscle pain (child refuses to walk)
Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
Not alert or interacting when awake
Seizures
Fever above 104 degrees Fahrenheit that is not controlled by fever-reducing medicine
In children younger than 12 weeks, any fever
Fever or cough that improve but then return or worsen
Worsening of chronic medical conditions

Flu symptoms usually appear 1-4 days after exposure to the virus, with an average incubation period of 2 days. Most people will feel better after 5-7 days. For some people, especially children, older adults and people with weakened immune systems, fatigue or coughing may stick around even longer.

You can spread flu to others 1 day before and up to 8 days after symptoms appear. You are most contagious during the first 3 days after symptoms start. It is possible to spread flu to others even if you don’t have any symptoms. Some people, including young children and people with weakened immune systems may be contagious for longer periods of time.

COVID-19 symptoms appear 2-14 days after exposure to the virus, with an average incubation period of 5 days. Most people will feel better in about 1-2 weeks. Recovery can take longer if your illness is severe or you have a weakened immune system.

You can spread COVID-19 1-2 days before and up to 8-10 days after symptoms appear. You are most contagious 1-2 days before and after your symptoms begin. It is possible to spread COVID to others even if you don’t have any symptoms.

RSV symptoms usually start 4 to 6 days after exposure to the virus. Most people will feel better in about 1-2 weeks. Recovery can take longer if your illness is severe or you have a weakened immune system.

You can spread RSV for 3 to 8 days after symptoms appear. Research on RSV suggests that you are contagious 1-2 days before you start showing symptoms. However, some infants and people with weakened immune systems can continue to spread the virus for 4 weeks or longer, even after they stop showing symptoms.

See a healthcare provider if:

Your symptoms are not getting better or are getting worse
You have a high fever or a fever that doesn’t go away after a few days
You’re older or have ongoing health concerns

Go to the emergency room if you have any of these symptoms:

Difficulty breathing or shortness of breath
Pain or pressure in the chest or belly
Sudden or persistent dizziness
Not urinating
Confusion
Severe muscle pain or weakness
Severe or repeated vomiting
Fever or cough that get better but then return or worsen
Worsening of chronic medical conditions

If your child or infant is sick, take them to the emergency if they have any of these symptoms:

Fast breathing or trouble breathing
Bluish skin color
Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
Pain or pressure in chest or belly
Being so irritable that the child does not want to be held
Not waking up or not interacting
Severe or repeated vomiting
Sudden dizziness
Confusion
Flu-like symptoms that get better but then return with fever and worse cough
Fever above 104 degrees Fahrenheit that is not controlled by fever-reducing medicine.
Fever of 100.4 degrees Fahrenheit or higher for children younger than 3 months regardless of using fever-reducing medicines.

How can I protect myself and my family from respiratory illnesses?

Vaccines are the best protection against viral respiratory illnesses. These vaccines reduce the risk of illness and potentially serious complications that can result in hospitalization or even death. Flu, COVID-19, and RSV vaccinations can all be administered at the same time.

Flu and COVID-19

The flu and COVID-19 vaccines are recommended for everyone ages 6 months and older.
Flu and COVID vaccines are updated each year and annual vaccination is recommended.
After you get your shots, it takes about 2 weeks for your body to build full protection against respiratory illness.
Protection against flu and COVID infection is strongest in the first 3 months after getting vaccinated. For this reason, we recommend getting your annual flu and COVID shots in the fall, so your immunity is strong during the holiday season when respiratory virus activity is at its highest. If you miss get the shots in the fall, you can still get vaccinated in November or later.

RSV

The RSV vaccine is recommended for adults ages 50 – 69 who are at increased risk of severe RSV illness and all adults ages 70 and older.
Pregnant women should receive the RSV vaccine during week 32 – 36 of pregnancy to help protect their newborns. Currently, eligible adults only need to get the RSV vaccine once.
Infants can be protected from RSV in 2 ways. They can get antibodies from their mother who was vaccinated during pregnancy, or they can get long-acting monoclonal antibodies (mAb) after they are born. These monoclonal antibodies are different from vaccines in that they do not train the immune system to recognize and protect against RSV. Instead, the antibodies themselves protect against RSV.
Infants younger that 8 months should receive RSV mAb shortly before respiratory illness season begins in the fall. Babies born during October through March (when RSV activity is highest) should ideally receive RSV mAb before they leave the hospital after being born. RSV mAb are recommended for some children ages 8 – 19 months who are higher risk for severe RSV illness. Talk to your child’s doctor about the best option for protecting them from RSV.

Prevention Tips

In addition to vaccines, these everyday actions can lower your risk of getting sick:

Close up of hands being washed in a sink with soap and water.

Wash your hands often with soap and water. Scrub your hands with soap under running water for 20 seconds. If soap and water are not available, use an alcohol-based hand rub.

A man sneezing with his other hand out indicating, "stop."

Avoid close contact with people who are sick.

man in a white long sleeve shirt holding his glasses and rubbing his eyes.

Avoid touching your eyes, nose, and mouth. This is often how viruses enter the body.

If you are sick

If you are already sick, you can avoid spreading your illness by staying home and away from others as much as possible. Stay home for at least 24 hours after your fever is gone without using fever-reducing medication. Only go out to seek medical care.

Increasing ventilation in your home can also help reduce the spread of respiratory viruses to the people you live with. Ventilation removes indoor air that may be concentrated with airborne viruses and replaces it with fresh outdoor air. You can increase ventilation by opening windows and doors (when it’s safe to do so) and turning on exhaust, window, or attic fans.

If you do go out, wearing a mask can stop respiratory droplets from being released into the air where another person might breathe them in. Cover your nose and mouth with a tissue when you cough or sneeze when not wearing a mask.

A hand holding a swab into a COVID-19 at home testing vial. Other testing material is also on the table.

Testing Options

Knowing which respiratory virus you have can determine what treatment you need to get better. Most healthcare providers, including urgent cares or walk-in clinics, can test for flu, COVID, and RSV. You can also purchase at-home tests at most pharmacies or grocery stores. Many of these tests can detect all of these three respiratory viruses.

Treatment Options

Most cases of viral respiratory illness will get better on their own. When you are sick stay at home, drink plenty of fluids, and rest. Over the counter medications, like acetaminophen or Ibuprofen, can help reduce your fever and ease pain. Carefully read the instructions and warnings on the package insert for all medication you take. If you are pregnant, or have any medical conditions, check with your healthcare provider before taking any medications.

If you test positive for flu or COVID-19 and you have or are at risk for severe illness, your doctor can prescribe antiviral medications. These medications work best when they are started soon after your symptoms start. They can ease symptoms, shorten the length of time you’re sick, and reduce risk of complications.

There is no specific treatment for RSV.

Get the facts

elderly man in a white long sleeve shirt and black vest and woman in a red jacket walking outside.

Fact:

Adults, especially those 60 years and older or with certain health conditions, can be at risk for severe RSV illness. RSV can lead to conditions like pneumonia and worsening of COPD.

Learn More

orange and white pill capsules spilling out of a pill bottle onto an orange surface

Fact:

Antibiotics do not work on viruses. When antibiotics aren't needed, they won't help you, and their side effects could still cause harm. Side effects can range from mild reactions, like a rash, to more serious health problems.

Learn More

hands in surgical gloves holding a vial and a needle.

Fact:

Flu vaccines cannot cause flu illness. Flu vaccines given with a needle (i.e., flu shots) are made with either inactivated (killed) viruses, or with only a single protein from an influenza virus. The nasal spray vaccine contains live viruses that are weakened so that they will not cause illness.

Learn More

Provider information

Cases of influenza, COVID-19, and RSV that require hospitalization are Class B reportable conditions, meaning they must be reported to CDPH by the end of the next business day. These cases are not automatically reported by Electronic Lab Reporting like many other conditions, so you must report by phone at (216) 664-3747 or email (disease@clevelandohio.gov). Positive test results for cases that do not require hospitalization are not reportable.

Recommendations for Infection Prevention and Control in Healthcare Settings

Achieving high vaccination rates of healthcare personnel (HCP) and patients is a critical step in preventing viral respiratory illness in healthcare personnel, and helps to reduce the risk of healthcare transmission of respiratory illness from HCP to patients and from patients to HCP.
When scheduling appointments, instruct patients and people who accompany them to inform HCP upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever) and to take appropriate preventive actions (e.g., wear a facemask upon entry, follow triage procedure).
Take steps to ensure all people with symptoms of a respiratory infection adhere to respiratory hygiene, cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. Provide facemasks to patients with symptoms of respiratory infection.
Implement droplet precautions for patients with suspected or confirmed influenza, COVID, or RSV.