"Tripledemic": Is it RSV, Flu or COVID-19

Something is making you feel sick and miserable. And unfortunately, this time of year, it could be any number of things.

Dr. Jason Bowling, chief epidemiologist at University Health, has some tips on how to distinguish between illnesses and know when to get medical attention.

When to Go to the Doctor

"The warnings for severe illness: If you are having chest pain, chest pressure, tightness in your chest, shortness of breath, particularly at rest ... those are all signs that your respiratory illness is more than just a mild illness and you need to get some medical care," Dr. Bowling said.

Sudden symptoms of confusion, having trouble remembering things or having difficulty staying awake are also signs of severe illness and need to be checked out.

Avoid Overwhelming the ER

Dr. Bowling said emergency rooms are overflowing right now with cases of respiratory viruses. You should try to see your primary care provider or go to a walk-in clinic instead of going to the ER. 

"Emergency rooms throughout the South Texas region are really busy right now. They are busy on top of the fact that respiratory viruses are up," Dr. Bowling said.

The Difference between Respiratory Viruses


Better known as the flu, influenza is the most serious of the cold-weather bugs that circulate in the fall and winter. Flu season typically starts around October and can last through May.

Symptoms of the flu include:

  • Fever
  • Headache
  • Body aches
  • Severe fatigue
  • Chills
  • Sore throat
  • Dry cough 

The hardest hit are often young children, seniors, pregnant women or those with chronic illnesses. If you have difficulty breathing, a fever over 100.4°F, chest or stomach pain, dizziness and confusion, or severe and persistent vomiting, you should consider seeking medical attention. Without the proper care and treatment, complications can worsen.

As always, the best way to prevent the flu is to get a flu shot every year. Even if the vaccine this year is not as effective, it will lessen the flu’s severity and keep you out of the hospital.

Respiratory syncytial virus (RSV)

According to the Centers for Disease Control and Prevention, RSV symptoms include:

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

There is no cure for RSV, but symptoms will typically resolve on their own within about a week or two.


By now, many of us are well-versed in recognizing symptoms of COVID-19 and knowing when to get tested. Symptoms of COVID-19 can include:

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

These symptoms may be similar to symptoms of the flu or a cold, so it is important to get tested for and vaccinated against COVID-19.

Other Reasons You May Feel Sick


A long list of other respiratory viruses (rhinovirus, enterovirus, adenovirus, parainfluenza and more) also circulate this time of year, and often wind up falling under the umbrella phrase of “colds.”

Symptoms for colds vary, but often include:

  • Runny nose
  • Congestion
  • Sneezing
  • Coughing
  • Sore throat

Unlike the flu, these viruses rarely lead to severe complications and recovery is often quicker. Over-the-counter medications can help ease symptoms of a cold, along with plenty of rest and fluids.


Allergy symptoms occur when the body mistakes harmless substances like dust or pollen for germs and attacks them as an immune response, just as when fighting viruses or other pathogens. This causes your body to release substances such as histamine, which results in inflammation.

Symptoms of allergies usually include:

  • Runny nose
  • Sneezing
  • Itchy and watery eyes
  • Coughing
  • Fatigue

For San Antonio residents, the timing of “cedar fever,” an allergic reaction to the Mountain Cedar tree commonly found in South Texas, overlaps with much of the cold and flu season.

A number of treatment options are available, including nasal rinses, antihistamines, decongestants, nasal steroids and allergy shots.


Strep throat starts very quickly. Symptoms include:

  • Pain when swallowing
  • Swollen lymph nodes
  • Fever
  • Tiny red spots on the roof of the mouth
  • Red and swollen tonsils, sometimes with white patches or streaks of pus

Strep doesn't cause a runny nose, cough or hoarseness, so if you have these symptoms, it likely isn't strep.

How to Prevent Infection

  • Get your COVID-19 and flu vaccinations if you haven’t already.
  • Wash your hands frequently – and teach your children to do the same.
  • Cover coughs and sneezes with the fold of your arm.
  • Stay home when you’re sick. 
Subscribe icon
Get healthy living and wellness information, recipes and patient stories from University Health.
View other related content by:

Tell us your patient story

Share your inspiring personal story of hope and healing at University Health.