"I'm Sick. Do I Have COVID, the Flu, or a Cold?"

GW MFA Primary Care Specialist Michael Knight, MD, MSHP, Explains the Differences Among the Three Illnesses
January 12, 2022
Michael Knight, MD, MSHP, smiles at the camera

It’s a new medical mystery, one facing everyone out and about during winter months: If you’re feeling under the weather, how can you tell if you have COVID-19, the flu, or a cold? Michael Knight, MD, MSHP, assistant professor of medicine, associate chief quality and population health officer, and patient safety officer at the George Washington University (GW) Medical Faculty Associates (MFA), explains the symptoms of each disease, what steps you can take to figure out which illness you may have, and how you can treat it.
What’s the difference between COVID-19, the flu, and the common cold? 
COVID-19, the common cold, and the flu are all upper respiratory infections caused by viruses. Unfortunately, it’s not always easy to quickly tell the difference between these conditions at this stage of the COVID-19 pandemic. Early on in the pandemic, with the original strains and the lack of a vaccine, the symptoms present in many people with COVID-19 were pretty severe. Almost all of our patients had a fever, many of them experienced a loss of taste and smell, and some progressed to severe respiratory compromise. We would tell patients, “If you have a fever, and if you have a loss of taste and smell, then it’s almost definitely going to be a COVID-19 infection.” However, now that we have vaccines, booster doses, and individuals who’ve already had a COVID-19 infection, we have individuals who have either no symptoms or very mild symptoms that almost replicate the symptoms you would have with a cold or even a minor flu.
There are a lot of similarities between the three illnesses, but there are some things to keep in mind that may be different between COVID-19, the common cold, and the flu. For example, with COVID-19, you may have a dry cough, as well as tiredness, a sore throat, loss of taste or smell, a fever, or sometimes diarrhea, nausea, or vomiting. With a cold, you may also have a cough and tiredness, but not usually diarrhea, nausea, vomiting, or a loss of taste and smell unless you have severe nasal congestion. 
The symptoms of COVID-19 are a lot more similar to the flu because of the level of severity you can see with these viral illnesses. The biggest difference between those two is that you rarely lose your sense of taste or smell with the flu, where that is possible with COVID-19. Almost every other symptom between the flu and COVID-19 is very similar. At this point, it really comes down to testing, and that is the way to tell the difference.
In that case, if you’re unsure of what you have, should your default be getting tested for COVID-19?
Yes, testing is the only way to fully differentiate COVID-19, a cold, and the flu. If you’re in doubt, and you have access to testing, get tested. If you are really concerned – maybe a friend of yours called and told you they’ve been diagnosed with COVID-19, you were in close proximity to them, and now you have developed what seems like a cold – it’s important for you to quarantine. Separate yourself from others in unmasked situations, and get tested for COVID-19. It’s very possible that you may have contracted COVID-19, even if you don’t have the symptoms that are common, like a cough, fever, or a loss of taste or smell. It may just be a scratchy throat that you are having, but you still may be harboring a COVID-19 infection that could be spread to others.
What are the best ways to manage your symptoms with each?
When you treat a viral illness, unless you’re using antivirals or monoclonal antibodies, you’re treating your symptoms and not the virus itself. Antivirals and monoclonal antibodies are currently available for COVID-19 patients at very high risk for, or who have developed, severe symptoms such as respiratory compromise requiring hospitalization or being on a ventilator. Antiviral medications are also available for patients with the flu.
For patients with mild symptoms, what we use to treat the cough, congestion, and fever in these conditions are over-the-counter products such as decongestants and fever reducers. These are medications that you’d find in the cold and flu aisle of your local pharmacy that are going to work for all three conditions.
What are the top five things that you recommend having on hand in case you get sick?
First, I would recommend having a thermometer. If you take your temperature and you have a fever, then it’s possible that you either have a COVID-19 infection or the flu. It’s not that common to have a fever with a cold. With COVID-19 or the flu, you really want to avoid being around other people if you have a fever because you can spread the infection to others. 
Second, I would recommend an antipyretic, which is anti-fever medication. That’s medication like acetaminophen that goes under the brand name of Tylenol, and it’s a product to have on hand. If you have a condition where you can’t take Tylenol, such as a liver condition, you may want to have something like ibuprofen available because that can also bring down a fever. 
Third, I would suggest having a good decongestant and a cough suppressant. Medication such as Dayquil or Robitussin DM have both. That’s going to be really important because the most common symptoms for all three (COVID-19, flu, and common cold) are congestion and cough. 
Finally, having fluids on hand is important. Whether it is water or liquid drinks that have electrolytes, such as Gatorade, it is important to stay hydrated. [Meals] with chicken soup, fruits and vegetables, or any kind of nutritious food also help to make sure that you are getting the vitamins and minerals that you need to help your immune system fight infection.
What are common misconceptions about treating a cold or fever?
The most common misconception is that you need antibiotics to treat a cold, COVID-19, or the flu. We have to remember these are all viral illnesses. Antibiotics are for bacterial illnesses, which is not the same. What you need to focus on is rest, hydration, nutritious food, and symptom control with over-the-counter products for mild to moderate symptoms.
How can GW help patients struggling with COVID, the flu, or a cold?
Patients struggling with mild symptoms for these conditions can be treated at one of our primary care locations. We also offer telemedicine visits in our primary care practices so that we can help patients who are having active symptoms that need a bit more counseling remotely. 
Patients wanting to know when they need to call for help if their symptoms get severe can always reach out to the MFA. They can schedule an appointment with one of our primary care providers at our main campus in Foggy Bottom in D.C. or at our community practices, including our immediate and primary care locations in other parts of D.C. – Rhode Island Avenue, Cleveland Park, and McPherson Square, or at our new primary care locations in Alexandria and Silver Spring.

To make an appointment with a primary care physician, visit GW Primary Care or call 202-741-2222.

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