Is it COVID-19, allergies, the flu or just a cold? How you can tell, based on symptoms

Flu season is in full swing, which is quite confusing in the middle of a pandemic involving a deadly virus with nearly identical symptoms.

The only way to tell if it's the flu or COVID-19, according to medical experts, is testing. 

Symptoms of COVID-19 include fever and chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headaches, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, and a loss of taste or smell. Symptoms can be mild to severe, and can appear two to 14 days after exposure.

Not sure if you have allergies, a cold, the flu, COVID-19 or a breakthrough infection? Doctors across Michigan agree: Get tested, even if you've been fully vaccinated against the virus responsible for the global pandemic. You could be contagious.

"There's no excuse. Go find out. It's as easy as getting a coffee," said Dr. Karen Kent VanGorder, chief medical and quality officer with the Sparrow Health System based in Lansing. "It's important to take responsibility for knowing you have COVID."

Doctors say flu symptoms can be very similar to COVID-19 symptoms.

Testing, said Dr. Liam Sullivan, an infectious disease specialist with Spectrum Health, a Grand Rapids-based hospital system, "is the only way to distinguish" between flu and COVID-19.

"Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis," added Dr. Sorabh Dhar, medical director of infection prevention, hospital epidemiology, and antimicrobial stewardship at the Veterans Affairs Medical Center in Detroit. 

More: Your biggest questions about COVID-19 vaccines, answered

What's the difference between the flu, COVID-19, or just a regular cold?

According to the U.S. Centers for Disease Control and Prevention, influenza and COVID-19 are both contagious respiratory illnesses, but are caused by different viruses. COVID-19 seems to spread more easily than the flu, and causes more serious illnesses in some people. It can also take longer before people show symptoms, and people can be contagious for longer.

Add colds and breakthrough infections, which occur in patients who have had the coronavirus vaccination and still get sick with the virus, to the difficulty of making a diagnosis. 

Symptoms of breakthrough infections can include significant sinus and nasal congestion, runny nose, sore throat and low-grade fever, Sullivan said. Symptoms of the common cold include runny nose, sore throat, coughing and congestion.

Dr. Diane George, a family medicine physician and chief medical officer for primary care for the Henry Ford Medical Group, said patients may be tempted to think they have a cold when they actually have a mild case of COVID-19, and decide to blow off getting tested, something she does not recommend.

"It's really about knowing, so you can protect other people, who might be at more severe risk for COVID. You don't want to spread it to people who could get seriously sick," George said. "For your own sake, it's important to know what you're dealing with in case your symptoms get worse."

And, knowing is key "because there are treatments, such as monoclonal antibody infusions, that can help prevent you from getting worse and needing hospitalization," George said.

Then there are allergies, with symptoms that can include runny or stuffy nose, itchy nose or eyes, red eyes or cough. Dhar said allergies do not usually involve fevers, difficulty breathing, muscle aches, diarrhea, nausea or vomiting. Allergies are also associated with a trigger, such as pollen, grass or pet dander.

So who should get tested for COVID-19?

Here's what Dhar recommends:

People who have symptoms of COVID-19.
Most people who have had close contact (within 6 feet for a total of 15 minutes or more over a 24-hour period) with someone with confirmed COVID-19.
Unvaccinated people who have taken part in activities that put them at higher risk for COVID-19 because they cannot physically distance to avoid exposure, such as travel, attending large social or mass gatherings, or being in crowded or poorly ventilated indoor settings.
People who have been asked or referred to get tested by their health care provider, or health department.

The CDC recently recommended that fully vaccinated people who have a known exposure to someone with suspected or confirmed COVID-19 be tested three to five days after exposure, and to wear a mask in public, indoor settings for 14 days or until they receive a negative test result.

Dhar, who responded to questions from the Free Press in an email, noted that the CDC recommends that anyone with any signs or symptoms of COVID-19 get tested, regardless of vaccination status or prior infection.

More: GM issues warning to salary workers who have not reported vaccination status

Can a fully vaccinated patient who develops a breakthrough infection give the virus to someone else?

At a briefing, the head of the CDC, Dr. Rochelle Walensky, said some vaccinated people infected with the delta variant, the dominant variant in the United States, "may be contagious and spread the virus to others."

She called this new science worrisome, and said the CDC felt it important for people to understand they have the potential to transmit the virus to others even after they've been vaccinated. She said this is especially significant should a person with a breakthrough infection be planning to visit someone with a compromised immune system. 

Vaccinated people who get breakthrough infections from the delta variant have similar amounts of virus in their system as those who were unvaccinated when they got sick, Walensky said. The CDC is continuing to study the issue "to understand the impact of forward transmission of those vaccinated people."

"But unlike the alpha variant that we had back in May, where we didn't believe that if you were vaccinated you could transmit further, this is different now with the delta variant and we're seeing now that it's actually possible that if you're a rare breakthrough infection that you can transmit further," she said.

Just how rare is a breakthrough COVID-19 case?

Internal CDC slides obtained by the Washington Post suggest breakthrough infections with the delta variant are not that rare. About 35,000 fully vaccinated people are contracting symptomatic coronavirus infections in the U.S. each week, the slides show.

Still, they suggest the Pfizer COVID-19 vaccine works against severe illness and death from the delta variant. It's 80% to 90% effective against symptomatic infection and 90% to 95% effective against severe disease in data from other countries, said Dr. Ashish Jha, dean of the Brown University School of Public Health, in a series of tweets about the CDC documents. Because the Moderna vaccine uses a similar mRNA technology, scientists say it can be assumed it performs similarly against the delta variant.

Vaccinated people are three times less likely to contract the delta variant and 10 times less likely to die from it than those who are unvaccinated, the leaked documents show, but vaccinated people are just as contagious as unvaccinated people.

The CDC documents suggest the delta variant is more transmissible than Ebola, smallpox, and polio, and spreads as easily as chicken pox. They urge public health officials to "acknowledge the war has changed," and insist that "given higher transmissibility and current vaccine coverage, universal masking is essential to reduce transmission."

If you've been vaccinated and suspect you're sick, doctors agree that you should be tested for the coronavirus.

What should I do to protect myself and loved ones?

In the midst of flu season, doctors recommend getting a flu shot and the COVID-19 vaccine, if you haven't already. And, don't let up on what you've learned during the pandemic: Wash your hands frequently, don't touch your face with your hands, social distance, and wear a mask indoors, even if you are vaccinated, if you are in areas with high rates of transmission, if you or a family member has a weakened immune system, or if it just makes you feel more comfortable.

According to the CDC, fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.

More: Stay home, even if you don't know if it's COVID-19

People who are at increased risk for severe disease include older adults and those who have certain medical conditions, such as diabetes and heart conditions, or if they are overweight or obese.

The CDC also recommends that people with compromised immune systems should wear a mask, social distance, avoid crowds and poorly ventilated indoor spaces, regardless of vaccination status.

Free Press staff writer Kristen Jordan Shamus contributed to this article.

Contact Free Press staff writerJennifer Dixon: jbdixon@freepress.com

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