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I Feel Sick. How Do I Know If I Have The Flu, COVID, RSV Or Something Else?
You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed?
Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough.
Best case scenario is that you have "a cold" (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting.
But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have.
Respiratory syncytial virus (RSV)For most people an RSV infection will feel like "a cold" – annoying, but only lasting a few days.
However, for babies, older adults and people with immune issues, it can lead to bronchiolitis or pneumonia, and even become life-threatening.
RSV isn't seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it disappearing almost completely during COVID lockdowns.
There is now a rapid-antigen test (RAT) for RSV which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms.
Recently, a preventative immune therapy has become available for high risk babies (nirsevimab) and there are also vaccines for higher risk adults. Nirsevimab is also available to all babies for free in Western Australia and Queensland.
A preventative immune therapymmune therapy is available for at-risk babies (and in some states, all babies). Polkadot_photo/ShutterstockBut there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to manage symptoms).
Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth).
If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised.
InfluenzaOnce you have had the "true flu" (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a "flu".
Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy.
Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and 290,000 to 650,000 respiratory deaths annually.
People who are at greater risk of complications from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is recommended and funded for vulnerable people.
Vaccination is also readily available for all Australians who want it, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In some states, it's free for all residents.
Vaccination usually costs less than $30 or is free for at-risk groups. 89stocker/ShutterstockInfluenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn.
If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap.
Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also prescribe antivirals to vulnerable patients; these work best if started within 48 hours of symptoms.
COVIDIt has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a public health emergency, it still causes more deaths than influenza and RSV combined.
Unlike RSV and influenza, only those aged over 70 are in a high-risk age group for COVID. Other factors besides age may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease.
Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels.
Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last more than 12 weeks, without any other explanation for symptoms, it's called long COVID.
Some people experience symptoms for weeks or months. Gorodenkoff/ShutterstockCOVID vaccines can prevent serious illness and have been monitored for several years now for their safety and effectiveness. Current vaccination recommendations are based on age and immune status. It's worth discussing them with your doctor if you are unsure whether you would benefit or not.
Antivirals can treat COVID in higher-risk people who contract it, whether vaccinated or not.
Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the general principles are always: avoid spreading the virus to others, and give yourself time to rest and recover.
What if it's not one of those?So you've done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be?
More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even undefined pathogens.
If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it's worth getting assessed by a GP who may do a chest Xray and/or test your sputum, particularly if they suspect pneumonia.
You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it's worth getting tested, in case antibiotics will help.
However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful antibiotic resistance and give you unwanted side effects.
Is A Persistent Cough A Cause For Worry? Doctors Say It's Not Always Linked To Lung Infection
SINGAPORE — You may have had this experience before: You have recovered from a cold or a flu but that pesky cough continues to linger. Not only is a nagging cough annoying, it can also be exhausting and cause broken sleep.
For some, a persistent cough may even be an alarm bell for something more serious such as lung cancer.
When is a persistent cough a cause for worry, and what can be done to relieve it?
WHAT IS A PERSISTENT COUGH?Coughing is a protective natural reflex intended to clear the airways of excessive secretions and foreign particles.
There are several reasons why some coughs persists for weeks or even months.
Dr Jessica Tan Han Ying said that a cough that lasts more than eight weeks in adults and more than four weeks in children is a "chronic cough".
She is a senior consultant and head of department of respiratory medicine at Sengkang General Hospital (SKH).
Although there is no formal domestic data on chronic cough, doctors from SKH and Tan Tock Seng Hospital (TTSH) told TODAY that in recent years, they have observed an increase in patients suffering from persistent cough being referred to them.
Dr Tan from SKH estimated a 25 to 30 per cent increase in patients at the hospital seeking medical attention for prolonged cough, compared to the period before the Covid-19 pandemic. These cases may not always be related to a preceding Covid-19 infection.
Every month, Dr Tan Wei Jie from Dtap Clinic, a private clinic, sees around two to three patients with chronic cough requiring treatment.
"In my general practitioner practice, many older adults have chronic cough due to years of smoking, while the non-smokers may have underlying infections or heart conditions," he said.
WHAT CAUSES CHRONIC COUGHA long-lasting cough can also affect younger adults and in such cases, doctors said that there can be many reasons for its persistence.
1. INFECTION
Based on Dr Anna Lau's experience, the most common cause of a persistent or chronic cough in younger adults is one that lingers after a viral infection such as Covid-19 or an upper airway cough syndrome.
Dr Lau is an associate consultant with TTSH's department of respiratory and critical care medicine.
"After a viral infection, patients can also continue coughing for a fairly long period of time. This is due to the inflammatory cascade that was triggered by the previous infection, leading to hypersensitivity of the airway," she explained.
An inflammatory cascade is a chain of reaction triggered by the body's immune system when it detects something harmful such as an infection or injury.
However, this response can sometimes lead to increased sensitivity and prolonged inflammation, contributing to conditions such as a chronic cough.
2. MEDICATION
For people experiencing a persistent cough, it is also important to consider other possible causes not related to the lungs that may require a different course of treatment altogether, Dr Tan from Dtap Clinic said.
For example, a dry cough is commonly a reported side effect of certain medications used to control blood pressure.
3. NOSE
Allergic rhinitis is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air.
It can cause a post-nasal drip, which can then make it hard to shake off a cough.
Excessive mucus may accumulate at the back of the throat and nasal passages, and "drip" down and irritate the throat, triggering a cough reflex, Dr Tan from SKH explained.
4. STOMACH
People who have chronic gastric problems may also have chronic cough. For those with gastroesophageal reflux disease (Gerd), stomach acid moves up into the oesophagus, the pipe connecting to the throat.
"Sometimes, acidic content may reach the throat and airways, irritating the lining of the throat and triggering a cough reflex as our body attempts to clear the irritation," she added.
WHEN TO SEEK MEDICAL ATTENTION FOR A PERSISTENT COUGHDr Tan from SKH advised people to see a doctor if a cough persists eight weeks after a bout of acute respiratory infection.
Patients are generally advised to consult a general practitioner, who will make a referral to a specialist if needed.
However, Dr Tan from Dtap Clinic suggested seeing a doctor earlier if the cough does not improve after more than two weeks, and especially if there are more serious symptoms.
For example, if it is accompanied by shortness of breath, chest pain, prolonged fever, low energy or if the person is coughing out greenish or yellowish phlegm.
Other more serious symptoms include weight loss and coughing out blood.
"You don't want to miss an important diagnosis that may jeopardise your health in the long term," he said.
Studies have shown that patients whose coughs lasts a long time experience frustration, fatigue, interrupted sleep and impaired quality of life.
In a multi-centre study published in 2019 in Lung, a medical journal that covers pulmonary medicine, almost all of the patients reported that chronic cough substantially affected their daily lives, with the worst seen in those whose cough remains unexplained.
Dr Lau from TTSH said that chronic cough "is definitely something that burdens our patients greatly".
"Without proper assessment and treatment of the underlying cause, the cough may not resolve. Managing the underlying cause is the key to managing chronic cough."
WHY IDENTIFYING ROOT CAUSE OF CHRONIC COUGH IS VITALTreating the symptoms without identifying the root cause of the chronic cough may potentially result in a worsening of symptoms due to complications or missing out an important diagnosis that may be life-threatening, Dr Tan from Dtap Clinic said.
To diagnose the underlying cause, the doctor typically takes into account the thorough history of the symptoms, followed by performing a full physical examination, he added.
This includes taking temperature, looking in the throat and listening to the lungs and heart.
"Based on the symptoms presented and the examination findings, we would then be able to come up with a preliminary diagnosis and advise on the appropriate treatment.
"For some cases of persistent cough, doctors may order a chest X-ray to further evaluate the condition," he said.
CAN A CHEST X-RAY ALONE GIVE A DIAGNOSIS?In general, all patients with chronic cough at TTSH's respiratory clinic undergo a chest X-ray, Dr Lau said.
"Chest radiograph (X-ray) is easily available and is a good screening test for any major and significant lung abnormality such as lung mass or any signs of chronic lung disease.
"But more often than not, we will not be able to come to a diagnosis with just a chest X-ray alone," she added.
Further investigations may be carried out. For example, a lung function test may be done if airway disease such as asthma is a concern.
A computed tomography (CT) scan of the thorax — the part of the body below the neck and above the waist — may be used in selective cases where diagnoses such as bronchiectasis, interstitial lung disease or lung cancer are suspected, Dr Tan from SKH said.
A culture and analysis of a patient's sputum or fluids connected to the lungs may be used to detect infections such as pulmonary tuberculosis.
Depending on the cause of the cough, treatments vary.
For example, with asthma, inhaled corticosteroids may be used, whereas people who have gastric reflux may be asked to modify their diet and prescribed medications that suppress gastric acid production, she added.
Dr Lau from TTSH said that there are also some cases where there is no identifiable cause, and this is known as idiopathic chronic cough.
"In this group of patients, we will consider medications that act directly on nerves."
An idiopathic chronic cough is uncommon and this diagnosis is made only if the physician is unable to identify any cause, despite extensive investigation. Dr Lau added.
It is not related to any psychological condition and not psychologically induced.
HOW TO MANAGE A CHRONIC COUGHFor people suffering from a lingering cough, the doctors gave general tips on how to manage it at home:
What Is Teflon Flu? Symptoms To Watch Out For
A recent report by the Washington Post suggests that US poison centres have received over 3,600 reports of Teflon flu in the last 20 years. Teflon flu, also known as polymer fume fever, is a flu-like illness caused by inhaling the byproducts released when fluorocarbons degrade at high temperatures, as per StatPearls Publishing. In simple terms, it is a temporary flu-like condition caused by inhaling fumes from overheated non-stick cookware coated with polytetrafluoroethylene (PTFE), commonly known as Teflon, explains Dr Manjeeta Nath Das, Consultant - Internal Medicine, Manipal Hospital, Dwarka.
In this article, we discuss some of the common symptoms associated with the condition and how we can safely use non-stick pans without exposing ourselves to danger.
Also Read: Why Is Stainless Steel A Necessary Ingredient In The Recipe For An Ideal Kitchen?
Common Symptoms Of Teflon Flu"Teflon flu usually occurs when non-stick cookware coated with PTFE is heated above 500°F (260°C), releasing fumes that can irritate the respiratory system," says Dr Das.
PTFE is a synthetic material known for its nonstick and heat-resistant properties. Commonly recognised by the brand name Teflon, PTFE is often used to coat cookware, making it easier to cook and clean.
Patients with polymer fume fever typically experience symptoms such as fever, malaise, difficulty breathing, chest tightness, and a dry cough.
According to Dr Das, these symptoms usually appear a few hours after exposure and can last for up to 48 hours.
It is also important to note that symptoms in humans generally do not begin until the material is heated to 350 °C (662 °F), as per a 2023 article published in StatPearls Publishing.
Also Read: Preventing Food-Borne Illness: FSSAI Tips For Safe And Healthy Meals At Home
How To Safely Use Non-Stick PanResearch suggests using non-stick pans coated with PTFE is safe, given that you follow proper instructions and guidelines. Dr Das shares a few safety measures that can help. These include:
While non-stick cookwares make your lives much easier, they must be used with caution. Such utensils, particularly those coated with PTFE, pose potential health risks associated with overheating these materials, which can release toxic fumes leading to polymer fume fever, also known as Teflon flu. This condition, while usually causing temporary flu-like symptoms, highlights the need for proper use and ventilation when using non-stick cookware to prevent exposure. Safe cooking practices and maintaining awareness of these risks can help mitigate potential health issues associated with non-stick utensils.
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