When you feel congestion coming on it can mean many things, especially in the winter. Respiratory syncytial virus (RSV) causes acute respiratory infection, ranging from mild, cold-like symptoms to more serious illness. RSV infections typically spike in the winter.

Just like influenza (flu) and COVID-19, RSV is a respiratory virus, and it can be difficult to tell respiratory viruses apart without testing.

Symptoms of RSV are similar to flu and COVID-19:

RSV Symptoms

• Fever
• Cough
• Congestion (runny nose)
• Sneezing
• Wheezing
• Decrease in appetite

For very young infants (six months and younger) with RSV, the main symptoms may be:

• Irritability
• Less activity
• Difficulty breathing
• Apnea (pauses in breathing), which may lead to needing mechanical ventilation

Flu Symptoms

• Fever and/or chills
• Cough
• Congestion (runny or stuffy nose)
• Sore throat
• Body aches or muscle pain
• Headache
• Tiredness (fatigue)
• Gastrointestinal symptoms like nausea, vomiting or diarrhea (more common in children than adults)

COVID-19 Symptoms

• Shortness of breath or difficulty breathing
• Fever and/or chills
• Cough
• Congestion (runny or stuffy nose)
• Sore throat
• Muscle or body aches
• Headache
• Tiredness (fatigue)
• Gastrointestinal symptoms like nausea, vomiting or diarrhea
• New loss of taste or smell

Key Differences Between the Three Viruses

While there is a fair amount of symptom overlap between RSV, flu and COVID-19, there are key differences to watch for:

• You are more likely to experience a headache with flu and COVID-19 than you are with RSV.
• Both COVID-19 and RSV can cause difficulty breathing due to inflammation of the small airway. However, with COVID-19, you are more likely to feel winded, and with RSV, you are more likely to experience wheezing.
• RSV typically comes with a decrease in appetite, whereas COVID-19 and flu are more likely to involve gastrointestinal symptoms like nausea, vomiting or diarrhea.
• Loss of taste or smell is seen more often with COVID-19 than RSV or influenza.

If you have symptoms of RSV, flu or COVID-19, talk to your primary care clinician about testing — and if you should do so at home or in a lab. Testing typically involves getting your nasal passageway swabbed.

How Respiratory Viruses Spread

Respiratory viruses spread through contact with respiratory droplets, the tiny bits of saliva and mucus that come out of your mouth and nose when you talk, laugh, sneeze or cough. If someone is infected with a respiratory virus, these respiratory droplets can get into your mouth, nose or eyes, spreading the infection to you. It’s also possible to touch a surface that has infected respiratory droplets on it and then touch your mouth, nose or eyes, which can cause you to become infected. That’s why it’s so important to wash your hands frequently, especially during respiratory virus season in the winter months.

Who Is at Risk for Severe RSV

RSV can be life-threatening for infants and older adults. They are at the greatest risk for severe illness and complications from RSV, including hospitalization. Hospitalization typically involves supportive care, like IV (intravenous) fluids, as your body can quickly become dehydrated when you’re sick with RSV.

Older adults at higher risk of worse outcomes from RSV disease include those with:

• Chronic heart or lung diseases
• Weakened immune systems
• Residence in a nursing home or long-term care facility

According to the Centers for Disease Control and Prevention (CDC), RSV is the most common cause for bronchiolitis and pneumonia in children under the age of 1 in the U.S. These infections of the lungs can cause severe inflammation. If your child is under the age of eight months or at high risk for serious RSV illness and under the age of two, they may qualify for a one-time antibody injection preferably at the start of RSV season (fall) or a monthly antibody injection to help prevent RSV. Talk to your child’s physician if you have questions.

Older children and younger adults can get RSV, but they typically have mild symptoms and recover in a week or two.

How to Treat RSV

There is no specific treatment for RSV and in most cases, RSV goes away on its own. Treatment typically is to reduce symptoms and treat complications like dehydration and trouble breathing. Antibiotics do not help, as RSV is not a bacterial infection. You can get a secondary bacterial infection, such as pneumonia (infection of the lungs) with RSV, in which case you may need antibiotics.

To treat RSV symptoms:

• Manage your fever. Going into respiratory virus season, it’s a good idea to talk to your primary care clinician about what medication to use to lower your or your child’s fever. Your clinician can help you know how much and how often to use medication as well. Never give children and teens aspirin or any medicines containing aspirin, as it can be dangerous for them and cause other complications.
• Manage your body temperature. Dress in layers to not get overheated in the event of a fever and make sure your child isn't wearing too much clothing. 
• Stay hydrated. Drink as much water as possible. If your child is old enough, keep offering them water to keep them hydrated. If you’re opting for an electrolyte beverage, opt for one with no or low sugar.
• Treat congestion. Standing in a warm shower is a wonderful way to steam your nasal passages to relieve congestion. You can stand in a steamy bathroom or shower with your baby as well to help open blocked nasal passages. After steaming, try removing mucus from your baby’s nose with a mucus suction device. Talk to your pediatrician for a recommended device and instructions for helping clear your baby’s nasal passage. Repeated suctioning with a device is not recommended as it can irritate and inflame the nasal passages. Consider using a cool mist humidifier in bedrooms overnight as well.
• Avoid tobacco smoke. Don’t let anyone smoke around you or your child. Stay out of public areas where smoking occurs.

People with severe RSV symptoms need to be treated in the hospital. They may need treatment such as:

• IV fluids
• Oxygen 
• Suctioning of mucus
• Breathing treatments
• Anti-inflammatory medicine, such as steroids
• Aerosolized or oral ribavirin, an antiviral medication
• Intravenous immune globulin, a concentrated mix of antibodies to help fight infection

Those with very serious breathing problems may need a breathing tube. The tube is put in the throat and down into the lungs. This is called intubation. The tube is attached to a machine (ventilator) that helps them breathe.  

Call your clinician or pediatrician right away if you or your child have any of these symptoms, which can be related to RSV:

• Fever in a baby under 12 weeks old or a fever over 104 degrees Fahrenheit at any age
• A seizure with a high fever
• A cough that's getting worse or with colored mucus or blood
• Wheezing, breathing faster than normal, or trouble breathing
• Flaring the nostrils or straining the chest or stomach while breathing (most commonly in young children)
• Skin around the mouth or fingers that turns a blue color
• Restlessness or grouchiness in your baby (can’t be soothed)
• Trouble eating, drinking or swallowing
• Shortness of breath
• Confusion
• Dizziness
• Needing to sit upright (in bed or in a chair) to breathe or catch breath

How to Prevent RSV

Remember, adults can get RSV and while their symptoms are typically mild, they can pass it to infants and older adults who are at higher risk of having a severe infection.  

Just like the influenza virus, RSV easily spreads through direct physical contact. It can also spread through coughing and sneezing, or by touching infected objects such as toys, cups, and countertops.

To protect your child:

• Wash your hands often. Ask others to do the same, especially before holding your baby.
• Avoid sharing cups, bottles or toys that may be contaminated.
• Limit how much time your infant spends around large crowds during the fall and winter.
• Guard your baby from secondhand smoke, which increases their risk of developing a more serious case of RSV.
• Talk with your child’s pediatrician about new medicines to help prevent RSV. They are available to all babies younger than eight months entering their first RSV season and some older babies eight months to 19 months entering their second RSV season who are at high risk of developing severe RSV.

Should I Get the RSV Vaccine?

The RSV vaccine can prevent severe sickness from the virus. There are two RSV vaccines (Arexvy, Abrysvo). The differences in the vaccines are based on how they are made.

The CDC recommends that individuals 60 years of age or older consider receiving the vaccine as a single dose after a discussion with their clinician or pharmacist.

Is the RSV vaccine safe for pregnant people? Yes. The CDC also recommends that pregnant women receive seasonal (September to January in most of the United States) vaccination at 32 through 36 weeks gestational age to protect their babies against RSV infection for approximately six months after birth. Talk to your clinician if you have questions about this vaccination.

Use our symptom checker to help determine if you have RSV, COVID-19 or flu.