(CNN) — Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention (CDC), said respiratory illnesses are spreading. He singled out the rise of three viruses in particular: influenza, coronavirus and respiratory syncytial virus, better known as RSV.
Hospitalizations from the three viruses continue to increase, according to the Centers for Disease Control and Prevention. As more people develop symptoms such as coughing, sneezing and fever, they may be wondering whether they should get tested to find out what virus is causing their symptoms. Which symptoms can be treated at home, and which symptoms should prompt people to seek medical care? Does it matter if you go to a doctor’s office or go to an urgent care or emergency room? If people haven’t been vaccinated yet, is it too late?
To help us answer these questions, I spoke with CNN health expert Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.
CNN: Is it important for everyone with a runny nose, cough or fever to get tested to find out what exactly is causing their symptoms?
Dr. Wen Lina: No, this is neither practical nor necessary. In addition to the oft-mentioned “big three”: influenza, coronavirus, and respiratory syncytial virus, there are many other viruses that cause respiratory illness, such as adenovirus, rhinovirus, and parainfluenza virus. It is estimated that there are more than 200 viruses that cause the common cold and produce the symptoms of runny nose, cough, or fever mentioned above. Most people don’t need a test to determine which virus is causing their symptoms.
There are three situations in which viral testing may be recommended. First, people who are susceptible to severe illness may want to get tested for both influenza and Covid-19. There are several antiviral treatments approved for people with the flu, including Tamiflu. According to the CDC, priority groups for flu treatment include people who are at higher risk for severe illness or complications from the flu.
Likewise, Paxlovid is an oral antiviral treatment that has been approved to treat patients in the early stages of Covid-19 disease who meet the eligibility criteria. Other treatments for Covid-19 include monopiravir pills and remdesivir injections or infusions. People at risk for severe illness from coronavirus should get tested if they develop symptoms of the virus so that antiviral treatment can be started as soon as possible if confirmed.
Second, if someone lives in a household with someone who is susceptible to severe illness from either pathogen, they may want to get tested for either flu or Covid-19. For example, a healthy child attending day care may not need to be tested every time he catches a cold. However, if they live in a household where a grandparent takes immunosuppressive drugs after a kidney transplant, they should be tested more frequently if they develop symptoms of the virus.
That’s because if a child has the flu, the grandparent may be eligible to take preventive antiviral medications to reduce the chance of getting the flu. There are currently no such precautions for Covid-19, but grandparents should be aware of symptoms and take antiviral treatment if infected with coronavirus. Of course, a child showing symptoms of the virus should be isolated from his or her grandparents to reduce the chance of spreading the infection.
Third, if a person is seriously ill or has been ill for some time, they can be tested for influenza, Covid-19, RSV and other viruses. This will be part of the evaluation to find out what is causing these long-lasting, severe and/or progressive symptoms. For example, people who are seriously ill and require hospitalization may receive comprehensive viral testing as part of the hospital’s evaluation.
CNN: Is it possible for a person to test positive for multiple viruses?
arts: Yes. In a 2019 study, researchers examined more than 44,000 cases of respiratory illness in Scotland and tested for 11 viruses, including rhinovirus, coronavirus, influenza and RSV. Of all patients who tested positive for the virus, 11% were co-infected with one or more different viruses. Some patients carry as many as five viruses at the same time.
Likewise, for most people, it’s not important to know exactly what’s causing their symptoms. Treatment is generally the same and is called supportive care. This means there is no specific antiviral treatment, but rather addressing symptoms to help patients feel better. So if someone has a fever, they can take a fever-reducing medicine like Tylenol or ibuprofen. They can drink plenty of fluids to prevent dehydration. They can rest to relieve fatigue. For influenza and Covid-19, the situation is different for specific patients who qualify for antiviral treatment; for these people, testing is most important.
CNN: Which symptoms can be treated at home, and which symptoms should prompt people to seek medical care?
arts: Most people recover fully with supportive care at home. Note that this may take some time; cold symptoms may last for more than a week, and a cough may last for several months.
Symptoms that should seek immediate medical attention include difficulty breathing, severe chest pain, severe vomiting, inability to control fluids, and persistent fever. Parents of young children should watch for symptoms of difficulty breathing, such as flaring noses, wheezing, increased respiratory rate, and blue lips. Babies are particularly susceptible to dehydration, and parents and caregivers should contact a medical professional if their child is not getting enough wet diapers.
Others who should contact their doctor early in their illness include those who are older and have serious underlying medical conditions, such as heart and lung disease. For these patients, a viral illness that may be mild in most people may exacerbate existing conditions and lead to hospitalization or more serious illness, so early and proactive follow-up is critical.
CNN: When should you go to a doctor’s office instead of an urgent care or emergency room?
arts: Urgent symptoms require urgent care in the emergency room. These include sudden, severe symptoms such as chest pain, difficulty breathing, and seizures. On the other hand, symptoms that last for several days can usually begin with an evaluation at the doctor’s office. In these cases, you can start by calling your doctor’s office. They may be able to tell you if they can see you urgently in the office or via a telemedicine visit. They may also recommend whether you should go to an urgent care or emergency room.
CNN: Can you remind us what steps people can take to avoid contracting the virus? Also, if they haven’t been vaccinated yet, is it too late?
arts: It’s not too late to get vaccinated. People who haven’t received this year’s flu vaccine or the latest Covid-19 vaccine can still get one now, as can those who are eligible for the RSV vaccine. These vaccines can reduce your chances of getting the virus and, more importantly, your chance of getting serious illness if you do get infected.
Other measures to prevent infection include washing hands frequently, staying away from people with cold symptoms and wearing a mask in crowded indoor spaces.