You wake up with a scratchy throat, stuffy nose, and that all-too-familiar feeling that you're getting sick. But is it just a cold? The flu? COVID-19? RSV? With so many respiratory viruses circulating during winter, especially around the holidays when families gather, it can be hard to tell what you're dealing with.

The good news? Understanding the differences between these illnesses and knowing when to seek medical care can help you recover faster and keep your loved ones safe.

Why Winter Brings More Respiratory Illness

Respiratory illnesses spike during fall and winter for several reasons. Cold weather drives people indoors where viruses spread more easily in close quarters. Dry winter air dries out the protective mucous membranes in your nose and throat, making it easier for viruses to take hold. And with holiday gatherings bringing people together from different locations, viruses have more opportunities to spread.

According to the Centers for Disease Control and Prevention (CDC), the 2024-2025 fall and winter respiratory season is expected to have similar or lower combined hospitalizations from flu, COVID-19, and RSV compared to last season. However, this doesn't mean you can let your guard down.

Common Cold: The Mild Troublemaker

The average adult in the U.S. experiences 2-3 colds per year, and children have even more, making the common cold a leading cause of missed school and work.

Symptoms typically include:

• Gradual onset (you slowly feel worse over a day or two)
• Sore throat and runny nose (usually the first signs)
• Sneezing, coughing, watery eyes
• Mild aches
• Congestion
• Fever is rare with colds

Todd Richwine, D.O., a family medicine specialist and physician on the medical staff at Texas Health Southwest Fort Worth, says cold symptoms develop gradually.

"Colds typically come on slowly, meaning there is a gradual progression of symptoms, and people go from wondering if they are getting sick to progressing to where they know they are," Richwine says. "With colds, typically we see more congestion, sneezing and sore throat. Headaches and fever (at least above 100 degrees) are rare, aches are mild and chills are uncommon."

Most colds run their course in seven to 10 days. Rest, fluids, and over-the-counter medications to ease symptoms are usually all you need.

Influenza (Flu)

Unlike a cold, the flu comes on fast and hits hard. You can go from feeling fine to completely miserable within 24 hours.

Flu symptoms include:

• Sudden onset (you feel sick all at once)
• High or moderate fever
• Severe body aches and muscle pain
• Fatigue and weakness
• Headache
• Chills
• Dry cough
• Runny or stuffy nose

Flu season typically runs from October to March, peaking between December and February. The flu is more serious than a cold and can lead to complications like pneumonia, especially in young children, older adults, pregnant women, and people with chronic health conditions.

If prescribed within the first 48-72 hours of symptom onset, antiviral medications can shorten the duration of illness and reduce the severity of symptoms. That's why it's important to contact your doctor quickly if you suspect you have the flu.

COVID-19

COVID-19 symptoms have evolved with new variants, making it harder to distinguish from other respiratory illnesses.

Current COVID-19 symptoms include:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Body aches
• Headache
• Loss of taste or smell (less common now but still possible)
• Sore throat
• Congestion or runny nose
• Nausea or vomiting (less common)

One key difference: COVID-19 symptoms can take longer to appear after exposure — anywhere from 2-14 days, with an average of around 5 days. With a cold or flu, symptoms typically show up within 2-3 days of exposure.

COVID-19 testing is crucial because symptoms overlap so much with other respiratory illnesses. If you test positive, antivirals like Paxlovid are most effective when taken within 5-7 days of symptom onset, so don't wait to get tested if you're feeling sick.

RSV

Respiratory syncytial virus (RSV) is most dangerous for infants and older adults, but it can infect anyone. In recent years, we've seen unusual surges of RSV in older children, teens, and adults — groups that traditionally weren't as affected.

This shift happened partly because COVID-19 precautions (masking, distancing) in 2020-2021 meant fewer people were exposed to RSV during those years. When precautions were lifted, RSV came back stronger, hitting populations that had less immunity built up. Health care providers now see RSV affecting a much broader age range than in the past.

RSV symptoms include:

• Runny nose
• Coughing and wheezing
• Difficulty breathing
• Decreased appetite
• Fever (more common in young children)
• In infants: irritability, decreased activity, trouble feeding

Despite the uptick of RSV in other age groups, Mark Till, M.D., an emergency medicine physician on the medical staff at Texas Health Dallas, says the virus is still particularly concerning for very young children.

"RSV is more of a problem in little babies and can be a bigger deal, but there aren't any good treatments, unfortunately," Till says. "If it seems like a cold, they have a snotty nose and a low-grade fever or one that comes down with Tylenol, it's probably okay. If they aren't feeding, are short of breath or they're starting to get dehydrated, they should see a doctor."

There is some good news: RSV vaccines are now available for adults over 60 and for pregnant women to protect those most vulnerable to the virus.

When to See a Doctor

So how do you know when it's time to call your doctor instead of just riding it out at home?

Till says to watch for changes in your symptoms.

"Colds make us all miserable but if there's a change in the pattern of your symptoms, you may be dealing with something else," he explains. "Usually pain with coughing is still just a cold because your muscles are getting overworked. Now if you're having a fever, are short of breath or start coughing up new stuff, go see the doctor to make sure it's not pneumonia."

Seek medical care if you experience:

• Difficulty breathing or shortness of breath
• Persistent chest pain or pressure
• Confusion or inability to wake up
• Bluish lips or face
• Severe or persistent vomiting
• Fever that doesn't improve with medication or lasts more than 3-4 days
• Symptoms that improve but then worsen again
• Dehydration (especially in young children or elderly adults)

High-risk individuals should see a doctor sooner:

• Infants and young children
• Adults 65 and older
• Pregnant women
• People with chronic conditions (asthma, diabetes, heart disease, weakened immune systems)

For these groups, early treatment can prevent serious complications.

Preventing Respiratory Illness

The best defense is preventing illness in the first place. Here's what works:

Get vaccinated: Annual flu vaccines and updated COVID-19 vaccines significantly reduce your risk of severe illness. RSV vaccines are now available for eligible groups.

Wash your hands frequently: Soap and water for at least 20 seconds, especially after being in public places or around sick people. Hand sanitizer with at least 60% alcohol works when soap isn't available.

Stay home when you're sick: Don't spread illness to others. If you're feeling unwell, skip work, school, and social gatherings.

Cover coughs and sneezes: Use a tissue or your elbow, not your hands.

Avoid touching your face: Viruses enter your body through your eyes, nose, and mouth.

Boost your immune system: Get enough sleep, eat a balanced diet, stay hydrated, and manage stress.

The Bottom Line

Most respiratory illnesses resolve on their own with rest and fluids. But knowing when to seek medical care and acting quickly when symptoms worsen can prevent serious complications and help you recover faster.

If you're unsure whether you need to see a doctor, it's always better to call and ask. Your health care provider can help you decide whether you need to come in, get tested, or continue managing symptoms at home.

Finding Care at Texas Health

Whether you need a same-day appointment, urgent care, or emergency care, Texas Health is here to help you and your family stay healthy this winter. Find a primary care physician who can provide flu shots, COVID-19 vaccines, and treatment for respiratory illnesses.

For non-emergency illnesses that need prompt attention, find a Texas Health Breeze Urgent Care location near you.

For more information on differentiating between cold, flu, and COVID-19, read How to Differentiate Between a Cold, Flu and Allergies.

Sources

• CDC: 2024-2025 Respiratory Disease Season Outlook
• CDC: Respiratory Illnesses Data
• CDC: About Influenza
• CDC: About RSV
• CDC: About COVID-19
• Texas Health Resources: Understanding the Common Cold
• Texas Health Resources: Five Common Winter Illnesses and How to Fight Them
• Texas Health Resources: How to Differentiate Between a Cold, Flu and Allergies