Are symptoms COVID or other illness?
4 experts help sort out differences, what to do
COVID-19 has added urgency to symptoms that many people are experiencing at this time of year, including fatigue, a sore throat and a runny nose.
The problem with COVID-19 is that if someone is infected, the virus easily spreads to others.
With nearly 22,000 known deaths in Arizona caused by COVID-19 since the onset of the pandemic as of Friday, it’s important for anyone who is infected to stay away from other people while infectious.
So, how is one supposed to know if it’s COVID-19, a cold, allergies, the flu or something else?
There are some differences to look for. A fever, for example, is rarely found when someone has a cold, and is not a symptom of allergies. But it could be a sign of the flu or COVID-19.
“There are lots of things that can present like COVID, like flu or like a cold. There’s a lot of similarities between them,” said Dr. Devin Minior, an emergency physician and physician executive for Banner Urgent Care.
“You could potentially have a fever or not have a fever and it could be any of them. So early on it can be very difficult to differentiate between really any viral illness when it’s initially starting.”
New loss of smell or taste could mean COVID-19, but it’s a symptom that sometimes accompanies a cold and allergies, too.
And while general fatigue and muscle aches could signal COVID-19, a cold or the flu, those symptoms could also be West Nile virus, or a fungal infection endemic to Arizona called Valley fever.
The Arizona Republic spoke this week to four local experts, including Minior, to help sort out how to know what your symptoms mean, when to get tested for COVID-19, and where to seek treatment.
The other three experts we consulted were Dr. Tiffany Pankow, a family physician and associate chief medical officer for primary care at Scottsdale-based HonorHealth; Dr. Randy Odero, an infectious disease physician at Abrazo Heart Hospital in Phoenix; and Thomas
Grys, who is co-director of microbiology and a Valley fever expert at the Mayo Clinic in Arizona.
Here are seven takeaways from the interviews:
There’s a long list of symptoms that could mean COVID-19
At the onset of COVID-19, when it was still being referred to as the new coronavirus, the list of hallmark symptoms was brief and easy to remember: a fever, cough, shortness of breath and fatigue.
But with more information and research, the Centers for Disease Control and Prevention list of COVID-19 symptoms has become more expansive and now includes muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; and diarrhea.
“We get a lot of questions and see a lot of patients who have concerns about whether it’s a cold or COVID or allergies because a lot of the symptoms really, truly do overlap. And so some people can have really mild symptoms with COVID
that can be really similar to a cold,” HonorHealth’s Pankow said.
The CDC’s website includes a selfchecker questionnaire for COVID-19 symptoms that gives advice on when to get tested, quarantine and seek care at https://www.cdc.gov/coronavirus/ 2019-ncov/symptoms-testing/ symptoms.html.
Just because you’ve had COVID-19, or you are fully vaccinated doesn’t mean you are 100% protected.
The level of COVID-19 community transmission in Arizona remains high, according to the CDC, which calculates transmission based on new cases per 100,000 people and the percentage of positive tests during the past seven days.
“The vaccine is really great at reducing the severity of illness and keeping you out of the hospital or ICU or even dying of COVID-19,” Minior said.
“We do see some breakthrough cases where individuals got vaccinated and then developed COVID afterwards. A lot of times it’s just an incidental finding, or they just had mild congestion and for whatever reason they got tested and ended up having COVID.”
Itchy eyes are probably not COVID-19
A wet summer in Arizona fueled plant growth, so there’s a bit of an uptick in allergy symptoms right now, said Odero, the Abrazo Heart Hospital infectious disease physician.
If you have itchy eyes, nose or mouth, or all three, that’s typically allergies, he said.
“When it comes to sneezing, you typically see that in someone who has allergies or someone who has the common cold. Sometimes with the flu, but not so much with COVID. That’s rare with COVID,” Odero said.
Upper respiratory symptoms might not be COVID-19 or another virus
“Upper respiratory symptoms can be in people who have a history of smoking. It could be related to emphysema. Some people have asthma, and that can also cause a cough and shortness of breath,” Pankow said.
Also, a bacterial strep infection can cause fever and a sore throat, she said.
Valley fever and COVID-19 have overlapping symptoms
Valley fever, which is a fungal infection also known by its scientific name coccidioidomycosis, is not well-known outside of the American West. But in Arizona and parts of California, it is common in both humans and dogs.
“The symptoms of Valley fever are a cough, fatigue, sometimes a rash, sometimes a fever, so sometimes can be hard to distinguish between other things,” Pankow said.
“We see certain features on a chest Xray . ... It’s a common thing we see here. Most people don’t even know they had Valley fever because the symptoms are very similar to a cold.”
Case reports of Valley fever are up so far in 2021. There were 8,514 cases reported by the state for the first nine months of the year, which was a 16% increase over the first nine months of 2020, and 48% higher than the state five-year median for that same time period.
Since Valley fever is notoriously underreported it’s unclear whether the jump in cases is because of more illness, more awareness of Valley fever, or more people getting tested.
People can get diagnosed with Valley fever throughout the year, said Thomas Grys, a Valley fever expert who is director of microbiology at the Mayo Clinic in Arizona. The fungal infection frequently
is misdiagnosed and diagnoses can be delayed, he said.
“I would say the shared symptoms (with COVID-19) would be shortness of breath, fever, night sweats, rash, fatigue,” Grys said. “Those are pretty nonspecific, not just these two diseases but more . ... It often gets confused with community-acquired pneumonia, or influenza. But those viral infections tend to have an acute onset of upper respiratory symptoms.”
It can get confusing for providers because someone may have upper respiratory symptoms such as a runny nose and sore throat from allergies, or a mild cough from dust and dryness in the air, yet they also have a fever because of Valley fever, Grys said.
While most people exposed to a coccidioides fungal spore won’t get sick, about 5% to 10% of people who get Valley fever will develop serious or longterm problems in their lungs, according to the CDC.
Even when Valley fever is suspected, it can take a few weeks for it to show up in a test. So a negative test might not be accurate, which can be frustrating. But it’s helpful to be persistent and get a diagnosis, said Grys, who along with Arizona State University is working on developing a more sensitive Valley fever diagnostic test.
“Having a diagnosis means you and your doctor can talk about what the typical disease course is, monitor certain symptoms if you are getting worse . ... But at least you know what you are dealing with and that is oftentimes a really important reason to test,” he said.
A high fever, headache, body aches and joint pains could be symptoms of West Nile virus
The wet summer has given rise to mosquito infestations that have fueled an uptick in West Nile Virus in Arizona. As of Friday, state health officials were reporting 57 deaths from the virus.
“We have seen West Nile virus patients in our urgent cares,” Banner Health’s Minior said. “Just like any of these other viral illnesses, the initial few days can be very mild, it might be a cough, congestion, maybe a mild sore throat, maybe a mild fever. It’s very difficult to differentiate it from any of these other things.”
More serious West Nile virus symptoms, including a high fever, severe headaches and muscle weakness typically take a few days to develop, he said.
Not everyone who is exposed to West
Nile virus will have symptoms, Grys said. But the symptoms that do show up could be confused with other illnesses, including Valley fever.
“We think it’s about 20% who will have symptoms but those who do have things like fatigue, nausea, diarrhea, dizziness, headache, rash. Sometimes the rash will come on when the fever breaks,” he said.
“If they have neuroinvasive disease they can essentially have a brain infection. They can have serious symptoms ongoing for months, headaches and things, dizziness, stroke-like symptoms,” he said.
There’s a higher risk for critical illness among older individuals infected with West Nile virus, he said.
“To think that a mosquito bite could lead to the death of a loved one is pretty sobering and not something that we’re used to thinking about as a country,” he said.
Always get tested if you suspect COVID-19
It’s imperative to ensure people with the SARS-CoV-2 virus that causes COVID-19 are not spreading it, which is why it’s important to get tested, Pankow
said. Another reason is to get treated early, she said.
“If you do have symptoms, I think the best thing to do is get tested,” she said. “If you are at high risk for complications it’s important for you to know so that you can get appropriate treatment if needed. There are treatments that can be done in certain patients to prevent hospitalization and death if they get that treatment in a timely manner.”
Odero said someone who gets a rapid antigen test for COVID-19 that comes up negative could go back and get a PCR (polymerase chain reaction) test if their symptoms persist and they still suspect it may be COVID-19.
And he encourages parents to get their children immediately tested at any signs of the virus.
“It helps to get them tested because if it’s COVID we will know right away and we will be able to protect the other kids,” Odero said.
“Given how bad it would be if a child had COVID and the consequences of what would happen if it spread to the community where they are based, whether it’s a school or a daycare setting, there may be people there who are very vulnerable to becoming ill.”
If a patient’s symptoms include a cough, cold, a mild fever, it’s hard to know whether that person has a cold, the flu or COVID-19. But since Arizona is in the midst of a COVID-19 surge and because those other illnesses are not as prevalent right now, Banner Health’s Minior said his approach with such patients is to always test for COVID-19.
“COVID is actually the most concerning of those clinical presentations between cold, flu and COVID itself. So we really want to rule out COVID,” he said.
“I will say we’ve had a few people come in with a few maybe classic flu symptoms, and a lot of times that’s going to be really severe body aches and severe fatigue, and maybe they’ll even report that they were around someone with the flu — in those cases we might go ahead and test for flu.”
Patient volumes are high right now and peak flu season hasn’t even hit
The ongoing surge of COVID-19 in Arizona combined with winter visitors and regular health community needs is leading to high volumes, Minior said.
Also, levels of RSV — respiratory syncytial virus — have been unusually high since summer. While adults can contract RSV, it typically impacts babies and children under the age of five most severely.
“It’s a confusing time with our flu season coming up and COVID still here and RSV and West Nile and the common cold,” Minior said. “Primary care is always a good option but sometimes you can’t get in that same day. Urgent care thankfully is open to both walk-ins and appointments. So if you need to get seen, we will see you on that day.”
Unless it’s a life-threatening situation such as difficulty breathing, shortness of breath or severe trauma, opt for care from a primary care physician, urgent care or other health clinic. An urgent care is also typically a lower insurance co-pay than an emergency room visit.
Urgent care clinics can see patients and do testing, and if patients need to go to an ED, the urgent care can send them there, Minior said.
“The biggest challenge now is we have all these different viruses and we’re seeing a lot of patients. The volume of patients can be a bit overwhelming at times,” he said. “The combination makes it very challenging to be a provider or a staff member.”