One ‘Flu’ over the COVID’s nest

by | Dec 24, 2020

A Black & White feature

Is that COVID…is that Coronavirus… 

No it is flu – just flu — Influenza!

Most of us who are at the wrong end of a cold, fever or throat pain, cough or stomach ailments are suddenly gripped by the fear that this could be the onset of the most severe and scary disease that has infected humankind in recent times.  And we panic. For the first time ever in the history of mankind, we live in fear of a common cold, a little sniffling, a tickle in our throats or the tiniest rumble of a cough. Even the slightest signs of any of these or related ailments put us in panic mode as we live under the constant shadow of this all-pervading COVID-19 pandemic.

Jumping to conclusions

But, are we just jumping to conclusions or has the dreaded Coronavirus sneaked inside us? This is the palpable fear among many of us and it is time that we distinguished one illness from the other. Or, will that be too complicated?

We need the help of the medical fraternity to set the minds of many a non-medical panicky person at ease. And we need to get rid of these worries bedevilling our minds, because there seems to be a very thin line between cautiousness and panic.
With these doubts in mind, Black & White reached out to some medical experts in town. The medical fraternity has patiently listed out what they think is best from their end, which we hope will help ease the anxiety of many of you out there.

Common doubts

A few of the common doubts that people have raised bordered on these lines: If we reach out to any doctor with a variety of ailments, including common cold, nose block/runny nose, cough, throat pain, headache, suffocation, stomach ailments etc, he or she might advise us to get a COVID test, but what if it is just one or two of the above, what happens then? How do we distinguish between a slight respiratory bug and the start of the dreaded COVID-19? And do most of the symptoms between COVID-19 and the common cold (and other stated illnesses) overlap?

Over to the experts:



“In today’s scenario, I would assume that any cold or flu as COVID-19 flu, unless proven otherwise,” Dr K.P. Raman, chairman and cardiologist, Al Hayat International Hospital, said in remarks made to the Black & White.

Symptoms alone won’t help

The COVID-19 disease and an ordinary flu or common cold cannot be distinguished by symptoms alone, Dr Raman stressed. “Though loss of taste, loss of smell and diarrhoea are said to be peculiar to COVID-19, I do not think that practically speaking they are helpful to differentiate between COVID-19 and others. History of recent air travel, attending a party or celebration in a closed space plus the symptoms of cold may favour COVID-19, again these are all soft points and not really helpful.”

Advise a PCR test 

“So, as a doctor, my advice would be to assume any cold or flu as COVID-19 flu unless it is proven otherwise. He/she should go for a PCR test (*) immediately and if it is positive, quarantine oneself for 14 days. 

“If the initial PCR test is negative, it could still be COVID-19 in a patient with symptoms and therefore it is necessary to isolate oneself for a week and repeat it and if the repeat test is also negative, one can be almost sure that the symptoms were not due to COVID-19 but due to common flu,” Dr Raman explained.

Some symptoms of allergy dominate 

Allergic symptoms are similar but watering of nose, sneezing predominates in allergy. The symptoms are seasonal or they appear only when exposed to the offending trigger, Dr Raman said.

Asthma – nocturnal cough or wheezing

Asthma usually has a long-standing history and presents more as nocturnal cough or wheeze and respond well to bronchodilator and steroid inhaler, Dr Raman said.



“Symptoms of cold, flu and mild COVID-19 are similar, so the only way out to determine whether a patient has COVID or not is through a lab test, Dr Mohammed Ali, internal medicine specialist, Abeer Hospital, Ruwi, tells the Black & White.

Many symptoms are similar

“Many of the symptoms of common cold, mild influenza, mild COVID-19 infection are similar. These include fever, body ache, headache, running nose, stuffy nose, throat irritation, congestion of eyes etc. 

Though loss of taste and smell, abdominal symptoms are more in COVID-19 infections, these are not very specific. Small percentage of COVID patients can get serious symptoms like breathing difficulty, bluish discoloration of lips, mental confusion, decreased urine output, fall of blood pressure etc., but these symptoms can occur in severe influenza, bacterial pneumonia. So to make a definite diagnosis, laboratory testing like RT-PCR are necessary. Patients with severe symptoms definitely need lab evaluation and may also need hospitalisation,” Dr Mohammed Ali said.

Better to have lab confirmations 

“Patients with mild symptoms may be managed at home, but better to have lab confirmation, especially if there is contact history. Also, if they happen to be positive they need to be isolated so that the community spread can be reduced,” he advised.


In seasonal allergy and asthma usually there is no fever, body ache and these patients give history of recurrent episodes of similar illness in the past. “But occasionally people with allergic rhinitis or asthma can get a COVID-19 infection and both disease may co exist,” Dr Mohammed Ali warned.

COVID-19 – specific strain of virus

Symptoms of common flu like sickness and mild COVID-19 infections can be very similar, he added. “Common flu-like diseases can be caused by different types of viruses. However, COVID-19 infection is caused by a specific strain of virus. Though loss of taste and smell, abdominal symptoms like diarrhoea is common in COVID-19 infection compared to common flu, this also is not confirmatory. A small percentage of COVID-19 patients can get severe diseases and also develop more severe symptoms.”



“It is just a thin line dividing the COVID-19 and non-COVID-19 symptoms – and therefore it is difficult to distinguish them from each other,” Dr Ravi Perumal, specialist, internal medicine, Badr Al Samaa Hospital, Ruwi, tells the Black & White.“Patients may present themselves with a variety of symptoms like cold, nose block/runny nose, cough, headache, suffocation, stomach ailments, etc., or maybe with one or two symptoms. At the beginning stages of the pandemic, all patients with fever were screened for COVID-19 as per the Ministry of Health (MoH) guidelines. However, this has been recently changed. Now patients with any of the above signs or those who are critically ill only need to be hospitalised for a COVID test,” Dr Perumal said.

Better to suspect as COVID 

“It is a thin line between COVID and non-COVID symptoms and difficult to distinguish one from the other. So, during this pandemic, it is mandatory to suspect all patients having such symptoms to be infected with COVID,” Dr Perumal stressed.

Mild difference do exist

“While COVID and non-COVID patients share all the symptoms, I have found in my clinical experiences that there is a mild difference between these two. Most COVID patients had high-grade fever, sore throat, cough, dyspnea, headache, body ache, and diarrhoea against common cold, runny nose, and common flu nose block,” Dr Perumal noted

RT-PCR is the gold standard

However, the COVID RT-PCR is the only gold standard in distinguishing between the two, Dr Perumal stressed. “Irrespective of COVID or non-COVID patients with noted symptoms, it has been advised to undergo isolation and report to the doctor if there are any danger signs such as high-grade fever and shortness of breath,” he added.



“Many people have built up immunity to seasonal flu strains, but COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection and some will suffer severe diseases. In the current pandemic, it is advised to consider all flu cases as COVID-19 until proven otherwise,” Dr Deepak Sharma, homeopathic consultant, Dar Al Huda (Homoeocare) Clinic tells the Black & White.

Test to rule out COVID

“If a patient presents himself with all or many symptoms such as cold, cough, sneezing, runny nose, throat pain, headache, diarrhoea, loss of smell etc., the first and foremost, as per the need of the hour, is to get a test done to rule out COVID 19.

Be alert to even the slightest indication 

“Even if there is a slight indication, perhaps just an associated loss of smell and taste then we have to shift the patient to the isolation room with all care taken and organise to shift the patient to the COVID-treating facility,” Dr Deepak Sharma advised. And, he added: “When it is just a few of these symptoms and not all, it has to be made clear whether the patient is having: An allergic rhinitis episode, where the symptoms are only episodic sneezing and nasal congestion with watery discharge and with a history of similar episodes. However, in such cases, fever and cough are rare; loss of smell and taste, body ache, sore throat, chills and fatigue are usually absent; shortness of breath may be present and diarrhoea is usually not present. There is usually an itching in the eyes and nose, which is not present in viral colds.

Common cold — which is caused by the Rhino viruses, will usually be without fever and the cough will be mild. It may be associated with loss of smell, sore throat, running nose and sneezing but the shortness of breath will be absent. The energy level and appetite will not be affected much and symptom of cold will be mild.

Influenza (non COVID) cases, which we commonly call flu, are caused by the influenza viruses. Here the patients suffer from fatigue, muscle pain and the symptoms appear more toxic than allergic rhinitis and the common cold.

“The flu spreads mainly through respiratory droplets that travel through the air when we talk, sing, cough or sneeze. It is also possible for a person to get infected with the flu by touching the same surface as someone who is infected, or by shaking hands or sharing cups and glasses,” Dr Sharma explained.

The COVID-19 and influenza viruses have a similar disease presentation. “That is, they both cause respiratory disease, which presents as a wide range of illness from asymptomatic or mild through to severe disease. Both viruses are transmitted by contact, droplets and fomites.  But, the COVID-19 causes more severe disease than seasonal influenza,” Dr Sharma said.

No immunity

While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. “That means more people are susceptible to infection, and some will suffer severe disease. In the current pandemic it is advised to consider all flu cases as COVID-19 until it is proven otherwise,” Dr Deepak said. Asthma is easy to diagnose as we get a clear history and most of the general symptoms like chill, nasal discharge, fever etc. may be absent and the major complaint will be shortness of breath with history of similar episodes, he added.

Entire family of virus

“COVID-19 Coronavirus is an entire family of viruses, which like the flu, mainly spreads through respiratory droplets. Four of these viruses are similar to the common cold in terms of symptoms and severity. The novel Coronavirus, or SARS-CoV-2, is a potentially deadly virus that can lead to HYPERLINK “”COVID-19,” Dr Sharma noted.

Common symptoms

COVID-19 and the flu have many common symptoms, including fever, muscle pains and body aches, sore throat, fatigue, headache, vomiting and diarrhoea.

Include other signs too. “The major difference from flu is that it may include a range of other signs, including loss or change in taste and smell, skin reactions and difficulty breathing. Symptoms may appear anywhere from two to 14 days after infection. The fallout from COVID-19 can last from days to months,” Dr Sharma noted.“These cases can present with practically no symptoms to a plethora of symptoms. Whenever there is a history of exposure even with no symptoms the patient may be a carrier and it is important to do the test.”

Starts with a fever and dry cough…

For most people, it starts with a fever and a dry cough, sore throat and headaches usually without a runny nose, Dr Sharma said. “Most people will have mild disease and get better without needing any special care. But we have to understand that some patients, especially those with lowered immunity, do develop severe systemic symptoms due to the cytokines storms and inflammations of blood vessels and this can be fatal.”

First rule out COVID-19

Many symptoms of the virus triggered respiratory diseases do overlap, it is not too difficult to reach the diagnosis but as mentioned it is better to rule out COVID-19 through test so that the measures to stop the spread can be taken, Dr Sharma said.

Our duty to take maximum precaution

“Since the whole world is fighting to control this deadly disease, it is the duty of every human being to take every possible precaution as instructed by the authorities concerned. Together we can and we will win this war against this disease,” Dr Deepak vowed.



Most of the symptoms, between the common cold and COVID-19, overlap and therefore clinically it is challenging to effectively distinguish one illness from one another, Dr Mithun C Mohan, specialist internal medicine and medical director, Starcare Hospital, Seeb, tells the Black & White.

Advised precautions and supportive measures

“Any patient presenting himself with a multitude of symptoms like cold, nose block, cough, throat pain, headache, suffocation, stomach ailments shall be advised for regular precautions and supportive measures like saline gargles, steam inhalation, adequate hydration, appropriate food intake and depending on the severity, medications as needed. In view of the evidence it is advisable only Paracetamol to be used for symptoms unless a medical consultation prescribes other medications,” Dr Mithun Mohan noted.

Tests depend on severity

Advice on COVID test is done based on the severity of symptoms and the regulations of the country. “Generally for mild symptoms, COVID tests are not indicated initially and keeping the probability of COVID due the pandemic situations, medical management and preventive measures are advised as a case of COVID. If symptoms progress to more severe situations or there are cluster of cases then tests shall be done for proving the infection,” Dr Mithun said.

Clinically challenging to distinguish

“Clinically, it is not effectively possible to distinguish from the other common respiratory bugs and COVID-19. This is due to multiple factors like similarity of symptoms, atypical presentation of COVID etc. Distinguishing COVID and other respiratory infections are documented based on testing with PCR to detect the viral genes,” he added. Most of the symptoms, between the common cold and COVID-19, overlap. Clinically it is challenging to effectively distinguish one illness from one another. Laboratory virology testing is the only key to confirm the diagnosis. Radiological testing with CT scan may also contribute to the identification of the infectious pathogen.


COVID-19: Primary symptoms may include fever, throat pain, runny nose, cough and sneezing, headache along with stomach ailments like diarrhoea. Loss of sensation of smell and taste has been reported commonly with COVID. Laboratory markers showing changes like high levels of inflammatory markers and the effects of the same may be contributory. Diagnosis is based on testing for PCR and CT scans of the lungs showing changes. Severity of symptoms and the results of the tests will vary according to the severity of the disease. Organ failures especially with lung functions are fatal complications.

Influenza and common cold: Symptoms are similar – Fever, sore throat, runny nose, cough, headache and to a minor extent stomach ailments. Laboratory picture varies but clear identification is by PCR for viral genes. Complications are rare but still may be encountered.

Allergies and asthma: Symptoms of runny nose, cough, and breathlessness are common. Fever usually not a feature unless there is added infection in the condition. Laboratory findings will lack high levels of inflammatory markers. Fatal complications are rare in seasonal allergies but occasional respiratory failure can be encountered in asthma. Other organ complications are extremely rare.

Differences — flu and COVID-19 

Clinically not much of differences are there in the primary symptoms, Dr Mithun said. “Laboratory values will show non-specific differences but cannot confirm expect for the PCR test to detect the viral genes. Radiologically with CT scan lung changes may be more suggestive showing patchy shadows and ground glass opacities in lungs. General treatments are same but it is ideal to avoid painkillers and other medicines for COVID-19; which may cause chances of complications. Paracetamol would be the safest medicine for use. Specific medicines like antivirals if needed for severe conditions are available now for COVID-19. Other flu-like illness shall not be requiring antiviral medicines,” he advised.



“In the current COVID-19 scenario, it is best to follow all protocols and to be frank, it is better to be safe than sorry,” Dr Sanjay Dalal, medical director, Healthy Life Clinic, Muscat, tells the Black & White.

Follow common sense

“And if we follow all the prescribed guidelines and just follow our own common sense, nothing or no one can infect you,” Dr Dalal adds.

However, since some of the symptoms of COVID-19 and flu are similar, it is very difficult to distinguish between them, he opined.

In COVID-19, symptoms are severe

“But, do bear in mind that the symptoms in flu are mild to moderate and in COVID-19, the symptoms are severe. The main difference being loss of smell.  Again this doesn’t occur in every patient. In a few cases of COVID-19, the condition worsens by the time they reach the second week and may require hospitalisation.”

Take the COVID test

Dr Dalal advises a COVID test as the easiest way to determine whether one has the virus or not. “Yes, but only on the basis of the symptoms. However, a test is available to diagnose COVID-19. So, when in doubt, I would suggest that it is better to take the test and find out and take the necessary steps according to the result. It is better to be safe than sorry!”

For COVID-19: Fever, muscle pain, sore throat, running nose, headache, cough, breathlessness and in some case loose motion/stools. 

However, it is not necessary that all these symptoms will be present in every infected person.

General advice:  Take proper precautions as per the guidelines given by the health authorities; maintain proper hand hygiene (sanitiser or soap and warm water); have hot beverages; avoid crowded places; keep social distancing whenever compelled to go to a crowded place; after returning home: take a hot shower, gargle, sanitise or wash clothes. 



“Although some symptoms overlap between cold and COVID-19, it is not very complicated to distinguish between the two — the former is restricted to the upper respiratory tract, while the latter majorly affects the lower respiratory tract,” Dr Wahid Khan, specialist internal medicine and critical care, Apollo Hospital Muscat, tells the Black & White.

It depends on the symptoms 

If a patient presents himself with cold, running nose, cough, throat pain, headache, suffocation, stomach ailments and other related problems, then it’s understandable that he is advised a COVID-19 test, Dr Khan said. “But, if a patient is having just one or two of the above symptoms, then it depends upon which symptoms he coming to us with. If you have two or more of the following symptoms, namely, fever, headache, new muscle aches, new upper respiratory symptoms (congestions, runny nose, sore throat), new loss of taste or smell, new nausea/vomiting/diarrhoea, or new rash, we consider COVID testing. If you have had a known close contact exposure to someone with COVID, you should be tested even if you have only one mild symptom.”

Adopt: wait and watch method

If it is just common cold with nose block then it is better to wait and watch for recovery/ worsening of symptoms, Dr Khan said. “Usually, a respiratory bug would just focus on the respiratory system whether upper or lower or both whereas COVID-19 has been noticed to get involved other systems as well like cardiovascular, gastrointestinal and sometimes even the central nervous system as some patients did present with stroke.”

Some symptoms overlap 

There are some symptoms that overlap between the common cold and COVID-19, however it is not very complicated to distinguish between the two as common cold is restricted to the upper respiratory tract whereas COVID-19 majorly affects the lower respiratory tract and presents as pneumonia and even pulmonary embolism (clot in blood supply to lungs), Dr Khan explained. “History of close contact with COVID patient at home or workplace will help us reach a (COVID-19) diagnosis faster.


COVID-19: Loss of smell; loss of taste; loss of appetite; fever with cough; generalised weakness; muscular body pains; exertional or ambulatory shortness of breath; sore throat, diarrhoea, congestion, runny nose, chills, shivering, headache, fatigue, rash and loss of appetite. “Some infected people don’t have any symptoms of COVID-19, but they’re still contagious,” Dr Khan noted.

Influenza: More commonly known as flu. Fever, muscle aches, and cough are the usual hallmark symptoms. There is usually no shortness of breath in flu.

Common cold: Runny nose, cough, stuffy nose with sore throat. Usually there is no shortness of breath and fever in common cold.

Seasonal allergies: Sneezing (mostly early mornings or on exposure to allergen) without fever, and itchy eyes. Allergies do not cause fever, shortness of breath or loose stools.

Asthma: Wheezing with chest tightness, difficulty in breathing and persistent cough with early morning worsening of symptoms is the usual hallmark of asthma. Usually, there would be no fever unless there is some ongoing infection, which serves as trigger of worsening of asthma.

Differences between flu and COVID-19 

“Common flu like sickness would usually present with fever; running nose; stuffy nose; throat pain; fatigue and cough whereas COVID-19 would have more elaborate symptoms like loose stools; loss of appetite; loss of taste; loss of smell; chest pain with shortness of breath; unilateral or bilateral leg pains if patient develops DVT. Usually, the common cold would not be so worrisome to cause shortness of breath in a patient, especially early in the course of illness,” Dr Khan noted.

Signs within two to 14 days

COVID-19 symptoms generally appear two to 14 days after exposure while the flu symptoms usually appear about one to four days after exposure. “The COVID-19 appears to be more contagious and to spread more quickly than the flu. Severe illness such as lung damage is more frequent with COVID-19 than with common flu-like illnesses,” Dr Khan said.

Continue wearing masks; social distancing

“Whatever it may be, my advice would be to wear your masks, continue to social distance, avoid large gatherings, avoid close contact with anyone outside your household and wash your hands often with soap and water or use an alcohol-based hand sanitiser to keep yourself and others at bay from these illnesses,” Dr Khan advised. 

(*)The full form of PCR or rather RT-PCR is Reverse Transcriptase Polymerase Chain Reaction. “The PCR test is used widely for carrying out molecular-based diagnostic tests. It is used to detect viruses responsible for diseases such as HYPERLINK “”HIV, Ebola, African swine fever, foot-and-mouth disease etc.  The RT-PCR test, and antigen tests (serology) are two different types of tests carried out for the diagnosis of COVID-19. The Real-Time RT–PCR is suitable to detect the COVID-19 virus as it contains only Ribonucleic Acid. It is the most sensitive technique for mRNA detection. It quantifies the presence of a particular genetic material of the virus or any pathogen,” says SRL Diagnostics on their website. – SOURCE: NET

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