Jan. 14, 2020 -- When you don’t feel well this time of year, figuring out the cause is important, because it will point you to you treatments that can make you feel better and even shorten the time you’re sick.
But figuring out what you have isn’t always easy.
That was the case for Amber Yahle of Springfield, VA. When she first got sick in January, she assumed it was a stomach bug and not the flu because she had gotten a flu shot in October. But her symptoms worsened so quickly, she ended up in urgent care the next day.
“I only had a mild fever the first day, but by the second day, I had the most extreme pain in my abdomen and I was coughing so badly, my ribs felt like they were cracking with each cough. I was literally holding a pillow to lean against each time I coughed because it hurt so much,” Yahle says.
She was diagnosed with influenza A -- and says she was shocked.
“I thought for sure it was more like walking pneumonia or bronchitis,” she says. She was prescribed Tamiflu for 6 days, which she says helped a lot -- and got her back on her feet in time to make a family vacation. “It made me feel so much better,” Yahle explains.
Flu diagnoses take some by surprise, and there are two different kinds you need to understand: influenza A and influenza B. Other people get diagnosed with “flu-like illness,” which can also be a confusing term.
Understanding the difference between these terms and your treatment options is important, with rates of these diagnoses high across much of the country. The CDC estimates that as of mid-January 2020, there had been nearly 10 million flu illnesses, 87,000 hospitalizations, and 4,800 deaths from flu -- including 32 children -- making this season one of the most deadly on record.
WebMD talked with some experts to break down the difference between the two diagnoses and what it means for you.
What is the difference between the flu and flu-like illness?
The flu is “a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs,” according to the CDC, which says as many as 11% of Americans get it each season. It says symptoms include some or all of the following:
There are different strains of flu, including influenza A and B. In January 2020, the CDC warned an early season pediatric influenza B is circulating -- something that hasn’t happened in 27 years. That strain is causing serious illnesses in the South in particular and is blamed for one death as of early January.
“Influenza-like illness” (ILI), also called “flu-like illness,” is a more wide-ranging category. The CDC says that with ILI, you have a fever of at least 100 F and a cough or sore throat, but the cause of the symptoms isn’t known.
How can doctors tell if you have flu or flu-like illness?
The flu is diagnosed from a swab test of your nose or throat. Flu-like illness is a clinical diagnosis, meaning it doesn’t involve an official test. A doctor simply decides by examining you.
Flu-like illness can be the diagnosis when doctors aren’t sure what virus is at play since signs and symptoms of bad colds and several other respiratory viruses can be difficult to distinguish from the flu.
“Flu-like illness can include other respiratory viruses that could make people feel that way -- common cold viruses, RSV, parainfluenza, even rhinovirus -- the most common cause of the common cold,” says Angela Campbell, MD, a medical officer in the CDC’s Flu Division in Atlanta. “All can cause symptoms similar to the flu.”
Michael Ison, MD, a professor of infectious diseases and organ transplantation at Northwestern University in Chicago, says regardless of the cause, treatment is similar.
“What influenza-like illness is saying to us is that you have a virus likely affecting your respiratory system that is making you feel crummy and, currently aside from influenza, there aren’t good therapies for these other viruses, so we just treat the symptoms,” he says.
An flu-like illness diagnosis can also mean your doctor thinks you have the flu but doesn’t see the point in doing an official flu test.
“Flu testing may be helpful for some, but for the majority of people, you don’t need to expect to receive a test,” Campbell says. “Most people probably won’t require testing because it won’t change what your doctor recommends in terms of symptomatic care.”
William Schaffner, MD, an infectious disease specialist at Vanderbilt University School of Medicine in Nashville, says tests can also be expensive and unreliable, and many doctors only use them when they aren’t sure of a diagnosis, which is rarely the case during a flu outbreak.
“For the most part, the official flu tests are done if you are hospitalized with an influenza-like illness. Some doctors will have the rapid test available in their offices, but the rapid test can be very inaccurate,” he says. “So a lot of people say if you are in the middle of an influenza outbreak and a patient comes into the office with an illness that looks like influenza, just go ahead and treat them. Don’t bother with the test.”
How do you treat flu vs. flu-like illness?
In 2018, the Infectious Diseases Society of America released updated guidelines to help doctors diagnose and treat the flu and flu-like illnesses during outbreaks.
The CDC says antiviral drugs can treat confirmed and suspected flu. They can lessen symptoms and shorten the time you are sick by a day or two. The agency says they are most effective when taken within 48 hours of the start of symptoms, although they can still help fight severe flu complications when given after that. The FDA approved a new flu drug -- baloxavir marboxil (Xofluza) -- in late 2018. Ison says it is approved for acute uncomplicated influenza and for patients at risk for complications. Other antiviral drugs approved by the FDA include:
- Oseltamivir (Tamiflu)
- Peramivir (Rapivab)
- Zanamivir (Relenza)
Doctors say it’s also important to know that antibiotics won’t help with the flu or ILI since they only treat bacterial infections.
Whether you have the flu or flu-like illness, doctors also recommend that you:
- Drink lots of fluids. Fever and viral infections can be dehydrating, particularly for younger and older people. “It not only makes you uncomfortable, it can also predispose you to the development of pneumonia,” Schaffner says.
- Rest and get plenty of sleep. Your body needs downtime to recover.
- Take over-the-counter cold and flu medicines to treat a variety of symptoms, such as congestion and cough. Tylenol, Advil, or Motrin can help control fever, aches, and pains.
- Use steam from a hot shower to moisten mucous membranes, open up your sinuses, and promote drainage if you are congested.
“A lot of patients want to go home with antibiotics, but a flu-like illness means it is more than likely being caused by a virus, so you don’t need an antibiotic,” says Ison, the Northwestern professor. “Getting an antibiotic you don’t need can cause antibiotic resistance to develop, and then if you get pneumonia, for example, we may not have good drugs or any drugs to treat the infection.”
What should you do if you think you have the flu or a flu-like illness?
For otherwise healthy patients, the CDC says you can expect to be sick with the flu for several days to 2 weeks. Flu-like illness is similar.
“If a patient feels having an extra day or two of being back to work is beneficial, then seek the care of a physician and inquire about an antiviral,” Ison says. “If symptoms are mild and you want to tough it out at home, that is reasonable too.”
But if you have underlying medical conditions, are pregnant, or have other high-risk conditions, you may be likely to get more serious infections, hospitalization, or even death from flu complications, so experts say don’t try to manage the illness alone.
“If you are at high risk … go see your doctor early. If you are a person with an underlying medical condition, a child less than 2, or a person over 65, don’t wait. Go see a doctor early and let them decide if you should be treated with antivirals,” says Campbell, the CDC medical officer.
When am I likely to get sick with the flu or flu-like illness?
The CDC tracks levels of both the flu and flu-like illness during flu season, which can begin as early as October or November and continue as late as May, but generally peaks between December and February.
“We track influenza-like illness across the country, and we know when lab-confirmed flu goes up, (flu-like illness increases. They go together,” Campbell explains.
What complications should I look out for?
Your fever will go away first, but don’t worry if your cough sticks around for a while. “The coughing can last longer because these viruses can set up an inflammatory response, and it takes longer for bronchial tubes and sinuses to calm down,” says Schaffner, the Vanderbilt University specialist.
You should notice a general trend of improvement after a few days. If you don’t, and your fever persists for a couple of days or you have a cough that worsens, call your doctor.
Other signs of complications include symptoms that improve and then get worse, more shortness of breath, or a fever that goes away and then comes back. These can be signs of secondary infections, and you should call a doctor right away.
How can I best practice prevention?
Doctors say the best thing you can do to keep from getting sick is get the flu vaccine at the start of flu season. It may protect you from getting the flu, or it can make your symptoms less severe. The CDC says the flu vaccination also reduces deaths, admissions to the intensive care unit (ICU), how long people stay in the ICU, and the amount of time people spend in a hospital from the flu.
If you have a condition like diabetes, lung disease, heart disease, or some other condition that suppresses your immune system, or if you are older, you may also want to avoid crowds if a flu epidemic is sweeping your area.
“If you have an underlying illness and get the flu, you are more likely to get complications of flu, like pneumonia, and have to go to the hospital,” Schaffner says. “So it might be time to be a bit reclusive if there is a flu outbreak where you live.”
Research shows your exercise and stress reduction habits can help protect you against these types of illnesses. Bruce Barrett, MD, PhD, of the University of Wisconsin School of Medicine and Public Health in Madison, is the principal investigator of two studies, including one published in 2018, that find regular exercise and meditation can help fight off illnesses that are common this time of year.
His team’s research shows about 3 hours a week of moderate and sustained exercise can make the illness less severe and cut how long it lasts. Three hours of meditation each week reduced the length of time people were sick. Barrett says it’s a reminder that regular healthy habits have a real and lasting impact.
“Regular exercise supports a healthy immune system. Both exercise and meditation can help to regulate the stress response, and thereby reduce the negative effects that stress can impose on the body’s immune systems,” Barrett says.
If you do get sick, do what you can to keep it from spreading to others. Recommendations include:
- Keep it to yourself. “Respiratory infections are very contagious, starting from a day before you get sick to well into your recovery,” Schaffner says. Avoid close contact with people, stay in bed, or separate yourself from your family, roommates, or loved ones so you don’t give it to everyone else.
- Stay home. Don’t go to work, school, the gym, religious services, or run errands while your symptoms are severe, because you don’t want to spread the germs around.
- Cover your mouth and nose with a tissue when coughing or sneezing to keep from spreading the virus.
- Clean your hands. This helps keep germs from spreading.
- Avoid touching your nose, eyes, and mouth, since germs often spread when you do this after touching something contaminated.
- Clean and disinfect common surfaces at home, work, and school, especially when someone is sick, to keep germs from spreading.