Back-to-school season also means a return to all those seasonal illnesses we know and don’t love. So how bad will respiratory viruses get this fall? Here’s your guide on what to expect when it comes to flu, the common cold, COVID-19 and more, including symptoms and treatment options.
Click on the links below to jump ahead to a certain fall ailment:
Flu
Symptoms
Sore throat, runny or stuffy nose and cough are all symptoms that the flu (aka influenza) shares with other respiratory viruses. But you’ll know that it’s flu if the illness hits you all at once (instead of symptoms coming on gradually, the way they do with a cold.) You’re also more likely to experience fever, extreme tiredness and muscle aches with the flu, which isn’t as common with a cold.
What the fall forecast looks like
The most recent surveillance data from the Centers of Disease Control and Prevention shows very little influenza activity so far this season. At a press conference held by Johns Hopkins on Oct. 2, Andrew Pekosz, a professor at the Johns Hopkins Bloomberg School of Public Health, said we should expect to start seeing cases of flu around November.
And during an annual conference hosted by the CDC and the National Foundation for Infectious Diseases on Sept. 25, CDC Director Dr. Mandy Cohen said she’s expecting this to be a “typical” flu season — meaning similar to last year’s. Still, even a typical season can result in a lot of hospitalizations and deaths.
“Influenza can kill upward of 25,000, to sometimes 50,000 individuals in the U.S. every year,” Pekosz said. “We often focus on those over the age of 65 as being particularly vulnerable to severe influenza, but children are also vulnerable to severe death, as last year’s numbers have shown.”
During the 2023-2024 season, there were 200 pediatric deaths related to flu — breaking the previous record high of 199 deaths during the 2019-2020 season.
What you can do about it
Everyone ages 6 months old and up is eligible for the influenza vaccine, which is reformulated each year to better combat the strain of flu that’s circulating that season.
Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, said at the Sept. 25 conference that based on flu activity in the Southern Hemisphere (which experienced its flu season during our spring and summer months), this year’s flu vaccine should be a good match for the strains of flu most likely to strike.
The flu shot may reduce your chances of contracting the virus, but more importantly, it reduces the risk of serious complications if you do get sick. About 80% of children who died of the flu last year had not been fully vaccinated against influenza.
It’s safe to get your flu shot and COVID shot at the same time, if you choose, and in the same arm or different arms. In September, the Food and Drug Administration also authorized an influenza nasal spray vaccine that can be self-administered at home, though the manufacturer says it won’t be available until next flu season.
If you do get sick, an at-home rapid test or a test from your doctor can confirm whether you have influenza or something else. On Oct. 7, the FDA authorized the first over-the-counter home flu and COVID-19 combination test outside of emergency use authorization, which can detect SARS-CoV-2 (the virus that causes COVID-19) and influenza A and B (the viruses that cause flu).
Antiviral medications, which can lessen the severity and length of illness, are also available for those who are very sick or at a higher risk of complications from the flu.
COVID-19
Symptoms
COVID-19 often shares a lot of the same symptoms as influenza, including stuffy or runny nose, sore throat, cough, muscle aches, fatigue and fever or chills. But unlike the flu, COVID symptoms can begin gradually and get progressively worse; and you may experience new loss of taste or smell, which isn’t common with influenza.
What the fall forecast looks like
This should be a “typical” fall for COVID-19, meaning similar to last year. But unlike other respiratory viruses, what sets COVID apart is its tendency to defy seasonal behavior patterns; while influenza and colds were, for the most part, lying low during the warmer months, there was a summertime surge in COVID cases.
Pekosz said the large number of summertime COVID cases may mean a slightly smaller surge in the early fall and winter because individuals infected in the summer may have immunity that lasts up to a few months.
So far, CDC surveillance isn’t showing much COVID activity, though it’s expected to pick up this fall and winter. Cohen said that overall, we’re seeing fewer hospitalizations and deaths from COVID-19, likely thanks to vaccines and previous infections boosting our immunity to the virus.
“But if you ask me to rank COVID next to flu, COVID is still causing more hospitalizations and deaths than flu,” Cohen said.
What you can do about it
Everyone ages 6 months old and up is eligible for an updated COVID-19 vaccine — which, like the flu shot, is reformulated every fall. Pekosz said this season’s COVID vaccines should be a “fairly good match.”
“They’re never a perfect match because the vaccine strain choice is made back in June, and while the vaccine doesn’t change, the virus keeps replicating and mutating and changing,” Pekosz said. “But for the most part, the circulating variants right now are a good match for the COVID-19 vaccine.”
The elderly, pregnant women, people with preexisting conditions and the immunocompromised are particularly encouraged to get vaccinated. Women who get vaccinated while they’re pregnant also pass that immunity on to their babies for the first few months of life. Daskalakis said over 95% of adults who were hospitalized last year with COVID-19 didn’t have an updated COVID vaccine. So while you may still get COVID, the vaccine can help you avoid more serious outcomes from the virus.
If you do get sick, there are antivirals available that can treat mild to moderate COVID in people who could otherwise become very ill. There are also free tests (available to order online here) that can help you determine if you have COVID or something else.
Colds
Symptoms
The common cold often shares many of the symptoms associated with COVID-19 or the flu but tends to be much milder. You may have a runny nose or congestion, sneezing, sore throat, cough, slight body aches and possibly a low-grade fever.
Unlike the flu, cold symptoms tend to come on gradually, peaking around two to three days after infection.
What the fall forecast looks like
You can get a cold at any time of year, but they’re especially common during the fall and winter because people are more likely to gather close together indoors — making it easier for colds to spread — and because the lower humidity dries out nasal passages, making us more susceptible.
There are more than 200 respiratory viruses that can cause colds, with rhinoviruses being the most common in the U.S. According to the CDC, adults have an average of two to three colds every year — and children have even more.
What you can do about it
There aren’t currently any vaccines, antivirals or special treatments available for the common cold, so your best bet is to take care of yourself and your symptoms until the cold passes. Drink lots of fluids like water, juice and soup or broth, and get plenty of rest. Over-the-counter decongestants or antihistamines can help with nasal symptoms, and pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) can help with muscle aches.
RSV
Symptoms
Initial symptoms of the respiratory syncytial virus, or RSV, can appear similar to a common cold — including sneezing, runny nose, a fever and cough. But a “barking or wheezing cough” can be one of the first signs of a more serious infection, and in young infants, the only signs might be irritability, decreased activity or breathing difficulties.
What the fall forecast looks like
Experts anticipate a “typical” RSV season. Dr. Flor Muñoz, an associate professor of pediatrics and infectious diseases at Baylor College of Medicine, said during the CDC’s Sept. 25 conference that we should expect more RSV cases to begin sometime in October, with cases usually peaking in December and January.
While most cases of RSV go away on their own, the virus can be dangerous for older adults and very young children and is the leading cause of hospitalizations in infants, according to the American Lung Association.
Daskalakis said up to 160,000 older adults get hospitalized for RSV every year, which translates to 6,000 to 10,000 RSV-related deaths per year among people over age 65.
What you can do about it
For pregnant women, an RSV vaccine given between weeks 32 and 36 of pregnancy can protect the baby for the first six months of life (when the baby is at the highest risk of severe RSV). For babies whose mothers didn’t receive an RSV vaccine, RSV antibodies given before 8 months of age can offer protection from more severe RSV illness.
The CDC also recommends the RSV vaccine for all adults ages 75 and older, and for adults ages 60 to 74 who are at higher risk of severe RSV — including those with preexisting conditions like diabetes or obesity, heart or lung disease, a weakened immune system or patients living in nursing homes.
There aren’t any antivirals routinely recommended for RSV, but the CDC says you should call your doctor if you’re “having difficulty breathing, not drinking enough fluids or experiencing worsening symptoms.” Otherwise, you can relieve symptoms at home with over-the-counter medications like acetaminophen or ibuprofen for fever or achiness. RSV should resolve on its own by getting plenty of rest and drinking lots of fluids.
Fall allergies
Symptoms
OK, so seasonal allergies aren’t a virus, but they are worth noting because they do wreak havoc on our respiratory system — and on the surface, have a lot in common with other fall ailments.
And no, seasonal allergies don’t just happen in the spring. Fall allergies are a common problem, and telltale signs include itchy, watery eyes, a runny nose and sneezing. Unlike with respiratory viruses, you won’t experience a fever with allergies, and symptoms tend to linger for weeks or months.
What the fall forecast looks like
Ragweed pollen is the most common fall allergy culprit. Ragweed, a wild plant, blooms and releases pollen which hangs around from late summer until early winter, or the “first hard frost of the year,” one expert told Today.
Other plants, including burning bush, cocklebur, lamb’s quarters, pigweed, sagebrush, mugwort, tumbleweed and Russian thistle, can also trigger allergies in the fall.
And if it feels like your allergies are lingering more than usual, that’s because allergy season is, in fact, getting longer. Climate change means more warm days — which leads to an earlier and more severe allergy season.
What you can do about it
There are plenty of over-the-counter options available for seasonal allergies, including nasal antihistamine sprays, saline sprays and steroid sprays, or oral antihistamines like fexofenadine and cetirizine (which won’t make you drowsy like so-called first-generation antihistamines like diphenhydramine).
Experts also recommend avoiding certain home allergy remedies, such as humidifiers, supplements and essential oils. Depending on what you’re allergic to, some of those would-be solutions may actually aggravate your allergy symptoms.