Cold vs. Flu, or RSV?

How Telehealth Nurses Can Use Triage Protocols to Address All Three

By Ravi K. Raheja, MD

Since COVID-19 restrictions have been eased, this fall is already experiencing a surprising surge of respiratory syncytial virus (RSV) in conjunction with flu and the common cold. Telehealth nurses have experienced a roughly 20 percent increase in patient call volumes and winter hasn’t even started.

While RSV symptoms are typically cold-like in appearance, the virus can be detrimental to infants, older adults, and those with medical conditions that put them at higher risk for serious, life-threatening complications. Symptoms for all three of these ailments can be similar, and because health systems are already being taxed with cases of RSV, it’s important that call centers and telephone triage nurses have the tools to accurately evaluate them.

Up-to-date nurse triage protocols developed by Drs. Barton Schmitt and David Thompson can help determine which ailments patients may have and direct them to the appropriate care. These protocols aren’t a substitute for the medical knowledge of a nursing staff; rather, they serve as a guide for their patient interactions to standardize care and avoid potential diagnoses.

First, let’s review the common symptoms and complications for colds, flu, and RSV, and then explore how protocols can address all three.


Although common, colds are typically mild. They usually begin slowly, starting with a sore throat before leading to nasal congestion and drainage. Common symptoms a few days after infection include coughing, sneezing, as well as a slight fever that usually doesn’t exceed 101 degrees.

As symptoms progress, nasal drainage can change from clear to dark, and become thicker. Many patients who come down with colds find it difficult to perform activities of daily living (ADL) compared to their normal energy levels. It’s also possible that colds will lead to other complications, like sinus congestion and ear infections.


A case of the flu is more severe than a cold and has faster onset symptoms. Because sore throats and fevers are common with both ailments, they can sometimes be confused. That said, coughing and congestion are more likely to be worse with the flu, and are usually accompanied by headaches, muscle aches, general soreness, and even severe exhaustion.

In layman’s terms, a bout of the flu usually makes patients “feel rundown” for a week or longer. Complications can also be harder on the body, including sinusitis, bronchitis, ear infections, and pneumonia.


The Centers for Disease Control and Prevention (CDC) notes that, as a respiratory illness, “RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than one year of age in the United States,” and that the vast majority of all children have experienced it by the time they turn two.

Initial symptoms are usually in the form of runny noses, decreased appetites, and coughs that may evolve into wheezing and trouble breathing. Infants may also be irritable and experience apnea. Older adults with heart or lung disease, or those who have weakened immune systems, are also at risk.

Similar to colds, there is no vaccine that can prevent an RSV infection, although palivizumab is a commonly prescribed medicine for young children who are more susceptible to extreme illness, including bronchiolitis or pneumonia.

There were already expectations that flu and COVID would both see higher case counts as we continued into the fall and winter months. But many health systems are now seeing a surge in RSV cases, and MassLive notes how this has pushed some of them to delay elective procedures for children to conserve available beds.

One doctor said that you typically have “hand-foot-mouth in the summer, RSV in the winter, [and] flu in the winter,” but that de-masking has now allowed all of them to spread sooner, and “with a vengeance.”

With RSV season here early, it can be difficult for parents (especially new ones) to evaluate potential cases in their children—not simply because the symptoms are similar to other respiratory viruses, but because their children aren’t able to verbalize what hurts.

Telephone and telehealth triage nurses—who are trained on how to obtain information about physical symptoms that they can’t see—rely on Schmitt-Thompson protocols to evaluate these symptoms and select the best dispositions for care.


These protocols are considered the gold standard for telephone triage because they cover symptoms for infants, children, and adults, including concerns about colds, the flu, and RSV. They do this by offering a decision-tree to nurses to identify and evaluate patient symptoms, which then determines where those patients should receive care—either from themselves at home, from a primary care physician, or a medical professional at an urgent care or emergency room.

These protocols are ideal for several reasons:

  • All calls are standardized and treated with the same procedures.
  • Patient needs are evaluated in the appropriate windows of time.
  • Patients are guided to the correct care providers, which means less chance for delayed care, potential health complications, or overcrowded ERs.

When selecting the appropriate protocol for cold, flu, or RSV, the best triage nurses know that you always give the highest acuity—or the safest outcome—for the patient.

Ravi K. Raheja, MD is the CTO and medical director of the TriageLogic Group. Founded in 2007, TriageLogic is a URAC accredited, physician-led provider of high-quality telehealth services, remote patient monitoring, nurse triage, triage education, and software for telephone medicine. They have both daytime and after-hours versions available and offer intuitive telehealth and telephone nurse triage software that uses these protocols to document all patient interactions and share that information securely with providers.