That Other Reason You Might Feel Terrible Right Now

A woman about to sneeze
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One morning in March, I woke up feeling horrible. Head: pressurized. Limbs: leaden. Nose: runny. Oh no, I thought, as I lay in bed. I rubbed my eyes. They were … itchy! I got up and went to the bathroom mirror. Red, too! Thank God, I thought. Allergies!

I don’t usually get so excited about the onset of my seasonal allergies. Most years, it goes something like this: I wake up feeling sick. I assume it’s a cold. I slouch around self-pityingly and wait for the illness to pass, but a few days later nothing has changed. At which point I start to wonder: Could it be allergies? But no, I think. It’s still so cold out! The temperature has hardly broken 60! Then I remember that this is what happens every year, and I vow, for real this time, that I will not let pollen blindside me again, that next year, I’ll launch a preemptive strike and begin my allergy-pill regimen before the weather even breaks 50—no, 45! Which, of course, I don’t.

This year, the stakes are higher. Now the most likely first reaction to feeling under the weather is not It’s probably a cold but Uh-oh. In the United States, as many as 30 percent of adults and 40 percent of kids have seasonal allergies, and many of them will soon, if they have not already, ask themselves the same question I did: Is this COVID-19 or just allergies?

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“This is obviously a tricky question,” says Aaron Pearlman, an otolaryngologist at Weill Cornell Medicine. Luckily, though, there are several ways to distinguish the two.

In the fall, public-health experts worried that the winter would bring a so-called twindemic, in which flu season and the coronavirus pandemic’s third wave would strike simultaneously and compound each other. They feared that emergency rooms, already filled almost to capacity with COVID-19 patients, would be overwhelmed by an onslaught of flu patients. They feared that if contracted together, the viruses could be doubly, or more than doubly, deadly. And they feared that the near indistinguishability of the symptoms would cause triage chaos for hospitals trying to separate the coronavirus patients from the flu patients. Both viruses tend to induce fever, muscle aches, and coughing. COVID-19 does have certain unique symptoms—patients sometimes lose their ability to taste and smell, for example—but in many cases, the illnesses are identical. Mercifully, flu season was virtually nonexistent. None of these dreaded scenarios came to pass.

Allergy season is not flu season, and none of the doctors I spoke with for this story predicted that the spring would bring anything like the ravages experts feared last fall. Influenza is a highly transmissible virus that, in an ordinary year, kills tens of thousands of Americans. Seasonal allergies, as uncomfortable as they make our lives for a few weeks each spring, kill almost no one. They will not strain emergency rooms the way flu season threatened to.

But they may cause a similar sort of confusion. Though not nearly so COVID-like as flu symptoms, allergy symptoms are alike enough to prompt a moment—or more than a moment—of panic. Thankfully, COVID-19 and seasonal allergies each have distinct symptoms that can help differentiate the one from the other. Most symptomatic COVID-19 patients develop a fever, and some have diarrhea or nausea, which allergy sufferers never do. Allergies, by contrast, can cause sneezing, a scratchy throat, and red, itchy eyes, which COVID-19 rarely does. (The Mayo Clinic and a number of other hospitals have put together helpful charts comparing the symptoms of COVID-19, allergies, a cold, and the flu.)

Maybe the most useful guide, Pearlman told me, is your own personal history. If this year’s symptoms align closely with last year’s, you’re probably in the clear. If you notice any irregularities, getting tested for COVID-19 can’t hurt. “Rather than being like, ‘Oh you have allergies; don’t worry about it,’” Pearlman explained, “I would say, ‘Listen, it’s likely allergies, but getting tested can only make you feel more confident in that diagnosis.’”

Subhadra Siegel, the director of the Allergy and Immunology Program at Boston Children’s Health Physicians, says that COVID-or-allergies confusion has already begun to affect her patients—though they’re not the ones who are confused. In recent weeks, a number of children with seasonal allergies have come to her after being sent home by schoolteachers worried their students had the coronavirus. The children’s parents didn’t seem particularly concerned; they knew that their child’s symptoms were the same ones they saw every spring. “The schools are just being hypervigilant in order to stay open, and trying to not let anyone in with any kind of a sniffle,” Siegel told me. “But that becomes more challenging as allergy season starts.”

Another concern is how allergies and the coronavirus might interact, says Casey Curtis, an allergy specialist at the Ohio State University Wexner Medical Center. It is generally understood that by suppressing proteins that limit viral reproduction, pollen exposure can weaken immunity to respiratory viruses—regardless of whether or not a person is allergic—and COVID-19 is no exception.

A study published last month in the Proceedings of the National Academy of Sciences found that higher pollen concentrations led to higher COVID-19 infection rates, suggesting that allergy season might make people slightly more susceptible to the coronavirus. In light of those findings, the authors wrote, it is all the more important this spring that people wear masks, which block both viral particles and pollen. For people with allergies, Siegel and Pearlman said, masks will likely help ease allergy symptoms simply by reducing exposure.

On some level, we’re uniquely prepared for this allergy season. Our year of learning and worrying about an unfamiliar airborne pathogen has readied us for a familiar airborne allergen. We wear masks. We have a new appreciation for ventilation and filtration. We’re better attuned than ever to the air we breathe, and in allergy seasons to come, that can only serve us well.


The Atlantic's COVID-19 coverage is supported by a grant from the Chan Zuckerberg Initiative.