All over the Philippines, families are navigating a surge of coughs, colds, and flu-like symptoms. Is it Influenza A or B, RSV, COVID-19—or just the usual “trangkaso”? This guide breaks down what’s circulating now, how doctors decide which tests are needed, who should get treatment right away, and the practical steps that actually protect you.

By Rebecca L. Castillo, MD

Over the last several weeks, clinics have reported more people with fever, cough, sore throat, runny nose, body aches, and fatigue—classic “influenza-like illness” (ILI). Crucially, the DOH says this is a seasonal rise, not a nationwide outbreak. As of early October, ILI numbers are within or below last year’s levels, typical for the “-ber months” when flu season starts locally.

So what’s making people sick?

• Influenza A and B do circulate in the Philippines during the rainy and cooler months and can cause true “flu” with higher fevers and body pains. (Globally, influenza activity varies by place and time; the Western Pacific Region sees periodic upticks.)
• RSV (Respiratory Syncytial Virus) is a major cause of cough and colds, especially in infants and young children; local surveillance pilots report notable RSV detection in the Philippines. Adults can also get RSV with cold-like symptoms.
• SARS-CoV-2 (COVID-19) still circulates but at much lower levels compared with 2024, per DOH reports; localized bumps can occur, but national trends in 2025 have been relatively subdued.
• Common cold viruses like rhinovirus and enterovirus are frequent culprits of runny nose and cough and often account for a large share of ILI, especially in children. Early 2025 DOH reports listed these among top detected agents, alongside influenza and RSV.

Local news has highlighted city-level spikes (for example, Quezon City temporarily crossing an “epidemic threshold”), but national authorities emphasize that such clusters don’t equal a nationwide epidemic and that the current rise remains seasonal.

When should you test—and for what?

Not every cough or cold needs a lab test. Doctors use syndromic cues (fever pattern, body pains, exposure history, high-risk conditions) and time of year to decide. Here’s a practical approach aligned with major guidelines:

Test is reasonable when:

• You’re high-risk (≥60 years, pregnant, very young infants, or with chronic heart/lung disease, diabetes, kidney disease, obesity, immunocompromise).
• You have moderate to severe symptoms, shortness of breath, persistent high fever, dehydration, or symptoms lasting >7–10 days.
• There’s a need to guide antivirals or isolation (e.g., influenza or COVID-19 treatment eligibility, or you live with medically vulnerable people).
• For infants and young children, clinicians may test for RSV during peaks, especially if breathing effort increases or feeding drops.

Which tests:

• Rapid Antigen/NAAT for COVID-19 when clinical suspicion exists, especially if you’re eligible for antivirals (which must start within days of symptom onset).
• Influenza molecular tests (RT-PCR) or rapid antigen during flu season to guide treatment for those at risk of severe disease or if results will change management. CDC guidance notes that treatment for suspected influenza or COVID-19 should not be delayed while awaiting results in eligible patients.
• RSV testing (typically RT-PCR/antigen) is most useful in infants/young children with lower respiratory involvement or high-risk conditions, or when it will affect admission and supportive care decisions. (Adults are usually managed supportively without specific RSV testing.)
• Multiplex respiratory panels (one swab checking multiple viruses) can help in hospitals or for high-risk patients but aren’t necessary for routine mild illness.

If pneumonia is suspected (worsening cough, chest pain, difficulty breathing, low oxygen), a chest X-ray and full clinical assessment are warranted.

Who benefits from antivirals—and when?

Influenza:
The WHO 2024 Influenza Clinical Practice Guidelines provide updated recommendations on when to use antivirals, focusing on early treatment of patients with severe disease or those at higher risk of complications, with clinicians using judgment for others during surges. The key message: when antivirals are indicated, start as soon as possible—ideally within 48 hours of symptom onset. (Local availability is typically oseltamivir.)

COVID-19:
For patients at risk of severe disease (older age, comorbidities, immunocompromise), oral antivirals (e.g., nirmatrelvir/ritonavir) can reduce hospitalization or death if started within a 5–7-day window from symptom onset. Your doctor will review drug interactions and kidney function before prescribing.

RSV:
There’s no routine antiviral for RSV for otherwise healthy patients. Care is supportive—fluids, fever control, monitoring for breathing difficulty. Prevention is the big advance: maternal vaccination during late pregnancy and/or infant long-acting monoclonal antibody (nirsevimab) reduce severe RSV disease in newborns and infants (countries differ on rollout and supply).

Antibiotics:
These don’t treat viruses. Doctors consider them only when there’s bacterial pneumonia, otitis media, sinusitis, or other bacterial complications.

What can you do at home?

• Isolate when ill for the first few days of fever/cough, especially around infants, older adults, and immunocompromised family members.
• Mask in crowded indoor spaces if you’re sick—or if you’re caring for someone vulnerable. Local hospitals continue to advise masking, hand hygiene, and cough etiquette during this seasonal rise.
• Hydrate, rest, and control fever (paracetamol/ibuprofen as appropriate).
• Track warning signs: trouble breathing, chest pain, persistent high fever (>3 days), confusion, poor oral intake/dehydration (esp. kids/older adults), bluish lips/face, or oxygen saturation <94%—seek urgent care.

Vaccines and preventive tools to know now

Influenza vaccine: Annual flu shots reduce your risk of severe disease and hospitalization. (Product composition and availability vary by season; clinicians generally advise vaccination for everyone ≥6 months, especially seniors, pregnant women, people with chronic disease, and health workers.) Global guidance for 2024–25 emphasizes updated trivalent formulations and immunization before peak.

RSV protection for infants: Two pathways—maternal RSV vaccine during the third trimester (timing varies by guideline; WHO supports vaccination from week 28 onward for antibody transfer), and infant monoclonal antibody (nirsevimab) before or during RSV season. Ask your OB-GYN/pediatrician what’s available in your area and who’s eligible.

Why DOH says “seasonal”—and why that still matters

Nationally, DOH reiterates there’s no new virus causing the current uptick and overall ILI levels this year are not worse than last year. But “seasonal” doesn’t mean “ignore it.” Seasonal respiratory waves still stress clinics, disrupt classes, and can be dangerous for high-risk groups. Sensible precautions—masking if sick, staying home with fever, keeping vaccinations current, and seeking timely care—remain the best way to protect families.

“Seasonal doesn’t mean harmless: the right test at the right time—and early treatment for those at risk—can turn a bad week into a safe recovery.”

Practical decision guide (for families)

• Mild cold-like symptoms, low-risk adult/teen: Home care; consider testing if you live with high-risk people or symptoms persist/worsen.
• Fever + body aches during flu season: Talk to your doctor early about testing and whether influenza antivirals are appropriate, especially if you’re high-risk. Don’t wait days if you qualify for treatment.
• Positive COVID-19 and high-risk: Ask promptly about oral antivirals (time-sensitive).
• Infant/young child with fast breathing, retractions, poor feeding: Seek pediatric care urgently

The bottom line Right now in the Philippines, the rise in coughs, colds, and flu-like symptoms reflects a seasonal mix of viruses—especially influenza, RSV in young children, and common cold viruses—with COVID-19 still present at lower levels than last year. The most effective responses are still the simplest: early care for high-risk patients, right-sized testing, time-sensitive antivirals when indicated, supportive care for everyone else, and consistent prevention habits (vaccination, masking when ill, hand hygiene, ventilation).

References / Sources (In smaller fonts)

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