Is it a sinus infection or COVID-19?

Sinus infection symptoms vs. COVID | Diagnosis | Treatment | Prevention | FAQs

If you know anyone who’s had COVID-19 lately, you’ve probably heard them describe their symptoms as similar to allergies, the common cold, or a sinus infection (aka sinusitis). At the beginning of the COVID-19 pandemic, the novel coronavirus was known for a dry cough, shortness of breath, and loss of smell or taste. The newer variants, such as Omicron, are often mainly affecting the sinuses. If you find yourself sniffling and sneezing, how do you know if it’s a sinus infection or COVID? Learn how to tell the difference, plus treatment options for both.

Sinus infection symptoms vs. COVID symptoms

Sinus infections occur when the sinuses, or air-filled pockets in the face, become inflamed and fill up with fluid. Sinus infections can be caused by a virus or bacteria. Common symptoms of a sinus infection include: 

• Stuffy nose or runny nose
• Facial pain or pressure
• Headache
• Post-nasal drip
• Sore throat
• Cough
• Bad breath
• Fever

COVID-19 is a disease caused by the Sars-CoV-2 virus. Symptoms of COVID-19 can show up anywhere from 2-14 days after exposure, and range from mild to severe, according to the U.S. Centers for Disease Control and Prevention (CDC). COVID-19 symptoms include:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

How to determine if you have a sinus infection or COVID

There are a number of overlapping symptoms between COVID-19 and sinus infections. “These may include fevers, chills, headache, cough, sore throat, nasal congestion, along with the feeling of facial pressure,” says Robert Glatter, MD, an emergency medicine physician at Lenox Hill Hospital in New York. 

COVID-19 causes upper respiratory tract inflammation, and the sinus cavities are often (if not always) affected to some degree, agrees Geoff Trenkle, DO, board-certified ENT surgeon, CEO and founder of LA Center for Ear, Nose, Throat, and Allergy. 

Because they have such similar symptoms, it’s best to consult with a healthcare professional and take a COVID-19 test.

RELATED: Do at-home COVID tests expire?

Treatments

If you test positive for COVID-19, the following treatments may be recommended by your healthcare provider: 

• Antiviral medications such as Paxlovid or molnupiravir
• Dexamethasone
• Remdesivir
• Monoclonal antibodies (mAb) including combined administration of bamlanivimab and etesevimab, sotrovimab, bebtelovimab, Evusheld, and REGEN-COV.

If you are hospitalized with COVID-19, other treatments have been authorized by the FDA for emergency use; these treatments for severe cases include convalescent plasma (blood plasma taken from people who’ve recovered from COVID-19), Olumiant (baricitinib), and Actemra (tocilizumab).

For viral sinus infections, supportive care is best, such as: 

• Irrigating the sinuses with a neti pot and saline rinse to loosen mucus
• Applying warm compresses to relieve facial pain and pressure
• Breathing in steam to open up nasal passages
• Taking over-the-counter pain relievers such as Tylenol (acetaminophen), Advil (ibuprofen), or Aleve (naproxen)
• Using a saline nasal spray to reduce sinus congestion
• Trying a decongestant or nasal corticosteroid to reduce inflammation and decrease mucus production

If your infection is caused by bacteria, you will need antibiotics to cure it. “In general, if your sinus symptoms last greater than 10-14 days, the chances of having a bacterial sinus infection are more likely,” says Dr. Glatter. For sinus infections caused by a bacterial infection, antibiotics such as Amoxicillin or Augmentin may be prescribed.

RELATED: See more sinus infection treatments and medications

Prevention

To prevent a sinus infection, Dr. Trenkle advises good nasal hygiene. That can include:

• Performing daily nasal rinses with saline to improve mucus flow and prevent inflammation 
• Avoiding contact with people who are sick with a respiratory infection
• Washing your hands regularly with soap and water
• Running a humidifier and air cleaner to improve your home’s air quality
• Avoiding triggers for sinus problems, including allergens, tobacco smoke, and polluted air

To prevent COVID-19, it’s vital to ensure you are up to date on your COVID-19 vaccines and booster shots. Then, take precautions when you are in crowded, indoor spaces, such as:

• Wearing a mask
• Washing hands
• Practicing social distancing from others

The importance of sleep as preventive medicine cannot be understated, Dr Trenkle stresses. Good sleep allows the body to improve the primary immune response, and that is your first line of defense against viral infections.

Sinus infection vs. COVID FAQs

Still unsure what’s causing your symptoms? Read on to learn answers to these frequently asked questions.

Can a sinus infection cause a positive rapid COVID test?

You will only test positive for COVID-19 if you have a Sars-CoV-2 infection. Sinus infections that are caused by another virus or bacteria will not result in a positive rapid test.

Can COVID cause sinus pressure? 

COVID can cause sinus inflammation and subsequent sinus pressure. Sinusitis also causes congestion, nasal drainage (post-nasal drip), productive cough (mucus), along with facial pressure and a facial headache between your upper cheeks, forehead, or between the eyes, says Dr. Glatter. 

Does a COVID headache feel like a sinus headache?

A COVID headache can feel a lot like a sinus headache. That’s because inflammation from a COVID-19 infection often affects the sinuses. COVID-19 can also cause other types of headaches.

How does loss of smell associated with a sinus infection differ from that of COVID-19?

It is possible to lose your sense of taste or smell with a sinus infection or with COVID-19, says Dr. Glatter. With COVID-19, losing your sense of taste or sense of smell often occurs without experiencing any nasal congestion. 

However, newer variants, such as Omicron, typically present with sore throat, hoarseness, congestion, aches, runny nose, fatigue, and possibly a dry cough. “Loss of taste and smell was more typical with Delta and the original ‘wild strain’ of SARS-CoV-2,” says Dr. Glatter.

Can you get a sinus infection after COVID?

It is possible to get a bacterial sinus infection after having COVID-19. The acute inflammatory response from viral upper respiratory infections can cause the sinuses to close up and become infected—especially if you have chronic sinusitis. “Those that get sinus infections often are more susceptible due to lack of good mucociliary flow,” explains Dr. Trenkle. 

Is a sinus infection contagious?

The majority of sinus infections are caused by viruses. If your infection is viral, then it’s possible to spread the virus that caused the sinus infection, but the infection itself that is already established is not transmissible. 

“Another person who caught the virus you carried may or may not become ill,” Dr. Glatter says. Whether they get sick depends on their immune defenses, sinus anatomy, general health, along with underlying medical conditions. The majority of such viruses typically lead to colds or cold-like symptoms (nasal congestion, sneezing or a runny nose), but not to sinus infections.

Which is worse: sinus infection or COVID?

Bacterial sinus infections very rarely cause deaths, and typically only for people with severe immune system issues. COVID-19 is an extremely infectious disease that affects everyone differently. Even otherwise healthy people can develop severe symptoms. “Sinus infections are often only deadly in the face of significant immunocompromise, whereas COVID-19 has killed almost 1,000,000 people in the United States as of April, 2022,” says Dr. Trenkle. “The short answer is COVID.”