As of late December 2025, respiratory virus activity across Iowa is low for all three major seasonal illnesses: COVID-19, influenza, and RSV. According to the Iowa Department of Health and Human Services surveillance report for the week ending December 20, 2025, test positivity rates sit at 5.2% for COVID-19, 3.9% for RSV, and 2.6% for influenza. That means none of the big three respiratory viruses are surging right now, though all are circulating at baseline levels typical of early winter.
COVID-19, Flu, and RSV Activity Levels
Iowa HHS classifies current activity for all three viruses as “low.” To put the numbers in context, a 5.2% positivity rate for COVID-19 means roughly 1 in 20 people tested for it are coming back positive. Influenza is even lower at about 1 in 40. RSV falls in between. These numbers can shift quickly once winter deepens, and January through February historically brings the peak of flu and RSV season in Iowa.
If you’re feeling sick right now, COVID-19 is statistically the most likely of the three to show up on a test, but a plain cold remains the most common explanation for mild respiratory symptoms at any time of year.
How to Tell What You Might Have
The illnesses circulating in Iowa right now share overlapping symptoms, which makes it hard to self-diagnose without a test. Here’s how they generally differ:
- Common cold: Runny nose, sore throat, sneezing, watery eyes, mild cough. Symptoms build gradually over a few days and usually resolve within 7 to 10 days. Fever is rare or very mild.
- Influenza: Fever of 100°F or higher (though not always), chills, body aches, fatigue, cough, sore throat. Symptoms hit fast, often within hours rather than days. Children are more likely to experience vomiting and diarrhea with the flu.
- COVID-19: Similar to flu but more likely to include loss of taste or smell, and symptoms can linger longer. Sore throat and congestion have become more prominent with recent variants.
- RSV: Looks a lot like a cold in most adults, with runny nose and cough. It’s most dangerous for infants and older adults, where it can cause wheezing and difficulty breathing.
The biggest clue that you’re dealing with flu rather than a cold is speed of onset. A cold creeps in; the flu tends to knock you flat within a day. If you have a fever above 100°F with body aches and fatigue, flu or COVID are more likely culprits than a cold.
Whooping Cough and Other Circulating Illnesses
Pertussis, commonly known as whooping cough, has been on the radar nationally over the past year. Iowa HHS has been tracking cases through 2024 and into 2025, though final case counts are still being reconciled and haven’t been published yet. Whooping cough starts with symptoms that look like a mild cold, then progresses to intense coughing fits that can last for weeks. The cough is often severe enough to cause vomiting or difficulty catching your breath. It’s worth keeping in mind if you or your child has a cough that isn’t improving after two weeks or is getting noticeably worse.
Norovirus, the most common cause of stomach bugs, also circulates heavily during winter months. It causes sudden vomiting, diarrhea, and stomach cramps, and spreads extremely easily in schools, workplaces, and households. If your main symptoms are gastrointestinal rather than respiratory, norovirus is a likely explanation.
Avian Flu: Low Risk but Worth Knowing About
Iowa reported its first human case of highly pathogenic avian influenza (H5N1) in December 2024. The individual worked with a commercial poultry flock in northwest Iowa, experienced mild symptoms, received treatment, and recovered. Iowa HHS emphasized that the risk to the general public remains very low.
H5N1 spreads through prolonged, close exposure to infected birds or herds, entering through the eyes, nose, or mouth. It does not spread easily between people. There’s no safety concern with properly handled eggs, poultry, or pasteurized dairy products. If you work directly with poultry or livestock, wearing proper protective equipment and avoiding contact with visibly sick or dead animals reduces your risk. Anyone with direct animal exposure who develops flu-like symptoms or an eye infection should get evaluated.
What to Do If You’re Feeling Sick
With all three major respiratory viruses circulating at low levels, a home rapid test for COVID-19 is a reasonable first step if you develop a fever, cough, or sore throat. If that’s negative and your symptoms are severe, a visit to your provider can include a flu test, since antiviral treatment for influenza works best when started within the first 48 hours of symptoms.
For mild cold symptoms without fever, you likely don’t need testing at all. Rest, fluids, and over-the-counter symptom relief are the standard approach, and most people recover within a week to 10 days. The current low activity levels across Iowa are good news heading into the holidays, but respiratory season typically peaks in the weeks ahead, so this picture could change quickly.