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Coronavirus Exposure, But No Symptoms

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Definition

  • Exposure (Close Contact) to a person with diagnosed or suspected COVID-19. Diagnosed (confirmed) patients have a positive COVID-19 lab test. Suspected patients are those whom a doctor suspects of having COVID-19, based on symptoms and exposure (CDC definition).
  • Exposure also includes living in or travel from areas where there is major community spread (hot spots).
  • If an exposed person has no symptoms of COVID-19, they need quarantine and monitoring at home to see if they develop any symptoms.
  • An update on Multisystem Inflammatory Syndrome (MIS-C), a rare and severe complication, is included in the Causes section.
  • Updated Guide version: 7/9/2020
  • Author: Bart Schmitt MD, FAAP

COVID-19 Disease: Frequently Asked Questions

  1. Trusted Sources for Accurate Information: CDC and AAP
    • To meet the high demand for COVID-19 information, when possible, find your answers online. Here are the most reliable websites:
    • Nurse advice lines and medical call centers are needed for sick patient calls.
  2. COVID-19 Symptoms:
    • This COVID-19 coronavirus causes a respiratory illness. The most common symptoms are cough, fever and shortness of breath (trouble breathing).
    • Other common symptoms are chills, shivering (shaking), sore throat, muscle pain, headache and loss of smell or taste.
    • The CDC also includes the following less-common symptoms: runny nose, fatigue (tiredness), nausea, vomiting and diarrhea
  3. COVID-19 - CDC Definition of Exposure (Close Contact): You are at risk of getting COVID-19 if the following has occurred:
    • Close contact with a person who tested positive for COVID-19 AND contact occurred while they were ill.
    • Living in or traveling from a city, country or other geographic area where there is documented community spread of COVID-19. This carries a lower risk compared to close contact if one observes social distancing.
    • Community spread is occurring in most of the US, especially in cities.
    • The CDC has the most up-to-date list of where outbreaks are occurring: Coronavirus.
  4. Exposure to COVID-19: Levels of Risk
    • Household Close Contact. Lives with a person who tested positive for COVID-19. This carries the highest risk of transmitting the infection.
    • Other Close Contact. The CDC defines 6 feet (2 meters) as how far coughing can spread the virus. How long the close contact lasts can also be important. Prolonged close contact is defined as more than 10 minutes. Close contact includes kissing, hugging or sharing eating and drinking utensils. It also includes close conversations. Direct contact with secretions with a person with COVID-19 is also close contact. Includes being in the same childcare room, classroom or carpool. These exposures are usually lower risk than living with an infected person.
    • In Same Building - Low Risk Exposure. Being in the same school, place or worship, workplace or building carries a small risk for exposure.
    • In Same City - Low Risk Exposure. Living in or traveling from a city or country where there is major community spread of COVID-19, also carries a small risk. These "hot spots" are identified by the CDC at Coronavirus. Outdoor contacts are much safer than indoor contacts.
  5. COVID-19 - How it is Spread:
    • COVID-19 is spread from person to person.
    • The virus spreads when respiratory droplets are produced when a person coughs or sneezes. The infected droplets can then be inhaled by a nearby person or land on the surface of their eyes.
    • Most infected people also have respiratory secretions on their hands. These secretions get transferred to healthy people on doorknobs, faucet handles, etc. The virus then gets transferred to healthy people when they touch their face or rub their eyes.
    • These are how most respiratory viruses spread.
    • Reports from China suggest that the initial coronavirus (COVID-19) cases were spread from animals (probably bats) to humans.
  6. COVID-19 - Travel:
    • Avoid all non-essential travel.
    • If you must travel, go to the CDC website for updates on travel advisories: Travelers.
  7. Multisystem Inflammatory Syndrome (MIS-C):
    • MIS-C is a very rare and severe complication associated with COVID-19.
    • Symptoms: the most common symptoms are fever, a red rash, abdominal pain and vomiting. Half of the patients develop trouble breathing. Some children become confused or overly sleepy. All patients with this syndrome should be seen by a doctor. Most need to be admitted to the hospital. Some cases are similar to Kawasaki’s Disease (KD).
    • Incidence: a very, very rare complication of COVID-19. In general, COVID-19 continues to be a mild disease in most children.
    • Onset of symptoms: usually about 4 weeks after COVID-19 infection and apparent recovery.
    • Age: 6 months to 21 years. Peak age 8 years.
    • Treatment: MIS-C is treatable with medications, including IV immune serum globulin (ISG). At this time, it cannot be prevented nor predicted.
    • Reassurance: if a child gets this rare complication, a parent will know that their child needs to see a doctor.
  8. Other COVID-19 Facts:
    • Incubation period: average 5 days (range 2 to 14 days) after coming in contact with the secretions of a person who has COVID-19.
    • No Symptoms, but Infected: over 20% of infected patients have no symptoms.
    • Mild Infections: 80% of those with symptoms have a mild illness, much like normal flu or a bad cold. The symptoms usually last 2 weeks.
    • Severe Infections: 20% of those with symptoms develop trouble breathing from viral pneumonia. Many of these need to be admitted to the hospital. People with complications generally recover in 3 to 6 weeks.
    • Deaths: children generally have a mild illness and recover quickly. Pediatric deaths are very rare. Older adults, especially those with chronic lung disease, heart disease, diabetes or weak immune systems, have the highest death rates. The overall death rate is around 1%.
    • Vaccine: there is currently no vaccine to prevent COVID-19. Research is on the fast track in many labs. New vaccines usually take at least a year to develop.
    • Treatment: new treatments for severe COVID-19 are becoming available. They are only used on hospitalized patients. Most are given by vein (IV).
  9. COVID-19 Outbreak:
    • An outbreak of this infection began in Wuhan, China in early December 2019.
    • The first COVID-19 patient in the United States was reported on January 21, 2020. During March 2020, cases were reported in all states.
    • The first COVID-19 patient in Canada was reported January 31, 2020.
    • The World Health Organization (WHO) declared COVID-19 a global pandemic.
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When To Call

Home-Quarantine; Self-Monitor

  • Close contact with COVID-19 patient within last 14 days, BUT No symptoms
  • Living in an area with major community spread for COVID-19, BUT No symptoms
  • Travel from a hot spot for COVID-19 (per CDC) within last 14 days, BUT No symptoms

Self Care at Home

  • Close contact with COVID-19 patient more than 14 days ago AND NO cough, fever or trouble breathing. You can stop quarantine.
  • COVID-19 exposure, BUT no symptoms: home care instructions
  • COVID-19 testing, questions about
  • COVID-19 prevention, questions about
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Care Advice

COVID-19 Exposure, but NO Symptoms

  1. Exposure and No Symptoms
    • Although you may have been exposed to COVID-19, you do not currently have any symptoms. COVID-19 symptoms start, on the average, 5 days after the last exposure. The onset can range from 2 to 14 days.
    • Since it's been less than 14 days, you are still at risk for coming down with COVID-19.
    • You need to watch for symptoms until 14 days have passed.
    • Stay at home and follow this medical advice.
  2. You Do Not Need to Contact Your Doctor
    • You do not have any symptoms.
    • You do not need to call your doctor unless you become sick.
    • Doctor's offices, health departments and nurse advice lines have become overwhelmed with calls about sick patients.
    • You can find the answers to most of your questions here or online.
  3. Measure Temperature
    • Measure your temperature 2 times each day.
    • Do this for 14 days after your exposure to COVID-19.
    • Report any fevers to your doctor.
    • Early detection of symptoms and quarantine is the only way to reduce spread of the disease.
  4. Self-Monitor for COVID-19 Symptoms
    • The most common symptoms are cough, fever and shortness of breath (trouble breathing).
    • Less common symptoms are chills, shivering (shaking), sore throat, muscle pain, headache, and loss of smell or taste.
    • Rare symptoms are red or purple toes ("COVID toes").
    • If any of these symptoms occur, report them to your doctor.
    • Early detection of symptoms and home isolation are the only ways to reduce spread of the disease.
  5. Home Quarantine: How to Do
    • Quarantine means restricting people who were exposed to a contagious disease from contact with others who are well.
    • The level of quarantine needed for an exposed person who has no symptoms, may depend on the degree of exposure. For now:
      • Stay at home.
      • Do Not allow any visitors (such as friends).
      • Do Not go to school or work.
      • Do Not go to stores, restaurants, places of worship or other public places.
      • Avoid public transportation or ride sharing.
      • Other family members are not on quarantine unless the exposed person becomes sick.
  6. Call Your Doctor If:
    • Fever occurs
    • Cough or trouble breathing occurs
    • Other symptoms occur

Testing for COVID-19

  1. COVID-19 Testing: Who Needs It
    • Your doctor is the best resource for up-to-date information on the availability of testing in your community and who needs it. Since testing is not urgent, if you have questions, call during office hours.
    • There are 2 types of tests:
      • Diagnostic tests: these are performed on nasal secretions and tell us if you have a COVID-19 infection now.
      • Antibody Tests: these are performed on blood and tell us if you have antibodies from a previous infection. They are not done until at least 3 weeks have passed from the start of your infection.
    • Tests for COVID-19 are mainly done on people who are sick (have symptoms of COVID-19). Tests are usually not done on people who have no symptoms.
    • Testing is usually performed on patients who have serious symptoms or are admitted to the hospital. It is usually not done on patients with mild symptoms who don't need to be seen.
    • Testing is also needed on adults who have essential jobs and need to know if they can return to the work force.

COVID-19 Prevention

  1. COVID-19 - How to Protect Yourself and Family from Catching It - The Basics:
    • Wash hands often with soap and water (very important). Always do this before you eat.
    • Use an alcohol-based hand sanitizer if water is not available. Remember: soap and water work better.
    • Don't touch your eyes, nose or mouth unless your hands are clean. Germs on the hands can get into your body this way.
    • Don't share glasses, plates or eating utensils.
    • No longer shake hands. Greet others with a smile and a nod.
    • If your child needs to be seen for an urgent medical problem, do not hesitate to go in. ERs and urgent care sites are safe places. They are well-equipped to protect you against the virus. For non-urgent symptoms, talk to your doctor's office first.
  2. Social Distancing and COVID-19 Prevention:
    • Avoid any contact with people known to have COVID-19 infection. Avoid talking to or sitting close to them.
    • Social Distancing: try to stay at least 6 feet (2 meters) away from anyone who is sick, especially if they are coughing. Also called physical distancing. Avoid crowds, because you can’t tell who might be sick.
    • If COVID-19 becomes widespread in your community, try to stay 6 feet (2 meters) away from everyone outside your family unit.
    • Stay at Home Orders: follow any stay at home (stay in place) orders in your community. Leave your home only for essential needs such as buying food or seeking medical care.
    • After Stay at Home Orders are Lifted: continue social distancing. Also wear a mask when entering any public building. These precautions will be needed for many months. Your state public health department will decide when they are no longer needed.
  3. Face Masks and COVID-19 Prevention:
    • Sick patients: must always wear a face mask, if they need to leave the home. Example: for medical visits. Exception: patients with trouble breathing (CDC). Consider a loose face covering, such as a bandana.
    • Well people: as community spread became high, the CDC has also recommended face masks or coverings for everyone going outside the home. Masks are critical if entering a public building, such as a grocery store. Reason: many people with COVID-19 have no symptoms but can spread the virus.
    • Well People Exceptions: face mask or covering is optional if outdoors and can avoid being within 6 feet (2 meters) of other people. Examples: on an outdoor walk or run.
    • Age Limits: face coverings are not recommended for children less than 2 years (CDC).
  4. Keep Your Body Strong:
    • Get your body ready to fight the COVID-19 virus.
    • Get enough sleep (very important).
    • Keep your heart strong. Walk or exercise every day. Take the stairs. Caution: avoid physical exhaustion.
    • Stay well-hydrated.
    • Eat healthy meals. Avoid overeating to deal with your fears.
    • Avoid the over-use of anti-fever medicines. Fever fights infections and ramps up your immune system.
  5. Breastfeeding and COVID-19:
    • Breastfeeding experts recommend you continue to breastfeed even if you are sick with COVID-19.
    • Wash your hands before feeding your baby.
    • The CDC recommends to wear a mask, if available. Be careful to avoid coughing on your baby.
    • Breastmilk gives beneficial antibodies your body is making against this illness to your baby. This should provide some protection against this illness for your baby, like it does for influenza and most other viral illnesses.
    • The virus is probably not passed through breastmilk, but this is not yet known for sure.
    • Call your doctor if breastfeeding isn't going well OR your baby becomes sick.
  6. Keep Your Mind Positive
    • Live in the present, not the future. The future is where your needless worries live.
    • Stay positive. Use a mantra to reduce your fears, such as "I am strong."
    • Get outdoors. Take daily walks. Go to a park if you live near one. Being in nature is good for your immune system.
    • Show love. As long as they are well, hug your children and partner frequently. Speak to them in a kind and loving voice. Love strengthens your immune system.
    • Stay in touch. Use regular phone calls and video chats to stay in touch with those you love.
    • "2-Household Bubble." To reduce social isolation, especially for young children, some families have joined up with one other family for visits. Rules: both families must agree that they will not have social contacts with any other families. No one in either family can work outside the home. Not approved by CDC, but a reasonable family decision.
  7. How to Protect Others - When You or Your Child are Sick:
    • Stay home from school or work if you are sick. Your doctor or local health department will tell you when it is safe to return.
    • Cough and sneeze into your shirt sleeve or inner elbow. Don't cough into your hand or the air.
    • If available, sneeze into a tissue and throw it into a trash can.
    • Wash hands often with soap and water. After coughing or sneezing are important times.
    • Do not share glasses, plates or eating utensils.
    • Wear a face mask when around others.
    • Always wear a face mask if you have to leave your home (such as going to a medical facility). Always call first to get approval and careful directions.
    • Carefully avoid any contact with the elderly and people with weak immune systems or other chronic health problems.
  8. Call Your Doctor If:
    • You have other questions

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Barton D. Schmitt, MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC. All rights reserved.
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